Statistics indicate that 63% of oncology staff suffer from stress and depression in their day to day service delivery in the health sector.

This depression is caused by burnouts due to heavy workload, fatigue, constant exposure to suffering patients, and trauma during death of these patients.

Facilitating a self-care session in a training for Level 4 hospital health care workers, M/s. Gladys Mukosi, palliative care nurse at Kenyatta National Hospital (KNH), said that these health care workers are involved with the physical and emotional suffering of patients.

“There is frequent exposure to suffering especially from patients with high morbidity and severe dependence.” M/s. Mukosi said.

She said that dealing with distressed, angry and blaming relatives as well as breaking bad news could depress a health care worker.

The high patient to healthcare worker ratio which M/s. Musosi estimated to be 30:1contributes to the heavy workload.

• The palliative care nurse identified other contributing factors as;
• Patient disease severity
• Insufficient equipment
• Evening and night shifts
• Endless demands from patients and their families
• Fear of committing error by health care workers

In order to offer quality palliative care to patients, M/s. Mukosi said that it is necessary for nurses and other end of life health care workers to have a burnout allowance.

“Give yourself time to relax from the day to day operations at the unit or ward. Take breaks/off duty and do what gives you enjoyment, pleasure and peace.” She advised.

She said that it is important for palliative care providers to celebrate success no matter how small it may seem.

“Identify external resources e.g. trainings, continuous Medical Education sessions (CMEs), support groups and discussion boards where you can share and talk about your depression.” M/s. Mukosi said.

This, she said, would lower the depression and stress levels significantly accompanied with good health.

Speaking on nutrition in palliative care, Dr Tasmin Mohamed, a pharmacist from Modupharma Limited said that we have a lot of cancer today because of small factors.

“There is a lot of chicken injected with steroids in our fast food centers that puts us at a risk of cancer as well as accumulation of fertilizer on our farms.” Dr Mohamed said.

She said that parental nutrition has become expensive and patients need to be consulted on what is available for their meals and advised accordingly. “We should not take the decision making process into our hands as most patients already have financial constrains.”

According to Dr Mohamed, it is important to develop guidelines for counseling medicated patients especially pertinent information regarding their medicine and the time to take the drugs.

She said that common nutritional problems and their solution include;

• Weight loss – eat energy rich foods
• Heartburn – avoid gassy foods and have small frequent meals
• Nausea – crackers and ginger tea
• Constipation – eat a diet with high levels of fiber.

Dr Mohamed said that an ideal food pattern involves starting to eat early, making healthy food choices, eating a variety of foods and making starchy food the basis of each meal.

She said that good nutrition helps a patient to tolerate treatment and improve the patient’s productivity.

“The role of a nutritionist is to assess a patient’s nutritional needs, offer nutritional counseling, plan diets to manage complications according to the patient’s medication plan and educate both the patient and relatives on nutritional matters.” She said.

In her parting shot, she quoted Thomas Edison 1870, who said “The doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition.”

The training was led by KEHPCA’s Special Coordinator for Access to Pain Relief and Palliative Care Dr Esther Muinga who took participants through Pediatric palliative care principles and Pediatric pain management and barriers to pain management alongside the Training and Research Officer Dr Asaph Kinyanjui who tackled Pathophysiology of Pain in pain assessment, Adult Pain management and the role of surgery, radiotherapy and chemotherapy in palliative care.

KEHPCA’s Executive Director Dr Zipporah Ali gave an overview of palliative care principles and overview of palliative care in Kenya.

Dr Ali said that this is part of the effort to integrate palliative care to 30 Level 4 Hospitals after integrating the same in Level 5 Hospitals.

Over 35 health care providers were trained and they expressed interest of having palliative care units in their places of work.

Additional contributors in the three day training included;

Nairobi Hospice’s Chief Executive Officer Dr Brigid Sirengo, Training Coordinator M/s. Jesca Ng’an’ga, Senior Nurse M/s. Catherine Ajuoga, KNH head of palliative care Dr Esther Munyoro, Gladys Warindi, Rev. James Clensham on Nairobi Hospital and Ann Mwangi also contributed to the great success of the training.