Physician Shadowing for Development and Implementation of a Paediatric Palliative Care Service in Enugu, Nigeria

Abstract

Background: The challenges facing Nigerian children with cancer and other chronic life-limiting illnesses are enormous, with many of them not surviving due to lack of supportive services. About 80% of children living with cancer in developing countries have no access to proper cancer care and usually present to institutions like ours with very advanced disease. Cost of treatment in hospital is astronomical, with most families having to pay out-of-pocket but being unable to do so. Also, many pediatricians are discouraged when they feel they are not capable of making progress with the child's treatment and are left with feelings of hopelessness, giving patients and families the impression they have given up. The combination of these factors usually results in patients absconding from inpatient admission, defaulting from treatment and eventually dying at home. Aim: The current practice of palliative care in our institution is near-completely adult-based with little pediatric involvement despite the huge pediatric palliative care burden. We want to change the current narrative and build the pediatric palliative care practice in our institution, through the practice of 'shadowing'. Methods: We intend to accomplish this through the opportunity of the 2018 UICC African Cancer Fellowship, by visiting the Paedspal, a nongovernmental South African pediatric palliative care organization affiliated with the Red Cross War Memorial Children's Hospital and the Rondebosch Medical Centre, that offers inpatient, outpatient and hospices services. Results: Outcomes from this project will define the probability of a clinical observer program in effectively serving as a catalyst for the development and implementation of a pediatric palliative care program and as well as a facilitator for the mentoring experience. Conclusion: We posit that 'the shadowing experience' may be an effective strategy to building capacity in hospitals with no specialist pediatric palliative care physicians.