Home Visits for Home Bound

A few years ago in 2010, Dr. Nyaki, Adella Kessy and Rosalia Mosha handed me palliative care proposal and expressed their interest in working, after their retirement, in the community to help people who are home bound and isolated with palliative illness. ‘Retired but not tired’ is a common approach to dealing with the persistent shortage of staff in the health sector. Last year, Mary Todd’s energy and enthusiasm vaulted the languishing plan to a higher level as she restructured the proposal and brought in expert advice from British colleagues. All their insights have been invaluable.

The plan as first outlined would put the collective experience of the three mamas in village to provide medical and nursing care to people without access to hospital for lack of money, or location. Many terminally ill people would prefer to be cared for at home to prevent incurring any hospital debt that would be passed on to family after their death. The mamas would provide education and counselling to caregivers in the home, provide treatment for symptoms common to the terminally ill; pain, shortness of breath, nausea, wound management, bowel concerns and provide materials like bedpans, catheters, plastic bed covers and wheelchairs. Home based care workers would reinforce the care plan, provide support to the caregivers and family and alert Nyaki, Kessy and Mosha for further needs.

For the last week we have been accompanying Dr Nyaki, Mama Kessy from house to house in the villages of Ngangu, Rosho, Kimaroroni, Mykashi, meeting people suffering from illness in established villages near the hospital, in remote ravines and most recently on the lowland plains at the base of the mountain which unlike Kilema is dry and scorching. To date we have had six days of visits and have collected data on 33 households.

Interestingly we are meeting plenty of elderly people, ancients, suffering from a range of illness; hypertension, diabetes, arthritis, dementia. Most have caregivers who are children, husbands and 2 had paid caregivers who are able to help with cooking, feeding animals as well as helping with the sick relative. We have met a significant number of disabled with little to no help. Even the local Rotary group at Kilema has targeted this group as one with needs enough that something should be done. Perhaps 5/33 have fit palliative criteria. The needs assessment has been providing some unexpected data and we are looking at how to adapt the original plan to meet the needs found in the villages. As Anna Nyaki says “the truth is in the community”.

Jan 9 visit

Down a ravine in Mkyashi we were led by HBC Mary to an eroded pole and mud house to meet and elderly husband and wife, both coughing and weak but the husband Peter bedridden. He described himself as an old orphan having lost parents when he was a child, was cared for by the parish and taught English. He was lying in a dark room with a sagging ceiling spotted with wasp nests and the air was thick and hot. What a welcome he offered. He was delighted to have company and greeted each of us from his bed. His bedside light was a small light bulb attached to battery. He asked for my contact and said he would write to me if he didn’t die. We completed the questionnaire and concerned by his chest congestion, likely pneumonia, resolved to buy him medication which we planned to pass to John Bosco, who would pass it to HBC Mary, who would deliver it to Peter. Peter never took the meds because he died that night. A few days later we sat in church with the community and then walked behind the pickup truck with them to the gravesite near Mkyashi primary school. We didn’t know Peter long but how grateful to have met him and shared such a lively visit. We were included in the ceremony; the villagers gave us all wreaths to lay.

Jan 16 Carolyn’s thoughts on visiting villages in the lowland flats……..

“It felt like we were burning from the inside out. We had come to find the very ill, and isolated, we did. Himo town is a local Tanzanian crossroad It is people isolated and at risk. We hired a local pick up truck to help our team locate a young woman who was thrilled to welcome her daktari and nurse to her tiny home/room where when it rains the family huddles together in one dry spot to survive the night. The midday heat threatened our resolve. We questioned local survival with little water, shade and resource. On we moved, meeting families living with deep commitment to carrying for their own, struggling from illness from which they would not recover . We nominate Mamas Nyaki and Kessy for sainthood. They inspire in everyway, the depth of caring, giving and deepest of friendships. They are how we want to be.

And yet when we find our way back to Himo town and shade, we drink our cokes and share the love of some beautiful scarves.”

Jan 21 visit …Carolyn’s thoughts

Today we went back to find more of the ill and isolated. Having learned about extreme heat and the elements on our last journey we hired a vehicle for this one. An expert team of nurses guided by HBC’s , today was a day of small worlds. We first encountered a 12 yr old girl living with the aftermath of polio. She is unable to go to school, no home schooling here. Her looks of admiration toward her care- giving dad remain with us. A paraplegic man injured by a rain soaked tree, devoted care-giving by his family, one a nephew living with HIV. A 49 yr old woman imprisoned by a stroke 2 yr ago untreated, unable to leave her tiny room, she breaks our hearts. Our assessments show extreme need though maybe not as was first imagined.

Even though it has become clear that there are not the palliative AIDS numbers that we first thought, there are many sick and isolated elderly, disabled, chronically ill and palliative as well. I think we are pleased to have an assessment that has given us small a window into the needs of the community and we will rewrite the project proposal to reflect those needs we uncovered. Our admiration to Mama Nyaki, Kessy and Mosha for wishing to take on these challenges in the future.