"The Mercy Ships Palliative Care Program was initiated after crew member Ann Giles identified a need to offer continuing care to people with inoperable tumors. Now in its tenth year, the program sends nurses into the community to offer pain relief, wound care, counseling and support to these patients.
Palliative care and cancer care are still in their infancy in Sierra Leone, and there is very little treatment available at local hospitals. “Often doctors here don’t tell people the truth because there isn’t much they can do to help them anyway,” says Palliative Care Team Leader Harriet Molyneux. The result is that many of the patients with whom the team works have never heard of cancer before. “We have to tell them, ‘This is what cancer is; this is what we can do for you,’” says Harriet.
It is never easy to tell people that they are going to die, but cultural differences between the palliative care nurses and their patients create additional challenges. “In this culture, it is very hard to break bad news to people,” says Harriet. “The culture is very much to say, ‘God is great’ and encourage each other and build each other up. So it’s difficult to say straight out, ‘I’m afraid you’re dying.’ I’ve never said it directly. You couldn’t do that.”
Esther Komba, a palliative care day-worker who has been a practicing nurse in Sierra Leone for over 15 years, has been an invaluable cultural interpreter for the team. “She struggled at first,” says Harriet. “She went home crying every day the first few weeks, because it’s completely going against her culture, but she’s a very strong woman, and she’s stuck with it – she does a fantastic job.”
In 2011, the Palliative Care Team was given a budget to develop income-generating projects for their patients. These projects help patients to support themselves and to be assured that their families will be secure after they die. The team works with patients to identify a skill or trade that they have developed in the past and then helps them to get the materials and training they need to start their business.
Adama Kargbo ran a cooked food business for 20 years before she developed a malignant facial tumor and became too sick to work. She came to Mercy Ships hoping to be healed, but unfortunately her tumor was inoperable. “When we first started with her, she was very depressed, very low,” says Harriet. “She had spent all of her savings on treatments that hadn’t worked, and she was unable to feed her family.”
Adama attends church regularly, and her faith and the support she has received from the Palliative Care Team have helped her to accept her condition. Her cancer is slow-growing, so after visiting her several times, the team asked whether she felt well enough to work. When she expressed a desire to restart her business, the team helped her to get everything that she needed to set up a food stall in the market. “From then, I’ve never slept hungry again,” says Adama.
Now Adama’s business, which she runs with the help of two of her daughters, is thriving. She has added benches inside her stall, and she has also started a second cooked food business that operates five days a week. Having managed to save a bit of money, she plans to start selling dried goods soon. The earnings from her businesses support ten family members and allow her to pay her grandson’s school fees so that he can continue his education.
“It’s dramatically improved her quality of life,” says Harriet. “She’s able to buy food for her family, and it has also improved her emotional state. She’s brighter, she has a lot more purpose. We’ve noticed a big difference in her.”
When the members of the Palliative Care Team arrive for their weekly visits, Adama always has a hot meal ready for them. “I prepare food for them to show them love because they have showed me love,” she says. “They are my family.”
November 2011
Written by Catherine Cooper
Adama outside her foodstall with her daughter Kadiatu and granddaughter
With Camilla and Dee, my palliative care team mates
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