KEHPCA is currently mid-way through a large scale programme in partnership with the Ministry of Health to support the establishment of palliative care units and palliative care teams at 11 Government Level 5 and Provincial Hospitals in Kenya. By the end of April 2012, teams at all 11 hospitals will have received a five day Introduction to Palliative Care training, and will have undertaken a three day clinical placement at their local hospice. In February 2012 KEHPCA visited the five day training for the team of health care professionals at Thika Level 5 Hospital, and caught up with the team on Day two, as Dr John Weru introduced a session on pain management.
We arrived just as the team were busily taking notes and preparing to begin the afternoon session with Dr Weru, and were told that within the team of 20, all hospital departments were represented. Dr Weru began with the World Health Organisation (WHO) Pain Ladder, and talked this through with the team, exploring how they currently assess patients in pain in their daily practise. The different types of pain medication available were explored, within Steps 1 non opioids and adjuvants for mild pain, Step 2 weak opioids for moderate pain, and step 3 strong opioids for severe pain. When asked which step the team thought would cause more side effects to a patient’s health if taken on a long term basis, the majority of the team responded with ‘Step 3 – morphine’; however Dr Weru explained this was a common misconception, that Morphine was perfectly safe to administer as a primary pain relieving drug over a period of time (and that the only common side effect is constipation), and that actually the Step 1 non opioid drugs were more harmful if taken on a long term basis. This was met with much surprise from the team.
The team participated in a lively session as Dr Weru threw many questions open to the floor, and explained that the team need to ‘continuously assess pain and modify medication regimes appropriately’. The team were then split into groups and given case studies of fictional patients to discuss and decide how they would manage their pain and breakthrough pain. As the teams worked we spoke to Nurse Esther, present from Nyeri Hospice, who is acting as Thika Hospital’s twin hospice. Nurse Esther explained ‘There are so many things they are learning about palliative care that they didn’t know before. They are seeing palliative care to be a new concept, and this to be a good training that will help them to give care. After this training they will come to Nyeri Hospice for three days clinical placement, and then we will make a plan to undertake regular ward visits with them at the hospital’.
Esther Nyeri Hospice Nurse
The groups discussed their case studies together, and then moved on to conclude the session discussing paediatric palliative pain management. As the afternoon session concluded, we were able to speak with some of the trainees. Ruth, a Theatre Nurse at Thika Level 5 Hospital, told us ‘It has been very educative so far. It has made me look back on my practise, and remember the times I have worked with patients in severe pain and felt unsure of how to manage it. We all need to be able to deal with pain assessment and management, and I have learnt much that I will be able to take back to work’. We also spoke to Lucy, a Nursing Officer in the Medical Ward who explained ‘the training is good, quite demanding. You need a big heart to go through this. We are talking about inspiring hope in patients who are likely to be feeling hopeless. As a nurse, you might carry their situations and burnout. We are learning in great detail how to go about implementing palliative care, and to make a real difference in changing the lives of the affected’.
Lucy Nursing Officer Medical Ward
As we were leaving, Chris, a Nurse in the hospital’s emergency unit told us ‘Morphine is available at Thika Hospital, but is not being prescribed – I actually didn’t realise it could be used to the affect that Dr Weru has explained today. From now on I will concentrate on pain – and I will tell all my colleagues’.
By Julia Strong