Thomas is 16-year-old and lives in a rural village in Kenya with his mother and four siblings. He loves to go to school and play soccer. Two months ago, he began experiencing pain and swelling just below his left knee. As the swelling and pain increased, his mother, Naomi, was alarmed and decided to take him 50 km to a hospital in Eldoret, Kenya, the nearest urban hospital to their rural village. Naomi stayed at the hospital with Thomas for 4 days as the diagnosis of osteosarcoma with lung metastasis was determined. Unfortunately, Naomi had to return home, so she could work and care for her other children. Naomi was heartbroken leaving her son at the hospital, knowing doctors were going to amputate his leg the next week, and fearing that he might die before she could return.
Thomas remained at the hospital in Eldoret for 1 month after doctors amputated his left leg. The postoperative days were difficult as Thomas experienced an infection in the stump and became septic. The numerous dressing changes were time-consuming and due to lack of staff, the dressings were not always changed as they needed to be. Thomas' mother, Naomi, was very distraught after learning about her son's infection. She wanted to bring him home, but she worked full-time, provided care for her four other children - all under the age of 8 - and for her ill mother, who lived close to her in the village. She had to continue to work to pay for Thomas' medical expenses. The palliative care team at the hospital in Eldoret spoke with Thomas and his mother about moving him to Kimbilio Hospice, a few kilometers from their home. As Thomas' disease progressed, his care became more complicated. His pain and dyspnea became more acute; his wound care more intricate and time-consuming and he required more frequent assessments. He appeared to be depressed, stating he was "lonely." Thomas' mother and siblings wanted to be closer to him so they could visit frequently, as Thomas was very homesick. After being assessed by both the hospital's palliative care team and a nurse from Kimbilio, the team recommended to Naomi that Thomas be transferred to Kimbilio. Two days later, the transfer occurred, after the hospital social worker's assessment of the family's financial needs justified the waiving of the remaining hospital costs. Although he was critically ill, Thomas was grateful to be closer to his home so that his family and friends could visit. The nurses provided oral morphine before each dressing change, and when Thomas was experiencing pain. His pain scores decreased dramatically. His dyspnea also was improved by the oral morphine. Thomas' school teacher came to Kimbilio for a visit and brought greetings from his classmates. Thomas was grateful to know that he was being remembered by so many friends. The social workers spent many hours providing counseling to Thomas, Naomi, and Thomas' siblings. The chaplain delivered spiritual support. Three weeks after his transfer to Kimbilio, Thomas died peacefully, with his mother at his bedside. Today, Naomi and her children receive bereavement care from both the Kimbilio social worker and chaplain, who make home visits throughout the villages.