Gaborone, the capital of Botswana. After a long flight, I wake to the cries of peacocks and the scurrying of monkeys outside my window. The morning air is warm yet still fresh. In Gaborone, it is spring.

In the conference hall — formal suits, bright patterns, firm handshakes and warm smiles. From 23 to 26 September, it hosted the 8th International African Palliative Care & Allied Services Conference, organised by the African Palliative Care Association (APCA). This year marks APCA’s 20th anniversary — an important milestone for the organisation that has become the leading voice of palliative care on the continent.

The conference was African in its setting and spirit, yet truly international in its composition. Alongside colleagues from numerous African countries were representatives of leading global and regional palliative care associations, international organisations, universities and research centres. The event was attended by Botswana's Minister of Health, who reminded participants that any discussion of palliative care is, above all, a discussion of dignity and justice.

I was invited to the conference by Global Partners in Care (GPIC) as a representative of PACED. This year, GPIC also celebrates its 25th anniversary. It was GPIC that initiated the international project Collaborating for Global Impact, aimed at joint creation of new concepts and practical solutions for the development of palliative care. Its goal is to explore fundamentally new formats of collaboration, grounded in a shared understanding of existing networks and relationships.

For PACED, participation in this project offers an opportunity to integrate our countries— Central Asia, the South Caucasus, Eastern Europe and the Baltics into the wider global professional community.

Many thanks to our colleagues at GPIC for the invitation and their support.

At the conference, colleagues from the Atlantes Global Observatory of Palliative Care (University of Navarra, Spain) presented the APCA Atlas of Palliative Care in Africa 2025, developed in collaboration with APCA and the WHO Collaborating Centre for the Global Monitoring of Palliative Care Development.

The Atlas will undoubtedly serve as a key reference point for advocacy and decision-making in the development of palliative care across the African continent for several years to come.

A few key facts from the Atlas:

• Over 17.5 million people in Africa need palliative care.
• Almost 70% of them are people living with HIV/AIDS.
• Palliative care is recognised as a medical speciality or subspecialty in only 5 out of 54 countries.
• 10 out of 54 countries hold at least one palliative care conference every three years;
• At this stage, only three countries have an up-to-date national strategy, policy or programme on palliative care that has been evaluated and audited within the past five years.
• In 17 out of 54 countries, there is strong national or regional advocacy for palliative care.
• In 48 out of 54 countries, less than 30% of the required amount of immediate-release oral morphine is available.
• The global average opioid use is 238 S-DDD, whereas across the African continent it is 77 S-DDD.
• The leading countries in terms of access to palliative care in Africa are Cabo Verde, Eswatini (also known as Swaziland), Kenya, Malawi, South Africa, and Uganda.

The figures reveal significant challenges — yet APCA, together with national associations and other stakeholders, is working hard to improve the situation. In its efforts, APCA emphasises three key priorities that help ensure palliative care is accessible to all who need it across Africa:

• Information: Increasing knowledge and awareness of palliative care among all stakeholders
• Integration: Strengthening health systems by integrating palliative care at all levels
• Evidence: Building a sound evidence base for palliative care in Africa

Many conference presentations also referenced the Global framework for the development of palliative care in countries and areas (WHO, 2020), which highlights the following key elements:

• Empowerment of people and communities;
• Policies
• Research
• Use of essential medicines
• Education and training
• Provision of palliative care

This framework feels very relevant and familiar, as it clearly reflects the same goals and priorities guiding the work of countries within PACED’s regions of presence.

I kept noticing how much Africa resembles the regions where PACED works. The same vast distances and 'invisible places ' on the map; the same dependence on families and communities; the same journey from the enthusiasm of a few committed professionals towards systemic change. In some places there is still a shortage of medicines and infrastructure, while elsewhere important legislative reforms are under way and palliative care is gradually being integrated into national health systems.
But the strongest similarity is the people themselves — calm, resilient, dedicated, and genuinely sincere.

I was fortunate to record a series of short video interviews with professionals from Botswana, Namibia, Uganda, Malawi and Tanzania. These brief conversations offer a glimpse into how palliative care is developing across different parts of Africa and an introduction to the people who make it possible and accessible every day.

In Africa, the theme of spiritual support receives remarkable attention — it was mentioned in nearly every session. It is not an addition to medical care but integral to the very fabric of the continent’s palliative care culture. Spirituality here is tangible: it lives in conversations with colleagues, in their stories, in their attitude towards life and death.

One phrase, shared during a session, stayed with me:

‘Death is a social event with a medical component, not a medical event with a social component.’ — Allan Kellehear.

That idea perhaps best captures the approach that shapes palliative care in Africa: the journey of care starts with a person — with their social and spiritual needs — and only then advances towards medical interventions.

The visit to Holy Cross Hospice in Gaborone was one of the most moving experiences of the entire trip. It is a small day-hospice — eight beds, six staff members including volunteers, minimal equipment, and maximum care. Patients are brought in the morning and return home in the evening. Their day unfolds through conversations, simple activities, and shared meals around the table.

A woman, wearing a straw hat, told me she had wept the first time she had a proper hot meal there after a long time. It was a gentle reminder that palliative care starts with the simplest things — comfort, dignity, and human presence.

For PACED, this trip was more than just participation in a conference — it was a series of meaningful conversations and a search for points of connection with a wide range of partners, from international and regional organisations and associations to national networks, hospices and individual professionals.

We discussed ways to increase the visibility of PACED’s regions — the countries of Central Asia, the South Caucasus, Eastern Europe, and the Baltics — on the global palliative care stage, explored opportunities for joint educational projects, and considered new formats of collaboration.

We were not merely exchanging business cards; we were building partnerships, learning from each other, and sharing practical solutions for working in resource-limited settings. In fact, most people didn’t have business cards at all — WhatsApp bridges distances far more effectively.

After Botswana, I spent a couple of days in South Africa. At the Cape of Good Hope, the wind smells of the ocean — and I can’t quite explain how the scent of the ocean differs from that of the sea. Waves crash powerfully against both sides of the headland. African nature is immense and unyielding. It follows its own laws, requiring neither approval nor interference from humankind.

Looking at it, you realise once again that we are only guests on this planet, where the true hosts are the animals, the birds, the trees, the seas and the oceans — all existing in their own rhythm and balance. That thought resonates deeply with palliative care: we are here to accompany and gently sustain life until its end, not to dominate it.

A heartfelt thank you to the wonderful guide, Leon, who showed me this beauty and shared the day, and these impressions, with me.

Africa turned out to be not only a place where I learnt from colleagues, but also a mirror reflecting PACED’s own journey: from initiatives to systems, from individual practices to shared principles, from local stories to palliative care as a social norm of dignity and compassion.

I returned not only with new ideas and partnerships, but also with a renewed conviction that the movement for accessible palliative care is one and the same across the world — each continent simply speaks it in its own accent.

Thank you, Botswana. Thank you, Africa. I hope our paths will cross again one day.