2016; Volume 17, No 4, April
Featured Article
IAHPC board member, Dr. Esther Cege Munyoro, is our guest writer this month
Throughout the year our board members contribute a range of opinion pieces and other thought-provoking articles to the IAHPC Newsletter. Now it’s the turn of one of our newest board members, Dr. Esther Cege Munyoro, who is Head of the Pain and Palliative Care Unit in Kenyatta National Hospital, Nairobi, Kenya. Here she explains how sharing ideas and experience with colleagues from other countries is the driving force behind their new clinic.
Driving good ideas into practice: The makings of a nurse-led Stoma, Wounds and Continence Clinic at a referral hospital in Kenya
“Good ideas are not adopted automatically.
They must be driven into practice with courageous patience.”
Hyman Rickover
A chronic wound can be a debilitating and very painful condition especially for those with non-communicable diseases such as cancer, diabetes or hypertension.
In an effort to improve quality of life for patients with chronic wounds, the Pain and Palliative Care Unit in Kenyatta National Hospital was grappling with ideas on how to offer this support.
Eva Schumacher and Birgit Jaspers dressing a wound
Luckily, I met Professor Lukas Radbruch through the Leadership Development Initiative (LDI) in San Diego (US), who arranged for Eva Schumacher, a nurse at the Palliative Care Centre, Malteser Hospital Bonn/Rhein-Sieg, Germany and Birgit Jaspers, a researcher, University of Bonn, Germany to visit the unit and share their experience. To prepare for the visit, I sent out a letter to the relevant wards asking them to inform us of any patients with challenging wounds. The consultations came flooding in, I had no idea how big a problem we had; we saw shocking, massive painful wounds that would smell if you delayed dressing them for a few hours. A few will always remain with me.
The young boy with a massive wound on his chest who asked for a lollipop instead of the chocolate Birgit offered him.
The groom-to-be who had wounds all over his body and could never thank us enough for making him pain free; he used the camera he bought to document his wedding to take pictures of all the wounds before and after the dressings.
The numerous cancer patients with perianal and perineum wounds who suffered in so many different ways; even opioids could not take care of the ‘total’ pain they suffered.
Elizabeth English as she donates a trolley to wheel stoma, wounds and continence supplies around the hospital. In the picture are members of the Palliative Care Team with Elizabeth: (l to r) Ann Mwangi, Catherine Abour, Esther Munyoro, Jane Ndungu, Elizabeth English and Grace Wanyoike
In a number of wards, giving morphine just before dressing the wound was a new practice. The use of charcoal tablets and essential oils to reduce odor was also new.
Many patients we visited were in hospital just to get the wounds dressed, but with the knowledge gained from our visitors we learnt of newer wound dressing material that enabled patients to be dressed less often and not have to stay in hospital. The hospital gave us a supply of the dressings to allow us to continue attending to this group of patients.
As we continued to struggle with the care of wounds another visitor came calling. Elizabeth English, a past president of the World Council of Enterostomal Therapists (WCET) and the current coordinator of the Kenyan AKUH (Aga Khan University Hospital) Stoma, Wound and Continence Nursing Education. Elizabeth took up the role of mentor, donor, educator and nurse while at the hospital and left us all the better for it. We now have five trained nurses in stoma, wound and continence who currently offer both inpatient and outpatient services. We have an active stoma support group and a good supply of donated supplies for stoma, wounds and continence care.
We are now in the process of setting up a nurse-led Stoma, Wounds and Continence service that will include clinical nurse specialist/nurse educators and clinic nurses who will focus on clinical practice, education, audit and research.
Lastly, just as we were looking for a home for this new service another visitor came calling and shared another experience. The good news is that we now have a potential building that will house the service – but that is a story for another day.
Links and resources
- Dr Esther Cege Munyoro email.
- Pain and Palliative Care Unit in Kenyatta National Hospital Facebook page.
- Kenyatta National Hospital.
- Read Esther’s bio on the IAHPC website.
Look out for more articles from IAHPC board members in the coming months.