From Esther (A UK Palliative Care Nurse Specialist working with the team
in 2007/2008)
Victoria is a 32-year-old woman who we first met in Hospital. She was
weak, emaciated and visibly short of breath. She complained of chest and
abdominal pains. She had been admitted and investigated for long
standing health problems and was found to be suffering from AIDS. The
hospital referred Victoria to The Shepherd’s Hospice and she agreed
that once she was sent home we could visit her.
The day after she was discharged the team set off to find her. She lived
in a remote area in the hills. We drove as close as we could in a land-rover
and then had to proceed on foot. We found Victoria sitting on a mat on
her veranda. She was happy to be home but still short of breath and in
pain. Since coming home she had not been able to sleep due to coughing at
night, she complained of chest and neck pains and was eating very little as
she had oral thrush. Unfortunately, she had left hospital without her ARV
drugs needed to treat her HIV infection.
We promised to liaise with the Sister at the hospital to obtain her ARV
drugs. She was too weak to attempt the return journey. Meanwhile we
gave some medication for the pain and treatment for the thrush.
Two days later the Community Health Officer returned to reassess
Victoria. She was visibly stronger, eating a little food now that her mouth
was healing. She now felt strong enough to make the return journey back
to the hospital to get her ARV drugs.
One week later, we found Victoria sitting over a pot cooking for her
children. She was much stronger and her shortness of breath had also
eased. She was now taking her ARV drugs. She still needed to take
paracetamol for the chest pains. In view of her on-going respiratory
symptoms the Doctor had requested she have a chest x-ray to rule out
TB infection. She could not afford the L30,000 (£5) fee. TSH patient
support fund was able to assist her and she was given L35,000 to cover
the costs including a taxi fare.
We await the results and continue to monitor her progress and support
her as she takes her ARV drugs.
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Isatu is 5 years old. Her mother had brought her into the clinic at TSH.
She was lying on the bed, feverish, weak and lethargic. She lived with her
mother at Grafton Camp, formally a camp for displaced people during the
war. Her mother was divorced, sadly Isatu’s father was not interested in
his child.
For over a year Isatu had been suffering from chronic health problems.
Her mother had taken her to many of the local clinics, paying for tests
and treatment, none of which had seemed to help. She had even paid for
prayers at the local church, now her money had run out. Fortunately,
another Shepherd’s Hospice patient had told her to come for help.
Isatu was malnourished, she had a swollen infected eye and pus drained
out of one ear. She wouldn’t speak and complained of pain in her throat on
eating. The lymph nodes in her neck were enlarged, as was her liver. On
examination she had reduced air intake into her lungs. Both of her feet
were odematus. It was clear that she was acutely unwell and needed to be
examined by a paediatrician. We were concerned that her chronic health
problems maybe due to an underlying HIV infection, although her mother
appeared well.
We took Isatu and her mother to the local children’s hospital. On
examination the Doctor decided to admit her but was concerned as to
who would pay the bill? The patient support fund (PSF) was able to cover
the consultation fee (£5) and laboratory fees (£2).
Two days later we returned to find Isatu much improved, sitting up and
able to reply to our greeting ‘Kushe’. She was smiling broadly. The
laboratory tests had shown that she was anaemic but her HIV test was
negative. The Doctor was concerned that she might have an underlying
cardiac problem, could he order a chest x-ray? Once again the PSF was
able to cover the (£5) fee.
The chest x-ray revealed that she was suffering from pulmonary TB. She
was commenced on treatment (free) and moved into the nutritional unit
attached to the hospital. She would remain there for one month whilst
she received intensive nutritional therapy and took her TB drugs. We left
knowing that she would be well cared for.
Five weeks later we visit Isatu in the camp. She is running around with
her friends, giggling with delight. The transformation in her is amazing.
Her mother thanks us, Isatu has started to talk again. She will need to
continue on her TB drugs but she should make a full recovery.
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John is 30 years old he has recently successfully completed treatment
for TB. He knows that he is HIV positive, his first wife died of AIDS. He
is keen to commence ARV treatment. He came to TSH for assistance. We
pick him up from the side of the road as arranged and take him to
hospital where he is commenced on Anti-retroviral treatment. His new
wife does not know of his status, only his mother.
A few days later, the Community Health Officer tries to visit John. He is
not at home, he has been feeling ill and has gone to church for prayers.
The next day we visit again. On arrival, we find John lying semi-conscious
on the floor of a back bedroom. He complains of having a headache last
night and today has not moved. He is unable to speak and is weak down
one side of his body. His teeth are clenched together in his mouth and he
moans quietly. If disturbed he stares but doesn’t appear to see. His neck
is stiff. A family friend who works in another clinic has set up an
intravenous drip.
In the UK we would dial 999 and call for an ambulance. There is no
ambulance and he is too large and unconscious to attempt to move him by
car. We know that even if moved to the main hospital in Freetown, he may
not receive the treatment needed to save his life. The journey would
involve sitting in heavy traffic for perhaps hours in stiflingly hot
conditions. His family are all too aware that they do not have the money
to pay expensive hospital bills.
We fear that John has meningitis, a complication of his HIV infection.
We help the family understand what may be happening to John and the
possible options. It is clear that they would like him to stay at home with
them; they are afraid to move him.
We reassure them that we will do our best to make him comfortable. We
provid a Home-based Care Kit and attend to his personal hygiene needs,
changing his clothes and bed sheet and laying him on incontinent sheets.
We cool his body with tepid sponging and encourage his family to talk to
him and keep him cool with a fan.
It is impossible to give him any medication by mouth and so we administer
an injection of Tramadol, the strongest pain killer that we have available
in Sierra Leone. (However since October 2010 oral morphine is now
available to Patients of TSH). We leave him and his family and promise to
return the following day. His family seem relieved to have some support
and tell us that he is now in God’s hands.