Samwell

by Nicholas Pfosi

Samwell Mosota Omaiyo sits up in his bed on Sunday afternoon at the Texas Cancer Centre in-patient facility in Nairobi, Kenya on Sunday, Aug. 23, 2015. He was recently diagnosed with late-stage mandible cancer and is extremely sick. The nurses who take care of him here at the Centre are trained in palliative care and tend to over a dozen patients around the clock in this small medical building on the outskirts of the city.

Although Samwell’s cancer is severe, he has been marginally improving over the past few days. After a visit, his family was relieved to find their 52-year-old relative had been experiencing more moments of lucidity.

Due to a lack of diagnostic technology and a stigma around cancer in Kenya, patients like Samwell often are not diagnosed until their illnesses become terminal.

At the Centre, all the nurses work exclusively with patients who have life-limiting illnesses. Part of what separates palliative care from other forms of patient care is the holistic approach to treatment. This includes caring for the patient's emotional and psychological well being as well as their physical needs, and working with their families.

Samwell, whose family visits him regularly, has his pain constantly managed through multiple high dosage opioids such as morphine. Since his cancer attacked his jaw, Samwell is unable to eat, drink or talk, receiving nutrients through an I.V. He is one of the few Kenyans who is able to receive pain management treatment.

The majority of medical professionals throughout Kenya -- and throughout much of the developing world -- are not trained in palliative care and pain management. Nurses in Kenya, unlike their Ugandan counterparts, are legally barred from dispensing morphine and other opioids to patients in need. They stand on the front lines of a national struggle with rising cancer diagnoses, HIV-related complications, and other life-limiting illnesses, but without many of the tools necessary to treat their patients' pain.

On Wednesday, Aug. 26, 2015, Samwell Mosota Omaiyo passed away due to organ failure early in the evening. He died peacefully.

A palliative care nurse, Carren Asembo, attended to him in his final moments. When his wife called to see how her husband was improving after a particularly lucid visit earlier that day, Carren had the responsibility of informing her of Samwell’s death. When asked about how she felt having to deliver the news, Carren said, “Nursing is not a job, it's a calling. Those who can't adjust and handle caring for others come, but they soon leave.”

Physician's assistant, Carol Apondi, center, and her colleague attend to Samwell. Although his cancer is late stage, Samwell has been marginally improving over the past few days. He has been recently experiencing more moments of clarity.

Due to a lack of diagnostic technology and a stigma around cancer in Kenya patients like Samwell often aren't diagnosed until their illnesses become terminal.

Physician's assistant, Carol Apondi, right, nurse Milca Mwankiki, center, and a medical student file patient logs at the Nurse's Station on the second floor the center. All the nurses working at the center have received specialized training in palliative care and work exclusively with patients who are terminally ill.

Nurse Carren Asembo checks on two patients at the Texas Cancer Center during the night shift.

A nurse holds Samwell's hand while his tumor is redressed. Part of what separates palliative care from other forms of patient care is the holistic approach to treatment. This includes caring for the patient's emotional and psychological wellbeing as well as their physical needs.

Samwell grimaces while physician's assistant, Carol Apondi, center, and her colleague provide Samwell with essential nutrients through an IV. Due to his mandible tumor Samwell is unable to eat, drink or talk.

Nurse Rebecca Nandinmaye removes Samwell's bandage.

Nurse Rebecca Nandimaye, left, and Carren Asembo, prepare medications at the Nurses' Station during the night shift. Most medical professionals are not yet trained in palliative care. These nurses, who are legally barred from dispensing morphine and other opioids to patients in need, stand on the frontline of a national struggle with rising cancer diagnoses, HIV-related complications and other life-limiting illnesses.

Nurse Milca Mwankiki talks on the phone with a friend during a break in her shift. For nurses like Milca who confront death regularly, connecting with friends and colleagues is an essential part of managing the stress of working in palliative care.

Nurse Carol Apondi rests her head in her hands during a break while family members visit patients.

On Wednesday, Aug. 26, 2015, Samwell Mosota Omaiyo passed away due to organ failure early in the evening. He died peacefully.

A palliative care nurse Carren Asembo, attended to him in his final moments and when his wife called to see how her husband was improving, she had the responsibility of informing her of his death.

Samwell Mosota Omaiyo's medications which will be sold back to the pharmacy to help save his family money.

Samwell Mosota Omaiyo's body in the holding room, approximately a day after his death on Thursday, Aug. 27, 2015. Omaiyo was 52 years old.

A janitor cleans a vacated room in preparation for the next patient.

Nurse Carren Asembo, who attended to Samwell during his final moments, when asked about how she felt following his loss:

Nursing is not a job, it's a calling. Those who can't adjust and handle caring for others come, but they soon leave.