When one thinks of global health and Africa, malaria, cholera, and HIV come to mind. Cancer, on the other hand, is limitless, ignoring both geography and demographics. The difference between cancer patients in Africa and that of the developed world, however, are vast. With the sprout of HIV/AIDS and other opportunistic infections associated with low immunity, death among cancer patients is increasing in the developing world, yet patients are receiving less than 10 percent of allocated resources for management of the disease (Hospice and Palliative Care in Africa, Oxford University Press, 2006).
Aiming to provide palliative care services to people with cancer and/or HIV/AIDS and their families, Hospice Uganda primarily supports patients in their homes, but also cares for those at the Hospice site and in health facilities. Hospice estimates that 50 percent of its cancer patients also have AIDS. Having the opportunity to go out in the field with the Hospice home-based care team, I found that although the patients visited were mostly cancer victims, the majority were battling other severe illnesses due to a lack of resources resulting in poor housing, facilities, and care.
One such illness, or rather condition, shared by many Hospice home-care patients is what is known as ‘bedsores’ (also referred to as ‘pressure sores’ or ‘pressure ulcers’). These sores, common among individuals with paralysis, spinal cord injuries, cancer patients, and other illnesses resulting in stagnation, is often termed as a needless condition that receives low priority worldwide, especially in Africa. Although not a new sensation or discovery in the medical field, bedsores are painful, prone to serious infection (sometimes resulting in death), and unnecessary if proper preventive measures are taken.
Meet Namugowa Francis, a 65-year-old retired schoolteacher who suffers from prostate cancer and bone disease. Francis is bed ridden in a small room behind his son’s home in Namugongo, a suburb of Kampala-Uganda’s capital and most populace city. Due to the fragility of his bones, pain, and malnourishment from his disease, Francis has not been able to sit upright for over 6 months nor regularly move from side-to-side without the help from his son. In addition to the discomfort he experiences from his illnesses, a very large abscess has formed on the back of his right thigh and a section of his buttocks. The abscess runs deep into the bone, full tissue loss about 8 centimeters in diameter, seeping excess fluids. A similar sore is beginning to form on his heal.
“Bed sores from poor care and lack of resources are common among cancer patients in Africa,” says Dr. Kelly Amery, a UK resident who has worked with Hospice Uganda for the past two years. Patients do not have access to specialized beds, mattresses, or the level of care available in places like Europe or the United States. Medical personnel are scarce at health facilities and caregivers for home-based patients (for those patients who can be moved regularly) do not have the capacity to continually reposition their sick relatives to the extent of preventing bedsores from forming. Even in the developed world, preventive methods to pressure sores have been low prioritized and literature suggests that health systems spend extraordinary funds on treating severe sores over investing in research to find cost-effective and adequate means to prevent them.
In Uganda, basic foam mattresses (shown in image above) is the standard bedding available in homes and health facilities and considered a luxury to many Ugandans who sleep on reed mats or sisal. Such foam mattresses, however, “are not conducive for immobile patients,” says Dr. Amery, especially patients with spinal injuries or related illnesses that cannot regularly be moved. “Multifactorial mattresses” she says, “ones that offer unequal pressure” (such as alternating pressure mattresses) are usually used in health facilities or homes for immobile patients in the United Kingdom, for instance. Although more ideal for these cases, they are much too costly and thus impractical for counties like Uganda, a country struggling to care for its rising HIV/AIDS patients (infections have jumped to around 135,000 per year) and the multitude of other diseases its citizens are facing.
Yet, as part of the palliative care model to reduce the severity of disease symptoms and improve the quality of life for people facing austere illnesses, a solution must be found for these patients in Africa. To keep Francis’ sore from seeping onto the linen and mattress underneath him, Francis’ son has placed a black plastic covering over the top sheet (a familiar home-made remedy) protecting it from the secretion. This method of preservation, on the contrary, will enhance the temperature between the plastic and the patient’s body, thereby inflating the sore and increasing the chances for infection. With an already low immune system and nutritional deficiency, a bedsore infection not only adds to the severity of pain experienced by the patient but it can also become a life threatening medical problem for many clients. A local, cost-effective solution is needed to reduce the occurrence and effects of bedsores among immobile patients in Africa. Without one, patients will continue to suffer from such arduous conditions.
Ashley Leech is ARCHIVE’s Global Health Correspondent in East Africa. She is also a consultant with Christian Aid in Uganda.