Tuesday Nov 23

Tuesday Nov 23
Todays entry was provided by Susan who has summarized her two day Palliative Care workshop.

Today was the first day of the palliative care workshop. Karen Giva chaired the event, which she actually preferred to call a briefing, a sharing of experience and knowledge as it were. The day got off to a very slow start... my heart started to sink when I found myself the first person there at 0750, after agreeing with the other facilitators, Karen Giva and Maggie Mhango from the nursing college, that we would all meet at ~ 0745 this morning to set up. The computer needed to be set up, the room had not been cleaned and the furniture still had to be arranged. Maggie and Karen arrived shortly after 0800, and it took 2 hours before we could start. Fortunately, the participants began arriving around 0900, and by the time we had lunch there were about 15. The slow start however was just “Malawi time”and once we did start, it was a great day. Discussions happened, questions were asked, some had some strong feelings about what might work for Nguludi in terms of a model of care. My role was to facilitate for each topic, add in comments, questions, stimulate conversation, etc.
Once again, I was struck by the very basic level of palliative care training we need to undertake here. Staff are doing this supportive care all the time in one way, but not recognizing it for what it is, or doing enough for various reasons – short on staff, leadership, supplies like fuel to make home visits, medications, knowledge. However, many do have the attitude required to do the palliative care, they just need the support of the hospital and perhaps PACAM to revive their program here.
Interesting examples of ‘ethical dilemmas’ came up during the session: One story was of a woman who kept ‘getting sick’ and was hospitalized every time there was a plan for her husband, who was HIV positive and very ill in the same hospital, to be discharged home. This continuned to happen, puzzling the staff, until the wife finally confided to one of the nurses that her husband was so angry over his imminent death from AIDS that he would would pressure her to have intimate relations so she too could contract the virus and die. He could not stand the thought of her living on after him and possibly being with another man. The dilemma presented was how to support the wife and still respect the right of this man to go home. Everyone agreed that he should not be discharged home and the wife would also remain at the hospital so he'd have no reason to want to leave. He finally was unable to be considered for discharge as he became more frail, and he died.
Some different models of palliative care were discussed in small groups then in a plenary session with a view to preparing the participants to discuss how the Nguludi Hospital palliative team wishes to move forward.
What I find promising is the cooperation between the nursing college and the hospital, the level of interest in being able to do palliative care at Nguludi again, and the sense of urgency to get started. I am very pleased to have been able to help facilitate this process, and share in their goal.
As for the weather, today was a doozy. The skies opened up at least 3 times. During our afternoon session at the workshop, the rain and accompanying thunder was so loud that we could not hear each other talk. We waited a while, then continued, but the paths and culverts and streets were flowing like rivers. The rainy season has truly begun. Some of the workers at the hospital are up at 0430 or 0500h to plant their gardens. Most people maintain gardens to grow what they need for themselves all year – at least maize, cassava, beans and the like. Almost everyone seems to live beside a mango or papaya tree as well. Of course, this sounds really good, but the fact is this is the only way to survive here for most Malawians, as their salaries if they are working do not enable them to support their families or themselves for that matter. Most Malawians of course do not have any kind of salary, but simply subsist on what they can grow and perhaps sell a little of that.

Wednesday, Nov 24
Day 2 of the workshop went well. We planned to start at 0900, agreed to by all the participants yesterday, and we started at about 1000! Malawi time again!! Oh well!!
That said, we had a great day. The group has settled in a little, with mostly the same people as yesterday, and the discussion was freer. The morning was spent talking about communication in palliative care, then a session by myself on pain assessment and management. Most of the afternoon was spent on team planning for ‘the way forward’ for a palliative care program at Nguludi. We came up with 14 recommendations. All of them really came from the participants, not me. I could not have wished for a better outcome.