W K, 33, from Yavi Village, T.A Chikowi, Zomba came to Salima on 14 July 2007. He was employed on one of the Estates in Salima (The growing season of August 2007 to June 2008). W K and his friends were employed on contract to grow Burley tobacco, to be paid at the end of the growing season.
In May this year WK started to develop a painful lesion of the left eye and he went to a number of clinics to no avail. The lesion progressed to the extent that WK went to Salima District Hospital, to the eye department and there was referred to Kamuzu Central Hospital (Opthalmic Hospital). A diagnosis of squamous cell carcinoma of the left eye was made and subsequently WK was discharged back to Salima District Hospital for palliative care.
On one of Ndi Moyo team's routine visits to Salima District Hospital, in October 2008, we identified WK. Although he had been discharged for palliative care there was nothing to indicate he was receiving it.
After taking a brief history we noticed a number of issues. WK was subject to physical pain from the cancerous eye. The pain was rated at 5/5 (severe pain). Although he had been given ibuprofen in the hospital the painkiller was insufficient to control his pain. WK was alone in hospital with no guardian and had no money. After one year of hard work at the estate he was paid a net pay of MK 2000 that he used to square the bills he had over the year.
It was also noted that WK was coming from Zomba, far away from Salima (300+km), and we realised that it was impossible to put WK on our programme. Currently Ndi Moyo has a catchment area of 20km radius from Salima.
Since the condition he has is progressive we tactfully counselled him that there was a need to refer him back to Zomba to access palliative care at either Malosa or Chipini. Ndi Moyo then referred him to the Social Welfare office where they raised MK 1180 for his transport back home. At Ndi Moyo we gave him a further MK 1000 from the Comfort Fund to top up his transport costs.
For the physical pain we gave him Morphine Slow Release Tablets 10mg every 12 hours for a month, and bisacodyl tablets 5mg (1–3) as a laxative to prevent constipation. We also provided him with facial tissues to wipe or keep his eye clean and we wrote him a referral form to St Luke's (Malosa Hospital).
WK left Salima for Zomba on the 18th October 2008. When he arrived home he phoned Ndi Moyo and confirmed that he will be attending St Luke's Hospital for his palliative care.
Footnotes
The author is a clinical officer. Article edited by Lucy V Finch, Team Leader, SRN, and specialising in Palliative Care Nursing