Volunteer Brings Expertise in Palliative Care to Philippines
Project HOPE volunteer Carma is an expert in the field of palliative care. She is caring for Elenita, who has breast cancer, while participating in disaster response efforts in the Philippines.
Five years ago, Elenita faced the hardest decision of her life. At age 79, she was diagnosed with stage three breast cancer. A large tumor had developed in the upper right section of her chest and was slowly eating away at the flesh near her armpit. The doctor advised an immediate operation. But Elenita refused.
“I couldn’t have the operation and still buy food for my family,” she said.
Elenita’s daughter Jossie and Jossie’s seven kids were all living with her, making a lot of mouths to feed. The small pension that Elenita received barely covered the 22 lbs. of rice that they all ate each week. As a well-loved former teacher, grown students would stop by to visit and joke with her about the days when she was still pudgy and strict with her classes, slipping a little money into her hands on the way out. But with Jossie unemployed, times were still tough.
When the Project HOPE team met Elenita, in the women’s ward at Tapaz District Hospital, she was skeletal but still elegant and poised, greeting the group with perfect English and a wide smile. The tumor had broken through the skin and was ulcerating, creating a wide, open wound that even Jossie refused to look at. It had been bandaged with a baby diaper. The typhoon had destroyed the family’s home and most of their possessions and they were taking refuge in a relative’s vacant house. Anxiety was clear on Elenita’s face, in her pleading expressions.
“I am done. I cannot stand this anymore. But I’m afraid: I have no money and I need to prepare for my grandchildren,” she admitted.
“She’s dying,” explained HOPE volunteer, RN Carma Erickson-Hurt. “But can she die well? That’s the ultimate goal with her: to have a good death. And for her daughter to experience that.”
Carma began to visit her every day, organizing a party in the hospital conference room, complete with cakes, balloons and decorations to celebrate Elenita’s 84th birthday. She inquired about the specific benefits due Elenita through her teacher’s health plan, learning that she was entitled to pain medications free of charge. She brought in HOPE volunteer and surgeon Mateo Rodriguez to help explain to Elenita the changes that were happening to her body. Finally, she picked up new dressings and exchanged the baby diaper for a bandage. As Carma finished gently winding the stretchy Ace elastic around her torso, Elenita’s face came alive and her arms swung up high.
“Now I can dance. I can move!” she laughed, rocking herself up and down on the hospital bed with her arms pumping.
Carma is an expert in the field of palliative care– an approach that focuses on a patient’s quality of life– teaching courses and organizing curriculum on the subject for multiple colleges and universities, as well as working as a palliative care nurse. “Palliative care is a holistic type of care: it is physical, social, spiritual and psychological. The medical/physical aspect is just ONE of the four focus areas. And it works because we focus on everything,” said Carma. “Yes, Elenita needed some Tramadol, but what she really needed was human contact.”
Carma continued that day’s visit by asking Elenita what she wanted that day. “I want to rest only,” said Elenita. “And I can now, because you are here. I had nobody to talk to. You are the first people who cared.”
“To everyone else, she has a specific role,” said Carma later about Elenita’s comment. “For her daughter she is mom and everything that comes with it. To her nurses she may be a body to take care of. I don’t think she felt that she could be in the role of “cancer patient” to anybody. I see her as a person and she has responded to that.”
Elenita surprised Carma by following up her comment with a blunt question, “So tell me, when is my expiration date?”
Carma responded that she didn’t know. But what she did know she told her: “When you stop wanting to eat and drink, and it’s harder to breathe, that’s when you know you only have a few days. Eat just a little but frequently through the day. Make sure to ask for pain medication when you need it.”
“There is a lot of fear around the dying process. It’s a fear of the unknown,” said Carma. “Maybe the patient has known someone who died terribly. It just gives a person peace to know how it will happen.”
Carma is planning to see Elenita every day that she is in Tapaz. And she is organizing some follow up care with the next HOPE deployment. She is also planning a session to teach hospital nurses the basics of palliative care.
“It’s about managing pain and symptoms. Making sure nurses know to give her pain meeds as she needs it. Maybe to bring in the priest if need be. Making those connections for people. And once they have the knowledge they’ll feel empowered. Would it be better to have the fancy medications that we do in the U.S.? Yes. but I think they’ll be able to do it with what they have.”
Carma added, “People don’t think in a disaster situation about palliative care. We focus on the acute, but we need to really focus on these patients too.”
She reflected on Elenita. “In the end, we are taking a situation and making it not so bleak.”