Pain relief for Nyarai – reflections from a Zimbabwean palliative care nurse
By Sr Franciscah Tsikai, Head of Clinical Services, Island Hospice and Healthcare
There is one little girl I will never forget. Her name was Nyarai*. This little 10-year-old girl was petite, thin and partially blind. At five years old she was involved in a serious car accident with her parents. Both her mother and father died, but she survived.
I felt pain in my heart wondering why she was going through all this suffering.
Five years later, Nyarai was diagnosed with retinoblastoma (cancer of the eye). She was cared for by her uncle, Tawanda. He loved her very much. He would come to Island Hospice and Healthcare offices to collect her morphine and every time he spoke her name tears rolled down his cheeks. He despaired that she had lost her parents and now she was suffering from cancer. One day Tawanda’s brother, John, came to stay with the family and was put in charge of Nyarai’s care. At that stage her main complaints were persistent headaches, generalised body pain and loss of appetite. She was on 5mg of morphine syrup for generalised pain and paracetamol for her headaches.
One day I visited Nyarai. When I went inside her bedroom I found her lying on her bed crying. I felt pain in my heart wondering why she was going through all this suffering. I asked her why she was crying and she explained to me that her uncle John was refusing to administer her ten o’clock dose of morphine. It was 1pm in the afternoon and Nyarai was in pain. I felt angry and frustrated. The medication was in the fridge, but Nyarai was not getting it. I walked outside and confronted John. He explained to me that he saw no reason to give Nyarai her morphine since they were told at the hospital that she would die. John told me: “I do not want to waste the medicine because when we took her for review at the hospital they told us that she will not get better.” I explained the importance of pain management and the need to keep Nyarai comfortable. John heard me.I then administered the morphine and involved another member of the household to ensure that Nyarai would continue to receive her medication. I lay down beside Nyarai and held her hand until the pain went away. That day I truly felt Nyarai’s pain. I thought if her mother were alive, she would be holding her and rocking her to sleep. I felt I had to do this. When she fell asleep I left.
Nyarai died 10 days later pain free. When I reflect about Nyarai and my visit that day I recognise that family members need to be given continuous information and support. We had provided information about pain control to the family, but we had not included John as he arrived late. We assumed he would be briefed by other family members. Regular assessment and updates of all family members is also necessary.
After my visit I learned that John had HIV. He died shortly before Nyarai. The experience reminded me to make time for all family members and to always check understanding as well as compliance in administering medications.
Original article: http://www.ehospice.com/ArticleView/tabid/10686/ArticleId/20750/language/en-GB/View.aspx