It is time to improve the quality of dyingBy DAVID MAKUMI | Tuesday, June 19  2012 at  11:11

Two years ago The Economist Intelligence Unit was commissioned by the Lien Foundation, a Singaporean philanthropic organisation, to devise a “Quality of Death” index to rank countries according to their provision of end-of-life care.

Britain with its well-developed hospice system emerged top as the best place to die in the world. Not surprisingly, developing countries scored badly in providing basic care for the dying.

Uganda at number 39 out of the 40 countries surveyed is the best place to die in East Africa. Kenya is among the African countries that have benefited from the Ugandan experience with palliative care.

Many deaths in Kenya are preventable and reduction of avoidable deaths should be the focus of the public, the healthcare system and government.

The category of preventable deaths include those from violence, accidents, and lifestyle choices such as tobacco use.

But where death is inescapable, for instance in very advanced HIV/Aids, advanced cancer that has spread or multiple organ failure, measures must be put in place to strengthen capacity to deliver good end-of-life care.

Death is both a social-cultural and public health problem. It is a social-cultural problem because of the number of people it affects, directly and indirectly, in terms of the wellbeing of loved ones, and the numerous cultural practices and beliefs associated with it.

It is a health systems problem because of the poor quality of end-of-life care in both the private and public sector.

Hospice programmes

For the vast majority of Kenyans, the end of life is characterised by a prolonged experience of chronic progressive disease, often associated with uncertainty, pain and other distressing symptoms, profound suffering, and very high costs.

This is compounded by lack of support and information for the family. A patient will be shuffled from one hospital to another without the family ever getting a candid discussion with clinicians that probably nothing will change the course of the disease or the outcome.

A good and peaceful death would ideally come “naturally” after a long and well-spent life. It may also be seen in a patient whose symptoms have been well controlled and who is at peace with him or herself and with the community.

Such an ideal death should be under the control of the dying person, preferably take place at home which is the epitome of peacefulness and surrounded by family.

Unfortunately, the dying process in this country has been systematically institutionalised so much so that when a patient dies at home even from natural or foreseeable causes, it is taken as a sign of neglect by the family and community.

During this election year, deaths will take a political dimension and are liable to political manipulation. Politicians are already trying to outdo one another attending every funeral. They are donating generously to all harambees (fund-raisers) called to offset funeral expenses.

Such money would be best channelled to setting up palliative care or hospice programmes in health centres to improve the quality of dying. We need leaders who will improve our quality of life and also improve our quality of dying.

Mr Makumi is co-chair of the Palliative Care Study Group at the Multinational Association of Supportive Care in Cancer and Manager of the Cancer Programnme at Aga Khan University Hospital, Nairobi