Inpatient approach to palliative care at Nazareth Hospital

Categories: Care.

Early in 2013, the Nazareth Mission Hospital management set aside two rooms as space for palliative care to support patients with life threatening illnesses.

The inception was spearheaded by Dr Mary Paul, a family physician in the hospital after seeing a close relative go through a lot of pain during his end of life and attending Kenya Hospices and Palliative Care Association (KEHPCA)’s 3rdNational Palliative Care Conference in 2012.

After setting up the unit, one room was assigned to male patients and the other to female patients where those who need specialised attention are admitted.

“Each of the two rooms has four private beds currently occupied by six palliative care patients,” says Dr Mary.

Dr Mary says that they have three trained caretakers to help the team in taking care of the patients in these wards and this helps in cushioning the staff shortage challenge.

Besides the special ward for palliative care patients, Dr Mary says that those in other wards are taken care of by the team during ward rounds, and medical students have a chance to visit the unit to have a feel of what care patients with life threatening illnesses deserve.

“We have a physician who helps in seeing our patients in the wards alongside our two trained nurses who attend to the needs of these patients,” says Dr Mary.

The Hospital’s Total Quality Manager Damaris Mburu says that Oral Morphine is available in liquid form at the pharmacy.

“The pharmacist and two nurses have since been trained in palliative care by KEHPCA and are involved in the day to day running of palliative care at the hospital,” says Mburu.

She says that there are plans to introduce paediatric palliative care to address the needs of children with life threatening illnesses. Currently they liaise with the paediatric ward to have any oncology case brought to their attention for appropriate care or referral to MP Shah hospital or Kenyatta National Hospital.

Kenya Registered Community Health Nurse (KRCHN) Susan Njuki who is part of the palliative care team says that they train the caretakers in the palliative care rooms on what to do in terms of feeding the sick and dressing their wounds among other support.

She says that besides the ward rounds and the palliative care unit, the team has a palliative care clinic every Wednesday where outpatient services are offered to patients with life threatening illnesses.

The team works closely with the physiotherapy department which is well equipped with services like traction, hydrotherapy, massage as well as Transcutaneous Electric Stimulation (TENS) therapy.

The hospital’s pastoral team assists the team to take palliative care patients through spiritual support.

Through monthly Continuous Medical Education sessions (CMEs), additional 15 hospital staff members have received palliative care sensitization and are supporting the team to reach out to all palliative care patients at the hospital. The team has since requested for more CMEs to address issues in palliative care including burn outs that have seen some of the caretakers leave because of the strain associated with taking care of very sick patients.

Dr Mary has been instrumental in prescribing morphine for the patients, a crucial medicine in management of severe pain and with a trained pharmacist, they hope to start purchasing morphine powder and do reconstitution to liquid morphine at the hospital.

Conditions needing palliative care attention in the region covered by the hospital include but not limited to HIV complications, cerebral hemorrhage, paraparesis and cancer.