Nairobi Hospice

The inspiration behind the hospice movement in Kenya came from Ruth Wooldridge, a British nurse working in Nairobi who was deeply moved by the death of Nancy, a young woman who had cancer. Nancy’s story features prominently in the history of Nairobi hospice and helped form the mission of the hospice:

Nancy died of cancer. Her real life story illustrates the many problems experienced by the terminally ill and their families.

Nancy was a 26 year old woman with two young sons who lived in one room with no running water. By the time her cancer was diagnosed and she went for medical attention the disease was too far advanced to cure. The treatment she had included surgery and radiotherapy, but this did not help and she began to get a lot of pain. When her illness reached this stage she had to give up her job as a teacher and so she no longer had any income to support herself, her children and her mother who came to help.

Nancy ’s condition deteriorated. She was in pain, unable to sleep, constipated, and having difficulty passing urine. She went back to hospital and was given some tablets but no-one explained to her why she was not improving, why she was having such pain, or what she might expect to happen next. For the las month of her life, she lay on the mud floor of her house, nursed by her mother. She was incontinent and in continuous pain.

Before she died, her mother, who had been unable to get help in any other way, put Nancy on her back and carried her to hospital. By this time, Nancy was semi-conscious; she had bedsores and was in continuous pain.

Nancy died in hospital, four days later, away from her family.⁴⁰

Ruth Wooldridge takes up the story:

I just thought ‘palliative care is what we need here’. So I spent about a year looking at all the hospitals and oncology departments and speaking to doctors - and realised that there was absolutely nothing for people with advanced cancer. Then a friend of mine, who was also VSO, sent me an article that Robert Twycross had written - it was in the Nursing Times - about the absence of palliative care overseas. I wrote to him outlining the situation in Kenya and he wrote back saying he was going to visit South Africa. So I responded that it would be brilliant if he could just come through Kenya. We could organise a workshop and call a group of people from clergy to social workers - anybody who is interested - as well as oncologists and nurses. We held it at the cathedral; it was a big workshop. Some of the oncologists presented their work and Robert helped them to see what they could do for patients with advanced cancer. So it gave us the green light, really.⁴¹

Brigid Sirengo continues:

They held a workshop in February 1988 … And at that workshop it came out very clearly that cancer was a problem in the community and we did not have the facilities to take care of cancer patients, especially those who were terminally ill. And it was also quite clear that the doctors and the nurses were not trained to take care of the terminal phase. So that is how the hospice was born: from that workshop it was decided that a steering committee should be set up to establish palliative care in the country. So from March 1990 we started taking care of the terminally ill cancer patients. From the outset the objectives were to train people in palliative care and to provide a service.⁴²

As the demand for a hospice gathered momentum, crucial support came from Professor Kasilli, a haematologist who worked at Kenyatta Hospital. Having spent time in Glasgow, he understood the importance of palliative care and became an enthusiastic activist. First, he chaired the workshop, then co-wrote a proposal for government and finally took the hospice forward as its chairman, remaining committed to the service until his death in 1996.

Although the concept of hospice had originated in Britain, efforts were made to ensure it was translated into a Kenyan service and accepted as such by patients and health professionals. Writing in 1991, Jane Moore - a contemporary of Ruth Wooldridge and co-founder of Nairobi hospice - tells how the hospice became grounded in Kenyan culture:

Although strong links have been forged with the UK and Zimbabwe, from the beginning the prevailing philosophy of Nairobi Hospice has been ‘This is a Kenyan Hospice in Kenya, for the people of Kenya.’ Every step has been devised and developed in the context of the Kenyan model of care, and made appropriate to the social, economic, geographical and human situations which are a mosaic of diversity, even within Nairobi itself, let alone elsewhere in the country.⁴³

Nyeri Hospice

Nyeri hospice developed as a satellite of Nairobi Hospice (1995). According to the hospice team at Nyeri:

Right from the start there had been concern about the patients from rural areas who are first seen in Nairobi but are then sent home. These people have even fewer resources available to them and the family is often left to cope alone because the community is suspicious and worried that the illness may be contagious. The establishment of an umbrella of hospices, functioning independently but linked through professional co-operation was envisaged.

Nyeri Hospice was launched on the 1st October 1995. Today, it is a registered Charitable Trust and although it is autonomous in its management and financial provisions, it has the support and guidance on a professional level from the Nairobi Hospice.

The Nyeri Hospice is the first rural project to be established and provides quality palliative care to patients and their families. Through the years, we have become known in the lay and professional communities and the demand for hospice services has grown.

Eldoret Hospice

The idea of having a hospice in this town was mooted in 1992 by a nurse, Mrs. Rose Abira. She encouraged other nurses to get involved and together they developed the beginnings of a palliative care approach at Moi Teaching and Referral Hospital.⁴⁴ In 1994 a palliative care team was established, and a year later the hospice was approved by the Ministry of Health and awarded a charitable organisation number. In 1996 a small plot of land was given to the hospice by the Moi Teaching and Referral Hospital where construction of their own premises started in 1997. By 2000 an independent one storey hospice building had been established and services began operating from there in July 2001.

Coast Hospice

The hospice was started in August 2001 by Dr. Faustine Mgendi who is currently the chairman of the board of trustees. It is hospital based and has developed to provide continuity of care to the many terminally ill patients who are discharged from the formal health sector.

Maua Methodist Hospital

In his retirement, David Allbrook was on a world tour that took in parts of Africa when an unusual turn of events led him back to Kenya and palliative care:

We did a tour around Uganda and I missed out the Uganda Hospice, I wasn’t interested - no, no that’s all finished now - and we went to Kenya and did the same thing. We were just leaving the Methodist guest house and my colleague there - one of my ex students said “Oh, I just want to introduce you to my bishop, and my bishop turned out to be an ex presiding bishop of the Methodist Church of Kenya. I said “Oh I’ve come from Meru; I nearly was posted there when I was a young doctor but I never got there, but we did actually travel there in 1954 with my wife and little boy”. He said “Oh, yes - I remember you, I was a young teacher’. So we talked a bit and I was getting a bit anxious about the plane you know and he said, anyway come back and we will do anything we can for you. You come and visit the Methodist university there and teach there if you want to or come to the hospital and teach there and so I said “yeah, OK, OK”.

I communicated and nothing happened, and then I couldn’t get this out of my mind. So anyway I decided as I haven’t heard from them I’ll see if I can find them on the net, and I did, and sent an e-mail off to the medical superintendent. Heard nothing for a month/six weeks, something like that, then suddenly got an e-mail back from Deitmar Zeigler who was the new medical superintendent, and it said “come, come now!” like that - and I got a travelling fellowship from the International Association of Hospice Palliative Care and I went over for I think four or five weeks.

I used that time as a feasibility study and I worked with Deitmar. Deitmar was a dynamic, hugely dynamic young thirty-something year old surgeon. Trained in Scarborough in England with his wife and he was the driving force behind the whole idea of palliative care in Meru district - and he needs to be honoured for that. And at the end of the time I advocated that the person who should be selected for [palliative care] training should go to the Uganda hospice because the Uganda hospice offered hands on practical, down to earth training, at a grass roots level and that was what was wanted.

Nurse Stephen Gitonga was selected for training and he takes up the story:

When we started, we targeted some specific areas; these areas were identified by the community through a church leaders meeting. The leaders of the church went down and mobilized their people and told them they can do something, and the hospital offered to give them facilitation and technical advice; but starting the programme and raising resources was up to the community - because they had seen the dangers of HIV/ AIDS; they were burying members of their community each and every other Saturday and as such they had got to a level that they were seriously suffering. That is why they came up and said, ‘Yes we are ready, we can mobilize the regional resources that we have.’

We right now have three pilot project areas that we are working in, the first area started operation in February 2002. The second programme, after seeing the good things that were happening with the first programme, started in October of the same year. The programme is managed from the hospital. We are the facilitators. We are really trying to help communities and their health committees who in turn are able to manage the programmes. They are go and identify the volunteers so that they can reach out and vet, and give the care that is needed to our people in our villages. So essentially I would say t it is the community’s project; it does not belong to our Methodist hospital. We are just facilitators.⁴⁵