It is midday on Friday and Dr Henry Ddungu is preparing to go out for a funeral service. One of the cancer patients he has treated for the last six years has passed on.
Such is his daily schedule throughout the working days of the week and sometimes on weekends.
If he is not at the hospital seeing patients at the Uganda Cancer Institute (UCI) where he works, he is doing home visits to offer palliative care to those who are sick but are too weak to make it to hospital.
Palliative care involves treatment aimed at relieving a patient of pain and other disease symptoms to improve their quality of life, but not necessarily to cure the disease. Although it was initially given to dying patients with end-stage diseases to die pain-free, it is currently given even to those with early stage diseases.
As a haematologist and oncologist, Dr Ddungu treats patients with diseases that affect the blood, including blood cancers and several tumours but majors in blood-related cancers, blood clots, sickle cells, and any other disease that is related to blood.
However, he is more inclined towards palliative care.
“I have been practicing this since 1998. I was doing palliative medicine in addition to other care, so I used to do a number of home visits for patients with cancer, HIV/Aids and a number of conditions, and people who had left hospital to die alone.
I used to do that and not only here in Uganda, but I also went to other countries such as Swaziland, Botswana, Lesotho, and Namibia to train them on palliative care,” Dr Ddungu says.
His job as a palliative care provider makes him spend most of his time around families experiencing distress and anguish, including receiving phone calls in the night and wee hours of the morning to attend to emergencies.
Although one would expect such experiences to sadden him, Dr Ddungu says they instead bring a smile on his face, as well as joy into his life whenever he is able to relieve a patient of pain.
“They [patients] can completely become pain-free. It makes me happy when a person who came in agony leaves pain-free. There is a woman who came in recently and got isolated. She was badly off with pus oozing from her chest. She had a very painful tumour. Although she still has some pain, she feels better because even her family could not stand her and asked us to admit her to hospital,” Dr Ddungu says.
He adds: “So, in the next few days when she is feeling much better, will I be sad? I will be happy because I have made her happy.”
In the course of his work, he admits it is exhausting to be present at his patients’ deathbeds, but he is always satisfied by the fact that they die pain-free.
What keeps him going, Dr Ddungu says, is the fact that he is always able to improve the quality of his patients’ lives and save a life.
“I get inspired when a patient who came in with so much pain gets better. You find them in the corridors and they remind you; ‘do you remember I was like this and this’? You get inspired. Someone who was left for dead and now back to work, you get inspired,” he states.
Dr Ddungu explains that palliative care is not the end of life but is used as a best approach to treating a patient with cancer, HIV, end-stage kidney disease, among others, to make sure one has the best quality of life.
“And we know like in cancer, if you initiate palliative care early enough, actually someone’s survival chances increase. It is not that when you talk of palliative care, it means death. From the time when patients are referred from the institute [UCI] to the time they get better or if they don’t get better because they came with a real complex disease, may be advanced, then they have an opportunity to get better. As doctors, we believe people with cancer can get better, especially those who are diagnosed early,” Dr Ddungu says.
Much as he didn’t grow up knowing he would be a doctor, Dr Ddungu says he decided to take on the career due to life experiences. He alludes to the challenges that Uganda faced in the 1990s, where many people were dying of HIV/Aids because so many had no access to treatment and all they could have was access to palliative care.
“One thing I observed during home visits in the 1990s is that people used to be in a lot of pain; physical and emotional pain. You would find an entire home in a lot of emotional pain because of the suffering their loved one is going through such as nursing a smelly septic wound,” he says.
“And then you come in and intervene. The pain goes away along with the smell, vomiting and diarrhoea. These are some of the things that made me feel good in treating patients in a lot of distress,” Dr Ddungu explains.
The patients, Dr Ddungu says, are always told the truth about the treatment outcomes and although they [doctors] want patients to be alive, they in most cases die, but the doctors ensure they die with dignity, free of pain and surrounded by love.
“A person is better off when they know there is a loving team around them. Someone is going to understand that their disease has advanced,” he notes.
He explains further that palliative care actually gives a better package of care where you are not just going to look at the disease the patient has but as a whole; you are going to look at the family’s spiritual, psychosocial, and financial needs.
“In the recent past, one would come in with breast cancer and they are told that the breast would be cut off. No counselling given. So people used to say, ‘leave my breast alone’. It feels sad when you lose a patient but if you know they died not because they were neglected but because it was their time and they died comfortably, you feel better,” he says.
However, this is not to say all is bliss. Dr Ddungu says because his work makes him to be part of these distressed families, as a result, he suffers a burnout because of so much happening around him.
“But we have coping strategies that can help us. You can take leave and move out from patients, you can go and be home, you do research, so it is not always patients,” he says.
On what could have inspired him into the field, Dr Ddungu says: “I know we have all had life experiences such as loss of loved ones but I cannot say I was inspired because I lost anybody. I think it’s within me that I like to take care of patients. I can even forego a holiday to take care of my patients.”
But one of his biggest challenges, he says, is seeing the condition of a patient who has greatly improved worsening and they fail to reverse it. Not just this, but also whenever there are drug stock-outs and patients cannot afford to buy them or even afford transport back home.
On a normal day, Dr Ddungu wakes up at 5am and goes to work until 4pm. He usually goes to bed after 11pm.
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