Hospice team has visit from Africa

A nurse and a social worker from Machame Lutheran Hospital in Tanzania, Africa, were in Minot Tuesday and Wednesday visiting the hospice team at Trinity Health.

Isaya Muro, a nurse, and Deograssius Mrosso, a social worker, are both involved with the hospice system in Africa. Rhoda Owens, registered nurse, site manager and instructor with Dakota Nursing Program at Williston State College, coordinated the visit. She has also visited Tanzania twice previously and has spent time with Muro and Mrosso.

The two caregivers, Muro and Mrosso, arrived in North Dakota on Sunday, April 28, and gave a presentation to nursing students at Williston State College on Monday. On Tuesday, they came to Minot and visited Trinity Hospital, touring different units as well as visiting the home healthcare center. They spent Wednesday with Trinity’s hospice nurses, made visits and sat in on the team meeting that afternoon.

The goal of the visit was for Muro and Mrosso to learn more about hospice care in the U.S. Owens said they would all learn from each other and exchange ideas on how they give care to patients.

Terri Nelson, registered nurse and hospice coordinator for Trinity, said the hospice system in Africa has the same principles as the hospice system in America, but the implementation of the care is different. The culture is different, too, she added.

“We provide the same care, but with different resources,” Mrosso said. “We do what we can.”

In America, hospice patients are covered by insurance, for the most part, and aren’t being billed for services, Nelson said. Africa, however, has a lot less staff and instead has a lot of volunteers who do simple dressing changes or other basic tasks, she explained. If a patient needs more sophisticated care like oxygen, Nelson continued, the person is taken to the hospital and are in the intensive care unit.

A lot of the families in Africa living in rural areas don’t have electricity or running water, Nelson said, and in rural areas there aren’t many hospitals. Two patients may share a bed, she added, and another patient may be on the floor. Resources are limited as well, Nelson noted, so patients may receive only Tylenol, Advil or Tramadol for pain, whereas the U.S. uses the big guns like morphine. “We’re very spoiled in the U.S. with staffing, medicine, equipment and resources,” she added. Recently, however, there is some access to morphine syrup at Machame Lutheran Hospital, Muro said, and he felt that pain control has improved with that.

Also, families in rural parts of Africa grow a lot of their own food in their own gardens, so if the one in charge of the family gets sick, someone has else has to take care of the garden, Nelson said. “A patient’s last meal may have been yesterday,” she added. Many physicians, nurses and missionaries come to Africa to help people who are sick and doctors will come for a couple of weeks to do surgery, Nelson explained.

The biggest difference between hospice care in Africa and America is the number of patients. Nelson said in Africa they have a social worker, a nurse and a clinician for about 1,700 patients, whereas Trinity Hospital currently has 20 hospice patients and numerous staff members. Of the 1,700 hospice patients in Machame Lutheran Hospital, about 1,500 of those patients have HIV/AIDS, Nelson said, and they see some patients with stroke and cancer. The common cancers for women include breast and cervical, Muro said, and the most common cancer for men is prostate.

It’s very faith-based in Africa, Nelson said. At Machame Lutheran Hospital, they open with prayer and singing every morning and then go on rounds and report on the patients’ health, she continued. If a patient gets in trouble during the night, Nelson said she didn’t know what happened. The trained volunteers are so valuable and it would be difficult for the patients without them, she added.

Mrosso said the length of time a patient with HIV/AIDS stays at the hospital is longer because they provide care from diagnosis to end of life. For patients with cancer, he said, the length of time for their stay can be two weeks to two months. Chemotherapy and radiation are only available in the capital, Dar es Salaam, Nelson pointed out.

“Some HIV patients start feeling better so they stop taking the medications because they think they’re cured and that’s difficult,” Mrosso remarked. They try to help those patients through education, he added. Muro said they also try to teach the patients about safe sex practices.

Recently, Muro said they at the hospital have just started using a vehicle given by the American government through the Bush administration. It’s difficult, though, he added, because sometimes it rains heavily and the roads aren’t very good like they are here in America. Also, they now have mobile phones to communicate with, Muro noted. Oddly enough, Tanzania has better cell phone coverage than the U.S., Owens pointed out, even with all the mountains and trees everywhere. “They have a lot of towers everywhere.”

Owens said she learned a lot about their culture in Africa. Health care is not a right and it’s not valued in Africa, she explained, but a privilege, whereas here healthcare is a right. “Family and friends are really valuable with the patients in Tanzania,” Owens continued. “Also religion is important.”

“I was impressed with how they (the caregivers and volunteers in Tanzania) can give such wonderful care to so many patients with so little resources,” Owens said. “They give really good emotional support (to patients). We learned from them as they learned from us.”

“We hope it (this visit) will help us improve the quality of care at home with what resources we have,” Mrosso said.