Patient Story: Hewyot

Hewyot was referred to Hospice Ethiopia by an Elder Leader. 70 years old, she had extreme pain in her right lower leg. Her distress was palpable, she was shaking uncontrollably, breathing rapidly, confined to her bed, her pulse was sky high, she was dehydrated and her mouth was sore.

She was also a diabetic and had been referred to the government hospital for control of the disease, but hadn’t gone as her son was busy at work. Nothing had been prescribed for her pain, and its cause was difficult to ascertain; it might have been a prolapsed disc.

Our medics visited Hewyot and gave her two different types of pain killer (Tramadol and Amitriptyline) and an antifungal gel (miconazole) for her mouth. We encouraged her to drink lots of water and go to hospital for control of her diabetes.

We returned two days later and found a completely different woman, smiling, relaxed and able to walk around her home. She had no pain and had been to hospital for management of her diabetes. She is receiving ongoing follow-up from Hospice Ethiopia.

Heywot-after

Patient Story: Fetle

Fetle is 24. She was diagnosed with breast cancer 6 months ago. Sadly the disease had already spread and could not be cured. When she came to us she was suffering with pain in her breast, spine, underarm and left leg. She had no pain killers. The breast cancer had spread through the skin, causing an open wound that was infected. She had become incontinent which, with other symptoms, suggested she had cancer in her spine and was at high risk of becoming paralysed.

Fetle was born several hundreds of miles outside Addis Ababa and been abandoned at birth. She had been brought up by a non-governmental organisation. At 18 she was raped by one of their workers and she subsequently had twins.

Fetle used to work as a cleaner but can’t anymore, due to the pain and other symptoms. As there is no welfare system in Ethiopia she had become entirely reliant on neighbours for food and support.

So what can Hospice Ethiopia do for Fetle?

We are giving Fetle pain killers, antibiotics for her infected wound and steroids to try and prevent paralysis. We will phone her and visit her each week, to review her symptoms and the effectiveness of the medicines.

We are also providing ongoing psychological, spiritual and financial support. £10 per month will be enough for her and her twins to eat properly. We will also help Fetle make plans for her twins, once she cannot care for them herself.

The Diocese of Norwich supports Hospice Ethiopia in the Bishop’s Lent Appeal 2017

In 2017 the Bishop’s Appeal in Norwich will be focused on raising money to provide a car for Hospice Ethiopia to reach those in need of palliative care.

Through the appeal, your money will go towards providing the Hospice with an off-road rental car for three years.  Roads are often rough and of poor quality, and public transport is busy and unreliable.  We want to help enable care and equipment to reach those who cannot travel to the hospice.

Cars are expensive and difficult to maintain given the availability of parts.  By renting the vehicle all maintenance costs are included; well advised given the quality of the roads.

In addition, the nurses are frequently carrying medicines to their patients, in particular opiate pain killers, which would make them vulnerable on public transport.

More information and resources are available at http://www.dioceseofnorwich.org/churches/seasonal/lent/ 

Hospice Ethiopia in the British Medical Journal

Blog as originally featured in the BMJ Opinion, 27 May 2016. http://blogs.bmj.com/bmj/2016/05/27/jamie-and-sue-mumford-palliative-care-in-ethiopia/ 

We have recently returned from our fourth visit to Addis Ababa. With less than 1% of the estimated 150,000 new cancer cases annually in Ethiopia receiving specialist oncological treatment [1], the need for affordable palliative care in the country is huge.

Hospice Ethiopia, the only palliative care unit in the country providing symptom control treatment, was set up in 2003 by Sister Tsigerada Yiswafossen. It is a non-governmental organisation and as such has to raise 90% of its funds from outside the country. When funding is dependent on donors there is a continuous need of international and domestic networking.

The objectives of Hospice Ethiopia are quality of life for their patients, training of health professionals, and raising awareness of palliative care needs and treatment. The four nurses and one part-time doctor at Hospice Ethiopia provide community based palliative care free of charge to terminally ill people in three districts (estimated population of 900,000) in the east/north of the city.

Access to opiates is finally improving. Since we first visited four years ago, the number of hospitals in Addis Ababa that have access to oral morphine has increased from one to nine. With training from Hospice Ethiopia staff, support from the Ethiopian government, and funding from the US, 700 healthcare professionals are now able to appropriately use strong opioids. It has been a privilege to see and be a small part of this process, (which puts our NHS work as a GP and Community Specialist Palliative Care Nurse into perspective). Hospice Ethiopia staff have also helped to produce national palliative care guidelines, published by the Ethiopian Ministry of Health.

A recent exciting development is a project supported by the WHPCA to enable Hospice Ethiopia to work with the traditional burial societies known as Iddirs to promote palliative care delivery to Ethiopia’s rural population. Iddirs were originally set up to help with the costs of burials but are now used for a wide range of community issues.

We are part of a small group based at Priscilla Bacon Lodge Specialist Palliative Care Unit in Norwich who support Hospice Ethiopia. We have close links with a similar group led by Dr Norrtsrom in Sweden and with Professor Anne Merriman at Hospice Africa Uganda. We endeavour to promote much needed palliative care in this fast changing part of Africa. We will be back in the new year!

References:

1 Woldeamanuel YW, Girma B, Teklu AM. Cancer in Ethiopia. Lancet Oncol 2013;14:289–90. doi:10.1016/S1470-2045(12)70399-6.

Jamie Mumford is a GP in north Norfolk and Sue Mumford is a community palliative care nurse.

Photo: patient consent obtained.

Norfolk nurse sees ‘slow progress’ in Ethiopian palliative care

A twinning arrangement between palliative care specialists in Norfolk and hospices in Ethiopia is starting to make “progress” in the Africa country, according to a nurse involved with the scheme.

Article in the Nursing Times, https://www.nursingtimes.net/clinical-archive/end-of-life-and-palliative-care/norfolk-nurse-sees-slow-progress-in-ethiopian-palliative-care/5082876.article

International Team Visits Hospice Ethiopia

International palliative care experts – Professor Anne Merriman, Dr James and Sue Mumford, community specialist palliative care nurse, and Sr Bernadette Basemera – visited Hospice Ethiopia last month to take part in teaching and to advise the organisation on marshalling their resources to survive the loss of a major funder.

See ehospice.com for full article: http://www.ehospice.com/Default/tabid/10686/ArticleId/14159#