Caroline Okwemba is a practicing nurse working at Kakamega Provincial General Hospital.
Before switching gears to palliative care, she was a general nurse engaged in wound dressing and was partly involved in dental care.
In a recent interview with ehospice, M/s. Okwemba says some of the wounds she was dressing were not healing as fast as she expected.
Following a three day induction course by Kenya Hospices and Palliative Care Association (KEHPCA) team in 2008, she came to understand that some of these wounds were cancerous.
“From the training, I came to understand that there is a lot more I can do other than just dressing my patient’s wounds,” M/s. Okwemba says.
She says that she discovered that palliative care is different because it addresses the patient and her/his family, different from nursing care that focuses on the patient alone.
“There is the component of pain management, psychosocial and spiritual support among others,” she says.
M/s. Okwemba says that palliative care is not fully embraced within the hospital but it is slowly being recognised after its impact on few patients.
“Sometimes you can walk in the ward and find patients suffering from pain yet there are drugs to alleviate the same with some medical practitioners saying they lack time to administer pain management drugs,” she says.
The palliative care nurse says that they have been forced in some situations to train care givers or patients themselves on how to administer the pain management drugs.
She says there are some patients who request for discharge and they see them at home but this is planned alongside outreach activities to reduce costs.
“Our patients have said that the drugs have helped them have quality of life especially after pain management,” says M/s. Okwemba.
“There is this patient I came across in the ward with a fungating wound that made people run away from her. I cleaned it and showed the nurses present how to dress it using flagyl. After two days, she was brighter and could afford a smile besides supporting herself. Staff who have seen the impact of palliative care have embraced it. They call me from the unit anytime they come across a patient in need of palliative care,” she gives an example.
Additionally, she says there is a patient who happened to be a researcher and did not believe that morphine was good for consumption as a pain reliever. After seeing its impact of other patients within the ward, he decided to give it a try. The patient said the results were amazing and he now believed it was a safe drug for pain management.
M/s. Okwemba has had her fair share of challenges, which she identifies as sexual issues among her patients.
“Ladies are mostly affected especially those with cervical cancer who say that their husbands abandon them leaving them with a lot of stress. We try our best to address the issue and once we talk to them, they get the relief as we endeavor to manage their distressing symptoms,” she says.
Besides ladies, M/s. Okwemba gives a case of a man with Prostate Cancer, married to two wives.
She says the patient was tortured besides his physical pain and on engaging him further, she discovered that he had gone to the extent of letting his younger wife free as long as she did not bring a disease home. The palliative care nurse says the training has helped her address such issues.
She is currently alone in the unit after her colleague retired last year but she gets support from the pharmacist and one clinical officer trained in palliative care under the Trainer of Trainers (TOT) program.
The unit has been active since October 2013 and it attends to an average of 170 patients per month.
“We look forward to conduct a series of CMEs to enlighten the hospital staff on the importance of palliative care,” she says.