The presentation of most cancer patients with a lot of pain and some dying while suffering called for the commencement of palliative care at Moi Teaching and Referral Hospital (MTRH), the second largest referral hospital in Kenya.
This program was started by Dr Dr Gregory Paul Gramelspacher, Professor of Medicine at Indiana University in September 2010 with the help of two nurses and a social worker.
According to MTRH Haemato-Oncology Division Head and Specialist Physician Dr Naftali Busakhala, palliative care was introduced as a formal section of Oncology within the hospital though it was being offered through Eldoret Hospice.
Dr Busakhala says that in the last one and a half years, the hospital has trained 55 health care workers within the hospital and with support from Tropical Health and Education Trust (THET) since 2013, the team has been trained and empowered to conduct even more training to other health institutions.
The training included a one day sensitization exercise, a five day Introduction to Palliative Care course and a six month Modular Training for 39 Health Care Workers.
“16 of the trained staff are senior doctors and nurses heading various departments and divisions within the hospital while the rest are additional health care staff,” says Dr Busakhala.
He says that they have trained 42 additional staff from other surrounding hospitals, 22 from the County and 20 from neighboring Counties.
“We realised that palliative care empowers patients and puts them in a clear perspective. Before they meet the palliative care team, most of them have been moving from hospital to hospital seeking for cure but once they are under the care of the palliative care team, they are empowered to make informed decision about their illness,” he says.
Dr Busakhala asserts that all hospitals need palliative care and all clinicians need to be knowledgeable about palliative care. “We need to see more and more integration of these services into our health system.”
“I wish that THET expands this project to be a continuous one as we have just made a scratch in palliative care and there is an enormous ground to cover. We need continuous sensitization and mentorship of the team already trained,” he says.
Susan Kipsang, a social worker by profession and the palliative care head at the institution says that when they started, they did not have a room to operate from. They saw patients at the various clinics on a part time basis having not been fully seconded to serve from the palliative care section of healthcare at the hospital.
“We’d juggled between oncology and palliative care but since 2010, we have grown and currently we have two nurses, a clinical officer and a social worker working full time at the palliative care unit,” says Susan.
She says that the team at the unit receives support from the hospital as well as from the oncology department.
“We are housed at the oncology department and we mostly see cancer cases but we have integrated our services to serve cardiac, renal failure and chest conditions among others that need palliative care attention,” she says.
The palliative care head says that her team handles pain and symptom management given that they have enough morphine supply and other pain management drugs.
Though the personnel are not enough, Susan says that they try their best to see patients across the vast hospital by conducting ward rounds.
“Currently, our palliative care unit works closely with Eldoret and Kimbilio Hospices for home based care in addition to their phone follow-ups. We also have day care sessions where our patients meet once every month,” says Susan.
Susan says that they are able to see family members of the ill to offer support such as counseling as they take care of the patient as well as pre and post bereavement support.
She adds that the team is dong their best to upscale palliative care services through training that started in 2010 and 2011 where 32 health care workers underwent a five day Introduction to Palliative Care course and the team has been able to offer mentorship to other trainees who come to the hospital for placement.
“Students come to have a practical experience of what goes on in the palliative care center so that they gain confidence in handling patients with life threatening conditions,” says Susan.
The palliative care head encourages more people to support palliative care since at one point in our life we shall need this care whether ourselves or our relatives.
For spiritual support, Susan says that the team uses spiritual leaders in the region to talk to the patients and their families.
She says that palliative care does not end at the death of a patient but more can be done to the family members.
The palliative care unit sees an average of 70 patients per month both at the hospital and those referred from other health institutions.