Though life expectancy in Zambia is lower than developed countries, I have seen many elderly patients in Macha. Some come for regular check-ups for their chronic conditions such as diabetes or hypertension, but some come for acute illness. Some come with “weakness” because of their older age.
With limited resources, we do not have much to offer for their palliative care. Currently, we have an elderly lady at the hospital due to generalized weakness. She sleeps most of the day, and does not eat much. But, when I go see her, she smiles and says she is fine. My Zambian attending and I try to come up with her care plan, but it is very limited what we can do here. One of the nurses mentioned that there was a nursing home in nearby large town, but it seems that it is not operational right now. I regretfully ordered to place a NG tube for feeding…
There is another elderly female patient, petite and a big smile on her face every time I go see her in the hospital. She was admitted due to “a wound” on her breast for more than one year. It is about the size of a quarter, granulated and had some foul smell, but without pain. We also noticed that there is a palpable mass on her another breast. The axillary lymph nodes on the side of the wound are very hard and enlarged quite a bit. No doubt this is breast cancer, and already advanced. We performed biopsy, but it takes a while to get the result back. Besides, the result probably does not change our care plan for her – observation. We discharged her from the hospital today, and recommended her to get some wound care at the local clinic. When I asked her to take a picture with me, she smiled, and said yes. I showed her the picture, and she laughed and made even a bigger smile. As knowing a close American family friend being a breast cancer survivor, being a cancer patient myself, and just lost my own mother with pancreatic cancer, it was a heart-broken moment to discharge her while she had a big smile on her face.
No good answers or solutions to these situations. Only God knows, and I hope he helps them all.
