Dr. Esther Munyoro

Dr. Esther Munyoro is the Cofounder and Coordinator of the Palliative Care and Pain Unit at Kenyatta National Hospital in Nairobi, Kenya – the first palliative care unit in a government hospital. The unit serves to offer palliative care education to all local healthcare workers. She also introduced the use of oral morphine into the Burns Unit at Kenyatta National Hospital and continues to consult with the unit.  She is a member of the Hospital Transfusion Committee and a Board Member and Vice Chairperson of Hope for Cancer Kids, a group that lobbies for the welfare of children with cancer.

The are some patients who make you realize what palliative care is.  An old lady had been referred to the Nairobi Hospice [when Dr. Munyoro worked there].  She had just come out of surgery for a mastectomy at Kenyatta National Hospital.  I just looked at her face and I thought she must be in a lot of pain.  So I sat her down, and I offered her some painkilkers.  She was very reluctant to take the painkiller, but I didn’t understand what the problem was. So I told her just take the painkiller and then we are going to talk.  I said, “Tell me about your pain.”  She said, “Why won’t they take care of me?  Then I realized that the wound was not the pain. 

Her daughter was throwing her out of her house, her husband was in the village alone, and she was very angry with God, why was he doing this to her. At that moment, then I understood what it meant that it’s the patient who defines what quality of life means to them, because when I looked at her wound, I thought it was causing all the problems. But she had a problem with her living circumstances, she had a problem with her inability to adjust to the fact that she had cancer, that she was no longer able to provide care for her husband.

Palliative care is for anyone with a life threatening illness.

One of the challenges, and solutions, is education, education and more education, and the patients must be able to demand their rights. 

One of the things we’ve done is that palliative care is now part of the [medical school] curriculum, and we also need the concept to be understood by the community.  The community does need to be able to help the palliative care unit because our funding is quite a problem and sometimes there are things that can be done to improve quality of life that the very poor people are not able to buy, like medication or devices. I think it’s important for the community to understand the concept and then to help fund the concept.