My name is Esther Nantongo Muyinga, I am a Registered Nurse currently pursuing a degree in palliative care and at the same time working in Mulago National Referral Hospital, Kampala, Uganda, in the palliative care unit.

Before joining the palliative care unit, I used to work on the wards and I used to come across patients who were challenging in their management, they had complex issues.  Little did I know that the patient is supposed to be managed holistically to achieve quality of care and quality of life.

According to my experience before and after working with palliative care team, I have learned that when a person falls sick, it is not only physical body which is sick but that patients also tend to have other issues surrounding their sicknesses.  If these are not addressed, it can be even more challenging for their health to improve and for healing to occur. 

During my practice I have witnessed patients who don’t want to be discharged, even though the medical personnel may feel they are ok.  And I have witnessed other people who change their faces to look like they are very sick when they see a Nurse or a Doctor coming in.  One person has even whispered to me, ‘talk to the Doctor not to discharge me’ and another one requested me to admit her.  All these circumstances mean that there issues that need to be addressed; issues that might be called psychological, psychosocial, and spiritual. My understanding about this grew after joining the palliative care team.

Have you ever wondered, why after giving a strong analgesic a patient may still remains in much pain?  Or have you ever witnessed a patient who cries in pain after seeing a medical person, yet before he/she was conversing well with fellow patients.  Both might mean there are unaddressed aspect of their lives.

In 2012 I had an opportunity to train as a link-nurse in palliative care for five days, helping to identify patients with palliative care needs on my ward.  After identifying them, I could manage those at Level 1 – Level 1 being those who had symptoms that were easy to manage.  Those I could not manage (Level 2), I consulted with the Doctor. If the patient’s symptoms were becoming more complex another palliative care team member was consulted (that’s Level 3), and when the team member could not manage alone, the whole team was consulted – which was Level 4.  I did that for for four years.

In 2015 I was brought on board and joined the palliative care team, but I felt that I was depending on the little knowledge and skills.  I had a challenge of not being recognized as palliative care personnel as I had no qualifications to show.  Despite having some knowledge and skills, I feared documenting in the patient’s files.

I thank God for the palliative care team because they have been so encouraging to me in taking this degree in palliative care.  I know I will make it with God on my side.  As of the 7thOctober 2018 I have finished writing examinations for the first semester of the first year.  As I learn, I grow and I know I will be of much help in addressing palliative care needs of palliative care patients.