The Big Five revisited…

Birgit Jaspers, researcher, University of Bonn, Germany, and Eva Schumacher, nurse at the Palliative Care Centre, Malteser Hospital Bonn/Rhein-Sieg, Germany, had a great, but also challenging time at Kenyatta National Hospital, Nairobi, Kenya.

Kenyatta Hospital Palliative Care Unit Team

The team: (left to right):Anne Mwangi (head nurse), Birgit Jaspers, Grace Wanyoike (nurse, malignant wound expert), Eva Schumacher, Catherine Abuor (nurse), Esther Cege Munyoro (physician and head of the unit)

Thanks to Dr Esther Cege Munyoro, who regularly meets Professor Lukas Radbruch, the head of our departments, through the Leadership Development Initiative (LDI) we were invited to Nairobi in order to discuss feasible and budget-friendly ways of management of malignant wounds. The Kenyatta National Hospital Palliative Care Unit team has been working as a wound management consultancy team throughout the hospital and is striving to expand their outpatient service at the palliative care unit to a wound management advisory centre.

Shortly after our arrival we were picked up by a ‘save taxi’ to meet our very welcoming colleagues and have a tour round the hospital. Traffic was quite an experience, and we admired the ease with which the all drivers (including Esther and her son!) manoeuvered through potholes and permanent traffic jams.

A seminar day with various talks on wound management also introduced us to hospital staff. In the next few days we were invited, together with the Kenyan nurses, to assess patients with malignant wounds in several wards, discuss wound care options and to show how to change the dressings. We also saw outpatients at the palliative care unit and visited a patient at her home.

Home visit

Visit to a patient’s home: (left to right) Grace Wanyoike, Birgit Jaspers, Patricia (the patient), Eva Schumacher and Patricia’s mother.

Our five challenges
Five major challenges emerged throughout the visit. These included: attitude (use of rescue medication before and during dressing changes, not wearing a surgical mask); prevention and treatment of malodour and bleeding; use of available material; creative approach (self-made charcoal compresses); and treatment goals (patients with severe malignant wounds were not informed of their prognosis).

There was a vivid discussion about pros and cons of wound management options. An evaluation at the end of the visit indicated that this ‘week of awareness’ was an important step to improve the knowledge of wound management on non-palliative wards and towards the establishment of a wound advisory

The team

Discussions with the team on the oncology ward

centre. Currently, we are thinking about ways of further cooperation.

And the other ‘Big Five’
At the weekend we had the opportunity to see representatives of four of the ‘Big Five’ in the National Park and an attached elephant orphanage – only the leopard was missing. Another good reason to come back to Kenya!

Find out more…
Visit the website of the The Kenya Hospices and Palliative Care Association (KEHPCA) to find out more about palliative care in Kenya.


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