Ruth Penfold

Ms A is a young woman of 28 years old but she seems just 22. She is from Kampong Cham province. The second of five children, she left her home several months ago coming alone to the capital, Phnom Penh, where she found a job in a textile factory.  Ms A is single and her family rarely visit her because transportation is expensive. 
For one year Ms A suffers from chronic renal failure which has suddenly got worse. She has been in the poor ward at Calmette Hospital for 10 days. She is very tired and suffers from diffuse pain throughout the body. In addition, she feels breathless and cannot sleep due to a major anxiety syndrome. 
Test results are bad. Disease enters its terminal state. Only haemodialysis would slow its progression. Unfortunately, this treatment is too costly for her. Then, the healthcare team approach the DSF technical team for joint care of Ms A to offer her palliative care, pain and symptom control and psychosocial and spiritual support. 
The physician in charge of Ms A and the DSF Technical Assistants (nurse and doctor) discuss openly with the young patient explaining to her the stage of disease, its gravity and answer her questions. She describes her worst symptoms as asthenia, dyspnea, tachycardia, headache, insomnia and anxiety and these are addressed. 
In addition, the DSF psychosocial worker offers her an attentive and caring listening. 
Days pass and this multidisciplinary teamwork around Ms A is successful: a team consensus is reached and the physician agrees to prescribe an anxiolytic to ease her anxiety and insomnia. The aim being patient comfort and benefits of this treatment outweighing the risk of side effects. Ms A is finally more rested, relaxed and the team can discuss further with her the irreversibility of the disease. She takes in and seems to understand all of this information. A trusting relationship is created between her and the psychosocial worker. She is able to let go of her anguish and face her future. She expresses her need to meet a monk to receive prayers and give offerings in order to lighten her next life of reincarnation. She also talks about her hope to visit the pagoda once discharged, if her energy allows. 
Thanks to his network of partners, the psychosocial worker contacts a local NGO, SCC  and facilitates the visit of monks in the unit. Visibly comforted by this ritual and by the team support, Ms A requests to return to her family home. So, the team organizes her safe departure which is planned for the following day. The team inform her that if necessary, she can come back to this unit or contact the referral hospital of her home province. Ms A leaves her contact numbers with the psychosocial worker who will take care to keep in touch with her. 

This support seemed to us interesting to share because it demonstrates that the partnership between teams, promoting patient wishes, has allowed a quality palliative care approach. It shows the value of the skills brought by each team member and the shared reflection essential for effective palliative care. 

We wish her to live peacefully for the time that remains. 

  • Phnom Penh, Cambodia
  • Written by: Ruth Penfold
  • Monday, 22 October 2012

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