For any palliative caregiver to offer the best services to patients with life limiting illnesses, understanding what they are going through is crucial.
Each patient must develop a sense of trust to the person offering the service to facilitate ease of communication and enable the caregiver get the necessary information needed to give the best in palliative care.
This is the secret that Thika Level 5 Hospital Palliative Care Unit has learnt and is utilizing it to instill confidence to its clients.
After struggling with the hospital management for some time, a small round hut was set aside in May 2012 for palliative care services outside the hospital premises.
The condition of the hut was dilapidated and renovation was inevitable. Kenya Hospices and Palliative Care Association (KEHPCA) stepped in, renovated the hut to hygienic standards, and opened it for operation on 19th October 2012.
The hut was partitioned into two rooms and a small corridor and it is in this hut that Ann Muthoni attends to patients with life limiting illnesses.
As the only palliative care nurse attached to the palliative care unit, Muthoni has so far seen 88 clients most of whom have applauded her kind approach in handling their health issues.
“In most cases patients are told to go home after they are discharged from the hospital without a detailed explanation of what they are ailing from.” Muthoni says.
She says she has set aside one of the rooms as a discussion room for four to eight people where they can discuss the health issues of the patient with their relatives without fear of the their illness being spread to unwanted ears.
“Most patients may feel embarrassed to talk about their illness in the open but once I bring them to this counseling setup, we get the freedom to discuss what the patient is ailing from and most of them have appreciated the approach. In fact they wonder why the doctors could not spend some time to do a similar explanation.” She says
Since the unit started running, Muthoni says the hospital is gradually seeing the importance of palliative care provision and they are constantly referring patients to her.
“The challenge I face is that am alone and still attached to the hospital meaning that when am on duty, the patients have to wait for me.” She says.
She says that some patients with palliative care needs have not been catered for due to this deficiency adding that they are working hand in hand with Thika Hospice to see that those in need of this crucial service receive it.
“There are willing nurses with a background in palliative care who sacrifice their free time to help me when am on duty but when am all alone, I prefer giving comprehensive care to one patient rather than spreading it to several patients which may eventually have no impact to anyone of them.” She says.
This, she says, has helped the unit to attend to patients at a relative frequency but disruptions to palliative care provision at the facility are still imminent given her double tasks that she has to fulfill at the same time.
To Muthoni, staffing is still a challenge as she is receiving an overwhelming number of clients whom, from time to time, have appreciated her approach to palliative care.
“If I could get an additional nurse in the unit, these patients will not have to wait for me to finish my work in the wards when am on duty.” She wishes.
She says most nurses have a palliative care background but putting it into practice is proving to be a challenge. She requested KEHPCA to organize for a CME for these nurses so that they can put these skills to practice.
Speaking at the unit after delivering a computer and a printer among other medical equipment to the unit, KEHPCA’s education and research officer Dr Asaph Kinyanjui said they are organizing several CMEs to health care providers at Thika Level 5 Hospital to bring them up to speed in palliative care.
Dr Kinyanjui said that KEHPCA will work hand in hand with the unit, the hospital and the hospice to see that palliative care services receive recognition not only in Thika but the country at large.
He advised the unit to discharge patients through the hospice so that in case there is need for home care, the hospice can take up the task of home care.
The palliative care nurse says they have collaborated with the hospital where they can prescribe, the patient pays and she dispenses the medicine.
“I cannot say we have enough drugs though the situation is improving as previously the patient would have a prescription to buy from the chemist only to return a few days later with the same complication due to lack of money to purchase the prescribed drugs.” She narrates.
She adds that the unit currently has syrup Morphine, Paracetamol and Bruphen which are helpful to the patients she attends to but her wish is for the unit to receive more drugs for efficient palliative care service delivery.
Muthoni hopes to begin day care sessions in future where patients can come together, share their experiences and encourage one another.
She also hopes that in the near future, she will have more colleagues join the unit to ease the workload therein.