Caring for terminally ill patients in Malawi faces a lot of challenges. Many such patients are either sent home to die painfully or, if kept in health institutions, do not get the required care because of resource constraints. Most are faced with harsh realities of facing death in isolation or loneliness as family members and friends go on with their lives in some sort of ‘abandonment’. One woman, Dr Jane Bates, filled with the compassion and calling from God, decided to make a difference by helping in the set up of the Palliative Care Association of Malawi (Pacam) within Queen Elizabeth Central Hospital (QECH). Palliative care is specialised medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms of pain and stress of a serious illness- whatever the diagnosis. The goal is to improve quality of life for both the patient and family. Among her patients are those living with HIV and cancer that now have reason to smile, feel hopeful with their hurt lessened. Josephine Chinele of Malawi News Agency (Mana) speaks with the doctor.
Who is Dr. Jane Bates?
I am one of Pacam’s founding members which began in 2004 but was registered in 2005.
I am happily married to Dr Jes Bates, an orthopaedic Surgeon at QECH. We have two teen boys, Tom and Peter.
How long have you been into this service?
I have been in the lead of palliative care services at QECH for 10 years now. Tiyanjane and Umodzi (Children Palliative Care) clinics situated at the hospital are my brain child.
What was your motivation for forming Pacam?
During my medical school days, I had a dream to establish a holistic clinic where families could come and talk about HIV and have their spiritual and social needs met.
Seeing people dying of Aids everyday whilst working as a young doctor in South Africa, I felt the time was ripe to make my dream come true. I noticed that many people died in denial but also with less social and spiritual support. Even though hospitals were overwhelmed with people suffering from Aids, the government then was not acknowledging the existence of HIV.
Was the idea of Pacam conceived in South Africa?
Yes. I mobilised a few people in the country and established a support group which never worked since it was a new phenomenon. Before leaving South Africa for the United Kingdom, I conceived a dream plan. I thought of establishing a holistic clinic where families could come and talk about HIV; give each other spiritual and social needs. Upon my return to the Bible College in the UK, I continued to pray for success to work with sick people and how to approach my next step.
How did you find yourself in Malawi?
I have always wanted to work in Malawi as I was motivated by various stories from our friends who were already here. We came to Malawi in 2002 upon invitation of friends who were living and working in the country. This was the time the country did not have Antiretroviral (ARV) drugs in full scale. I am part of the Word Alive Christian family, which has lived in Malawi for 11 years. Malawi is our home.
How did you establish Pacam?
During the first year, I was finding out what was already there in support for Aids patients and I discovered that some services were lacking. In 2003, I began palliative care among HIV patients admitted at QECH on a small scale. They used to meet to discuss the disease, diet and how to look after a patient at home, among other things.
What have been your experiences in palliative care?
Very few patients realise that they need palliative care, especially HIV and cancer patients. Following up on patients has been a big challenge in palliative care treatment. I believe that HIV patients need to understand the illness, pain and care. The main challenge is that many health workers do not know what to do in palliative care since they were not trained. Knowledge and skills of palliative care is not expensive to acquire. It is more of an approach to care.
What is your comment on Malawi’s medical provision?
I feel we would benefit as a country if we had radiotherapy treatment and adequate supply of drugs. Many cancer patients on palliative care had their cancers advanced because they did not have access to such treatment. Malawi is a fertile ground for palliative care but what is needed is for every nurse to have knowledge of the service and this could be achieved if Ministry of Health takes the lead.
Give me your overview of this service.
Palliative care came in many years after the advent of Aids and the increase in non-communicable diseases such as cancer because many medical practitioners were not conversant with it and were not trained on how to administer Morphine, a drug which is given to reduce severe pain.
How is palliative care fairing in the country?
The frequent drug shortage is our biggest challenge, short supply of cancer drugs and lack of radiotherapy treatment as major factors affecting palliative treatment in the country.
What are the benefitting numbers?
On average I assist 300 patients a month; 15 admitted patients at QECH per day and even follow ups on those who were discharged. There are many patients with advanced diseases in the country but the palliative care team is very small.
Give me your brief educational and work background.
I have a Bachelor of Medicine and Surgery; and Masters in Philosophy (Palliative Medicine) from Bristol University in UK and University of Cape Town in South Africa respectively. I have also worked in India and Philippines as a young doctor.
How do you juggle family and work?
As a woman it is always difficult to balance since you need to be around to guide children and make contact with them. Family time is very important and it is a mother’s key role to make it exciting.
Any last comments?
I am motivated by Philippians 3 verse 14 which says: “Press on toward the goal to win the prize for which God has called [you] heavenward in Christ Jesus”. Any girl who gets inspired by my story should be motivated by this verse.