Prostate cancer: Surviving with palliative care

Apart from the Bible and the rosaries, the only other items on a small table adjacent to Paul Lubega’s bed, are his oral morphine bottles.

It is this morphine that has brought relief to Lubega, a 65-year-old man battling HIV/Aids and protate cancer. He is a resident of Kyanjovu Village, Buwunga Sub-county, Masaka District.

Before Lubega was enrolled for palliative care, he had, for a full year, suffered both physical and emotional pain. His bones hurt severely and because he was bedridden for almost a year, he had developed bed sores. He longed for death so as to be relieved of the pain and suffering.

Homecare
But after being taken on by Kitovu Mobile, a faith-based Medical and Community empowerment organisation under Masaka Diocese, Lubega shares that he now has relief from the pain. The organisation is one of many that offer palliative care to patients with chronic illnesses, by way of medication, counselling and it’s healthworkers carry out home visits.

Moses Muwulya, Kitovu Mobile’s communications officer says, the organisation in conjunction with Kitovu Hospital carries out minor cancer screening for example for cervical and prostate cancer. However, for comprehensive cancer screening, patients are referred to Uganda Cancer Institute (UCI) for biospy which was done for Lubega.

“He was referred to UCI in early 2015 ( March) and it was confirmed that he had prostate cancer which was at an advanced stage. Palliative care was reccommended,” Muwulya says.

“Because of the pain, I could not walk or support myself, but thanks to God, I can now support myself with the care that I am receiving. I just take the morphine they give me in a four hour interval and feel better,” Lubega says.Lubega has been on palliative since 2015.

When palliative care was recommended, the caregiversdid their best to restore hope by making frequent home visits and counselling him and the family.

“The family had lost hope but after starting him on morphine, the condition normalised and he started siting without difficulty and hope was regained,” Muwulya shares.

His wife, Maria Nasamula says before palliative care, her husband’s condition was terrible.
Ms Nasamula reveals that her husband’s relief has given her room to live a little.

“Before palliative care, I spent almost all my time tending to my bed-ridden husband. I couldn’t engage in agriculture and home business ventures which are our source of livelihood,” Nasamula notes.

Home visits
“Since I was too weak to travel, home visits were such a relief. Every time, my caretakers tried to lift me off the bed for the journey. It hurt so bad,” Lubega says. Lubega was given a wheelchair to aid in mobility.

Prostate cancer
In Uganda, prostate cancer is the commonest cancer among men with an age-standardised incidence rate for prostate cancer of 39.6 per 100,000 which is one of the highest rates observed in Africa.

Prostate cancer screening is an attempt to diagnose prostate cancer in asymptomatic men although most men barely turn out for the practice.
Prostate cancer has the following signs and symptoms
Frequent urination: Weak or interrupted urine flow or the need to strain to empty the bladder, the urge to urinate frequently at night, blood in the urine, blood in the seminal fluid, new onset of erectile dysfunction, pain or burning during urination, which is much less common, discomfort or pain when sitting, caused by an enlarged prostate.

According to Research conducted by African Journal of Urology, there was generally poor knowledge and several misconceptions regarding prostate cancer and screening in their study population which was centre in Uganda’s capital Kampala who concluded that community based health education programmes about prostate cancer are greatly needed for the population.

Acording to www.kitovumobile.com, the purpose of Kitovu Mobile is to lead the provision of innovative, mobile health services and empower marginalized communities affected by HIV/TB, Cancer and other emerging life threatening chronic illnesses.

It is widely known for pioneering home-based care model in the earliest stages of HIV/Aids by visiting patients within the confines of their homes, to provide care services in rural remote Lake Victoria areas of Uganda. community based health education programmes about prostate cancer are greatly needed for the population.

Acording to www.kitovumobile.com, organisation’s aim is is to lead the provision of innovative, mobile health services and empower marginalized communities affected by HIV/TB, cancer and other emerging life threatening chronic illnesses.

It is widely known for pioneering home-based care model in the earliest stages of HIV/Aids by visiting patients within the confines of their homes, to provide care services in rural remote Lake Victoria areas of Uganda.

Principles for palliative care
A caring attitude
This involves sensitivity, empathy and compassion, and demonstrates concern for the individual.

There should be a non-judgmental approach in which personality, intellect, ethnic origin, religious belief or any other individual factors do not prejudice the delivery of optimal care.
Consideration of individuality

The practice of categorising patients by their underlying disease, based on the similarity of the medical problems encountered, fails to recognize the psychosocial features and problems that make every patient a unique individual.

Cultural considerations-Ethnic, racial, religious and other cultural are to be respected and treatment planned in a culturally sensitive manner.

Consent- The consent of a patient, or those to whom the responsibility is delegated, is necessary before any treatment is given or withdrawn.

Choice of site of care- The patient and family need to be included in any discussion about the site of care patients with a terminal illness should be managed at home whenever possible.

Communication- Good communication between all the health care professionals involved in a patient’s care is essential and is fundamental to many aspects of palliative care. (Compiled from www. hospicecare.com)