High incidences of cancer call for palliative care in Murang’a

The high number of patients presenting with life threatening illnesses especially cancer in Murang’a County has triggered the District Hospital to move with haste in establishing a palliative care unit to address their plight.

Most patients visiting the hospital are referred to Nyeri Hospice and Nairobi for management and further treatment respectively, some services which could be offered at the hospital with availability of an equiped unit within the hospital.

During a Continuous Medical Education (CMEs) session to the Murang’a Hospital health care team, Dr Kahura J K, the Hospital Physician said that they not only receive patients from outside but also some of their staff have also had personal incidences of cancer and other life limiting incidences.

Dr Kahura said the hospital was dependent on Murang’a Hospice which relocated to Maragua following space limitation at the county government offices where it stood.

“The hospice is picking up but patients are finding it to be a far place to receive palliative care,” said Dr Kahura.

He added that the hospital has allocated a room for the palliative care unit and gladly reported that the County Government has agreed to meet its renovation costs and a recent office furniture donation from Kenya Hospices and Palliative Care Association Recently (KEHPCA) would go a long way in equipping the unit.

The Hospital Physician said that most incidences are Breast, Cervical, Ovarian, and Lymphoma cancer.

Palliative care nurse  M/s. Monica Juma has a Diploma in Higher Education in Palliative with five more nurses having completed the induction course.

M/s. Juma said that the palliative care concept was incepted as a clinic by Nyeri Hospice following the high number of patients that visited them from Murang’a.

“The Hospice helped in mentorship of the team at the hospital and offered drugs to support the palliative care clinic,” said the Nursing Officer.

The Murang’a team conducts home visits to patients from around the hospital given that they have no vehicle to facilitate home visits far from the hospital.

She appreciated the hospital management with lead support from Dr Kahura for the corporation they have shown in the effort to establish a unit within the hospital.

“The patients we have seen and their relatives have appreciated our support for we have assisted some even to write their wills,” said M/s. Juma.

KEHPCA’s Executive Director Dr Zipporah Ali in her presentation said that most people think that palliative care is for the dying yet it is meant to alleviate patient suffering with the aim of curing sometimes, relieving often and comforting always.

Dr Ali told the hospital staff that everyone can provide palliative care given that it is a concept easy to practice with a change of mindset and it can be offered anywhere.

“Palliative care is now a right recognised in the Kenya National Patient Rights Charter launched by the Ministry of Health in 2013 and they can demand it,” she added

She said that in palliative care, the patient is the most important person adding that it is a service well deserved for all for our patients get depressed due to their illness and they need a holistic care approach.

“Most people think that palliative care is a luxury service that can be afforded by the rich yet it can be easily accessed by patients from all backgrounds,” said Dr Ali.

Head of palliative care at Kenyatta National Hospital (KNH) Dr Esther Munyoro said that patients present late and there was a need to create more awareness among patients and doctors as it is the most important course of action in our collective fight against cancer.

Her sentiments were echoed by the hospital Pathologist Dr Njau Mungai who said that the problem is big and the cancer treatment approach that is in place is wanting.

Dr Munyoro said the queue at KNH is ever increasing for patient needing cancer treatment indicating that they are currently scheduling patients for treatment in 2015.

The European pain in cancer survey established that pain was the highest criteria leading patients to seek out a health care professional on which a diagnosis of cancer was made yet it is the least assessed and attended to by health care providers.

“Most patients are put on wrong treatment yet they have cancer. It is good for us to be wrong by thinking of cancer when patients report pain and work backwards. We need to bring the cancer closer to us as most of us think cancer is far away unless we are victims,” she said.

She said that most people do not tend to think of children cancers yet they are common adding that everybody needs to know facts because when it comes to cancer, we are all at risk.

KEHPCA’s Special Coordinator for access to pain relief and palliative care Dr Esther Muinga took the participants through the pain assessment, World Health Organisation (WHO) pain ladder and opioids dosage and urged participants to always assess patient’s pain for proper pain management interventions using correct treatment options.

The Murang’a Hospital team appreciated shared knowledge and promised to put it into practice in their various professions.

Msambweni Sub-County Hospital to introduce palliative care

Msambweni Sub-County Hospital is planning to set up a palliative care unit soon.

Leading to this achievement, the hospital team recently visited Coast Hospice to familiarise themselves with operations in a palliative care environment.

Coast Hospice Clinical Coordinator Eric Amisi took the team through the process of handling clients including patient and family experiences while attending clients in a palliative care clinic.

The Hospice administrator M/s. Jane Mwanyumba was delighted with the move by the hospital to embrace palliative care.

“This is a big step towards alleviating patient and family pain while dealing with life limiting illnesses within our community. Soon, these essential services will be readily accessible to residents of Kwale County,” said M/s. Mwanyumba.

The two teams agreed on the need for a mentorship program for the Msambweni team to commence immediately on a rotational basis.

“Our hospice is humbled to be part of the team that is helping set up of palliative care units in counties within the coastal part of Kenya in line with our vision; to provide palliative care for all,” added the Hospice Administrator.

The Msambweni Hospital team included the Hospital Physician Dr Ndegwa Wanjuki, Administrator Obed Limo, Nurses Lydia Ndambi, Betty Nakhungu, and Florence Wambua.

Supporting a patient to the last day; a story from Chogoria PCU

Palliative care has not once nor twice, but many times proved beneficial to patients with life threatening illnesses even when it starts at late stages of an illness until their last day.

Joy (not her real name) died at the age of 87 years towards the end of March 2014 and her story elaborates the care palliative care providers are willing to offer even amid scarcity of resources.

She remains the late mother of six children; five ladies and one son. Her home is approximately 20 kilometers away from Presbyterian Church of East Africa (PCEA) Chogoria Hospital.

The daughters have since been married and she was mostly staying alone at home. Her age had advanced such that she could not take care of herself without assistance.

Her husband died many years ago and the only available carer to look after her was her son who unfortunately drinks and unfortunately lost his wife to cancer of the cervix.

Joy developed a lump on her right breast in 2010. The swelling was not painful initially but with time, she started experiencing some pain. She went to several hospitals and later a biopsy was taken that revealed her ailment; cancer of the breast.

She sought for cure in various health institutions but no interventions could heal her. By this time she had developed a big wound which was oozing pus and blood profusely. The wound was progressively becoming large and had started having a foul smell and maggots.

After exhausting all her resources, she decided to stay at home since she had nobody to turn to, including his children who could also no longer afford to take her to hospital.

One day the Chogoria Palliative Care Unit (PCU) team was visiting one of their clients near her home and received work of Joy’s condition. The team paid her a visit the same day.

They found the patient very desperate with no one to support her. The team assessed the client and after referring to her documents, they found out that she had cancer of the breast, confirmed by biopsy results.

The palliative care team discussed with her and her son about their palliative care programme and she was very positive about the services explained. She was enrolled in the programme and this made her so happy.

Initially the team visited her frequently to closely monitor her care and ensure the dressing was done in the right way as well as to ensure that she takes the drugs as per prescripts.

The palliative care team supplied dressing materials and drugs after every two weeks but this reduced significantly with time as the unit could not afford to buy more when the dosage was exhausted. Her comfort was entirely dependent on the project (Chogoria PCU).

The only son, who stays with her leant how to dress her wound and administer drugs correctly. The main challenge was that the son is alcoholic and the home care for Joy was not at its best.

She was put on DF 118 60mg three times a day, dulcolax one tablet daily and paracetamol 1gm three times a day. The unit also supplied dressing materials namely gauzes, cotton wool, bandages, strapping, gloves and dressing lotions.

All of them used to be supplied free of charge from the palliative care unit but as finances became a challenge, the client was required to meet half the cost of the mentioned materials which she could not due to the high level of poverty. Sometimes, the client suffered because of lack of transport to pick supplies from the unit. Her relieve was left to the home visits that became less frequent due to the unit’s financial constrains as the project (PCU) is yet to secure more donor support.

Up until her departure, Joy had grown very weak. Her lower limbs were weak to an extent that she could not stand on her own. She also had incontinence of stool and urine. Unfortunately the unit was not able to provide diapers and mattress covered with mackintosh due to the earlier indicated financial constrains but the unit tried the best it could to offer comfort with available materials.

As this story goes to press, the funeral arrangements are in progress to give her a decent send off.

From Joy’s case, the team from the unit says there are lessons to learn.

  • With encouragement and open discussion on cancer, there is reduced stigma and this promotes good care
  • Suffering at home silently can be reduced if one is counseled for a positive living and finally, relatives should be involved in the care for the clients with life limiting illnesses.
  • Disclosure is very important as it improves care

The Chogoria Palliative Care Unit team says that people with life limiting illnesses need support and love as the service is so crucial despite being costly and says that the relatives have appreciated the comfort the team gave to Joy from the time they heard of her situation until her recent departure.


Naivasha Hospital to accelerate palliative care

Naivasha District Hospital will soon have a unit to accelerate palliative care service delivery in the region after the team received 40gms of morphine, some tools and reading materials from Kenya Hospices and Palliative Care Association (KEHPCA) alongside furniture courtesy of funds from Hospice Care Kenya (HCK) to equip their unit.

The HCK funds raised through a BBC radio appeal in September 2012 by Mike Wooldridge that featured the plight of children suffering from life threatening illness in Kenya aim at supporting integration/strengthening Pediatric Palliative Care in three hospitals namely Homa Bay, Kisii and Naivasha.

Being one the hospitals set to integrate paediatric palliative care, the team from Naivasha happily received the chairs alongside other furniture to enhance office operations at the unit.

Sharing the progress, palliative care nurse Mary Gacheru said palliative care has been ongoing within the hospital despite not having a designated room to see patients, a challenge occasioned by the new devolution system on governance in the country.

“We are trying to ensure that nurses know that palliative care is part of health care that patients with pain and other distressing symptoms from life limiting illnesses need by guiding them on how to go about it,” said Gacheru.

Despite the limited time she has due to many duties at the hospital, Gacheru said they have no excuse of not seeing patients, both adults and children who need this (palliative) care.

“These reading materials will go a long way in helping us understand more on dosage, especially morphine and other palliative care knowledge that would improve our service delivery,” she said.

She said that with the materials and furniture, the set up pace would improve and once the unit fully starts its functions, they have a lot of activities in the pipeline including starting a support group for mothers with cerebral palsy children. “Most parents have no one to sit with and help them tackle the psychological problems they are going through,” she added.

Accompanying her to pick the items was Dr Esther Gitahi, a pharmacist at the hospital who will help in reconstitution of morphine for the unit.

Dr Gitahi said the hospital previously had injectable morphine adding that the 40 grams received from KEHPCA would go a long way to ease the patient’s pain.

She said that most of patients served in the hospital present with pain and other distressing symptoms which they are able manage as much as possible adding that the setting up of a unit will complement their service delivery.

The team said they do counseling to patients with distressing symptoms and hope to reach more once the unit is up and running following existing support from the hospital administration.

The hospital serves patients from Naivasha, Narok, Kiambu and most parts of Nakuru County.

UK mentors support Kenyan palliative care providers

In the effort of strengthening palliative care in Kenya, Tropical Health & Education Trust (THET) is supporting palliative care experts from University of Edinburgh and other institutions to offer mentorship to palliative care providers in three hospitals namely Moi Teaching and Referral, Nyeri and Homa Bay Hospitals.

Speaking during a visit to Kenya Hospices and Palliative Care Association (KEHPCA) the UK mentors who were assigned to Nyeri Group comprising of Dr Jane Whitehurst, Dr Annette Edwards and Dr Mary Murray indicated that their role is to help mentees cope with any challenges they are facing to improve their ability to offer better palliative care services.

“We help local palliative care leaders understand various situations in palliative care within the hospital setup and in the surrounding areas and help them to consider how services can be improved,” said Dr. Whitehurst.

Dr Murray said that the team does not come in and tell the palliative care team what should be done rather help them understand the situation in which they are operating.

“This will help the doctors and nurses find workable solutions to challenges they may be facing in their day-to-day palliative care service provision,” she said.

The doctors said that it is easier to mentor if one has already worked in a similar environment for she/he understands the environment well.

“We are trying to use available resources and allow palliative care to be part of the general health available to all,” added Dr Whitehurst.

The team said KEHPCA has continually enabled training of palliative care to take place and their hope is to see those trained and mentored become mentors to other providers.

The team said the mentorship approach aims at helping people find solutions to their own problems and realize their own potential.

UK has well established palliative care services and Kenya is well on the road to achieving this. By mentors observing the current practice, and sharing their experience, the mentee feels supported and better informed.  Some of the areas covered during mentorship: clinical care of patients, psychosocial support of patients and relatives, research, data management and networking

Call for Abstracts now open for KEHPCA Conference

The Kenya Hospices and Palliative Care Association (KEHPCA)’s 4th National Palliative Care Conference call for abstracts is now open.

The Biennial conference taking place from 12th to 14th November 2014 at the Laico Regency Hotel in Nairobi seeks to bring together experts, care givers, patients, policy makers and many others to share experiences and deliberate on hospice and palliative care issues.

In 2012, over 350 people attended the 3rd National Palliative Care Conference which was a great success. This year the conference promises to be even more exciting, creating an opportunity for delegates to hear from international, regional and national speakers; network with hundreds of decision makers and explore the latest developments in palliative care at the national, regional and international platform.

Abstract categories are accessible on the conference website. Deadline for submission of Oral Presentation and Workshop abstracts is 31st July 2014 while submission of Poster abstracts closes on 31st August 2014.

This year’s theme is ‘Palliative care is everyone’s business’. Palliative care is an issue that will affect all of us at some point in our lives, whether as a patient, carer, family member, neighbour or friend.

KEHPCA, together with its partners, has been at the fore of advances in palliative care in Kenya, focusing on integrating Palliative care into health care systems; developing National Palliative Care Guidelines and National Palliative Care Training Curriculum; advocating for patients’ legal rights; pioneering the integration of medical and nursing undergraduate training in palliative care and working with the Ministry of Health and the Oncology team in Kenya to ensure that palliative care is included in the National Guidelines for Cancer Management and other relevant documents.

Visit the KEHPCA conference website for more information on abstract template, guidelines and much more about the conference.

KEHPCA moves into new office

The last two weeks have been busy for Kenya Hospices and Palliative Care Association (KEHPCA) as the association parked from its office at Chaka Court along Argwings Kodhek Road to unpack at Top Plaza along Kindaruma Road/Kamburu Drive.

During the opening ceremony, KEHPCA Executive Director Dr Zipporah Ali said the association has come a long way since its inception in November 2005. “We are here for patients. The new office should serve as a motivation to work harder and meet our goals of advocating for palliative care for all.” She said.

Board Treasurer Mr. Faustin Mugendi said that this transformation is a new beginning. “This is God’s work. Be encouraged for we are going places.” He said.

The Administration/Finance Officer, Miriam Igobwa gave a brief history of the association and thanked the team for the continued dedication towards realizing the association’s vision of quality palliative care for all in Kenya.

Mr. F. N. Njanja, KEHPCA’s new neighbor, dedicated the office to the Almighty God. He gave a word of encouragement from the Book of Psalms 91 urging everyone to seek God, for under Him things will fall into place.

The ceremony culminated with cutting of the ribbon followed by a feast where the staff and invited guests celebrated with a special meal and drinks.

More photos are available in the gallery below the home page as well as KEHPCA’s facebook page.

KEHPCA has continued to advocate for palliative care in the country at various levels with the following achievements among others.

  • Recognition of palliative care as a human right in the Kenya National Patients Rights Charter 2013
  • Inclusion of palliative care in the National Cancer Control Strategy
  • Development of Palliative Care Training Curriculum to be used by institutions teaching palliative care
  • Commencement of a Higher Diploma in Higher Education in Palliative Care at Kenya Medical Training College
  • Continuous Medical Education sessions for Health Care Workers on aspects of palliative care as well as regular training workshops

The entire office could like to thank all donors and supporters for providing a shoulder to lean on as we continue to advocate for palliative care to reach each and every Kenyan faced with a life limiting illness.

May God Bless KEHPCA

Lecturers and tutors attend a four day palliative care workshop

Lecturers and tutors from training institutions converged in Nairobi for a four day workshop on teaching methodologies in palliative care through the collaboration of African Palliative Care Association (APCA) and Kenya Hospices and Palliative Care Association (KEHPCA) with support from Diana Princess of Wales Memorial Fund.

Palliative care consultant from APCA, Irene Kambonesa said that the training aimed at equipping the tutors with knowledge on how to impart knowledge to health care trainees at various training institutions.

“I believe you have learnt a lot from us. Take the good things you have learnt from us for the last four days and pass it on to others,” said Kambonesa.

KEHPCA Executive Director Dr Zipporah Ali said that palliative care is being integrated into public hospitals hence the need for more trained health care workers to take up the task of providing palliative care to patients with life threatening diseases calls for such a workshop.

“I hope this training has improved your interest in palliative care so that once you go back to your stations, you will be able to pass on this noble skills.” Dr Ali said.

Judy Johnson, an oncologist from the USA consulting for Daystar University said she was pleased with the progress of palliative care in Kenya.

“Having nurses understand palliative care is so important,” said Johnson. She added that they are trying to create a program for health care workers to care for patients at home by instilling confident in them as most patients do not want their families to have full knowledge of their illnesses.

As for the trainees, Gilbert Sigei from Tenwek Hospital said that the course has simplified palliative care concepts and made it an interesting field to work in. “The forum was lively and we felt part of the training team,” he added.

Gladys Owira, a nursing lecturer from the Great Lakes University, Nairobi Campus said that in class, some of her palliative care students are positive about the course while others are negative.

“I think it is because they have not had a practical encounter with patients who need palliative care. I commit myself to propose placement of our students in a hospice setup to my colleague so that they practice what they have learnt.”

She said she thought she understood all training methodologies but the workshop has enlightened her of two more areas; scalping and problem based methodologies.

“We in the medical field need this knowledge because we are in touch with these patients, directly or indirectly. I feel many people are lacking knowledge about palliative care,” said M/s. Owira.

Dennis Nyambane from Kenya Red Cross is a trainer in palliative care. He said that Red Cross is running a hospital in Dadaab Camp and there is a need to take care of terminally ill patients.

“This course has come in handy and I am planning to do some Continuous Medical Education sessions on palliative care for the health staff and health assistants at the hospital.” Mr. Nyambane said.

KEHPCA Education and Research Officer Dr Asaph Kinyanjui said that the workshop presented a platform of equipping lecturers and tutors with appropriate knowledge, skills and attitude for them to effectively train palliative care.

Topics covered during the workshop include problem based learning, clinical placements/tools, role play, cooperative learning, care based learning and case conferences among others.

Anyone can offer palliative care; medical practitioners told

Everyone in the healthcare field has a role to play in palliative care.

This was the message to health care providers attending the Kenya Medical Association Scientific Symposium on Oncology held at the Kenya International Conference Center last Friday.

Speaking during the symposium, Kenya Hospices and Palliative Care Association (KEHPCA)’s Coordinator for Pain Relief Dr Esther Muinga said that 80% of patients with life limiting illnesses present with moderate to severe pain while 50% of patients with HIV present with the same.

Dr Muinga said that management of this pain is crucial for comfort of these patients with life threatening illnesses.

She indicated that more than 30% of cancer can be prevented by avoiding risk factors like smoking and alcoholism.

Dr Muinga added that there is a challenge in selling the concept of palliative care to hospital administrations but progress has been made with support from the Ministry of Health.

She challenged the medical practitioners to give support to patients in need of palliative care since over 40 centers in which they practice have a palliative care service unit.

The symposium run concurrently with a free two day basic screening for cancer at the Kenya International Conference Center (KICC) grounds where hundreds of city dwellers presented themselves for the exercise.

Among the cancers screened were breast and prostate with most attendees undertaking the Body Mass Index test.

Most of those screened said they came to capitalize on the free screening and know their cancer status because they have heard that it is a killer disease and it is costly to treat if diagnosed late.

They urged the government to make screening available in the rural areas since those people have a little understanding of what cancer is and take such illnesses to be acts of witchcraft.

The screening exercise was part on the ongoing campaign by KMA dubbed ‘Bila Cancer Society’ (a society without cancer) aimed at creating awareness about cancer using activities scheduled across the year.

Partners on board for the screening event were Aga Khan University Hospital, Karen Hospital, The Beacon of Hope Clinic as well as Moi Teaching and Referral Hospital.

Malindi palliative care unit; the new kid on the block

Malindi District Hospital is the latest entrant into the palliative care service provision bracket following the launch of its palliative care unit last week.

Part of the cerebrating team was Kenya Hospices and Palliative Care Association (KEHPCA) who conducted a Continuous Medical Education to the team at the hospital.

The CMEs are aimed at equipping teams at hospitals providing palliative care with knowledge in pain management and other distressing symptoms.

Kilifi County Physician, Dr Fatuma said that the cases of patients who need palliative care has been on the rise making these services crucial in the hospital.

She emphasized the importance of integration of palliative care for the management of all life threatening illnesses and not just cancer.

“The palliative care team has been seeing at least 15 patients, including pediatrics, every week and this number is bound to increase.” Dr Fatuma said.

Present at the celebration was the Coast Hospice team that has provided technical support through creating awareness, supplying drugs and mentoring the team at Malindi over the years.

Speaking at the opening ceremony, Coast Hospice administrator M/s. Jane Mwanyumba said that Malindi sub-county patients and their families will now have close access to this facility, easing the burden of traveling and expenses

“The environs of Malindi will also benefit from the palliative care services offered in this unit,” said M/s. Mwanyumba.

Dr Eleanor Foster, a Canadian doctor who has volunteered since October 2011 to establish palliative care services at Malindi District Hospital said since they started offering the services in November 2011, the number of patients has steadily increased, with a current figure of between 10 – 15 new patients per month.

Dr Eleanor said that most patients receiving care at the unit have cancer of the Cervix, Breast and Prostate alongside other patients of HIV and Kidney failure and the official launch will see the unit continue serving even more patients in need of palliative care as well as supporting their families.

The Kilifi County Health Secretary’s (CHS) office confirmed that it has bought the unit enough medicines to be given to patients for free for the next 3 months and will continue to support them in future.

This support of drugs will go a long way in alleviating patients’ pain at the new unit with a promise from the CHS that they will look into the issue of staff shortage at the hospital and find a solution.

Following the support, the hospital has donated some morphine to Coast Hospice as they await supply from Laborex pharmaceuticals.

The Hospital Matron Mrs. Deche said that they have a breast cancer support group at the hospital with 21registered cancer survivors.

Group leader Rosemary Ndung’u said the support group members meet every Wednesday to share their experiences and give each other strength.

With the support of Dr Eleanor, Rosemary and her colleague Asanta Komora, are undertaking a Higher Diploma in Palliative Care course offered at Nairobi Hospice in collaboration with Oxford Brookes University.

“I have a passion in palliative care and I have worked with women with cervical cancer in the villages who I refer to a gynecologist for further tests.” Rosemary said.

She said that her fear is breaking bad news to a patient once the results are positive and this is one of the reasons she is undertaking the course to learn how to break bad news to patients.

Rosemary says once she completes the course, she would be better equipped to break bad news and enhance support to patients with life threatening illnesses.

The opening of Malindi District Hospital Palliative Care Unit is part of the ongoing integration of palliative care into government hospitals by KEHPCA in collaboration with the Ministry of Health.