“While pain management is a cornerstone of palliative care, so communication and networking opportunities should be a foundation of nursing.”
Sylvester Wambua-Mulyunga talks about his work in Kenya to build capacity and capability through education of colleagues, including community health workers, nurses and doctors
Just as pain can really isolate those who suffer it, so palliative care nurses, particularly in low- and middle-income countries, can find themselves feeling isolated.
While pain management is a cornerstone of palliative care, so communication and networking opportunities should be a foundation of nursing.
As a palliative care nurse practitioner, leader, and Secretary General of the Palliative Nurses Society of Kenya (PANUSK), I have had the opportunity to learn from global experts through my Fellowship in Palliative Care (2022) at the Institute of Palliative Medicine (IPM) and Masterclasses in Palliative Care (2022 & 2024) in India.
My visit to the Trivandrum Institute of Palliative Sciences (TIPS) further deepened my understanding of opioid use, telemedicine, home care services, and compassionate communities.
As a member of the GPNN I wanted to share my experience of taking the lessons I learned from those experiences when I returned to my practice in Kenya at Ikutha Hospital where I have been working alongside colleagues to improve palliative care training, advocacy and opioid access for patients in need.
Through a Hospice Care Kenya (HCK) grant, I trained 24 health care workers – nurses, clinical and medical officers from our three public and one mission hospital on basics and Pain Free Hospital Initiative, as well as an Introduction to palliative care to 30 Community Health Promoters (CHPs) in our Sub-County.
Drawing on local experience and the global expertise I’d accessed, we implemented an evidence-based set of practices to ensure safe and effective pain relief.
The first step is a comprehensive pain assessment using validated tools in line with the World Health Organisation Pain Ladder.
Recognising that constipation is a side effect of opioids, we always prescribe laxatives or stool softeners alongside them. To enhance the opioids’ effectiveness, we also combine them with adjuvants like antidepressants and anticonvulsants.
Effective pain control is as much about a multi-disciplinary approach as it is about medication. That’s why we work together as nurses, doctors, pharmacists and community health promoters to monitor and manager opioid use and side effects.
“Effective pain control is as much about a multi-disciplinary approach as it is about medication.”
Additionally, following my visits to India for TIPS and the IMP Masterclass, we now integrate a person-centred approach in our practice – using home-based care, telemedicine and compassionate communities.
That’s not to say things always run smoothly! We have experienced a number of challenges to optimal opioid use.
These have included shortages of the preferred opioids like morphine and fentanyl. A lack of specialist opioid prescribing knowledge and no funding for ongoing palliative care education are further causes of inadequate pain management.
While we would like to extend palliative care beyond the hospital setting, the lack of a structured follow-up system for patients on opioids make it difficult.
The final barrier to effective pain management is the absence of a strong advocate for resource allocation in the form of a dedicated person in the County Health Management Team.
There are five steps we need to take to strengthen and improve opioid access and palliative care in Kenya:
- Expand home-based care programmes to support patients outside hospital.
- Strengthen procurement systems to ensure a consistent supply of opioids
- Train more healthcare workers in opioid prescribing and pain management
- Secure more funding to support training, sensitisation and patient follow-ups
- Instal a dedicated palliative care focal person at county level to influence policy and budgeting
At Ikutha Hospital, we have witnessed firsthand how proper opioid use transforms the lives of palliative care patients. My global training and leadership in PANUSK have reinforced the need for stronger advocacy, education, and resource allocation to ensure that every patient receives compassionate, pain-free care.
By sharing this on the Global Palliative Nurses Network (GPNN) website, I hope to connect with fellow palliative care practitioners worldwide, exchange ideas, and strengthen our collective fight for better pain management.
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