Communicating with terminal patients: training health workers in Mauritania

Mauritania is located where the Sahara desert meets the Atlantic Ocean. It is a resource poor country and is four times the size of the UK, with a population of 3.5 million. In June 2016 the Scottish charity ‘Cairdeas International Palliative Care Trust,’ in partnership with the Mauritanian association Action Sahara pour la Santé, l’Innovation, le Développement et l’Éducation (ASSIDE), organised the first of three THET sponsored palliative care training events. Twenty-five healthcare workers travelled from the interior of the country to the capital; the furthest distance travelled was 680 miles. Ten of these participants were selected to stay for a second week to be trained as partners. The training was interactive, with a mix of short lectures, small group work, role play, video recording and playback of communication skills. In addition, the trainees have also visited actual palliative patients in their homes.

95% of participants graded the training as excellent or very good, and 90% stated that it was relevant to their work situation. Evaluation involved both qualitative and quantitative methods of data collection. Qualitative evaluation involved anthropological observation, two focus groups and fourteen semi-structured qualitative interviews. Initial analysis of these data suggests that many participants are considering what is a Mauritanian interpretation of palliative care. Quantitative evaluation employed before and after confidence rating scales and knowledge tests. Confidences increased for all participants, for example being more confident in providing holistic care and evaluating pain. Knowledge tests showed improvement with the average score increasing from 63% to 73%. Domains showing most improvement were treating common symptoms and the evaluation and control of pain.

In September, participants were contacted to collect stories of change since completing the training (most significant change). A participant noted:

Before the training I thought I was good at communicating with my patients, rating myself as perhaps 9 out of 10. After watching the video recording of my role play, I realised that I was really only functioning at around 4 out of 10.

Many participants reported that they now take more time to talk with patients and try to understand them, placing themselves in their shoes. One participant described how this new approach helped him care for a patient with extensive prostatic cancer in his village, who was suffering with a lot of pain. The patient, and the participant, were delighted with the results.

The project implemented by Cairdeas International Palliative Care Trust (CIPCT)  and Action Sahara pour la Santé, l’Innovation, le Développement et l’Éducation (ASSIDE) is part of the Africa Grant Programme, managed by THET and funded by Johnson & Johnson.