Visiting day

 

Home visits again today. My favourite activity really, for the insight I get into local life. A long drive again, almost to Korogwe, the neighbouring town. We almost always seem to incorporate shopping into the road trips, with the palliative nurse making the most of local produce en route. Today we stopped in to another convent who deal in dairy & chickens. We came away with eggs, fresh milk and an enormous chicken ( already plucked I hasten to add).

Another wonderful example of what the palliative team offer to this community. I admit I was somewhat sceptical before we set off, on what would be almost a 2hr round trip, to visit a lady who has been on the books for 9 years with 'liver cirrhosis'. No identifiable cause, and other than a massive build up of ascites (fluid in the tummy due to a failing liver) every few months doing remarkably well. The palliative nurse got a dr to teach her how to do an ascitic tap and has been doing it every few months since then when the pressure build up becomes unbearable. I was hugely relieve she wasn't expecting me to do this - I've only assisted a long time ago as a medical SHO. This procedure in the UK is usually done under sterile conditions by a specialist doctor in hospital. Here our nurse made things as aseptic as possible in a small mud hut with chickens flapping in through the window. One large cannula, a bit of tubing and an old cooking oil container later and we had a huge amount of fluid draining. We waited an hour, sucking on oranges which her husband proffered for our refreshment. Her abdomen deflated from that of a lady looking like she was about to go into labour, to one ready to leave the maternity unit. Her relief was palpable and we left a very happy customer to rest.

The nurse told me that most patients with ascites will be refused the same procedure at the hospital as it is not curative and the fluid will only reaccumulate. She is doing it purely for symptom relief, and I suspect without this input today's patient would not still be around, let alone enjoying her life between times.