Since its inception in 2006 Ndi Moyo Palliative Care Centre in Salima has provided care to over 1,900 patients. In addition to the direct patient care, Ndi Moyo also trains and mentors health professionals in palliative care through the Palliative Care Initiators’ Course which is aimed at equipping health professionals with knowledge and skills necessary for the provision of quality palliative care in their respective health facilities. These trained health professionals are followed up in their health facilities for further mentoring through Palliative Care Support Visits. These visits also help to identify challenges and possible solutions regarding palliative care. From 2015 to 2019 Ndi Moyo trained over 80 health professionals from different health facilities across Malawi.  Courses have been temporarily suspended during the Covid pandemic.

One of the health facilities that benefited from the Palliative Care Initiators Course & Support visits is Zomba Central Hospital in the southern region of Malawi. It is a major referral hospital for Malawi’s eastern region. Ndi Moyo trained two nurses and one physiotherapy assistant from the site. Before these personnel were trained, palliative care was not active at the site and patients suffered because liquid morphine was not always available and there was no specific room for palliative care.  After their training Ndi Moyo followed up to help them establish a better palliative care unit and provided them with essential palliative care medicines such as oral liquid morphine and Bisacodyl.

The trained providers with their mentor during a mentorship visit.
Like any other government facility, the Zomba Central Hospital has continued to face challenges which included unavailability of liquid morphine, lack of full time palliative care personnel in the palliative care unit (despite the three trained personnel) and use of a room dedicated solely to palliative care.The management of Zomba Central Hospital were engaged to discuss the challenges and map a way forward.The facility responded very positively by addressing all the issues that stood in the way of delivering high quality palliative care services.  Zomba Central Hospital is now one of the health facilities with outstanding performance in the provision of palliative care services with patients being provided with quality care and essential medicines along with trained providers always available for them.
Making palliative care accessible to patients
Home based care remains the most effective mode of palliative care provision in Malawi. Ndi Moyo conducts an average of 80 home visits in a month with a catchment population of 5000 people needing palliative care.Due to bad terrain, poor road network and long distances to most villages, Ndi Moyo has taken palliative care service to their homes through home visits. In addition, Ndi Moyo conducts outreach clinics at three health centres from the 12 government health centres. The clinics are located 35km to northern and southern part of Salima respectively.
This is Nester the oldest palliative care nurse teaching a guardian how to measure liquid morphine during home visit.The use of cars has been the most effective way of reaching patients but due to financial constraints Ndi Moyo Palliative Care Trust is facing, motorbikes have been recommended so that the cost of running vehicles is reduced as a mode of sustaining the service. The furthest health centre is 50km and it is a private health centre owned by the Christian Health Association of Malawi.
This prompted Ndi Moyo management to embark on training its nurses in riding motorbikes. The training was designated to two youthful nurses who have completed the training and have licences to ride motorbike.  Covid-19 has halted home visiting patients, however the clinic will re-start visiting once the Covid-19 precautionary measures have lessened.
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Farida’s Story
Farida Mussa is a 21-year old school girl completing her secondary school education in the Central region of Malawi. Farida came to Ndi Moyo Palliative Care when she was 17 years old when her right leg became swollen.  Fortunately her mother had heard about Ndi Moyo through a friend.
Upon examination the leg had Kaposi’s sarcoma lesions on it and her health passport book documented that she was HIV positive. The palliative care journey with Farida has not been that easy as she blamed her mother for transmitting the virus to her. Ndi Moyo team helped Farida via counselling and in all aspects of life, physically, socially, spiritually and emotionally. Farida started chemotherapy and also received pain and symptom control medications.
However, each time Farida came for review her health status was deteriorating. As a team we monitored how she was taking her Anti Retroviral Therapy, and checked her viral load, where the results showed a high viral load which was a sign that she was not taking her Anti Retroviral Therapy properly. We referred her to a psychosocial counsellor within our District Hospital for monitoring and to have lessons with her. In a few months Farida started feeling well again, had gained weight and looked much healthier.Farida receives school fees and scholastic materials from Ndi Moyo’s vulnerable children’s fund. She also gets monthly food supplements like cream of maize 10kgs, 3 bottles of sibusiso and 10 packets of soya pieces from the clinic.
Breast cancer is the number two cancer affecting women after cervical cancer.
‘MC’ was enrolled on the Ndi Moyo programme on 13th April 2021 with diagnosis of breast cancer. She came in with symptoms of severe pain and a pricking sensation on her left breast. Upon examination, MC had a big wound on her left breast with foul smell, pus discharge and some bleeding. Clinically she really looked to be in severe pain due to her advanced cancer.  This had started as a small breast lump and then swelling of the breast which eventually led to a fungating wound. She had used traditional medicine before going to the hospital and it was already in advanced stage.
At Ndi Moyo the patient was given holistic palliative care to improve the quality of her life. She was started on oral liquid morphine to relieve her severe pain. The wound was cleaned and treated with crushed Metronidazole to prevent the foul smell. She was given Tranexamic acid to control bleeding.  MC was advised to go to Kamuzu Central Hospital, over 100 kilometres away from her home village, for biopsy and possibly palliative chemotherapy. Unfortunately she had no money for transport.  Ndi Moyo came in to support her with transport money and also provided food supplements to help boost her immunity.
Although MC has an incurable condition with distressing signs and symptoms, she can now what time she has with the pain relieved and foul smell no longer there. Socially she is supported to minimise her worries and her children are supported with scholastic materials from Ndi Moyo.
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