Managing Pain and Adding Comfort: A Day in Atupere Phiri's Life

To help people suffering from long-term debilitating illnesses, Partners In Health partnered with the Malawian Ministry of Health and the Palliative Care Support Trust, a charity based in Blantyre, to launch a palliative care program in 2012 in Malawi’s remote southern district of Neno. Since its inception, the program has provided clinic- and home-based care to 225 patients living with health conditions such as Kaposi sarcoma, cervical cancer, hypertension and stroke, and liver cirrhosis.

Atupere Phiri is the program’s lead clinical officer and a trained health care provider known for his commitment to his patients.

Here he describes a day he and his team spent visiting patients, helping them to manage their pain and discomfort.

At 9 a.m., as usual, our palliative care team gathered for home visits around Neno. There were three of us: Judith Kanyema, a palliative care nurse, Knowledge Chaima, our driver, and me. Five patients expected us today.

Nurse Judith Kanyema measures Rachel Mpakati’s blood pressure, while Atupere Phiri takes notes.

By 10 a.m., we arrived at Rachel Mpakati’s* house in Nyakoko Village, which is about six kilometers from the nearest clinic. After a stroke six years ago, Mpakati suffers from partial paralysis. We visit her regularly to monitor her blood pressure and make sure that she takes her medication for hypertension. Thankfully, Mpakati has very supportive daughters who help make sure she takes her medication, sometimes coming to our offices to fill her prescription.

Since we started seeing her, she has done well. Her blood pressure is always normal, which is good.

Phiri, Kanyema, and Chaima travel to visit their next patient of the day.

Next we visited John Sachali, who has been in the palliative care program for more than three years now, and whose story is a constant reminder to me of the impact of our work.

When Sachali arrived at Neno District Hospital, which PIH supports, in 2012, he was in excruciating pain and was too weak to walk. Doctors diagnosed him with HIV and two forms of meningitis, and referred him to our team to begin physical therapy and treatment for his infections. We also worked hand-in-hand with clergy to counsel Sachali through his depression, and we assisted him financially and helped renovate his home through another PIH program that provides social support.

Phiri and Kanyema talk with John Sachali at his home.

Today, Sachali is walking with the help of an aide and enjoys a happy and productive life. During our visit, we made sure that he is still taking his drugs and provided some pain medications for his aching limbs. He also complained of some problems with his catheter, which he has needed for the past two years during his illness. We made a note to look into referral options for urological care.

As we prepared to leave, Sachali presented us with several tree saplings as a parting gift. Such kind gestures remind me how much patients appreciate the care we provide and motivate me to do more to improve their quality of life.

The road to Mphatso Phiri’s home in Neno District.

It took us about two hours on Neno’s winding dirt roads to reach our next patient, but we finally met Mphatso Phiri and his family at his home around 1:30 p.m. Phiri, a 48-year-old man from Ndoma Village, had completed chemotherapy for Kaposi sarcoma before he joined the palliative care program in 2012. We monitor early signs of cancer recurrence and other complications.

He’s been experiencing muscle contractions in his arms and legs, causing severe pain in his joints, so we’ve been providing pain medication. We were pleased to see that today he was able to walk around his house, a task that proved too painful during past visits. He told us he’d started working in his garden again, which was amazing. We couldn’t believe that. He once thought he’d die or be left crippled, but he’s now living happily.

Kanyema, Phiri, and Mphatso Phiri discuss his progress in the palliative care program.

As we walked back to our vehicle, the family generously offered us “nsima”—a traditional Malawian lunch made with maize flour—but we had to decline to reach our next patient in time.

At 81 years old, Emily Muleso, our fourth patient, suffers degenerative arthritis, so we provide painkillers. She was also diagnosed with hypertension, which we monitor and treat with medication. She’s frail and lives more than 10 kilometers from the nearest clinic, so she would not have access to this care if we did not make the trip to her house.

Today, we checked her blood pressure and resupplied her medication. Mphatso Phiri actually referred Muleso to us. This tells me that we’re doing good work.

An impassable road, washed away by rain, means Kanyema, Chaima, and Phiri can’t reach their final patient of the day.

Our last patient was new; we were enrolling him because he has advanced diabetes. Unfortunately, the road had washed away about 2 kilometers from his house, and we were unable to reach him. I will have to reschedule the appointment and return on a motorbike.

By the time we returned home—about 3 p.m.—we were exhausted. But there is nothing as rewarding as working with these patients. Caring for the chronically ill can be physically and emotionally draining because effective palliative care requires constant empathy and a genuine connection with patients. It requires a heart of caring.

But I take pride knowing how vital these services are to the overall wellbeing of our patients and families. We are not just prolonging their lives, but adding happiness and meaning to them as well.

Kanyema dispenses drugs for patients to take until their next home visit.

*Patients’ names have been changed to protect their privacy.