Pabalelong: Home of Love and Care

Growing old and being ill can be difficult in any country, but in Botswana the challenges are often compounded by lack of facilities to deal with terminally ill and disabled patients. Botswana is unique in the fact that most of the elders in the community are cared for in the homes of their children – there are no retirement homes or nursing homes here. This culture of home-based care for the elderly and terminally ill places a high burden on families that want to care for those loved ones but may be ill-equipped to provide adequate medical care. The families may have limited time, financial resources, and access to medical knowledge, not to mention the fact that they themselves may be in poor health and unable to perform some of the physical activities needed to give sufficient care.

This week we had a chance to work at Pabalelong Hospice: Home of Love and Care, a home for those in ill health and unable to be cared for in their own homes. Opened in 2010, Pabelelong is distinct in that it provides care not only to the elderly and terminally ill, but also to those incapacitated by chronic conditions such as TB, HIV and stroke. The hospice has 12 beds, and is surrounded by a wraparound porch, where patients enjoy sitting in the sun and socializing with visitors. Although the hospice sees many patients pass away during their stays, as opposed to the Western conception of “hospice” they also care for patients who are not terminally ill, but simply need extra care that their family is no longer able to provide.

During our time at Pabalelong we had the privilege of meeting a man by the name of Mr. Andrew – a 70 year old retired farmer who had suffered a stroke, leaving him paralyzed, and unable to communicate. Mr. Andrew was well cared for by staff, and well loved. Mr. Andrew refused to eat or drink at lunch on our first day with him. The nurses were concerned about him, and continued to offer food for the remainder of the afternoon. Near the end of the afternoon, the nurses investigated possible causes for his lack of interest in food or drink and found that his urinary catheter had become infected and was leaking. We assisted the nurses in removing the catheter, cleaning the patient, redressing his wounds, and attempting to provide him some measure of comfort. Despite his inability to talk, it was obvious that Mr. Andrew was in pain and suffering from a fever – a situation that we as nursing students were eager to fix immediately. However, there were no available antibiotics in the hospice, and none could be obtained until the next morning when the village clinic opened. Also, the strongest painkiller available to help Mr. Andrew weather the pain was Tylenol which we had brought with us to the clinic.

You might be asking yourself how this could be possible – a severe urinary tract infection, and no antibiotics or painkillers available? Almost incomprehensible to the American nursing student who is accustomed to stocked supplies of antibiotics from ampicllin to zythromycin, and an entire Pyxis of pain killers on hand for hospice care. While Botswana provides free or low cost drugs to citizens, the center receives no funds to purchase any medical supplies or drugs that are not directly prescribed for a patient. Patients must be seen at a government clinic or hospital to get their medications free. Therefore, if the hospice has an independent physician come in and consult, the prescriptions they write must be bought with hospice funds. In addition, the hospice receives no funds to purchase supplies such as bandages, gloves, IV solutions, or adult diapers. This places the hospice in a precarious situation – both in terms of provision of supplies and care. For example, the hospice is chronically short staffed, as they can only afford to pay two retired nurses, and cannot offer a salary attractive to anyone young enough to work in a hospital.

Our time in Pabalelong touched us, and truly reminded us of why we decided to pursue a career in nursing. Mr. Andrew’s struggle is one that is faced by many patients here, making Pabalelong an important source of community care and support.

Erin, Linden, Grace & Danielle