Over 35 health care providers attended a one day palliative care sensitization meeting organized by Kenya Hospices and Palliative Care Association (KEHPCA) and Nyeri Provincial General Hospital (PGH) under the Tropical Health and Education Trust (THET) project.
Opening the event held in Nyeri Town, the Deputy Medical Superintendent Dr Julius Macharia said that palliative care is a key component in the management of chronic illness that the country has so far not laid much emphasis in.
Dr Macharia said that the focus to communicable diseases has been emphasized at the expense of non-communicable diseases.
“Refocusing on attending to the two sets of diseases would relief us the burden we are currently experiencing, as non-communicable diseases (NCDs) are on the rise.” He said.
He added that resources should be channeled to both ailments since inattention to NCDs has often led to patients suffering in silence.
“Patients die with a lot of discomfort which is not a good gesture in the medical field. A human being deserves to live and exit the world peacefully.” Dr Macharia said.
The deputy medical superintendent said that KEHPCA has teamed up with developmental partners to reinforce the need for palliative care, not only in hospices but also by integrating it in hospitals.
“We also want the level 4 hospitals to have palliative care integration in their services to ensure that patients receive holistic care. We should be able to walk with our patients from diagnosis to the day they depart and even beyond, with their family members.” He said.
KEHPCA’s Education and Research Officer Dr Asaph Kinyanjui took attendants through palliative care principles and overview of palliative care in Kenya, introduction of THET project and meeting expectations and pain management in palliative care.
While facilitating, Dr Kinyanjui said that THET project aims at driving the advocacy agenda in palliative care both at the national and county level.
“The project’s activities include staff capacity building, both health care workers and the community, to offer holistic care and be able to train others.” Dr Kinyanjui said.
He said that after its accomplishment, the project aims to improve palliative care service delivery in the regions selected (Nyeri, Eldoret and Homa Bay) as well as strengthen referrals and partnerships.
Though transfers and change of profession of palliative care trained health care workers remains a challenge, Dr Kinyanjui said that the project aims at training officers who would in turn capacity build other health care workers to fill the gap.
He added that the Kenya Medical Supplies Agency (KEMSA) has agreed to procure two kilograms of morphine in its effort to ensure it is available in the government hospitals that have already integrated palliative care in their services.
Mrs. Lydia Warui, Nursing officer in charge at Nyeri PHG palliative Care Unit, facilitated the meeting with an elaborate state of palliative care services in Nyeri region including the PGH.
Mrs. Warui said that it is important for health care workers to walk the journey of end of life with the patient from diagnosis so that they are not stigmatized at the time of referral to the hospice.
“Moving the care to where the patient is would help curb the notion that referral to a hospice is a death sentence.” Mrs. Warui said.
She said that integration would help the patients to understand that palliative and hospice care are not separate entities in a patient’s care but a process that ensures they lead a comfortable life all through their illness.
Attendees expressed concern over privacy of patients as handled by some nurses who call patients by their ailment adding that it is important for the nurse on duty to keep the patient’s disease as a private matter between a health care worker and the patient.
According to Mrs. Warui, over 80 health care providers have participated in a Continuous Medical Education (CME) that has improved their understanding of what palliative care entails.
“We chose a multidisciplinary team from various departments that included pharmacy and laboratory.” She said.
The palliative care unit in Nyeri PGH was allocated abandoned washrooms that they managed to renovate with funds from KEHPCA.
Since it started its operations in 2011, statistics at the unit indicate that 220 patients have benefited from palliative care with availability of morphine to treat the pain.
Mrs. Warui said that the unit has always collaborated with Nyeri Hospice to hasten referrals and treatment of pain.
She said the unit recently started oncology services and on the third Friday of every month, they have visiting oncologists from Kenyatta National Hospital.
Nyeri Hospice palliative care nurse Eunice Nyokabi explained in detail symptoms assessment and management in palliative care to the meeting attendants.
M/s. Nyokabi said that without knowing symptoms in life limiting illnesses you cannot be able to manage them effectively.
“As a palliative care service provider, you need to assess, plan, implement and evaluate a patient’s ailment while involving the patient and her/his relatives.” She said.
She told the health care providers to treat what is treatable so as to enhance comfort of the patient as much as possible.
M/s. Nyokabi urged the participants to embrace truth telling and avoid the conspiracy of silence when it comes to breaking bad news to patients.
“Let them know what their disease is and what their drugs are and involve relatives because if you are not infected, you are affected.” She said.
The palliative care nurse said that team work is important in the care of a patient as divisions along professional ranks will not work in favor of the patient, which is at the heart of palliative care.
The common symptoms handled during the meeting include constipation, virginal discharge, nausea and vomiting among others.
Challenges Identified
- Lack of awareness about palliative care among patients and their relatives who take referral to hospice as a death sentence.
- Shortage of staff, as not many health care providers are trained in palliative care and even those who are trained transferring to other places or changing their profession.
- Shortage of palliative care drugs still remains though the hospital has always supported in the purchase of these drugs
Solution and way forward
- All developmental partners are involved in training more healthcare providers to help fill the gap of professionals in palliative care.
- Enhancement of integration of palliative care in hospitals to enable patients start palliative care at the point of diagnosis that will enable them understand the process hence reducing the stigma attached to hospices when time comes for referral.
- Approach developmental partners, targeting the top management first so that once they embrace support for palliative care, involving the lower management would be easier rather than climbing the ladder.
The health care providers were advised not to forget themselves when it comes to health matters as they too are human beings who can be caught in the disease circle if they do not watch their nutrition.