On a warm Friday morning at Murang’a Level 5 Hospital in Murang’a County patients are seated in rows waiting in front of different units within the hospital. Monica Juma the only Kenya Registered Palliative Care Nurse (KRPCN) in Murang’a walks few steps in front of her visitors as she takes them round the various hospital amenities. She is excited about the rapid development of the hospital in the last few years and especially the inclusion of palliative care services.

“These patients spent a lot of money by the time they are diagnosed with a life-threatening illness. Why should they again pay for palliative care services?” Juma said as she welcomed to her office visitors from Kenya Hospices and Palliative Care Association (KEHPCA). Edith Mwihaki a KRPCN from Thika Level 5 hospital was also in their company. Since the introduction of palliative care in Murang’a Hospital in 2015, Juma has vouched passionately not only for its survival and growth but for free palliative care services for these patients. Her efforts have earned the support of the hospital’s administration together with its medical personnel.

Murang’a Level 5 Hospital has a whole year program to have Continuous Medical Education (CME) for their clinicians on every Friday of the week. As a confirmation of their support for palliative care, the Hospital invited KEHPCA to give a CME on pain management on 2nd March 2018. A total of 36 members among them doctors, clinical officers, nurses and interns gathered for the session that ran from 12 to 1 p.m. It was something so touching to see these men and women finding some time out of their demanding responsibilities to attend a session seeking for better ways to relieve the pain of their patients. The consultants present were the Clinical Pharmacist, Surgeon, Radiologist, Pediatrician, and the Physician.

Through a PowerPoint presentation, Dr. Muinga the Coordinator for Access to Pain Relief and Palliative Care began the session by explaining the two types of pain; nociceptive which arises from stimulation of intact nerve cells and neuropathic where nerves are damaged. She went on to elaborate ways of measuring and managing pain. Opioids being the main drugs used to treat severe pain, Dr. Muinga explained their background, dosage and side effects. Apart from treating pain with opioids, she engaged the participants in discussing pain treatment methods that do not involve the use of drugs like massage, dance, and meditation among others. Dr. Muinga concluded by saying that, “If we do not treat patients satisfactorily, we multiply their complications, increase their expenses as well as those of the health facility”. Dr. Wambui the Consultant Physician appreciated the interactive session saying that it was timely especially for the interns who have been inquiring much on pain treatment.

A visit to the Nursing Service In charge Mrs. Agatha Kariuki revealed a challenge on the shortage of medical personnel in Murang’a hospital. “Many of our colleagues have retired and more of us are soon going to follow suit yet there is no replacement”, she said. “As much as I am willing to uphold palliative care in Murang’a, I cannot afford an assistant to Juma”, she regretted. She, however, commended Juma for the great job she has been doing in Murang’a County and emphasized that the hospital will remain supportive. Palliative Care remains everyone’s business.

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