Ken Cornetta – (Not) back home again in Indiana

Ken Cornetta Not back home again

I'm finishing up my first week in Eldoret, Kenya; though, this is my third trip here to work with the Palliative Care program at the AMPATH Oncology Institute. My first two trips were part of my fellowship in Palliative Care and supported by Greg Gramelspacher and Lyle Fettig who run the fellowship program at IU. For me, palliative care has been a lifelong interest, but one that I came into late in my career. Previously, I spent 23 years as a faculty member doing clinical work in bone marrow transplantation and running a research laboratory in gene therapy. In some ways, my career has been the polar opposite of palliative care.

For those unfamiliar with palliative care it is a relatively new specialty that focuses on the quality of life in patients with a terminal diagnosis. We concentrate on minimizing pain and suffering, but also help the patient and their family decode "physician speak" in order to weigh aggressive interventions versus comfort care. In the US, the decision for many patients is when it is appropriate to forego aggressive therapies like mechanical ventilation, dialysis, or resuscitation in favor of focusing on care at home. For many, end of life care involves hospice.

In Kenya, aggressive therapies are not available to the majority of patients. Ventilators and dialysis are extremely limited resources. Moreover, they are financially prohibitive for all but a few. Nevertheless, patients and the family are faced with the same challenges around decision-making as those in the US. Questions such as, "What is wrong?" and "Can I get better?" are shared issues across cultures. All patients and families hope to maximize the quality of life for as long as possible.

While the emotions are similar, the practice of palliative care differs. Palliative care patients generally present with very advanced diseases. In Kenya, medical expenses must be paid up front and it is common for patients to sit in the hospital for a week or more waiting for the family to raise money for a biopsy or CAT scan. Each hospital ward has a cashier so families can pay for the antibiotics that their loved one needs. It is always heartbreaking to witness a family forced to make the decision that their loved one, which could be a child, will not get the chemotherapy or radiation therapy that they need.

I am honored to work with an outstanding palliative care team at the AMPATH Oncology Institute. They are a group of wonderfully caring clinicians, social workers, and nurses. They see patients in the hospital and those in outpatient oncology clinics. They also run a 24-hour hotline for patients to help manage pain and other symptoms. Don't get me wrong, there are many barriers. Oral morphine is the only available opioid medication and getting refills to patients that live long distance is more than a challenge. Nevertheless, the team finds novel ways to get patients what they need. With one week under my belt I am still processing the patients I've seen and hope I am contributing. I'm over the jetlag, but with the time difference I am still having trouble falling asleep. The need here is so great and every day I struggle with how I can do more.

Ken Cornetta, MD
Director, Inpatient Palliative Care
IU Health Bloomington Hospital
Professor of Medical and Molecular Genetics
IU School of Medicine

 

Posted at 06:26

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