The first task for staff at St Martin de Porres hospital’s Pavillon St Raphael unit was to explain the rationale behind palliative care. photographs by Juanjo Pérez
As the sun rises over Yaoundé, the medical round begins in the Pavillon St Raphael unit. Accompanied by a group of nurses, a doctor visits each of the facility’s six rooms. All are at full capacity.
Before the round, the group convenes next to a poster bearing the words of Dame Cicely Saunders, the founder of the palliative care movement: “We all matter until the last minute of our lives.” This is the first and only dedicated hospital unit in Cameroon to care for terminally ill patients.
Last April, when the unit opened at St Martin de Porres hospital in the Mvog Betsi neighbourhood of Yaoundé, there were only three or four patients. People didn’t seem to understand why someone would go to a hospital to die.
One of the first jobs of the staff was to explain the importance of offering this kind of care. “We worked a lot to increase the awareness of palliative care among the general population,” explains Christian Tsotie, a veteran nurse who now works at the unit. “We organised conferences, we trained medical staff.”
Cristina Anolín, the Dominican hospital’s medical director, said: “There was a time in the hospital where we started to receive several cancer patients rejected from other health centres in the city because, since they were terminal cases, they were seen just as timeless bed occupants. But, of course, we couldn’t say no to them, so we started to think about creating a space like this.”
The unit feels cosy. Its six bedrooms, containing a total of 10 beds, are arranged around two living rooms decorated with plastic flowers and bright, colourful curtains. Such details transform a humdrum waiting room into something closer to a home.
On the living-room table lies a palliative care pocket guide. A permanent fixture, everything is explained in it, from the basic principles of palliative care to its origin and evolution. Symptom control and ethical questions are also addressed.
Maria picks up the guide from time to time to read aloud while she checks on her husband, Joseph, who slowly falls asleep in one of the bedrooms.
Angele, whose daughter Anne Sophie is a patient in the unit, lies on a mattress in the living room.
As evenings draw in, relatives lay out mattresses on the floor, supplied by the hospital, in preparation for another sleepless, watchful night. Angele takes a mattress and lays it on the floor in the living room. She watches a Mexican soap opera alongside her daughter, Anne Sophie. It’s the first time that day that Anne Sophie has left her bed. She watches the TV while eating a meal of rice and chicken. She has a tumour in her eye that is too advanced to be treated. She is only 32.In the next room is Roufine, a Spanish teacher. Until last September, when illness left her bed-bound, she worked in a city high school. “When they brought me here I wasn’t able to breathe by myself and I thought I was going to die,” she says. “But look at me now. I’m no longer in pain and it’s been three weeks already.” Previously at another hospital, she was transferred to St Raphael’s on her brother’s advice.
Relatives say the availability of mattresses is one of the main advantages of St Raphael’s. “In the Central hospital, for example, relatives are forced to sleep outdoors under hordes of mosquitoes, so it is quite usual that visitors end up being patients themselves,” says Dominique, son of one of the patients.
“I also love that, in here, the person comes first and then is the money,” Roufine says. The sentiment is common among patients. However, what they most appreciate is also the biggest headache for the administration. The palliative care unit has become a financial black hole.
Costs are considerably cheaper at the unit. Hospitalisation rates at St Martin’s are set at about CFA 3,000 a day, while costs at Central hospital are roughly CFA 5,000, for example. At some hospitals there is an expectation that extra, unofficial treatment costs will creep into a patient’s bill, but not at St Martin’s. Palliative patients in the St Raphael unit pay about CFA 4,000 a day, including the costs of medicines.
It’s been 20 days since Christine arrived. “I have a huge ball that puts pressure on me in the stomach, and it hurts a lot,” she says. After several operations, there is nothing left to be done. It was while in hospital for one of the operations that someone told her about St Raphael’s.
An empty rooms speaks volumes at the Pavillon St Raphael unit
When a room becomes available in a regular hospital ward, it can be a cause for celebration, as a patient has been healed. An empty room here is synonymous with sad glances.
Christine’s room is empty today. An old sheet lies carefully over the mattress, and next to the bed there’s a broken suitcase with her clothes. “When I was leaving yesterday night I had a sort of feeling,” nurse Tsotie says. “We are able to see patients’ evolution daily and hers had sped up lately, but you never get used to this kind of situation.” Tsotie’s habitual warm smile is notably absent as she talks about the erstwhile occupant of room number six.
Less than a week later, there’s another occupant in the room. Life goes on. Even in palliative care.