In sub-Saharan Africa, cancer is the third leading cause of death (after infectious diseases and cardiovascular diseases). Most patients who consult for malignant tumours in hospital facilities are still at very advanced stages, often incurable. Nevertheless, these patients should at least be able to benefit from palliative care and pain management.

As in Europe, palliative care is essential to provide patients with a humanely acceptable quality of life.

The evaluation of the continuing training courses organized in West Africa in the 2000s by the AMCC had shown the difficulties of pain management, mainly related to:

• a lack of systematic pain assessment,
• insufficient control of painkiller prescriptions,
• difficulties in the supply of medicines,
• a particular social context combining financial problems and difficulties in expressing pain and psychological suffering,
• a suffering of the carers related to their helplessness.

If today there are still no known palliative care units or services in French-speaking countries (except for a few religious or military care institutions), nevertheless the situation has changed considerably in terms of continuing professional training.

Indeed, thanks to the links created with the Hospice Africa organisation and the creation of a French-speaking branch based in Brittany (Hospice Africa France), the palliative care model proposed by Uganda has proved extremely useful, in particular the use of morphine powder to fight pain.

AMCC therefore participated in the development of a continuing education program in palliative care and pain management with the assistance of African volunteer medical teams. Significant financial support was provided by Hospice Africa France. Multidisciplinary teams from many countries have already participated in these 5-week training courses in Uganda. Theory (3 weeks) and practice (2 weeks) allow many doctors, nurses and pharmacists to train in palliative care each year.

This programme, which is being carried out in Uganda, at the Kampala International Hospice for Palliative Care Training Centre, is open to Francophones with a priority objective, which is to eventually make it possible to create referral centres for Francophone Africa.

In addition to training teams, AMCC is also involved in raising awareness among local authorities for effective and affordable pain and palliative care.

With this in mind, AMCC has established a partnership with the Association Francophone de Soins Oncologiques de Support (AFSOS) to organize annual Franco-African meetings alternately in France during the AFSOS congress (2012, 2014, 2016, 2018) or in Africa. The first days took place in Abidjan in September 2013, then in 2016 in Brazzaville and in 2017 in Cotonou. These workshops provide an opportunity to train local teams, raise awareness among local authorities and promote African initiatives.

In 2017, thanks to the support of the Pierre-Fabre Foundation, the Palliafrique Forum was set up (http://forum-palliafrique.org/). It is an Internet communication tool open to all Africans wishing to learn, read and discover the programmes set up.

In 2019, AMCC approached the FISP (Fédération Francophone Internationale de Soins Palliatifs) to pool certain projects, in particular the creation of a platform.

Laure COPEL, Alexis BURNOD