2020; Volume 21, No 7, July
Frontline Reports
Effects of COVID-19 on Service Provision at Mobile Hospice Mbarara
By Kabigarire Moses, Nduhukire Moses, and Antonia Kamate Tukundane
Mobile Hospice Mbarara, Uganda
Mobile Hospice Mbarara is one of the centers of Hospice Africa Uganda (HAU) that delivers high-quality palliative care for all in need, targeting the southwest of Uganda. The COVID-19 pandemic has greatly affected many health care activities, including palliative care. This has hindered effective provision of palliative care services to patients. Here are some of the observations we made at Mobile Hospice Mbarara during the lockdown period.
A Mobile Hospice Mbarara palliative care specialist conducting a telephone consultation. Photo used with permission.
- In an effort to achieve social distancing, there were no regular home or hospital visits, no outreaches, and no roadside clinics conducted during the period of lockdown, except for emergencies within a limited distance. Some patients experienced pain and suffering at home, unable to access the care we provide on routine home visits, hospital visits, and outreaches.
- Some cervical cancer patients at home were bleeding with no access to radiotherapy, which they would usually access by traveling to the Uganda Cancer Institute in Kampala. There was no public means of transport to facilitate this travel fairly cheaply. Getting permission from the Resident District Commissioner to travel out of the district initially was hard. A few weeks into the lockdown, however, measures were instituted for travel using referral letters from the regional referral hospital. In this way, HAU managed to transport some mothers, while others found their own means of transport. Private means of transport is expensive.
- Fewer patients were coming for reviews and diagnosis at our centre in Mbarara. We managed to keep the clinic open while following Ministry of Health guidelines, but still very few people could make it to us. There was no public transport for patients who needed medicine refills.
- Boda boda (motorbike taxi) drivers who know nothing about the patients were representing them for reviews. The boda boda drivers were only allowed to ride alone, and could only carry cargo. So as a means to get medicine refills, patients found drivers they could trust with their medical information, and sent them to our center for drug refills. We were concerned about maintaining confidentiality, and also the adequacy of the telephone consultations and third-party discussions we resorted to as a means to help patients.
- We were afraid that patients may have taken their medicines wrongly because they did not get explanations on how to take them directly from our team.
Conclusion/recommendation: There is a need by the Government of Uganda, through the Ministry of Health, to further integrate palliative care services so that they may reach patients more easily. There is also a need to be prepared for pandemics, as it is difficult to predict when they may occur.
Learn more about Hospice Africa Uganda in the IAHPC Global Directory of Palliative Care Institutions.
Feeling Helpless in the Global Epicenter: Brazil
By Claudia Burlá
Geriatrician and IAHPC Board Member
At the moment I write this, there have been over 10 million confirmed COVID-19 cases worldwide, with more than 500,000 deaths, a significant proportion of which are Brazilians. A sense of helplessness and embarrassment has taken over me. Brazil has become the epicenter of the coronavirus pandemic, with over 1,000 deaths a day.
As a bedside geriatrician, I see older people with multiple chronic conditions; at times, they present acute events. In addition to suffering all the impairments and deficits they present, the most important recommendation for the prevention of COVID-19, social isolation, is not a possibility for them; they require the care of caregivers full time (24/7), whether they live in long-term care facilities, nursing homes, or in the community.
Older people present
these atypical symptoms
One of the challenges for diagnosing COVID-19 in older individuals is the atypical presentation of the infection, particularly if they are frail and/or have dementia. Oftentimes, rather than presenting high fever, older people either have a slight increase in their temperature or present hypothermia. Another atypical symptom is excessive sleepiness; the older person feels drowsy, unwilling to do anything, taking naps more often than usual. Other events of concern are unusual agitation and increase in the number of falls. Although falls in older people are common, they are not normal. One must be extra attentive if they gasp or become short of breath after a fall.
Office closed so that
home visits can prevail
Differently from other medical specialties, geriatricians tend to keep their patients at home as much as possible. Frail people and those with dementia feel more comfortable with the familiar environment of their homes. Only highly compelling medical reasons justify hospitalizing older people. For the safety of my patients, who should not leave their homes during this pandemic, I have decided to close my practice and go to their homes. It is true that I see fewer patients, but, like the bird that carries a drop of water at a time to fight a fire in the forest in order to do its part, I see patients at their homes in order to do my best to prevent them from being hospitalized.