By Busisiwe Mashiri | Harare Branch Coordinator
Ruva (not her real name) an HIV positive patient was referred to Island Hospice and Healthcare (Island) with advanced disease, and had been told that she had two weeks to live. Ruva tested HIV positive two years prior to the visit and was commenced on ARVs but unfortunately took them erratically and not timely as prescribed. Despite all the health education on adherence she failed to comply. Her health deteriorated very fast and she had uncontrollable diarrhoea and became severely wasted, weak and bed ridden.
Upon follow up home visit, the Island nurse found Ruva very sick and in severe pain. It was very difficult to engage in a meaningful conversation as both patient and her mother were weepy due to the pain. On physical examination she was in excruciating pain. The nurse’s main goal was to convince Ruva that her pain could be relieved if Ruva complied with the instruction of taking pain medication every four hours.
Ruva hesitantly agreed to take the strong pain killers with the support of her mother. An initial dose was given instantly by injection followed up by oral morphine tablets four hourly. After a few hours Ruva felt some relief, which then encouraged her to proceed in taking her doses as instructed, and the pain killer also immediately stopped the diarrhoea which brought respite to Ruva and her mother.
As the pain subsided it paved way for discussions of other concerns. Ruva shared that she had given up on life and had no desire to live. She felt this after her husband left her and moved in with another woman and never explained why he had left. She felt rejected, abandoned and neglected and then when a year later she tested HIV positive she felt that there was no need for her to take medication. A lot of people encouraged her to take the medication but nothing motivated her. She watched herself deteriorate and had no strength to pick herself up. She was very angry with God and got more upset if anybody tried to advise her to forgive her husband or his actions. With further exploration she had much pain from the past.
Upon the patient’s request the nurse organised for her to get a spiritual counsellor to support her. The priest came and she shared her issues and he helped her to go through the forgiving process. She was able to invite her ex-husband to talk about the future of their son. They agreed that their son would stay with her sister in the case of her death and her ex-husband would provide money for school fees. She encouraged her sister to strengthen her relationship with her nephew as this would help them in bonding. The child began to share his pain with her as he had not had an opportunity to express his feelings. He was worried that he would be transferred from his school and would need to make new friends again but he was reassured that he would remain at the same school. Ruva spent more time with her son despite that she was now weak and frail.
She managed to transfer the ownership of her two houses to her son and rental from those houses would be used for her son’s upkeep. She took her son to her sister’s house and requested her sister and the sister’s husband to adopt him. This was a painful moment but it brought a lot of relieve to her heart. She talked openly about her death.
She was able to pray to her God, and confront and deal with issues in her life with the help of the priest and nurse. She died peacefully a year later due to complications of the disease. Her family was very grateful for the support given by Island and the priest
By Elias Masendu | Acting Programs Manager
By Lovemore Mupaza & Tanaka Mudadada | Monitoring,Evaluation and Research Officer
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