Jeanette, a resident of Kigali, was diagnosed with cervical cancer last year. The mother of five says the cancer was in its late stage where treatment was impossible. Because of her condition, she was depressed, and developed psychological disturbance to the point that she couldn’t eat. “I was going to die of starvation at that point, and not the disease. Although I was under medication, I was unable to cope and accept reality,” she says. But with holistic nursing care, she says the ordeal has been made more bearable. The Ministry of Health has integrated holistic nursing for patients under palliative care in 42 district hospitals across the country to help patients with incurable diseases. Holistic nursing focuses on promoting wellness by removing physical suffering and healing the whole person. Diane Mukasahaha, the national coordinator of palliative care at Rwanda Biomedical Center (RBC), says this kind of approach has seen a number of patients who were bedridden become liberated, and some even still work to provide for their families. UNDERSTANDING HOLISTIC CARE She says that research shows that when there is no holistic care for a patient, at least three people in the family are affected. “Imagine three people in the family being affected because of the pain of one person, these people do not sleep because of depression and there is a lot that can’t go on because of this,” she says. Mukasahaha says that when one is suffering from a curable disease, the illness is attend to and treated. However, when it comes to an incurable disease, focus is no longer on the disease, because it is not treatable. Because of this, she says, they focus on holistic care. “If someone is very sick or has a complicated life condition, they are not just in bad physical condition, but also bad emotional, social, spiritual and psychological,” she says. James Tuyizere, a trained health practitioner on palliative care, says it starts with the assessment of the patient, and that this is not just about the physical aspect. He notes that although the physical aspect is there, emotional assessment is also required. For instance, he says, if one has stage four cancer and one part of their body is going to be amputated, they are not just suffering physically, they also have emotional pain. He explains that the emotional pain is linked to the disease and the outcome of the treatment, the background as well as the loss, and that’s why multidisciplinary support is required for the patient. He adds that when a patient loses a body part, they are thrown into despair; some even end up refusing to take their medication. OTHER ASPECTS When it comes to social aspects, Vedaster Hategekimana, a senior officer at Pain-Free Hospital Initiative at RBC, says some people close to a patient may think that they have done all it takes for the person to get well, and when nothing changes, they give up—like the person is dead already—because there is nothing that can be done to for them. According to Practical Nursing,a medical information website, illness has the power to strike down the mightiest of individuals; no one is immune. Nurses must be knowledgeable about how diseases affect patients. Due to the high patient load and often intense time constraints placed on nurses, it can be easy to simply treat the physical being and move on to the next patient, resident, or client. It is important to care for the whole person and to see them as just that; a whole person, not just a patient or diagnosis. Holistic nursing care involves healing the mind, body, and soul of patients. It involves thinking about and assisting patients with the effects of illness on the body, mind, emotions, spirituality, religion, and personal relationships. Holistic care also involves taking into consideration social and cultural differences and preferences. Every person is their own individual. There are many easy ways to improve relationships with patients and promote a healthy psychological, emotional, and spiritual environment. Learn the patients name and use it Make good, strong eye contact Ask how a patient is feeling and sincerely care Smiling and laughing when appropriate Use therapeutic touch Assist the patient to see themselves as someone that deserves dignity Preserve their dignity Educate your patients on the importance of self-care Ask the patient how you can reduce their anxiety or pain Use non-pharmacological methods of pain control such as imagery, relaxation techniques, and more Encourage patients and assist as needed with alternative treatment modalities; never underestimate the benefit of a massage, aromatherapy, or music. Ask if patients have certain religious, cultural, or spiritual beliefs; be sensitive and accepting if they do. This is a small list of changes that can be implemented in order to focus more on holistic care of patients. At the end of the day, holistic care is not even about how many holistic actions you performed. What matters is having the intention to care for each patient as a whole and being present for that patient while you can. Holistic nursing can be practiced in any healthcare setting, the website suggests. ********************************************************************************************************************************************** THEIR VIEWS I think there is a need for family members and the community in general to be sensitised on what is required for patients with incurable diseases. When this is done, it’s easier to provide the support needed for them. Dr Francis Kazungu, Medic - Galien Clinic Kigali *************************** Such support is needed for patients who are suffering from curable diseases as well. It’s good because it helps them feel cared for, which is important, and will quicken the healing process. Dr Yvan Ntwari, General practitioner *************************** Family members of patients who need holistic care should also be counselled on what is going on. Failure to do this, it’s possible for them to get depressed, which is unhealthy. Dr Gonzalue Niyigaba, Practitioner - University Teaching Hospital of Kigali *************************** It’s important for patients to be guided on what to eat, this is because some conditions require one to not eat certain foods. If taken, there can be associated risks. Joseph Uwiragiye, Nutritionist editorial@newtimes.co.rw
