Dr. Catherine Nyongesa

Dr. Catherine Nyongesa-Watta is the first and, as of yet, only female radiation oncologist in Kenya. She founded the Texas Cancer Centre in Nairobi in 2010 to address the serious need for additional cancer services in the region. Motivated by her personal story—seeing her younger sister suffering from uterine cancer while still in medical school at the University of Nairobi—Dr. Nyongesa has a reputation for empathy, even known to waive her doctors fees and subsidize the cost of treatment and medicines for patients in need.

A leader in her field, Dr. Nyongesa sees patients with cancer-related pain on a daily basis and is a vocal advocate for the use of morphine to control pain. At the point of diagnosis, eighty percent of the patients she encounters are already in the late stages of cancer, and dealing with severe pain as a result. Though she maintains that regular screenings for and early diagnosis of cancer would be the optimal way to control the disease, she is realistic about the current state of affairs, and adamant about the crucial role that palliative care and pain management play in the treatment of cancer patients.

Dr. Nyongesa shared some of her thoughts on palliative care, pain management, and morphine, including some of the challenges as well as what gives her hope.

As a doctor, what does pain mean to you?

It’s an expression of discomfort. And, when you say “pain,” that discomfort is usually unbearable. And then there are different types of pain, that’s more medical. It can be piercing, it can be throbbing pain, it can come and go. The intensity matters, so we’ll ask the patient, how intense is your pain? Is it mild, moderate or severe? It’s important to ask the patient how they are feeling.

If you could tell everyone in Kenya something about pain management and palliative care, what would you want them to know?

I think I would want everybody to be aware of that kind of option. And that it’s really part and parcel of managing a cancer patient. At one stage in their journey through this cancer treatment, they need palliative care. And sometimes a patient with cancer does not need chemotherapy or radiotherapy. All they need is comfort—somebody to be there, counsel them, talk to them, give them pain medication. Then even if they know that the end of life is coming, they can cope better. Because like I said, most of the cases we see are presenting late.

You see a lot of difficult things every day. How do you cope?

It’s not easy. I get attached to them. I lose them. Some of them it’s just so sudden, like, I didn’t expect this. And some of them you see it coming. But I know there’s light at the end of the tunnel, and we see some light coming in quite a number of cases. Because I see some happy endings, that light is what keeps me going. Otherwise I would break down. When I see a patient who came in a very bad shape and they’re improving, when I see them one year later, two years later, three years later, I get so happy. And that keeps me going. And I know there are some cancers which are curable. As a doctor, I do appreciate my limitations, and I pray a lot. Some things are beyond me, and if I’m not able to do anything, we let God’s will be done.

What do you think are the biggest challenges country-wide in terms of getting people pain relief?

I think just accessibility is the biggest challenge. And awareness. People are not aware. You know, people fear morphine. When you go and prescribe morphine, the nurses often hesitate. They fear, they say, Ah, if you give morphine, this patient maybe is not going to make it.  So I think with more awareness, and people knowing that actually morphine is safe and can be used in cancer patients when they’re in a lot of pain, it will help. And just make it accessible. In my practice, since we started getting morphine, it’s the most prescribed drug for our patients. It’s quite affordable compared to the other opioid pain killers. And it’s simple to take, for instance in syrup form. And we do not fear addiction. Because these are people who actually need morphine. And I’ll say, in our country—really—if morphine is made available, the majority of the time it will be used genuinely on deserving patients.

So do you think the general fear of morphine, both among healthcare professionals as well as patients and even the government is unfounded?

It’s unfounded. Morphine is a very safe drug. And if you can even just have morphine syrup accessible to most county hospitals, or ideally all hospitals in Kenya, it will really help.

Should nurses be allowed to prescribe morphine?

I don’t think legal issues are a big hindrance for the nurses prescribing. I’m sure they should be able to prescribe, so long as they are trained and empowered. You know, before, a nurse would not even give an injection. They would say they cannot fix an IV. But now, they’re fixing IVs. Even chemotherapy, they are mixing, you know, and administering to the patients. And because we have few doctors, if we empower more nurses, we help more people. You know, a nurse is a very integral part of patient care, especially for cancer patients, because it’s so easy to access a nurse—any patient can access a nurse from wherever they are. And a nurse can even visit them at home and deliver morphine, and explain to them how they should take the medicine.

It has been a bit slow for the nurses to embrace prescribing morphine. But I’m sure, with more training, more people will be willing to prescribe morphine. And in a place where there is no doctor, no clinical officer and no physician’s assistant, I think nurses should be allowed to prescribe the morphine. Because it will help a lot of people. I see people dying in pain—that should be a thing of the past.

Interview conducted by Elizabeth Mealey