Rolf Hansen
The Cancer Association of Namibia (WO30) proudly marks the first anniversary of the House Zietsman Care Facility, under the auspices of Palliative Care Namibia, a programme in our organisation. This milestone offers an opportunity to reflect not only on victories but also on the many challenges that continue to shape our journey.
It has not been an easy road. Yet the reward has been overwhelmingly positive. One lesson stands out clearly – the understanding of palliative care, even within Namibia’s broader medical ecosystem, remains limited. Too often, there is a reluctance to confront the reality of death and dying. Many nurses and clinicians still believe that “keeping patients alive is the only way”, while formal training offers little more than a passing glance at what true palliative care really means.
Former Minister of Health and Social Services, Dr Kalumbi Shangula, on 28 June 2024, reflected on this during an interview with journalist Vitalio Angula in the Namibian, where he described palliative care in Namibia as “what happens when a patient is removed from acute medical care, given medication, and sent home to free up hospital beds”. While this reflects the current practice, it is far removed from the WHO standard and from what palliative care should mean in the Namibian context.
The WHO definition of palliative care:
“Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.”
The WHO also emphasises that:
1) Palliative care is not limited to end-of-life care; it should begin at the diagnosis of a serious illness.
2) It affirms life and regards dying as a natural process.
3) It provides relief from pain and other distressing symptoms.
4) It integrates psychological, social, and spiritual aspects of care.
5) It supports both patients and families.
6) It can and should be provided in hospitals, community health centres, and at home.
7) It requires a team approach, including trained health professionals and community caregivers.)
Dr Shangula further noted that some patients choose to return to their rural homes to die in peace, suggesting the need for training family members as an extension of the health workforce. This is valuable, yet in today’s Namibia, many families cannot provide that level of support. Our cultural fabric has shifted. Pain management, wound care, and round-the-clock attention are simply not possible in households where everyone must hustle daily to survive.
Why then does Namibia lag behind when other African countries have embedded palliative care within state systems? The reasons are clear – a lack of political will, outdated assumptions about family-based care, and an absence of structured tariff systems that respect the value of caregivers.
Palliative care is not “frail care”. Yet we see time and again how medical aids and insurers misclassify it, forcing patients and families into bureaucratic battles. The current NAMAF tariff, which only allows two weeks of “hospice care”, is wholly inadequate. The result? Terminally ill patients are shuttled between home and acute hospitals; hospital wards overflow with dying patients; and too many Namibians spend their final days suffering on mattresses on the floor.
This reflection is not written in blame. It is written in concern — and as a call for solutions.
Namibia urgently needs both state and private palliative care facilities. We need a national policy and guidelines, trained professionals, sustainable funding, and a commitment from political leaders and medical insurers alike to make it a successful reality.
The Cancer Association of Namibia has taken the first step by opening the doorway to quality palliative care. I am very proud to have been part of this – but after 365 days of active service, the message is clear: “Unless all stakeholders work together, too many Namibians will continue to be sent home to suffer in silence until their final breath.”
