In 2001 I spent four months at Kijabe Medical Centre, and during that time was involved in the care of terminally ill patients in the wards of the hospital. The hope was to improve this care, to teach palliative care principles and practice, and to encourage its acceptance into the clinical departments of the hospital.
At the end of this visit, I was informed by the Administrator that Budget approval had been given to the appointment of a Palliative Care nurse from July 1st 2002, and we agreed that the appointed nurse should undertake some training before this time. I was asked to return to assist in the establishment of this service.
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Report
Kijabe Medical Centre is a large Christian hospital, of 230 beds, set in mountains overlooking the Rift Valley about 45 minutes drive from Nairobi. The hospital has medical, surgical, obstetric, gynaecology, paediatric, and dental departments as well as very busy outpatient and casualty departments. There is a School of Nursing and an adjacent Rehabilitation Hospital for Crippled and Handicapped children.
Palliative Care is not new in Kenya. The Nairobi Hospice was established in 1991 for the care of terminally ill cancer patients, but has now extended this care to AIDS sufferers. Several other services have now been started, most of these offering home care in a rural setting.
Kijabe Medical Centre is a very influential health care facility in Kenya, and recognizing this, the initial focus was educational – aiming to teach all staff the principles and practice of palliative care. This included students from the nursing school, ward staff, family carers, general service staff, AIDS field workers, volunteer pastoral carers, and chaplains and students from a Bible college nearby. Death from AIDS now affects almost every family in Kenya and so Health Care staff with some knowledge of Palliative care will be better equipped to help patients in their own communities, as well as in the hospital.
The number of AIDS patients presenting to the hospital, acutely ill, is increasing. Some can be symptomatically improved, but many are in the terminal stage of their illness requiring ‘intensive’ management. Antiretroviral therapy is now available in Kijabe, and at no cost to the patient because of the generosity of overseas donors. The changing pattern of AIDS and its management has meant, in Kenya, a need to redefine terms.
Palliative care . Care intended to keep the person with AIDS as healthy as possible for
Terminal care. Care given to a completely bedridden and dependant patient, pending
PLWHA Person living with HIV AIDS (always referred to in this way, to protect
Morphine is available in Kenya, but this hospital had little in stock last year, because doctors were not prescribing it.
Parental morphine was available, but now there is liquid oral morphine in stock, in all departments. There is still much to be done in encouraging its use and to teaching of its role in pain management.
A support group has been started, with the aim of helping families who are nursing terminally ill patients at home. This will be done through the sharing of experiences, teaching of basic nursing care, educational programs regarding AIDS and its symptomatic management. Volunteer support carers will be involved in the development of this group, as will chaplains and palliative care nurses.
At the end of the two month visit, palliative care was better known to all staff members, and this increased awareness, and concern, is leading to better care within the hospital of those who are terminally ill. Patients are discharged home earlier, with the support of the palliative care team, and with arrangements being made for the care to be followed up in the home.
The hospital has a number of rural clinics which are, at present, providing Primary Health care to the people living in the communities nearby, and who are a long way from medical care. In the future, staff from these clinics could be brought to the hospital for more training in the care of the terminally ill patients. They will then be enabled to support families in the villages, which will be responding to a great need.
It is good to see the development of Palliative Care in Kenya and of the support being given by international, experienced palliative care health care professionals, both financially and professionally.
The Palliative Care Association of Kenya had its first meeting in September 2002 with the attendance of representatives from seven services. This alone demonstrates a commitment, in Kenya, to continue to work towards palliative care being available to all those who are facing, or will face, a terminal illness.
