MY EXPERIENCE WITH HOSPICE JINJA

Rays of Hope Hospice Jinja (RHHJ) (Hospice Jinja) is a charitable christo-centered organization, without discrimination of, race, gender and religious background. It was founded in 2003 as a mobile palliative care team in Jinja regional referral hospital after it was established that there was great need for palliative care services in Busoga region. It was officially launched on 8th August 2005 as Hospice Jinja. Though an independent NGO, Hospice Jinja operates in supervision by and in close collaboration with Hospice Uganda (HAU) which is a model for Africa. Being the only Hospice in Busoga region, it works closely with the palliative care team of Jinja regional referral hospital.

I was requested to give technical support by Dr. Anne Merriman to Hospice Jinja for a period one month (23rd August to 23rd September 2005) This was because Hospice Jinja lacked full-time trained palliative care personnel .All they had were , a part time Doctor and a clinical palliative care clinical officer. Both of them work in Jinja Hospital. I was able to work with the two nurses who just had a 6-day palliative care course for health professionals and then two weeks course Palliative care experiences with Hospice Africa. Together we were able to assess and manage new patients together. This gave them a good opportunity to enhance their pain assessment and management skills.
Daily work was quiet hard because the program lacked transportation and supplies. We had to use public transportation means to go around the city and see the patients.
Those who were still strong to come by the clinic office, were encouraged to do so. We could see only three to four patients a day in home visits. I noted the staff was so dedicated and eager to learn

Activities

Hospice Jinja runs a daily out patient clinical. Visits the hospital twice and provides home care service

Source of patients

Majority of our patients are referrals from Jinja Hospital, Nyenga Hospital, Kakira Hospital, Iganga Hospital, many surrounding Health care clinics and a few by the community volunteers. In one month , August to September 2005, we admitted 45 new patients, of which 17 were HIV/AIDS patients, 14 were cancer, 4 were HIV/cancer and 10 were non cancer or HIV including gangrene, chronic arthritis, eczema and stroke. Many patients came when are in advanced stages and were quite very sick .

Achievements include:

• We visited patients from Hospice, Hospital, homes and follow up were also done.
• Access to morphine is now available to the hospice patients
• There was good collaboration with the Jinja hospital and the DDH’s clinics
• Had regular team meetings to discuss new patients and any other challenges
• Two of our nurses went for three weeks a palliative care training at Hospice Africa
• Acquired experience in setting up a new organization/Hospice

Challenges: Funding:

All staff members did not earn a salary due to lack of funds and even upkeep for me was a nightmare. Home visits were seldom even when the patients were very sick and this was crucial due to lack of vehicle, however some patients were visited using public means (boda boda and public transportation) Poor administering of morphine (*hours or prn by staffs on the ward or even failure to administer it to patients). Lack of Medical equipment.

Recommendations:

• Continuous lobbying for funds from other partners and expand outreach through mobile clinics.
• Consider providing a constant of morphine supplies and other medication to Hospice
• Provide Palliative care sensitization and education workshops for health workers in the hospital and in the district to learn pain management and to administer morphine
• Build capacity through training to address skill deficit
• Provide financial support to hire full-time palliative care specialist for proper patients’ care..

As we noted that the resource is limited, it is therefore beneficial and cost effective to involve the volunteers in palliative care daily service delivery, thus training of selected volunteers who can effectively deliver the services . You can help in offsetting this need by coming to their rescue. Please support them as God may lead you.

The hospice care team now offers mobile services within a 20km radius of the hospice. In the first two years the team consisted of 2 administrative staff, 3 nurses, a social worker and a driver. In 2006 the team was joined by 2 volunteer doctors from Ireland for a period of three months. Due to the constraints in funding the new advisory board deemed it necessary to cut down on the paid staff. This would enable the organization define job descriptions and roles and responsibilities for a few full-time staff who are directly answerable to the board. Three full-time staff was appointed in April 2007 and is keeping the hospice running. Despite this there is need to recruit 3 more full-time nurses, 2 full-time social workers, a bereavement and volunteer manager to enhance quality of care, alleviate the patient -staff case load and be able to carry out mobile clinics and handle the increasing number of patients. (Currently a nurse curries a case load of over 100 patients)!! There is need for more qualified clinicians e.g. a doctor or clinical officer. Currently the hospice is seeking consultative services from clinicians from Jinja hospital or Hospice Africa, both who are already very busy people

Lesson learnt

Future

 The work continues and there are many patients yet to be admitted but no financial resources to carter for them!! In this part of town Hospice and palliative care is the only answer for people HIV/AID and cancer terminally ill. They can resource health, emotional and spiritual support without being stigmatized

By Elizabeth Nabirye

Palliative Care Clinical Officer (HAU)

Sovereign Wings of Hope Ministries Inc
PO BOX 218432
Houston, Texas 77218
Te. 713 503 8011 Houston .Texas 77084

E-mail hospiceJinja@yahoo.co.uk 011-256-43- 122924 or USA email sovereignwings@yahoo.com  Tel 1 713 503 8011

or

FHSSA and designate your gift to Hospice Jinja
Foundation for Hospices in Sub-Saharan Africa
1700 Diagonal Road Suite 630
Alexandria, VA 22314 Direct: 703-647-8506