University of Virginia School of Nursing
A contemplative moment for associate professor Cathy Campbell, whose Fulbright grant is supporting her work to train rural Thai and South African caregivers in palliative care.

An icon of an elderly person's walker to signify scholarship in aging end-of-life and palliative care. While palliative care has become part of America’s cultural lexicon, the same cannot be said for places beyond our borders. In the world’s poorest, most rural regions—where chronic illness and death from diseases like HIV/AIDS, malaria, and tuberculosis are tragically common—palliative care is spotty at best, if not entirely absent.

In many developing nations, palliative care is anemic due to a dearth of providers trained to give it. In South Africa, for instance, the nurse-to-patient ratio is 1:417, a reality that forces community health workers (CHWs) to take on a majority of nursing tasks, especially in rural areas. Most CHWs have basic training in patient care, an understanding of disease transmission, and possibly knowledge on how to take vital signs like blood pressure and a pulse. But palliative care, says associate professor and Fulbright Scholar Cathy Campbell, is “learned on the fly,” even as it’s an increasingly robust part of these workers’ jobs.

Gaps in knowledge also exist because palliative care concepts haven’t yet been fully integrated into overseas’ nursing curricula. It all adds up to a perfect storm, says Campbell, even in this era when the World Health Organization has declared access to palliative care “a human right.”

Given these realities, Campbell says a movement to buttress CHWs’ education, skills, and reach is afoot—and she is in the thick of the march. In 2016, she received a two-year Fulbright Global Scholar Award to augment what little palliative care exists in two rural provinces of South Africa and Thailand, and explore how best to broaden this type of care, with CHWs’ support.

In the summer of 2017, Campbell—a longtime UVA Center for Global Health fellow and researcher—collaborated with colleagues at the University of Venda and Price Songkla University for a fourth year of longitudinal research on CHWs’ engagement in community care. She’ll continue the work in the summer of 2018.

With the Fulbright, Campbell and her team conducted focus groups with rural CHWs across Thailand and South Africa to discuss the palliative care cases they encounter, document how they handle them, and ultimately determine what types of educational and training programs make the most sense for these contexts. The ultimate aim is to expand palliative care practices in places where it has existed only informally, and to train 48 CHWs in palliative care concepts.

Campbell has already observed community health workers’ appetite for training in palliative care—“they’re eager for it,” she reports—and in many cases, strong CHWs are likely to receive training and education and then return to their peers to train them.

“We can train community health workers to do more, because they’re really the ones doing the work,” says Campbell. “They’re a community treasure.”