By the side of a breast cancer patient

RecurrentbreastCA1We were called to see a breast cancer patient. Even though we have seen several of them before, this particular one was unique. You could hear the gasps of members of the group on seeing the patient. The cancer was seen late.

It was made worse by further delay in allowing health care interventions.

Like we often see and hear, there were several consultations around the country till it was realised that conventional health care was the best option for her resort.

I recall the sharing of a bit of the patient’s condition on our forum (Cancer) and the alarming calls from members as to why this particular case had gotten so bad. At the affected person’s house you could feel the distress of the household: spouse, children, mother and other relations.

The family had rallied together to give the affected person some support. Throughout our visits I never heard any laughter, not even from the children. The victim was in pain and on loads of pain relievers. She was most times constipated because of the pain relievers and the simple chore of moving the bowel sometimes became an ordeal. She was to take a laxative every eight hours but confessed to taking it as and when needed because of the extent of constipation. She was on antidepressant to lift her mood and also complement the pain relief.

Nothwithstanding this, sleep did not come easy and had been put on medication to induce sleep. A member (Anticancer advocacy group) asked to properly scrutinise the medications to be sure they were real and not fake/counterfeits. Cancer pain is bad enough. It does not need to be made worse by deception.

The ulcers, which were not only at what used to be the breast (but could be found under the armpit) had to be cleaned and dressed on a daily basis.

The time of wound dressing was always an ordeal, the pain expressed was palpable. You had to give adequate dose of the pain reliever about 30 minutes before the dressing. The dressing itself consumed lots of materials because of the size and extent of the ulcer. It had to be packed adequately to be able to soak up oozes before next dressing. A powder containing a medication was used to mop the odour from the ulcer.

This kind of dressing needed to be done by trained personnel. This comes at a cost, in addition to the dressing materials, the medications and the trained carer(s). There were reviews at the medical facility from time to time. Each visit on itself was difficult, moving the affected and transporting to and from the medical facility had its own implications. So far the narrative only addresses the physical aspect of the pain.

A lot was done to psyche the patient and family about the problem but going through it for real required continuous counselling, and reassurance of the affected and family members. It was well and good that other family members had moved in to support. Somehow they had spread the cost of feeding, and housekeeping between themselves reducing the burden on the spouse.

Neighbours and friends of the family weighed in with food, and other household supplies. The church of the family was also playing its part with frequent visits and prayers for the affected and family members. The patient used to blame herself for the disease. She thought it was a punishment for some wrong perpetrated by either herself or a family member. So far she could only remember being the first person to be affected in the family. It was important to let her understand that breast cancer was not a curse.

Hearing her favourite songs being sung by church members always brought smiles to her face. Gradually she accepted that even death could be another phase needed to be crossed into another realm. I am sure as a reader, you notice four key points of intervention for this case: physical, psychological, social and spiritual.

These are referred to as Palliative Care, which is using a holistic approach to problems to improve or safeguard the quality of life of the affected person. Of course this example has got to the terminal stage but even at this point palliative care is still useful. Palliative care is all about looking after people with illnesses that cannot be cured, relieving their suffering and supporting them through difficult times. It is not only applicable to cancer but other areas such as persons suffering from HIV, progressive neurological disease, severe kidney or heart failure, etc. Palliative care is not terminal or hospice care which usually refers to care for persons who usually have six months to live. Palliative care should start right from the time that a diagnosis is made that the illness is incurable. It should be available to every person diagnosed with an incurable disease as already mentioned. I do know of the efforts being made by the health care delivery system to make palliative care a key feature in every health care facility in the country.

It should also be accepted that the competing interests within the health delivery system make it difficult for comprehensive palliative care by the available cadre of health care professionals. Thus the intervention by NGOs to complement the efforts of the formal health care delivery system.

But more importantly, the emphasis should be more on preventive health care and finding ingenious ways to infuse it into our regular health care system. Cadres within the health delivery system are gradually rising to this challenge.

Next week the Ghana Association of Quasi government Health Institutions (GAQHI) will be having their annual conference on this aspect of health care. Some cliché in life remain true ‘Prevention is better than cure’. Need I say more after the experience of the breast cancer patient?

By Edward O. Amporful

 

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