Pamela Were is an Oncology and Palliative Care Nurse and also the Community Outreach Coordinator at International Cancer Institute (ICI) in Eldoret, Kenya, and is currently spearheading cancer prevention and advocacy in 11 counties in the country. Some of her responsibilities are implemented through a model for oncology outreach services that integrate palliative care as an integral component of cancer care. The effectiveness and impact of the model on patients’ lives have attracted the interest and attention of many local and international stakeholders working in non-communicable diseases. The model also mainstreams research and advocacy.
The continuum of care for patients with cancer
At ICI, a range of services are available to help patients and their families manage not only the clinical and biomedical aspects of cancer, but, through the integration of palliative care, emphasis is also placed on addressing related psychosocial problems that can cause additional suffering, affect adherence to treatment, and jeopardise a patients’ return to health.
COVID-19 and Cancer Care
The advent of the COVID-19 pandemic has had a significant negative impact on the delivery of cancer care across all the geographical operational areas. ICI interviewed 50 healthcare workers in 11 counties in Kenya to establish the key effects so that ways could be worked out to counter the impact of the pandemic on cancer care and related palliative care services. Some of the findings included but were not limited to;
- Shifting the focus to COVID-19, neglecting oncology services
- Staff shortage in cancer care due to re-assignment to COVID-19 or redeployment to county hospitals
- Reduced patient inflow or longer than normal clinic return dates in some facilities due to movement restrictions
- Suspension of oncology outpatient services or closure of some oncology facilities, including the reassignment of oncology facilities to be COVID-19 isolation centres.
- High risk among patients because of the compromised body immunity owing to interruption of treatment for those who could not access major cities/towns (Nairobi) due to lockdown
- Chemotherapy stock out in treatment centers. Some patients resorting to herbal medicine rather than no treatment at all
- Suspension of non-emergency radiotherapy services at the public treatment center (KNH). (Relatives reported patients referred for radiotherapy dying at home before treatment).
- The only 2 designated public pediatric oncology units were not functional since the services were suspended due to COVID-19 pandemic.
Reasons for low patient turnout
Patients gave different reasons for not reporting to the health facilities as usual.
- Fear of being infected with COVID-19 from hospitals
- Fear of any form of travel amidst COVID-19 pandemic plus lockdown reducing movement. At an earlier stage, patients were specifically advised not to go to hospitals as a directive
- Patients being aware that there was chemotherapy shortage/ stock out
- Late and/or poor communications especially from the Ministry of Health regarding the pandemic
- Patients opting for private facilities for care
Challenges for health care workers
The Health Care Providers (HCP) too faced a different set of challenges that were uniquely brought about by the COVID-19 pandemic. A number of health workers themselves contacted the COVID-19 infection, resulting in long periods of isolation and absence from work, and in some instances, loss of life and the trauma of losing colleagues to COVID-19. A number of health workers lost their jobs as projects were closed due to re-allocation of designated funds to COVID-19. This included cancellation of opportunities to attend oncology training, before any transition could be made from face to face sessions to online.
On a technical level, lack of appropriate PPEs affected patient care significantly, with the double-faced fear of passing COVID-19 infection to the patients or contracting it from them. This, together with the shortages of other supplies such as speculums hindered service provision.
In a couple of cases, the oncology clinic was reassigned to be the COVID-19 screening room, thereby disrupting the oncology service. Plans to establish oncology clinics in some counties had to be shelved as responding to the pandemic was prioritised over everything else.
The new normal
It took a while for the necessary adjustments to be made at the patient level, facility level, and even at the county and national levels to enable the continuity of all services, as well as incorporating the relevant standard operating procedures for the prevention of COVID-19 infection. For instance, despite much awareness and effort being made, some time elapsed before the appropriate PPEs reached all the health facilities and for the continuity of the mass screening services whereby the only activities that may be conducted are the facility-based mass screenings that only targets a specific community unit.
ICI also came up with several other innovative ways of reaching out to the patients for routine pain management, including, for instance, the use of the motorcycle riders to deliver painkillers with a tracing system in place to ensure the medicines were delivered to the right person and in good time.
To access the Zoom session where Pamela made this presentation during the commemoration of World Cancer Day click here.
About the writer
Pamela Were is an Oncology Nurse who, together with others, was instrumental in securing the establishment of Oncology Services in Moi Teaching & Referral Hospital, Eldoret Hospice, and Oncology Outreach services in the Western Kenya Region. She has over 25 years of working experience in Cancer Care and Observership in several International Cancer Institutions. For more information on her work, you can contact her on: email@example.com