Death as we know is inevitable and final. As a Nurse though we learn to deal with it by ensuring our patients and relatives’ journey to the end of life is as comfortable as possible – physically, emotionally and spiritually.
Sadly, this is often not the case in Sierra Leone. With high mortality and morbidity rates in Sierra Leone palliation is paramount, but it is often non-existent.
Kambia Government Hospital has a catchment area of approximately 300,000 people. A massive population for a small 60-80 bedded hospital with limited investigations, diagnostics, trained staff and surgical expertise. Health provision is free in Sierra Leone for under 5’s and pregnant and lactating mothers. Everyone else has to pay an admission fee and for most of the investigations, diagnostics, drugs and operations.
Patients often present too late and with little money for conventional medicine. The hospital, often as a result of presenting late, witnesses too many tragic stories.
Santigi was a 37 year old man who presented to the hospital with abdominal pain and peritonitis. His family had little money but he was operated on as a ‘destitute case’ by a respected locum surgeon. He had an initial laparotomy and resection of a gangrenous bowel but developed sepsis post op. IV antibiotics and IV fluids were purchased by the family and nursing staff and he recovered marginally.
Unfortunately the operating surgeon left, and his care was taken over by the Medical Super-intendent surgeon. He was starved for at least 7 days post op and each day I saw him becoming more skeletal like. His family had no money for food and despite being in a government hospital where I am told patients receive 2 meals a day he continued to starve. On numerous occasions I went to the local corrugated shack across from the hospital for bread rolls which he ate with gusto. Shortly after he begun to eat however, faecal fluid poured out of his wound. The flies feasted on his belly despite the best efforts of the dressing team to keep the wound clean.
He was however given a chance and taken back to theatre again as a ‘destitute case’ for a further laparotomy and removal of more gangrenous bowel with 2 anastamsois.
A week later he was in pain and had pressure sores on his buttocks, hips and shoulder. Again he was told he could not eat!
The sheets had been removed from his bed and he lay on a filthy plastic mattress. His abdomen continued to ooze faecal fluid and the smell of decay was overpowering. He lay alone as his only surviving relative had left him to go back to her village.
The nurses had moved all the other patients out of the 4 bedded bay over the weekend and the door was left closed. Santigi was dying a slow, painful, and lonely death.
I felt completely helpless and heartbroken at the lack of basic nursing care. I spoke to all the Volunteer Nursing Aids and SECHNS on shift and demanded to know why he had been left in this condition. The lack of care was inexcusable. They responded by saying it was the relatives responsibility and because they had left, he no longer had soap or lappas to wash with.
I left the hospital distraught at the poor level or care and returned with soap, lappas and a sponge to wash him with. I thought about how unfair it was that he would he had not received the same standard of palliative care as others enjoy.
Santigi died a few days later.
Since his death I have spoken to the Matron about the care of the dying patient and the role of the nurse in Sierra Leone. She has told me that ‘we must do everything for the patient’. This aspiration is sadly far from reality.
My experience of palliation in a resource poor setting has often been disturbing. Basic nursing care and care of the relatives does not cost any money yet this fundamental cornerstone of care is often missing.
Why is this though? Is it because of poverty, lack of education of just because death is a too common a sight here?
All names of patients have been changed for confidentiality.
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