Twenty-first century palliative care: a tale of four nations T.C. ONYEKA, FWACS, Pain & Palliative Care Unit, Multidisciplinary Oncology Centre, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, M. VELIJANASHVILI, MD, National Cancer Center, Tbilisi, Georgia, S.G. ABDISSA, MD, CSIM, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia, F.A. MANASE, MD, Pastoral Activities and Services for People with AIDS (PASADA), Dar es Salaam, Tanzania, & D. KORDZAIA, PHD, SCD, Institute of Morphology at Tbilisi State University, Tbilisi, Georgia ONYEKA T.C., VELIJANASHVILI M., ABDISSA S.G., MANASE F.A. & KORDZAIA D. (2013) European Journal of Cancer Care Twenty-first century palliative care: a tale of four nations Hospice and palliative care development, in terms of availability and services, occur to varying degrees in the developing world. In this paper, the evolution of palliative care practices in four developing nations (Nigeria, Georgia, Ethiopia and Tanzania) is described. By highlighting common problems as well as the unique individual perspectives of each country’s practice, this paper aims at increasing global awareness of palliative care in the developing world. While the call for palliative care to become a fundamental human right is sustained, it is also hoped that this article will stimulate a global discussion on the best possible way to encourage the establishment and growth of palliative care services in other developing countries where hitherto it has not been in existence, with policymakers and healthcare professionals taking the lead through the institution of sound national policies to promote and provide palliative care to all citizenry. Keywords: palliative care, developing nations, practice. INTRODUCTION Care of chronically ill patients and their families have come a long way from the days of Dame Cicely. While practice in developed countries has reached subspecialisa- tion to ensure provision of care to all strata of society, palliative care in developing countries is still far from optimal. In Africa, less than 5% of people in need of palliative care are receiving it (Grant et al. 2011) and the demand for the latter continues to surpass service delivery especially with the rising burden of non-communicable diseases (NCDs). The Declaration of Venice (2006) has called for prioritisation of education and research as means of promoting palliative care development in devel- oping countries, taking into consideration cultural, geo- graphical and socio-economic differences (IAHPC 2007). While there has been some increase in palliative care publications from all continents over the years, research from nations in Africa in particular remains sparse, with just 23 articles published in 2010 (Grant et al. 2011). While Harding et al. (2008) report a lack of cadre of African palliative care researchers, publication bias towards articles from African nations (O’Connor 2012) also contributes to the challenges in providing effective palliative care in these countries. The idea for this article was birthed following the attendance of four of the authors to the 2012 Annual Assembly of the American Academy of Hospice and Palliative Medicine (AAHPM) in Denver, Colorado, USA. This article gives historical timelines and describes pal- liative care practice in four countries – Georgia, Nigeria, Ethiopia and Tanzania. It aims at increasing global aware- ness of the peculiar situations in these nations and at inspiring discussions on the way forward with palliative Correspondence address: Tonia C. Onyeka, Pain & Palliative Care Unit, Multidisciplinary Oncology Centre, University of Nigeria Teaching Hos- pital (UNTH), P.M.B. 01129, Ituku-Ozalla, Enugu, Enugu State 400001, Nigeria (e-mail: doctortoniaonyeka@gmail.com). Accepted 29 March 2013 DOI: 10.1111/ecc.12064 European Journal of Cancer Care, 2013 Original article © 2013 John Wiley & Sons Ltd