Increasing World Access to Palliative Care

An estimated 40 million people worldwide require palliative care each year. Over three-quarters of those needing care are from low-and middle-income countries where programs are non-existent or primarily limited to urban areas. A significant barrier in low-resource areas is the lack of palliative care training available for health care professionals.

One MUSC College of Medicine faculty member has spent his career trying to close this gap. Patrick J. Coyne, MSN, Assistant Professor and Director for Palliative Care at the Medical University of South Carolina, has worked extensively to create palliative care programs and education initiatives in the United States and in numerous medically underserved countries including Tanzania, Indonesia, Kenya, Georgia, Albania, Mexico, Belize, and Tajikistan.

Coyne has partnered for years with a Kenya-based organization Living Room International to provide palliative care education to local healthcare providers. Founded in 2009, Living Room International works to develop local partnerships to bring hospice and palliative care services to more areas of Kenya.

 

In 2019, Living Room International opened a second inpatient palliative care facility in Eldoret, Kenya. However, due to the growing COVID-19 pandemic, the majority of education programs were halted. This situation posed a significant challenge for Coyne's planned education pursuits with local Kenyan health care staff. He worked with his partners to search for an alternate plan. 

In the fall of 2021, a solution came in the form of a newly created MUSC Center for Global Health Virtual Exchange Grant to pursue a telehealth project in place of the traditional in-person education program. A collaborative effort between the MUSC Palliative Care Program and Living Room International, the aim of this virtual program was to create a joint palliative care curriculum that would increase training for Kenyan medical professionals and improve the quality of life for local patients and their families. 

 

This innovative virtual program was conducted via Zoom and each session had an average of 45-62 interdisciplinary participants divided between the two sites (MUSC and Eldoret). Each site developed case studies and teaching points relating to the delivery of palliative care in their specific country. A wide range of topics were discussed between the groups, including pain management techniques, symptom management, cultural, ritual, and spiritual issues, communication, breaking bad news, and care for the dying. An open forum allowed participants to discuss what was important to them and any challenges moving forward. Coyne discussed details of the program in a recent MUSC College of Medicine's Diversity, Equity, and Inclusion Faculty Spotlight.

“I feel like this has been an excellent opportunity for our palliative care team to gain awareness of what it would be like to practice internationally and has allowed for some interesting discussions on both sides. In Kenya, they are treating things like leprosy that we have never seen. They also see a lot of tuberculosis cases and have a lot of challenges with wound care that we don’t have here in the United States. We have medications they don't have, and they've got medications we don't have, so it has been interesting to hear their experiences with those."

This virtual program produced insights for both organizers and participants, including the need for ongoing education for both health care providers and the general public, and discussion of themes such as hopelessness and truth-telling. The groups examined how resource availability impacts different utilization of interventions and how culture and religion impact care delivery. The MUSC Pediatric Care Program was active in the project, and part of each session was dedicated to issues relating to children. Coyne was pleased by the results of this virtual global health initiative and was grateful for the opportunity to be a part of the exciting program.

“Originally my goal was to try to develop some partnerships outside of the United States to give the team different experiences. In the future, I'd like to see this partnership evolve to where (in a world without COVID) there is an opportunity to cross the oceans and do some training on both sides - a few of their staff could come to spend a week or two here and vice versa. I know when I go over there, I always learn and come back with new ideas and I often feel very thankful for what I have.”

The success of the 2021 virtual program has inspired the next phase of in-person collaboration. Recently, MUSC project members Patrick J. Coyne, MSN, Lauren Mims, D.O., and Leigh Meade Vaughan, M.D. were awarded a Center for Global Health Faculty Mentor Travel Grant to support their leadership of an upcoming trip to Eldoret, Kenya. A group of trainees will join the professors to gain clinical experience, attend educational seminars, and conduct home visits in collaboration with Living Room International.

Coyne continues to expand access to education programs for health professionals across the world. In the fall of 2022, he will travel to Romania through a U.S. Fulbright Award to improve palliative education in the country. He was recently awarded an additional grant through the Open Medical Institute to help initiate palliative education in other Eastern European countries.

Learn more about the MUSC Palliative Care Program, Living Room International, and MUSC Center for Global Health funding opportunities.