Good mobile nursing is a challenge

Thursday, April 28 2005 New Straits Times: Life & Times
Tender Care Till the End

For families who want the best possible options of care for their loved ones — especially those who have been written off by doctors and hospitals, the services provided by the Home Nursing Providers may be just what they need. SARAH SABARATNAM writes.
WHEN my father's health began its inevitable decline in January this year after battling cancer for more than two years, the family immediately looked at options for nursing support at home. Caring for him had been manageable in the past but he was fast deteriorating and had become bedridden. We wanted to know how we could make him as comfortable as possible. We needed help with the physical aspects of caring for him when my sisters and I were at work and my mother was alone with him. We also wanted to be prepared for any medical eventuality. We found just what we needed in the form of the Home Nursing Providers. Not only were the staff willing to come to the family home in Rawang — which was out of the work zone of other palliative care providers such as Hospice, they were very professional and compassionate where nursing agencies were not. Private nursing agencies we called offered us limited options: we could take a nurse for a minimum of eight hours a day, or nothing. They were expensive and although we were willing to pay whatever it costs, we were not sure we needed someone for so many hours. There was no consultation or assessment involved; the nursing people seemed interested only in making a transaction. The people behind the Home Nursing Providers surprised us. Yakob Abdul Rahman W. Scholer, the outfit's managing director and nursing officer, turned up at our doorstep just a few hours after we called him. YAKOB: ‘While we may not be able to add days to a patient's life, we can add life to their days'. He told us he could only make an offer on the kind of service that would be provided, and its costs, after meeting the patient and making an assessment. He spent almost 20 minutes with us discussing my father's medical history, asking us what we felt we needed from his side, and what our concerns and fears were. Then he examined my father and gave us his assessment. After more discussions, he made suggestions as to how we could care for our father, what material we would need to make him comfortable, how to prevent bed sores, and how to care for his skin. He assigned us a nurse, at our request. She would come in for one to two hours a day, and help my mother wipe my father down and change him, check his blood pressure and pulse, change his dressings and do whatever else was necessary. He confirmed that it would be unnecessary to employ a nurse for eight hours. Although a nurse had been assigned to my father, busy Yakob continued to drop in regularly, to check on us, all the way from his office in Kelana Jaya. He never seemed in a rush and would spend time talking to family members, counselling, reassuring and preparing us for the inevitable. They charged only for what was necessary and based on what kind of nursing or care was provided. Everything was itemised and a daily log was kept. We found, later, they were less than four times as expensive as some of the nursing agencies we called. They promised round the clock availability. We could call them any time there was an emergency, or if we simply had a question. Yakob even gave us his handphone number. “In Malaysia, it is very difficult to get doctors to make house visits. We can fill in this gap,” he said. The Home Nursing Providers don't just provide nursing services for the terminally ill. The staff also work at rehabilitating patients that doctors have given up on. Wan Nor Gat Ismail, 77, is one such person. He had been bedridden for three months when Yakob was assigned to him in January this year. Pak Wan's wife, Kalsom Amir, 72, says that at that time, her husband was just tunggu mati (waiting to die). MAKING HOUSE CALLS: Yakob helping Abdullah with his exercises. Mobile nursing can help where the doctors leave off, relieving the stress of patients who would rather be at home. The doctors had found nothing wrong with him, despite keeping him hospitalised in Alor Star for a month. Yet he was fast deteriorating. He was constipated and had no appetite. Within a month he had lost almost 20kg. He could not go to the toilet himself. He hardly ate. He became incontinent. By New Year's Day, Pak Wan had been bedridden for three months. He was so skinny his dentures could not fit. And when they put him on the toilet bowl, he almost fell through the seat, for he had lost all the flesh on his rear end. But seven months since he first became bedridden, Pak Wan is on his feet, greeting us as we arrive in his daughter's house in Bukit Jelutong, smiling and proud of the fact that he shaved himself that morning. The transformation is attributed to Yakob's special touch. “My daughter discovered Yakob about four months ago,” says Kalsom. “Now my husband can walk and eat. He is going to the toilet himself. Yakob takes him to the park to exercise every day. His progress had been so good, we are thinking of going back home to Alor Star next month,” says Kalsom. The Home Nursing Providers provides mobile nursing services in the comfort of one's home. For families who want the best possible options of care for their loved ones — especially those who have been written off by doctors and hospitals, the services provided by the Home Nursing Providers are just what they need. “While we may not be able to add days to a patient's life, we can add life to their days,” says Yakob. He says that many people assume that as people get old or sick, they must become slow, lose their muscles and deteriorate physically. “This is not true. With some exercise, motivation and the right amount of nursing, they can improve so much.” A family member of another patient attests to this: “The doctors had given my father one week to live, but under their (Home Nursing Providers) care, he lived a month and even improved so much that for a while we thought he was going to survive.” The mobile nurses believe in early intervention and rehabilitation, unlike doctors who focus only on treating the illness and give very little attention to the physical, emotional and psychological needs of the patient. Besides, the longer a patient is kept in a hospital, the more sick he becomes. This is especially true of elderly people who find it hard to adjust to the hospital setting. Instead, mobile nursing can help where the doctors leave off. “It can save families a lot of money, and relieve the stress of patients who would rather be at home,” says Yakob. Mobile nursing is also a better alternative to nursing homes. “People who end up in nursing homes feel rejected, unwanted and a burden. They tend to go into depression and fall ill easily. Studies show their life span shortens dramatically because they have no purpose in life.” Yakob and his staff help nurse elderly people whose family finds it beyond their capability to look after. Or they can help make the days of a dying patient bearable, comfortable and free from unnecessary stresses. They provide necessary equipment such as oxygen compressors, ripple mattresses, hospital beds and cushions to prevent bed sores. They check on the person's blood pressure, sugar level, heart rate, eating habits and so on. They can install catheters and tend to dressings. Mostly, they are there for patients who are no longer in need of medical attention but in need of nursing. Yakob, who has had extensive experience in mobile nursing in Germany and had spent many years nursing in Malaysia, believes that mobile nursing has to meet two important criteria. Firstly, he says, there must be transparency. “The family of the patient must be consulted, involved and given decision- making power. Just like someone should be able to walk into a shop and choose what he or she wants to buy, the family must not be pressured. There are nursing agencies which impose on families very limited options.” Secondly, mobile nursing must be accessible and available to everyone in need of it. “A minimum service must be given irrespective of financial capabilities. The minimum would be to teach the patient's family how to do general nursing, and this can be done in a relatively short time to willing parties.” He says a lot of families want the best “but everybody should have a right to this best, according to their budget”. A complete one and half hour coaching and consultation, says Yakob, is only RM75 which is within the reach of an average income earner. “Mobile nursing is different from hospitals. You are not dealing with the patient alone but the whole complexity of a family setting. When there is more than one person, there is more than one idea, or opinion, or expectation, or emotional contact with the sick patient.” This is where he says mobile nursing, as provided by the outfit he runs, differs drastically from the hospital setting, or the standard of services provided by some nursing agencies. “Our nurses are taught to be sensitive. We give a clear picture of what can and cannot be done. We give the family options. Respect for the family has to be the highest criteria. They get the last say. I cannot impose my nursing experience or ideas onto the family. It is not acceptable. My duty is to show them options and consequences, and then they choose.” The patient too, if able, should be included in the decision-making process. Most families who have utilised the services provided by the Home Nursing Providers are struck by their compassion and commitment to their profession. The son of one of Yakob's patients says, “We are the lucky few that managed to get Yakob's full attention. He is such a knowledgeable person, caring and, of course, very dedicated. Sometimes I just wish there are more of him so that he can attend to my father's rehabilitation more often in a day. My father, Haji Abdullah Haji Shukur, is 90 and suffers from a paralysis due to a stroke some years ago. I wouldn't know what to do and how to care for my father without him and his nurses.” Note: The Home Nursing Providers Sdn Bhd is located in Kelana Jaya and can be contacted at 03-78777202 or through email: hnpys@streamyx.com. Visit its website at HNP-mobilenursing.com Nursing is Yakob's Passion YAKOB Abdul Rahman Wilhelm Scholer (right) first came to Malaysia in 1957 to join the Catholic Order of the Brothers' of Mercy who were running the Fatimah hospital in Ipoh. “I have been fascinated about Malaysia since my teenage years. I remember reading about the Sultanate of the Straits of Malacca which records the fights between the different States and their Sultans. “Later on, I came across several books about Asia. This part of the world fascinated me,” he said. When he had the option of going either to Brazil or Malaysia to work, he chose the latter. Since then, he has gone back to Germany several times to further his study and expand his experience. But he keeps coming back to Malaysia. He has previously worked with a mobile medical team during the emergency period in Ipoh, and was founding member and manager of the Yayasan Pusat Pertolongan in the 1970s which was Malaysia's first drug rehabilitation centre. He also founded Yayasan Alkoholisma Malaysia in the 1980s and was involved with the nation's first all-female drug dependents rehabilitation centre at around the same time. He also helped set up the first non-governmental organisation (NGO) for the awareness of HIV/AIDS in Malaysia and the AIDS Hotline, which later led to the development of the Malaysian AIDS Council. He has also spent many years doing street work. Nursing remains his biggest passion and he, together with the owner of the Home Nursing Providers (who wishes to remain anonymous), intends to provide affordable mobile nursing services for as long as they can. “I see mobile nursing as a major future in health service. The cost of medical fees will continue to escalate and anyway, hospitals are not places for recuperation. People, especially the elderly, are uncomfortable in hospitals.” Mobile nursing will also be important in Malaysia as very few doctors are willing to make house calls. Besides, many elderly patients need nursing care more than medical treatment. Mobile nursing provides follow-up supervision after a person is discharged from the hospital. It involves doing everything a nurse would do in a hospital setting but in the comfort of one's home. Says Yakob, “Mobile nursing is something beautiful if done nicely. To see a patient recover, ask you when you are coming again, and to see the family looking contented — that is something money can't buy. The feeling is irreplaceable, and that is our motivation.”

For further information contact:
Home Nursing Providers 0060378777202
www.hnp-mobilenursing.com
or nursing@hnp-mobilenursing.com