To those of us in the States and Europe, hospice and palliative care are things we take for granted. If someone has a terminal friend or relative, it is a natural question to ask, “Have they signed up for hospice?” We have come to understand the value of hospice care, of dying at home, of help for caretakers, and the like. In other words, we completely take it for granted.
In Uganda, there are six hospices in the entire country. I work with two of them. Hospice Jinja, with a dozen staff and two vehicles, is supposed to service a population of 8.5 million. Hospice Tororo, newly begun in the Tororo Hospital, is near the Kenyan border. Their supposed reach is probably in the neighborhood of 4-5 million, if I had to guess. Their first vehicle has just arrived (it hasn’t gotten it’s paperwork yet, though), so they’ve been visiting patients by boda or at the hospital.
In one of my first conversations about Andros, before I had visited this Easter (I’d been once, for something totally different, for 1 day 4 years ago), I found out that there is nothing for the elderly on Andros. So naturally, after working with hospice in Uganda for over three years, that was the first thing I thought of. Once we returned, I started doing some research. I thought that, surely, there would be a hospice in Nassau I could talk to. And maybe in Freeport, too. But the internet didn’t find anything except a newspaper article about an in-patient hospice opening in Freeport late last year. However, the Cancer Society of the Bahamas was involved with that, so I decided to call them.
The secretary/treasurer of the Cancer Society called me back, and we had a nice long chat. What I learned right off the bat is that there IS no hospice in the Bahamas. At all. The four room facility in Freeport is technically hospice, but it’s expensive to run and all there is. There is no outreach, no visiting, no training, no care. My contact said that the culture is somewhat resistant, but then, so has been Ugandan culture until they learn what hospice does and how it benefits them.
I have been in touch with Dr. Frank and Dr. Patricia, the retired Irish couple who go to Uganda twice a year for a month at a time to volunteer. They’ve given me a long list of things we’ll need to do to get hospice off the ground in the Bahamas. We will have some challenges… well, a lot of challenges, but some that they don’t have. For one thing, in Uganda, nurses are allowed to prescribe morphine and other drugs, so that a doctor doesn’t always have to accompany the team in the field. This is good because there is no staff doctor, only volunteers that come. They carry a portable pharmacy (otherwise known as a suitcase) and are able to dispense meds right away when they see a patient. This is an obstacle for us, as I’m sure nurses aren’t allowed to do that. We’ll need a doctor, physicians assistant, or nurse practicioner, which is expensive and complicated. (I’m hoping we can get volunteers from Florida on a regular basis, since it’s so cheap and fast to get to Andros from there…)
We’ll have to work with the government, which is always delightful (*cough*), and will no doubt be doubly so on an island where the government seems to be too involved in life.
We’ll need community volunteers and community training about what hospice/palliative care is, how it helps, and why they need it.
Finally, I believe we’ll need a vision that isn’t limited to Andros. There are only 8,000 people on Andros. But there’s also no hospice in Nassau/New Providence, where there are over 250,000 people. None in Freeport with 50,000 people. None in the Abacos or other family islands that make up the rest of the Bahamas. Eleuthra. Exuma. Inagua. 700 islands. No hospice.
It’s a big task. It’s too big to think of as a whole, really. But I firmly believe that it is something that God has called me to, and so He will give us the ability and the funds and the favor to accomplish it. Who am I? Nobody. But the God I serve is big enough!