Tales from an African Hospice, as told by LOROS nurse Tracey Hinde

I stepped off the plane and the heat hit me. It was a dry heat; not a horrible heat, but definitely a dry one. We had spent 24 hours flying from the UK to Malawi, of which included three connections and to be honest, I was just happy that the numerous bags of medical supplies, clothes and stationary had all arrived safely with me and my colleagues, Rose and Cecelia.

We were the lucky trio of LOROS nurses that were selected to attend a trip to Ndi Moyo, a hospice in Malawi, Africa that we twinned with last year. A twinning that has been made possible from a gift left in their Will by John and Elsie Orr.

Ndi Moyo was founded by a couple called Lucy and Tony Finch. It is privately run and has an annual income of £170,000, with no government financial support, just fundraising. They have only 10 employees, in comparison to our 300 plus, while they support at least 1,000 more patients than us every year.

The aim of our eight day visit was to see how the hospice is developing their palliative care services, while finding out how the two organisations can benefit one another.

I’d been told what it would be like, thanks to colleagues who had previously visited, but nothing could have prepared me for what I was able to see over the next few days. From the moment we stepped off the plane, the poverty was clear. The conditions that some of the people lived in were awful; with many using their living rooms in their very basic straw-roofed huts, to keep their home-grown crops, either to sell, or to feed on themselves.

As we spent our first day settling in and finding our feet, enjoying breakfast as monkeys swung between the trees above us, it struck me that this was a totally different world to the one we know.

We spent the next week exploring the work of Ndi Moyo, which supports 4,000 terminally ill patients every year. Although they don’t have an inpatient unit, they have an outpatient facility, visit people throughout the community and invite families in to enjoy their day centre.

We visited a number of patients, most of whom were in their 40s and many of which had young children. It was heart-breaking, not only to see them suffering but also to see the conditions in which they were suffering. The ‘lucky’ ones slept on mats, while some had to spend their days lying on the floor. They were so happy to see us though; clearly a visit from the Ndi Moyo staff was something they looked forward to.

Later on, we re-visited a lot of the families with the community team, who regularly visit patients and their families unannounced to assess the conditions they are living in, mainly to ensure the children weren’t suffering. We helped the social team distribute mats for the youngsters to sleep on, mosquito nets if necessary, as well as clothes, stationary and books for learning. We’d taken some clothes, stationary and books over, so it was nice to see them bringing such happiness to so many little lives. They were such small things but they made such a huge difference; a concept we noticed was so often the case.

Some of the patients needed to be transported to the district hospital for their course of chemotherapy, so we made this trip with them too. To say the conditions in the hospital were heart-breaking would be an understatement. Some of the beds had no mattresses on, with critically ill patients sleeping on barely a frame. And, while patients were using the beds, it was clear that in most cases their relatives were actually caring for them, with nurse numbers drastically low. The nurses’ station was basic, with an over-flowing bin sitting underneath the desk; I couldn’t help but think back to the infection prevention staff at LOROS and how horrified they would be to see all sorts of rubbish spilling over the dustbin, which sat just metres away from extremely ill patients. The emotion I felt was overwhelming; a mixture of sadness and disbelief, as well as gratefulness for the conditions I work in back at LOROS.

Our final glimpse of hospice life in Malawi was in their day centre. Able patients are invited to spend the day in what is a dome-like building under the trees, which has a straw roof but no doors, walls or windows, allowing the breeze to cool everyone throughout the day.

The patients, who can bring their children along if they need to, make jewellery, play games, have their toenails painted and watch TV. It was so fascinating to see so many of them, sat, staring at the television, laughing along at every opportunity; they don’t have televisions in their tiny man-made huts, so watching television was clearly a privilege and something they didn’t do very often.

As we sat, painting toenail after toenail, which they all seemed to love, I reflected on my time working with the team at Ndi Moyo and I soon released that actually our two worlds were more similar than first thought. In fact, the passion and ethos over there is the same, the reason behind the work they do is the same and their goals are the same. They just want to make life as comfortable as they can for terminally ill patients they support, just like LOROS does. Unfortunately, they just don’t seem to have the facilities to do it.

It was so lovely to see such big smiles on faces as patients enjoyed their time in the day centre; proof that the work Ndi Moyo does makes such a difference.

I really hope that our visit benefited them. As well as the physical items we took over, we talked to staff about their own well-being and looking after themselves, which is vital, but something that seems to be so low on their list of priorities. We also shared with them our advice on speaking to bereaved children, whose parents have died; a concept that the staff struggled with and didn’t always know how to handle.

Best of all though, I’ve been assured that just our presence encourages them to keep going; showing them that we believe in what they do re-assured them to keep doing what they’re doing.

I was sad to leave. While we offered them lots of advice and support during our stay, I think we equally learnt so much from them too. They make the most of every single thing they have and they take absolutely nothing for granted. What I saw out there, both the hard times and the happy times, will stay with me forever and I feel so grateful for being given the opportunity to see first-hand the work Ndi Moyo does. It was an unforgettable experience.