The rainy season had just started so our long drive to the outreach centre was cool and we did not arrive covered with red dust. We were assigned to use the Physical Therapy room at Little Hospice Hoima and quickly set to moving things around to make a comfortable and private area to see our patients. The pharmacy was unpacked and we were set to go.
A smiling adult woman, Maria, and a little boy, Solomon, who looked at me timidly (he was not sure about my white skin), sat down at our makeshift clinic space. Maria had come to pick up medicine for her sister, Helen, who was actively dying of breast cancer. Maria was the main caregiver of her sister’s children and of her own grandchildren.
Her husband, son and her sister’s husband had left so she, as the healthy adult, was caring for everyone. Solomon now was eating a samosa and looking a little less afraid of me. He was one of her grandsons.
Maria told us that her sister was no longer eating and drinking and was having some increased generalised pain. She was taking her morphine as prescribed, and it was helping, but not completely taking the pain away. She related how she had cared for her mother who had died of breast cancer so she was aware of what was coming for her sister.
We discussed the signs and symptoms of impending death and how Maria, Helen, and the rest of the family were dealing with the psychological and spiritual aspects of Helen’s death.
We also discussed changing Helen’s morphine dose and gave Maria the new prescription. She then told us she was also a hospice patient and opened up her dress to show us a small fungating mass on her right breast. We asked her if she had been getting any treatment and she said no, she did not have the money or time. There were too many people who depended on her for her to leave and she needed any money she had for school fees.
She related that she was having some pain in her chest and we renewed her morphine. We asked her what else we could do to help. She said she was fine and she and Solomon, smiling, walked to our makeshift pharmacy to get the medicine for both her and Helen.
After getting the medicine both she and Solomon picked up an Orange Fanta and a chapatti, waved to us and left the building. I stood there with a heavy feeling in the pit of my stomach.
Judith Hills, MD,MS is a Hospice and Palliative Care Physician and the President of “Friends of Hospice Africa USA,” a non profit based in the United States whose goal it is to help support Hospice Africa.
Click here to learn more about the work of Little Hospice Hoima and ways to get involved.
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