After a training of two Naivasha hospital nurses for one week in palliative care in June 2010 by Nairobi Hospice staff and Nakuru Hospice Staff, the struggle to have palliative care recognized in Naivasha District Hospital started.

Intensive awareness creation and advocacy within and outside the hospital premises to spread the work on the importance of palliative care commenced to reach out to as many as could be possible.

Kenya Hospices and Palliative Care Association (KEHPCA) visited the hospital to ascertain the steps the hospital has taken to integrate palliative care at the facility following a projected expansion of palliative care services to over 30 more hospitals at the district level.

Mary Gacheru, the senior nursing officer in charge of palliative care services at Naivasha District Hospital has been in the forefront of pushing for the palliative care agenda at the slightest opportunity she got.

“We go out to churches and schools to spread the word on the importance of palliative care and create awareness to the community at large.” Mrs. Gacheru said.

She added that they have incorporated a nutritionist who is a breast cancer survivor into their team who always gives advice on nutritional factors in palliative care.

Trainings and Workshops

KEHPCA Executive Director, Dr Zipporah Ali, Dr John Weru, a palliative care and pain specialist and Dr Laura Oyiengo, a pediatrician with an interest in pediatric palliative care, earlier this year gave the hospital staff a one day training.

The training touched on the principals of palliative care, pain management in adults and children as well as pediatric palliative care, thus increasing the knowledge base within the facility.

The training was well attended with most of the doctors in the hospital participating.
One nurse got a one month attachment with Nairobi Hospice in February 2011 to have practical skills on how palliative care services are offered.

In September the same year, one nurse and one Registered Clinical Officer (RCO) were trained for ten days by KEHPCA and Catholic relief services.

KEHPCA conducted a workshop for 23 Naivasha hospital staff to equip them on aspects of handling patients with life limiting illnesses.

A Continuous Medical Education on pain management for all hospital staff took place in June 2012 and in July the same year, all staff took part in training on nutrition in relation to cancer.
The hospital staff got to learn a lot in palliative care from these series of educational meetings and positive results have so far been noted in their day to day health care activities.

Progress

The medical officer and coordinator of palliative care services at the hospital Dr Dennis Wamalwa said that the morphine theories have subdued among the hospital staff and the medical officers including those on internship are able to subscribe morphine to patients in need.

“Any patient with a malignancy is put on record and followed to ascertain the cause of cause of such malignancy and appropriate referrals are made to avoid late diagnosis.” Dr Wamalwa said.

Dr Wamalwa said they always not able to get all the help patients may require but they try their level best to attend to their needs.

He said that continuous training is necessary so that they keep refreshed on the fundamental principles of palliative care as well as equipping new medical officer interns with this prerequisite knowledge. “More knowledge is not harmful.” He said.

Mrs. Gacheru said the number of those seeking screening has increased following awareness creation. “Once we screen them and an illness we cannot handle is confirmed, we refer them to Kenyatta but cases like Kaposi’s sarcoma can be handled at our hospital.” She added.

David Musyoki from KEHPCA said the struggle Naivasha Hospital is putting up with is a great step towards realizing palliative care service delivery to the patients.

“If medical officer interns are prescribing morphine, it is a step towards eliminating the myths that have been hindering strong opioids use to help patients with severe pain.” Musyoki said.

Dr Wamalwa said they have plans to visit an operational palliative care unit to have a practical touch on how to handle palliative care patients at different levels.

He said that the establishment of a palliative care unit  would largely make the hospital management understand the need for the services, as they can be able to measure the output at the facility level more easily.