Treat the Pain / Life before Death

In Collaboration with

International Association for Hospice & Palliative Care

15. Nurse in the House

About this Video

We see Hospice Nurse Charlotte Komunda treating late stage cancer patient Beatrice in her home in Kampala, Uganda. She uses simple, effective gesture-based communication to rate Beatrice’s level of pain. African leaders describe the challenges they face to find enough prescribers in Africa. Martha Rabwoni (Uganda), Charlotte Komunda (Uganda), Eugene Murray (Ireland), Dr Faith Mwangi-Powell (Uganda), Dr Natalya Dinat (South Africa), Rose Kilwanuka (Uganda) and Beatrice (Uganda) provide notable quotes:

“Sometimes we visit patients in their homes because when the patient has to move it makes the pain worse,” explains Martha Rabwoni (Uganda). “The pain if is not treated, the patient is in total chaos – they cannot think, they cannot do anything, they concentrate all their mind on the pain – they cannot eat, they cannot dress, they cannot bathe, they cannot move. The relatives in that home – nobody sleeps.”

“Many developing countries still have a real problem about the use, importation and manufacture of morphine,” explains Eugene Murray (Ireland). “The second thing is having appropriate ways to distribute it. In Uganda, they dilute powdered morphine into water which is which is colored with a dye to indicate the three different strengths and is distributed by nurses in a community using recycled water bottles. That may seem very crude but in terms of pain control that is absolutely transformational.”

“We need morphine because most of the drugs don’t control the pain in cancer patients so morphine is very important,” states Nurse Charlotte Komunda.

“Uganda is at an advantage because doctors are allowed to prescribe [morphine] and nurses who have done their 9 month palliative care course can prescribe morphine,” explains Dr Faith Mwangi-Powell (Uganda). “But in other countries only doctors are able to prescribe. So sometimes you find that morphine is available but there’s no one to prescribe it.”

“For many people living in rural areas, or poor township areas, their first point of contact is with a nurse clinician,” continues Dr Natalya Dinat (South Africa).

“Currently we have over 120 nurses who have had specialist training in palliative care and are now able to prescribe it for the patients in the districts,” concludes Rose Kilwanuka (Uganda). “So at least as a country, we’ve increased our number of prescribers.”

Call to Action

  • Tell a nurse you know to watch this video
  • Then ask that nurse whether s/he is comfortable:
    1. assessing and giving morphine to control pain
    2. explaining to a patient and/or family how to administer morphine every 4 hours for constant pain
  • Share your experiences in the comments section below…

Supporting Resources

Comments on 15. Nurse in the House

Comments are the opinions of the individuals who post them. They are not the opinions of the faculty or staff of the Institute for Palliative Medicine at San Diego Hospice.

  1. Charmaine Blanchard says:

    I realise that I was not clear about my meaning in my comment. There are some very real barriers to pain control, but some of these are based on misconceptions and phobias. Some of the fears which prevent nurse prescribing or the availability of morphine to patients at home, are perhaps unfounded. The very concerns which are often raised in lectures or tutorials about morphine prescribing are shown here to be not an issue when morphine is used responsibly for pain.

  2. Charmaine Blanchard says:

    It’s wonderful to see how so much can be achieved by simple effective solutions, if there is a will to act. There are so many barriers to good pain relief, which in the light of this vignette, seem to be artificial; and phobias that are unfounded. For the sake of our patients, we need to continue to work on removing these barriers and misconceptions.

  3. jo Christodoulou says:

    Very poigniant, simple message, where there is a will there is a way to attain good pain relief. The dilution and colouring of different strength morphine is a good example of such a simple well thought out solution that’s appropriate and effective.

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