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Heroes & Survivors

Why Palliative Care Is Also Pertinent In The Pandemic

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Eric Kabisa of the Rwanda Palliative Care & Hospice Organisation sets off with his team; image supplied

The real heroes are also palliative care providers who go out of their way for patients with chronic illnesses, like this Rwandan team of professionals that conducts home visits offering critical care to those afflicted even more during the Covid-19 pandemic.

It’s a Tuesday morning in mid-May, and the team from the Rwanda Palliative Care & Hospice Organisation (RPCHO) is preparing to visit the homes of terminally-ill patients in need of palliative or specialized medical care. The team, led by the organization’s Executive Secretary, Eric Kabisa, comprises a doctor, a nurse, a social worker and a psychologist.

For this team, their work tending to needy patients is more than just a job – it’s a deep calling.

This small team cares for over 70 patients with life-threatening illnesses; visiting them in their homes, providing medical consultation and nursing care as well as addressing some of their basic needs. They also offer counseling services to patients and care-givers.

FORBES AFRICA joins Kabisa’s team, all masked-up and ready with supplies, for the home visits. This team also includes nurse Peace Kyokunda.

The Covid-19 pandemic has no doubt disrupted the momentum of their work and though RPCHO was part of the essential services that had the green light to operate during the government-imposed lockdown in the country, Kabisa explains why the team had to temporarily stall the home visits.

“Since March 14, when the first Covid-19 case was discovered in Rwanda, we had to stop the home visits and would only do phone consultations. This is because we did not want to put our patients, most of who have very low immunity levels, at risk.”

For cases that needed urgent medical attention, Kabisa and his team would ensure an ambulance was dispatched to pick them up and rush them to hospital whatever time of day or night.

Technology was the only point of contact with the patients during the lockdown period as the team would offer counseling sessions and even guide care-givers via phone on how to handle the patients.

Sadly, the lockdown was not without casualties. Nurse Kyokunda narrates how they lost one of their patients during that period.

“One of our patients who suffered from cancer needed morphine to manage his severe pain but for two weeks, he could not access it… Even though we got him an ambulance to take him to hospital, it was too late. He died at the emergency ward,” she says, her voice laden with emotion.

As soon as the Rwandan government eased the lockdown restrictions, the palliative care team was ready to resume their duty-trips, exercising utmost precaution.

With supplies including cartons of milk and adult diapers, among other things, we set off to visit the first patient with them.

Soline Kabagwira lies silently on a mat spread out on the floor of her small living room. A combination of cervical cancer and HIV/Aids has left her scrawny and frail.

The house is quiet save for the birds chirping outside her small window and young children playing in the distance. Her own two children are up and about doing chores their mother would probably have been attending to had she been well.

On seeing Kabisa and Kyokunda, Kabagwira barely manages a faint smile and can hardly move. She welcomes us but does not allow us to take any pictures.

We are the first group of people to visit her since the lockdown.

“This pandemic robbed me of something precious; people’s company. Before, people would come to see me, talk to me and even pray for me. That would give me hope, something to look forward to. But now, it’s quite lonely, no one comes by anymore,” she tells FORBES AFRICA.

Besides the loneliness, her days are filled with thoughts of what would happen to her children after her time.

“Who will take care of them when I’m gone?” she asks, shedding silent tears.

Kabisa and Kyokunda empathize with Kabagwira and take time to counsel her. They speak words of reassurance and comfort while exuding utmost professionalism. By the time we leave, Kabagwira is calm and gently falling asleep. We leave, but with an assurance of another visit soon. (Unfortunately, FORBES AFRICA learned that Kabagwira breathed her last on June 5.)

On our trip that day in May with RPCHO, we also meet Antoinette Bayambaze, another patient suffering from cervical cancer. Since the start of the lockdown in Rwanda, her condition has been moving from bad to worse. She is unable to speak but her daughter Angeline Nyirasabimana graciously agrees to share her experience from a care-giver’s perspective.

With a family of her own to take care of, Nyirasabimana has had to find a way to juggle between being a wife, mother, businesswoman and care-giver to her terminally-ill mother. She had somewhat mastered the art of wearing each of these hats, but the Covid-19 pandemic threw her off balance.

“This period has been particularly difficult for us. With the lockdown measures, I could not go to see my mother who lives very far from me. The palliative care team also had to stop the home visits. My mother did not take our absence well as she did not understand much about the pandemic. Her condition quickly deteriorated,” she tells FORBES AFRICA.

Being far from her mother when she needed her most weighed Nyirasabimana down.

“It was tough helping my mother remotely. Taking care of a sick loved one demands physical presence. There are some situations that just cannot work with social distancing,” she says.

Apart from the distance, Nyirasabimana could not easily access pain medicine as well as supplies such as adult diapers crucial for her mother, which was a main cause for concern during the lockdown.

“It was tough helping my mother remotely. Taking care of a sick loved one demands physical presence. There are some situations that just cannot work with social distancing.”

The RPCHO does not work in isolation. In fact, the government considers it a crucial link in the palliative care chain.

Dr Francois Uwinkindi is the Director of the Cancer Diseases Unit at the Rwanda Biomedical Center. He works closely with Kabisa and his team to ensure patients with life-threatening diseases in the community get the care they need.

For many cancer patients, accessing the Butaro Cancer Center of Excellence located in northern Rwanda for treatment and drugs was an uphill task during the lockdown period, forcing the government to come up with various solutions.

“Drugs that could only be found at the Butaro Cancer Center were now available at the Rwanda Cancer Center located at the Rwanda Military Hospital in Kanombe. The government would also provide transport services for patients who needed to go for treatment at the Butaro Cancer Center,” says Uwinkindi.

The Rwanda government also explored the option of using drones to deliver drugs to cancer patients in the rural areas, saving many lives in the process.

Post Covid-19, Uwinkindi is of the opinion that technology is the way to go. “Where necessary, we should exploit ‘telehealth’ and continue with consultations via phone or video calls. This greatly reduces costs and time,” he says.

All in all, palliative care teams around the world have had to find creative ways to work around the Covid-19 pandemic to provide crucial services to patients with chronic illnesses, recognizing that palliative care is a necessity, even during a flu pandemic.

– Tesi Kaven

Heroes & Survivors

The Test, Trial And Triumph

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Motlabana Monnakgotla on an assignment for FORBES AFRICA

After 14 days in isolation as a Covid-19 patient, this FORBES AFRICA photojournalist recovered to see the world with new eyes and realize he had the gift of life.

It was around 3PM on June 24 when a nurse called to tell me that I could now officially end my 14-day self-isolation period at home. I had tested Covid-19 positive three weeks before and now was in total disbelief that I had survived this particular physical trial and mental ordeal.

Before testing positive, I was like any other ordinary South African, pursuing my work from home, and as a FORBES AFRICA photojournalist, recording the impact of the coronavirus.

I had thought my face-mask and hand-sanitizer were my armour against the virus, but I guess one can never be too careful.

The first 72 hours of knowing that I had confirmed positive for Covid-19 came with its own set of emotions and experiences. Some friends, and even family, criticized and judged me for carrying the virus, but I also came to know about the ones who cared.

A group of doctors visited me at home to check if I needed hospitalization. They were young and not cloaked head-to-toe in PPE as I had thought. One of them was wearing a camouflage top and sported a few tattoos on his left arm. After his consultation with me, he spoke excitedly about the baby he and his wife were expecting, due later in the year.

There was hope in the world.

I was confident my health was getting better until a nurse called me a few days later. She was the pin that burst my bubble, as she stated things I didn’t want to hear at the time. They were facts, she clinically warned, as she sees people dying daily of the virus.

My mind raced to the previous two nights, when I experienced mild short breaths and thought how the attack could have been worse. I could have died at night all by myself, just trying to breathe. I shed tears as she spoke.

Soon after that, an old friend of mine, who had been shot (and injured) in the spine during an armed robbery attack, called. His timing was perfect. He encouraged me to live on and smile, and told me that the nurse was only doing her job, in advising me to keep to a healthy diet during this time. He brought a smile to my face.

A week later, it was my mother’s birthday. Every year, I visit her with a gift and a cake. This time, all I could do was video-call her; she was both happy and sad not to be able to see me. Two days later, it was my own birthday. I felt low and lonely, but was glad to be alive as my two weeks in self-quarantine was going to be over soon.

“I asked if I would be added on as a statistic to the official recovery numbers, and she laughed.”

I was reluctant to leave the house, but on June 24, the call by a lady who identified herself as “Nurse Nomsa from the Department of Health” liberated me. She was following up on my health status for the previous two weeks and I had ticked all the right boxes. I asked if I would be added on as a statistic to the official recovery numbers, and she laughed. She told me I had recovered, but should continue maintaining a healthy lifestyle.

Today, I can stand outside my home in Soweto and watch the neighbors’ kids play, shout and scream, asking from their yards, “Malume (uncle), are you okay?”

With a gentle laugh and nod, I acknowledge my story of survival to them.

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Heroes & Survivors

A Day In The Life Of A Taxi Driver In Lockdown

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Tshepo Ralephata; images by Motlabana Monnakgotla

Tshepo Ralephata has been plying the roads to ferry essential services workers during the Level 5 lockdown in South Africa.

Modern heroes don’t wear capes; they either only don blue scrubs or show the willingness to offer a public service in the time of crisis.

In the time of Covid-19, today’s heroes are the men and women next door, and those on the streets, such as taxi owner, Tshepo Ralephata, who has been plying the roads to ferry essential services workers since the stringent days of the Level 5 lockdown in South Africa.

Ralephata has been working in the taxi industry for over 10 years now, but has never worked under “such life-threatening circumstances” as he is now, he observes. But he has to do so also to look after his family.

“I don’t think about being infected with the virus when I’m on the road because I have to make money, I need to pay rent, the kids have to eat any my partner is unemployed making me the only bread-winner, so I don’t have a choice, I have to work,” says Ralephata.

As a FORBES AFRICA photojournalist looking for great street images, I joined Ralephata in his taxi to document a day in his life in the time of lockdown. His blue Toyota Hiace minibus taxi is his mobile office and the permit to drive during the lockdown sees him working every two days; which has admittedly affected his daily earnings, which has come down from R1,400 to R650.

“We are only allowed to work from 5AM to 10AM and from 4PM to 8PM, the breaks are also an inconvenience. I can also only load 10 passengers at a time, while on the other hand, I buy my own sanitizers to make sure passengers maintain hygiene.”

Indeed, that is what Ralephata did after picking me up at a busstop. He leaned over with a disinfecting sanitizer and sprayed it on to my hands before I entered.

A kilometer into the trip, a young lady entering the taxi refused to be sanitized insisting that she had sanitized at home.

“This is what I deal with some days,” rues Ralephata.

On arrival at a taxi rank, I saw dozens of commuters going about their daily working lives wearing facemasks and gloves, hopping from one taxi to another.

The taxis at the rank are sanitized twice, but Ralephata laments they are not getting much support from the government because they have to buy their own protective gear.

As we wait for the second load of passengers, Ralephata keeps his sanitizer close at hand and stands by the sliding door, spraying every passenger coming in.

On our way home, he tells me about his daily fears.

“When someone coughs or sneezes, I get scared and think that’s the virus. I just wish that the person is not carrying the virus,” he says.

The young entrepreneur is aware that his job could put his family at risk.

“When I go home after work, I sanitize my hands before holding the door handle, then I go straight to the bathroom for a hot bath and only then, can I bond with the kids.”

Covid-19 is crippling his business and he prays for a vaccine soon because his liquor store business has also been affected.

Ralephata is not reaching his daily targets but helping the community is as much an important motive for him.

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Heroes & Survivors

How This Aid Worker Kept Calm As He Battled Covid-19

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Deserted streets in Kigali during lockdown; image by Steven Muvunyi

Frank Songa, Rwanda’s second confirmed Covid-19 patient, lost his sense of smell and taste, but armed himself with information.   

Imagine not being able to smell your morning coffee or taste your favorite food. This was what Frank Songa mostly experienced as he battled Covid-19. Thankfully, he is recovered and now able to smell his morning cuppa at home in the beautiful hill country of Rwanda.

Research findings strongly link sensory loss (taste and smell) to Covid-19, and Songa, a Rwandan humanitarian aid worker, was deprived of these senses for close to two weeks.

Today, he is one of many patients who have recovered from Covid-19 in the tiny East African country. 

“Food was just that; food! I could not taste it, nor could I smell the strong chlorine used to mop the floors,” says Songa. He is, however, grateful he did not develop severe symptoms.

On March 14, he drove to hospital to get himself tested after experiencing mild symptoms. He was not prepared for the results.

“I had a mild fever and a congested nose. Due to the nature of my work, I am a frequent traveler, so I decided to get tested just to make sure I was fine. On the 15th of March, I got a call from the hospital informing me that I had tested positive for the virus,” says the young man. 

Frank Songa; image supplied

Songa was Rwanda’s second confirmed patient and was taken to the Kanyinya Health Center, one of the three treatment centers accommodating Covid-19 patients in Rwanda. Meanwhile, the process of tracing his contacts began.

While in isolation, he had many questions running amuck in his mind but being armed with the right information helped him keep a level head.

“I read widely, but I also ensured that I sifted through the information I received on the pandemic and this really helped me remain calm,” he says.

He will forever remain indebted to the frontline workers including the team of doctors, nurses, nutritionists, lab technicians and even janitors who journeyed with him on the road to recovery. 

What was even more puzzling to him was the fact that all the services rendered, including tests, accommodation and even meals were all free of charge.

“They did not charge me for anything, all the expenses were covered,” he says, adding that this is not the case in most African countries.

After 22 days in isolation and a series of tests, Songa was finally declared free of the disease and was given a clean chit to return home. This was followed by another 14 days of self-quarantine.

Apart from taking seriously the precautionary measures put in place to curb the spread of Covid-19, Songa cautions against the stigmatization of people who suffer the disease, saying that this would only be regressive and counter-productive in the fight against the pandemic.

By Tesi Kaven

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