Yesterday the current palliative care doctor at the hospice handed in her notice. Today she is gone. Apparently that's just what happens here - no working out a 3 month notice period. Here today, gone tomorrow!! It leaves the palliative care team with 2 nurses and the hospice administrator. There is one other doctor and the clinical officer but they are employed for the HIV care & treatment and not the remaining palliative work.
I am still trying to piece together how the hospice runs, how it is funded, how it integrates with the hospital but this news has put me on fast track. I hadn't until now given the time to read the hospice website (I have put the link on this blog). I am humbled by just how much Dr K achieved in setting us this place and the whole embryo ethos of palliative care in Tanzania, her MBE undoubtedly well earnt.
It is unlikely that Dr H will be replaced (employment arrangements are too complicated for me to explain) but I do hope this doesn't mean the hospices drive to improve palliative care access regionally and nationally doesn't suffer. I had a meeting with the hospice director today and we will meet with the hospital medical superintendent tomorrow to devise a plan.
Today however a busy day care awaited (the usual role for Dr H) so instead of mentoring the clinical officer I waded in to run things myself. The hospice runs weekly day care clinics for all the palliative patients on the books, helping with transport and providing refreshments for the day. A chance for people to come together with others going through similar situations and have a regular contact with the hospice team. This itself an invaluable support. One of my favourite quotes from the founder of the palliative care movement is "You matter because you are. You matter to the last moment of your life and we will do all we can, not only to help you die peacefully, but also to live until you die". I think the hospice day care encompasses this beautifully.
I was happily in my comfort zone as it is similar to a gp clinic, dealing with any problems patients brought up, a lot of which are unrelated to their underlying cancer/HIV illness. And of course the problems related to their life limiting illness are also things I can help with. At times I almost forgot where I was, others frustratingly handicapped by the language barrier. Plenty of moments completely stumped by my bread and butter clinical situations which here I stumble on knowing what treatments or tests are available. I add trip to pharmacy and laboratory to my long to do list.
Who sticks in my mind today; the youngest and the eldest:
The 26yr old beautiful girl, HIV +ve who is wheeled in and peels back her skirt to reveal a hideously deformed and elephant like leg with Kaposi's sarcoma (an HIV related skin cancer).
The 96 yr old chirpy, toothless lady who whips out a distorted breast which looks like it encloses a hard edged boulder. She's remarkably well, and thanks to the palliative team has not spent her family's fortunes chasing surgery and chemotherapy. She would rather enjoy her days amongst her children, grandchildren and greatgrandchildren and as and when she becomes more unwell is reassured to know the support is there.
In between a likely DVT, housemaids knee, angina, rectal bleeding, infected eczema amongst others and the largest abdomen I've ever seen in a non pregnant lady, full with a huge dermoid cyst.
School went back today: one child went. One I'm going to homeschool (in between stretching my brain), the other we are still negotiating over.....
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