…lack of adequate palliative care exacerbating patients’ pain
…ministry says making concerted efforts to improve access to care
Mathatisi Sebusi
WHILE cancer is a known death threatening chronic disease, a lot of cancer patients have died needlessly during treatment owing to the reluctance by doctors to prescribe morphine tablets due to the scarcity of the drug and lack of palliative care in the country.
Dr Paul Myres, who is the chairperson of the Starlight Oasis of Hope Hospice, knows this very well, as his clinic is one of few offering home-based palliative care services to cancer patients in Lesotho.
The lack of palliative care in the country is a cause for worry. In recent years, the country has experienced a surge in chronic diseases including cancer and complications associated with diabetes, Tuberculosis, among others.
Dr Myres, who is a retired family doctor, says as much as they go all out to ensure that they make their patients’ pain as bearable as possible and their journey to recovery as tolerable as can be, access to morphine and the reluctance by doctors to prescribe the medication remains a challenge.
Dr Myres says while reservations to prescribe morphine for patients are logical, the drug, if used appropriately is a helpful pain reliever. It helps make pain for patients undergoing chemotherapy and radiotherapy bearable.
Morphine is a strong pain relief tablet. It requires daily, round the clock long-term opioid treatment.
When used for a long time, it may become habit- forming, causing mental and physical dependency.
Palliative care is specialized medical care for people living with serious chronic illnesses. It focuses on providing relief from pain and other symptoms of a serious illness. Palliative care also helps patients cope with side effects from any medical treatment.
Sixty-year-old Mabataung Chaka of Ha Tsolo, a slum situated just outside the Maseru city centre, is a cancer survivor who was diagnosed with breast cancer 11 years ago.
Ms Chaka tells the Lesotho Times, of the heart-rending recovery journey she walked without palliative care as she was ignorant of its existence. She had no idea what cancer was and how serious her condition was but learnt from her doctor’s body language that her situation was dire.
Her agonizing journey to recovery was a lonely one, and full of mysteries from start to end.
Ms Chaka says no one explained to her the situation or walked the journey with her, let alone counsel her to be mentally and psychologically ready for what awaited her.
As such, Ms Chaka says, lack of physical and emotional support for cancer patients has seen many die while on treatment.
In 2012, Ms Chaka experienced some tension and pain in one of her breasts which she thought was the result of a hard day’s work.
But when her condition persisted, she sought medical help only to be given pain killers and sent back home.
However, her situation deteriorated, compelling her to seek medical help from a different doctor. It was at this stage that Ms Chaka learnt that she had a lump in one of her breasts which could be a sign of breast cancer.
Due to her ignorance of cancer and its effects, Ms Chaka says the revelation did not register any danger to her. But her doctor’s facial expression communicated otherwise and she was directed to urgently undergo intensive medical tests.
She says the results confirmed the doctor’s theory and was immediately referred to Queen Mamohato Memorial Hospital to get tested again.
Ms Chaka says no medical procedure was performed on her breast but was told to report back to the hospital after five months.
During the waiting period, the cancer started spreading across the breast and her biggest fear of losing one of her breasts became a grim reality. She was told that she had stage three breast cancer and there was an urgent need to cut off the affected breast.
Even at that juncture, she did not receive any guidance or the therapy she mostly needed.
Cancer was new to her and she understood nothing about it at the time. Her doctor did not tell her anything apart from the medical procedures and guidelines she needed to take and follow.
“I was in the dark the whole time. I did not exactly know what was happening to me or the magnitude of danger I was in. Worry in my doctor’s eyes was the only sign that my life could be in danger. There were no counsellors or psychologists to emotionally support me along my journey of recovery,” Ms Chaka says.
After having her breast removed, Ms Chaka thought all was well and that she had been cured. To her surprise, she was told that she had to go to Bloemfontein, South Africa, for chemotherapy and radiation therapy.
Ms Chaka was scheduled for six doses of chemotherapy. She ventured onto the journey still blank, not knowing what to expect.
She said the therapy journey was hard, lonely and that it came with a lot of side effects she did not anticipate which included memory loss.
Despite the hard journey, Ms Chaka persevered and successfully finished her treatment and is today cancer free and a proud advocate for cancer awareness and palliative care for cancer patients.
As much as she emerged successful from the challenging journey, the side effects of the medication haunted her even outside the hospital walls.
Three months after being released from hospital, Ms Chaka got a job but was fired because of her memory loss which her employer mistook for dishonesty.
“I used to forget people’ s names and recent events. I would go to the extent of even asking my children and close friends who they were,” she narrates.
Ms Chaka, who deems herself a victor after her harrowing experience, now encourages people to get tested for the disease. She says that the sooner it is detected, the better the chances of it being treated.
She says the tragedy with Lesotho is that cancer is still a scare and patients are not given the support they need.
The hardest part, she notes, is going through medical procedures without any guidance on what to expect and without psychological support to ensure that a patient is mentally ready to take on the life-threatening disease.
Ms Chaka says when a patient is sent to Bloemfontein for chemotherapy, they must find accommodation for themselves for the duration of their treatment. That poses a huge challenge to poor people who have no friends or relatives close by.
She therefore urges the government to assist cancer patients with transport and accommodation while outside the country for treatment.
“Another thing which is a challenge and needs the government’s intervention is food insecurity among cancer patients. We urge the government to consider giving grants to cancer patients so that they can buy food and food supplements during and after treatment,” she says.
She also calls for the Ministry of Health to ensure that psychologists and counsellors are made available to counsel patients during the treatment journey.
Meanwhile, Lebohang Tlouoe who is a caregiver for his wife, tells the Lesotho Times of the hardships that come with looking after a cancer patient.
His wife, Makhauhelo Tlouoe, a popular news anchor for MoAfrika FM, was diagnosed with choriocarcinoma cancer in 2020.
Choriocarcinoma cancer is a rare cancer that starts in the uterus. It develops from cells that were part of the placenta during pregnancy.
Being the sole caregiver, Mr Tloutloe believes he would not have survived the journey due to its emotional and psychological burden if it was not for his church which has supported his family throughout the journey.
Mr Tlouoe says there were times that he believed that he too had developed cancer and was even scared of sleeping alone for fear of dying in his sleep.
He says having to watch over his wife suffer with little help to offer to ease her pain, was a torture he could not bear.
“There were times where my wife would call from the hospital informing me that she could not take chemotherapy because her body’s blood supply was very low. This was one of the desperate instances in which I had to call my church to pray for us,” he says.
Despite the glaring shortcomings, the Ministry of Health is making efforts to sensitize Basotho about cancer, its stages and the care that should be provided.
During last Friday’s commemoration of the World Hospice and Palliative Care Day, the Ministry of Health Director General, Nyane Letsie, said there was need to raise awareness to “make people understand that palliative care is not only about cancer patients” but “is also about other chronic diseases where people need specialised care”.
She said people with chronic diseases including cancer were not necessarily neglected but were rather marginalized owing to scarcity of services.
She said it was time that palliative services for cancer and other chronic diseases were made available in the country.
“Most importantly we need to prevent, and make sure that we reduce the number of people contracting chronic diseases because we all know how difficult it is emotionally, physically, financially and otherwise, to manage chronic diseases,” Dr Letsie said.
“Through primary health care…. we need to make sure we raise awareness on prevention, management, and early screening of non-communicable diseases.”
Dr Letsie acknowledged the gap in palliative care and said the country appreciated all the help it was getting from local and international partners with expertise in the field.
She said to make palliative care effective at household level, her ministry was planning to capacitate families and caregivers, ensuring that they were well equipped to look after patients with chronic diseases.
She also emphasizes the importance of partnerships to ensure that chronically ill patients receive the best palliative care, further stating that the Ministry of Health had partnered with StarLight Oasis of Hope Hospice, and that some of their health workers had been capacitated by the hospice on palliative care.
She said their partnership was also based on cancer care, palliative and holistic care for Basotho who were afflicted by chronic diseases.
She said the ministry was committed to developing and executing evidence-based policies and guidelines, and support regarding palliative and hospice care in Lesotho, in line with international standards and guidelines.
“We are proud to announce that Lesotho is rolling up capacity building sessions of multi health and social professionals…
“Two sessions have been conducted virtually by Starlight Oasis of Hope Hospice and international partners from the United Kingdom, United States of America, Uganda, Kenya, South Africa among others. The participants were 220 pharmacists, medical doctors, nurses, social workers and nutritionists,” she said.
She says the Ministry of Health is tasked with spearheading the review of a multi sectoral integrated plan for the prevention and control of non-communicable diseases.
The ministry’s principal, Mamoliehi Ntene, says Lesotho is experiencing a “growing invasion” of chronic diseases including HIV and AIDS, cancer, diabetes among others.
World Health Organisation (WHO) country representative, Dr Richard Banda, said annually an estimated 56.8 million people globally, including 25.7million in the last year, needed palliative care. Most of them lived in low- and medium-income countries like Lesotho.
Dr Banda, however, stated that only 14 percent of these patients received quality palliative care.
Dr Banda said, Lesotho, likewise, is conflated with an increasing burden of non-communicable diseases, which affects not only the physical health of those diagnosed but also puts a strain on the country’s health system.
“The high burden of cancer in Lesotho suggests a possibility of a good number of individuals enduring severe pain and in need of the right palliative care measures,” he said.
“This country, therefore, needs to make urgent and concerted efforts to scale up access to palliative services. Palliative care is not the last resort; it should be integrated early in the care of people affected by life threatening conditions.”
He said WHO advocated for the fundamental human rights for everybody to receive adequate and dignified palliative care.
Dr Banda added that WHO had resolved that palliative care was the responsibility of any health system.
According to Dr Banda, optimum palliative care in Lesotho would require proper research, a supportive environment, an empowered community, access to essential palliative care medicine, a strong education and training system for palliative care workers, as well as qualified professionals…
As a way of addressing these gaps, Dr Banda said, WHO recently released resources to support countries in accessing the development of palliative care and improve the quality of palliative care services.
