A Day in Palliative Care

Hello!

Yesterday, Maggie and I had the opportunity to accompany the palliative care team on their rounds which occur once weekly. They are given the names of sick people by each village's community leader and do their best to see each patient. Ilula Lutheran Hospital provides these services free to the community as many of these patients will never be able to afford the cost of care or cannot physically travel to the hospital. The palliative care team includes a nurse, doctor, social worker, and pastor. Emma, the nurse, explained that their focus was to relieve all patients of physical, mental, social, and spiritual pain. The team was designed to help meet the patient's needs and provide care and compassion. The list of patients in need grows each day while the resources remain very limited. Currently, there is over 400 patients on their waiting list that need to be seen. They told me there was a recent period of several months where they had to suspend these visits due to a lack of hospital funds. Every member of the team expressed how much they loved getting to care for and help their community and wished they could do it more often. 

After the bumpy ride and hike through the plains and forests to reach our first patient, I began to understand the barriers to healthcare that many patients faced. Our first patients were a husband and wife couple. We all sat on buckets, rocks, and wooden stools as they explained their medical problems. The patients were welcoming and refused to sit until we all had a place to sit. The husband had epilepsy and was having 3 seizures a week. The wife had lower abdominal pain that was interfering with her life. After much medical discussion, the wife was given medication for peptic ulcer disease and the husband was advised to come to the hospital to see the Doctor at Ilula who specialized in epilepsy. The social worker spent time identifying resource and transportation concerns, and then the pastor prayed for the family before we left. It was an amazing experience to see the palliative care team use their different skill sets to comfort the patients. They were so grateful for the visit; it was wonderful to see the impact of human connection and care. 

Our last patient was a more solemn experience. We had to ask for directions several times before we arrived at the correct home. When we got there, I wasn't sure who our patient was as we saw a happy and healthy-looking older couple with several young adults. The farm did not appear impoverished, and there were many animals roaming about. Then our patient slowly limped over and attempted to sit down. She had been suffering from a wound with discharge for two years and could not even sit down without enormous pain. She leaned uncomfortably in her chair for the entirety of the visit to avoid pressing on the wound. She looked very undernourished and unwell. Although she was in her 40s, she looked well beyond that in age. This was not the first time the palliative care team had visited her. Three months ago, they gave her 1 week of antibiotics and pain medication and urged her family to bring her to the hospital. Nothing has been done since then. The social worker spent most of the visit discussing with the family the urgent need for their daughter to have medical care in a hospital, but they insisted they did not have the money. There was not much more we could do at this visit from a medical standpoint other than provide more antibiotics and pain medication. The patient was grateful for the visit and appreciated talking with the pastor. However, I left the visit feeling defeated as she may never get the care she needs. The social worker did not give up and discussed plans for further action, including involving the government for negligence.

Overall, it was a very impactful experience, and I was grateful to learn from the palliative care team. The lack of resources and access to care can completely change a person's life. I reflected on the concept of emergency medicine in America and how patients cannot be refused care even if they can't pay. There is no such concept here, and it is heartbreaking to see medical emergencies that cannot be treated due to a lack of resources. Despite all this, the Tanzanian medical community does its very best with their limited funding. I was amazed at the love and compassion shown by the palliative care team and can see the difference it is making to each patient they visit. 

-Rachel