Near the shore of Lake Victoria in Tanzania a man roughly in his 40s or 50s lays on a mat, his arms and legs immobile from the effects of the poliovirus.
Ramadani contracted polio at a young age and his mother has been his primary caregiver for his entire life. As he grew, the virus spread through his body and he developed paralysis, unable to walk, sit up or use his hands.
Each day, Ramadani’s mother carries him out of his small home to lay on the mat next to his stoop. Nearly 100 feet from his home is the shore of Lake Victoria, which spans over 200 miles and connects Tanzania, Kenya and Uganda. But Ramadani won’t see this view, he can’t move without assistance and he relies on his mother and the others in his small community of huts to take care of him.
Despite this Ramadani is expected to provide an income for his family. He fulfils this expectation by making soap, which he sells to people on their way to the lake to wash their clothes.
Even with such vast physical limitations, Ramadani is rarely without a smile when visitors come to his small shack.
Dr. Alex Nesbitt, medical director of The Gatehouse and Family Hospice, part of UPMC Home Healthcare of Central Pennsylvania, first visited Ramadani nearly 12 years ago when he traveled to Shirati, Tanzania, to see the new palliative care department he and his team in Williamsport decided to help fund.
The growth of palliative care in the United States began in the 1980s as it became evident there was more care needed for people with chronic diseases who did not yet qualify for hospice care.
After realizing the importance of palliative care, Nesbitt spearheaded efforts to implement it in the Williamsport region.
But Nesbitt didn’t stop at palliative care for Lycoming County.
“When you see how it is for most humans when they have serious or advanced disease … they don’t have any of this support. That’s millions and millions of people and hundreds and hundreds of thousands of children,” Nesbit. “There were several of us who looked into that and thought maybe there is some way we could help or give funds so that some people somewhere else …. it’s a little better for them.”
Nesbitt advocated for an international support program for two years. After receiving approval, Nesbitt looked for the right program to partner with, ultimately finding the Shirati KLM Hospital in Tanzania. He was shocked to discover the hospital staff had already started a palliative care program without the funds to support it and had also been working for two years to find funding.
“Here there is a human being,” said Dr. Chirangi, medical director at Shirati hospital. “We’re here to serve or to help each other. It is our responsibility to help others… If we don’t do that, people will be dying by pain.”
The full-time coordinator of the Shirati Palliative Care Department is Dorothy, a registered nurse who is a powerhouse of the hospital. Dorothy’s position is key to organizing the palliative care efforts and is fully funded by donation from the team in Williamsport.
In addition to Dorothy, two doctors, Chris and Biko work with the palliative care department, as well as a number of other chaplains, social workers and volunteers.
Even with this effort, providing end-of-life care for free is a daunting task. The region surrounding the hospital is home to over 80 villages and towns, but only five are served by the palliative care team.
Through donations from its partnership with Williamsport, the hospital is able to provide care to patients like Ramadani through pain medication, wellness checks, spiritual support and family support.
“It is a holistic approach,” said Dorothy.
The resources of the palliative care team include a handful of motorcycles, an office building at the hospital and use of the hospital’s one range rover.
When they have enough money to purchase pain medicine it is supplied to the patients who need it, and when there are no drugs the team continues to help and support in any way they can, according to Chirangi.
It’s been 12 years since Nesbitt’s first visit to Shirati. Since their partnership began the group has been able to help many people live and die surrounded by love and support.