CARE OF DISTRESSED PATIENT DUE TO INCURABLE CONDITION

ABOUT THE PATIENT: Afidhu Mwesiga Yunusu  19 years old boy, he is the first born in the family of 7 siblings, living in Mubango hamlet, Nyakahama village  in Bulyakashaju ward within Kamachumu Division. Completed form two and was selected  to continue with form three but this was not possible due to none responding pain of left knee which was associated with swelling, later he was not able to stand without support finally he was completely bad ridden .

HISTORY OF THE DISEASE

In March 2020 he experienced pain during walking and had difficulties to use his left leg. Pain increased day and night, later he developed knee swelling which was very painful and tender. He was not able to stand or walk without support, used sticks and sometimes failed completely. This condition goes more worse. His parents decided to seek help from traditional healers. They used local medicine without reliefe and finally they decided to seek medical care. Attended different Health facilities and diagnosed to have osteosarcoma. They were advised to be referred to Bugando  for further investigation and if possible for amputation. It takes time to process the new information and due to superstition issues, they went again to tradition healers and to those who pray and request gods to bring miracle to cure incurable illnesses. Afidhu was in severe pain and developed depression with loss of hope to live because he didn’t expect any help from the relative.

His father said “I have done my part no way out”.

MEANS OF IDENTIFICATION

It was on 26.6.2020 when palliative care team were invited to attend the Village Development Committee of Nyakahama village. The village Chairperson reported that there is a boy in Mubango Hamlet with huge swelling of the knee diagnosed cancer and he is bed ridden for more than 3 months. Dropped school due to severe pain and nature of the disease. Due to ignorance and superstition issues associated with poor economic status his father decided to leave this boy at home until GOD wishes. The village Chair person requested palliative care team to see that boy after the meeting

When we reached there Afidhu  was not around, he was away to tradition healer in Muleba village. His farther was against the medical services and he doesn’t want Afidhu to be taken by anybody for any service. He stated that “Nothing to do, I know the disease progression”

Counseling is ongoing process. We planned another day for visiting the family.

On 30.6.2020 we visited Afidhu again; when we reached there he was laid on the old mat screaming with pain, his father was sitting aside watching his son. After greetings, the team deal with the pain. Morphine 10 mls was given at start, then we wait for 30 minutes. When the pain decreased Afidhu was able to express his feelings.

Findings from the physical examination: Huge mass, very tender, shining and very hard. He was very week and depressed due to fear of death associated with disease progression.

Plan of care and services offered. Morphine 5ml 4hourly in day time them 10 ml at 10pm for two weeks, feed patient in small amount but regularly.

At the Hospital Afidhu was discussed during clinical meeting and all physicians advised to bring him to Hospital for investigation.

The family was visited several times in order to be convinced with our advice.

On 10.8.2020  the parents agreed to bring Afidhu to Hospital, He was admitted and knee x ray was repeated and again it revealed Osteosarcoma. He was covered with antibiotics to control secondary infection. Then referred to Kagondo Hospital for bone specialist to review. On 18.08.2020  Afidhu was escorted by Palliative care coordinator to Kagondo. He was admitted, parents and patient counseled, all agreed to remove the affected leg. The operation cost was covered by palliative care as it was indicated in the budget of the EKFS Foundation.

On 21.09.2020 Amputation was done successfuly and Afidhu recovered well.

Current situation: Afidhu is living happily enjoying life with parents and friends. No pain. Morphine was stopped. Now supported with nutrition diet for rehabilitation.

Word from the AFIDHU “I appreciated the service provided by Ndolage Hospital Palliative Care Team. I was lost but now I found. My days were numbered but I was taken out of the grave. I can sleep, talk  and walk by using crutches and visit  my friends. Thanks GOD for all you have done through the blessed hands of palliative care team and all who supported the project. As you see me I am still young I want to go back to school and hoping that GOOD SAMARTAN to help me at least to get official leg. MAY GOD BLESS YOU ALL“

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Der Bericht wurde von Amelia Musikampingo der Leiterin des Palliative Care Project erfasst.

Leider ist Afidhu Ende Oktober 2020 gestorben. Er hatte Lungenmetastasen. Die Amputation hat ihm dennoch zwei gute Monate ermöglicht. Das ganze Team war sehr betroffen und hätte ihm eine längere Lebenszeit gewünscht…

Area: CARE OF PATIENT LIVING WITH HIV AIDS

About the patient: Mectirida Augustine  aged 68 years old. Living in Mbale Hamlet  within Bulamula village. Educated up to standard eight ,married and got 3 children. Her Husband died due to unknown illness 2006, and her second born died in the same year.

She was among of the first patient affected from HIV  and there were no ART(Antiretroviraltherapy) . At that time she was in a critical condition. She was admitted in Hospital and after being tested she was discharged for home core. There was no hope for cure. At home she collapses  several times and  recovered. Finally she refused to eat and developed self stigma and wanted to die because of pain.

History of the disease: In 2006 after being diagnosed  she was very sick. And started ART on 23.04.2006 but she was sometimes hiding the medication under the mattress. Condition goes more worse day and night. During that time the Home based care services was provided by AIDS CONTROL PROGRAM under North Western diocese. They visited her but  she didn’t  follow what was told, she continued to hide the drugs under the mattress .

In 2008 when palliative care initiated at Ndolage Hospital, she was visited by the team and holistic counseling was done. She regained slowly and accepted to take her ART regularly.

As the time goes, she improved slowly  from bed ridden to ambulatory  and finaly  was able to cultivate some food material for family use .

Means of identification: She was identified during case finding from CTC when palliative care initiated at Ndolage hosptial.

Findings from the physical examination: During the first visit she was very  weak , loss of body weight (skin to born) enable to move from the bed ,crying and loss of hope

Plan of care and services offered.

Due to psychological and physical pain we started with muscle reluctant to make her to rest a bit. Diazepam  5 mg was given at start then to continue at a few hours of sleep for 3 days . After 2 hours we left the patient and promise the family members  that we will come to see her on  the following day. On next day she was a bit calm and able to express herself.

She was counseled and advised to take drugs according to instruction .After good drug adherence she improved speedily and gain her body weight.

Current situation: Mectrida now she is a palliative care client and counselor to other  .She is our community ambassador on how somebody can die due to stigma. Drug adherence, good nutrition and treatment of opportunistic infection  patient may live longer.

A word from Mectrida: “I appreciated the service provided by Ndolage Hospital Palliative Care Team. I was half died due to fear and self stigma. My parents were much worried due to my  condition. Neighbours didn’t came to visit due to fear of being infected by HIV/AIDS .

I decided to hide drugs so as I can die quickly. But when my guardian angels came from Ndolage, they make me live longer. Now I am 14 years living with HIV/AIDS.

I am completely physically fit, able to cultivate food material for my family. I am living happily with my neighbour and all family members .

To be HIV positive it is not the end of life. Drug adherence, good nutrition and exercise including social interaction to change ideas with others. Removes fear and living positive with HIV/AIDS. „

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Ein Bericht von Amelia Musikampingo, der Leiterin des Palliative Care Projects.