By Bernadette Basemera
The drive to advocate and support the integration of palliative care services in Rubya hospital, Muleba district, Kagera region, Tanzania was initiated by the Dutch doctors known as Friends of Rubya hospital. Their aim was to ensure Rubya hospital team is able to provide relief of pain and suffering of patients and their families later cascade such services to the community through a home based care programme.
The integration process began with training of onenurse and one doctor to supplement each other through PC courses ran by HAU. The training of the two was aimed at equipping them with knowledge and skills to integrate and provide PC services to patients as well as teach others.
The Friends of Rubya hospital realised that the need for palliative care provision was quite huge and required more health professionals to be trained to increase on the number. They raised funds to train more health professionals within the different departments with an aim of supporting the PC team to identify, assess and manage patients on their wards. The hospital management identified 21 participants from the hospital and these were taken through and five day introductory training in PC. During the five day PC training, participants undertook practical clinical skills experience on the wards. They were able to participate in holistic patient assessment and management enabling them to practice the theoretical knowledge gained in class. There was a female patient admitted with excruciating headache. On assessment, she was very restless, crying, rolling in bed touching her head an indication of severe pain. The carers were equally disturbed and looked very worried about the patient’s condition. She had spent 2 days without food or a drink. Investigations revealed cryptococcal meningitis in AIDS. She was not on any Anti-Retroviral treatment. Intravenous Fluconazole was prescribed but it was too expensive for the relatives to afford. Holistic assessment could not be conducted fully because of her condition. The team started the patient on oral morphine 5mg/5mls, 5mgs 4 hourly, Bisacodyl 5-15mg nocte, Dexamethasone 16mg od for 2 days then reduce by 2mg on alternate days. Given IV glucose since she was not eating before the medications. The start dose of morphine was immediately given and in 5-10 minutes the patient was calm and dosed off a bit.
On reviewing the patient the following morning, to the amazement of the participants, the patient was sitting very calm in bed able to smile and express herself and the overwhelming pain she was experiencinghad greatly improved. The main lesson learnt from this case for all the participants was that pain assessment and management is key in providing palliative care services and this should focus on the family as well.
A support supervision visit was organised and took place in September 2016 with an aim of providing mentorship and support in identifying gaps in PC service provision and their solutions. During the visit, trained health professionals assessed and managed cases with mentors, discussed challenging cases and had teaching on identified sessions for better understanding. The participants had gained a lot of experience in holistic assessment of patients and their families through team work and case discussions. They also did home visits of bedridden patients as well as conducted a community volunteers training to support them in identifying PC patients in communities and giving them basic nursing care. Palliative care training requires ongoing mentorship to enable participants provide quality services to patients and their families. This also provides continuing education where there is experiential learning from experts in order to identify gaps and improve on service provision.
Bernadette Basemera is a nurse trainer with Hospice Africa Uganda international programs department