We traveled to Salima, Malawi on June 26 to visit Ndi Moyo, an innovative hospice facility devoted to providing care for patients with terminal illness. The vast majority of Ndi Moyo patients are cancer patients and over 90% are HIV-positive. Unlike St. Gabriel’s, Ndi Moyo is not a hospital. Rather, it is a standalone palliative care clinic. Ndi Moyo patients visit the clinic periodically for outpatient appointments. Additionally, several days each week, the clinical staff goes to nearby Salima District Hospital to do rounds and see current patients as well as those who would benefit from palliative care. Additionally, the staff members travel to do home-based visits for patients several times per week.

Ndi Moyo offers patients medications as well as homeopathic treatments to address and alleviate symptoms of their respective illnesses. When we toured the small campus, we were stunned by the beautiful gardens where some of the homeopathic treatments are grown. Lucy, the director of Ndi Moyo, served us incredible lemongrass tea made from lemongrass grown in the garden.

We visited on the last Tuesday in June. On the last Tuesday of each month, Ndi Moyo invites patients to come for the day to give their caregivers a much-needed break. In Malawi, the vast majority of day-to-day hospice care is provided in the home by relatives or community members. This round-the-clock care is very tiring and leaves little time for mundane tasks like going to the store or getting a haircut. By providing care for these patients for one day of each month, Ndi Moyo provides support for these dedicated caregivers. On these days, patients assemble in Ndi Moyo’s large open-air dome. The structure provides a large communal area for patients to rest and socialize with each other. Patients passed the day by playing games, watching a movie (a novelty here), and by making beads. The patients seemed to be happy to spend the day in the company of others with similar experiences.

Ndi Moyo boasts a devoted, professional staff. We spent an hour or so talking to the director, Lucy, about her experiences. Lucy’s passion for palliative care and her dedication to her patients inspired me. She lamented the lack of access to and funding of holistic palliative care, particularly for patients with HIV/AIDS. While governments, NGOs, and individuals have devoted vast sums of money to address the HIV/AIDS epidemic, much of this funding does not reach patients who currently suffer from the disease. Certainly, the increased availability of antiretroviral therapy (ART) in resource-limited settings has improved the trajectory of HIV-positive individuals. However, palliative care programs continue to bear the burden of this disease with scarce recognition or financial support.

At Ndi Moyo, we also received some feedback on the InvertaBottle liquid morphine dosing device and were able to solicit the impressions from several current liquid morphine users, thanks to Christopher, the Ndi Moyo clinical officer that I met at St. Gabriel’s. (See Teresa’s blog for more details about this portion of our day.)

We learned so much in our short time at Ndi Moyo. After working so intensively with the palliative care program at St. Gabriel’s, it was interesting to see a model of this type of care outside the hospital setting. We are so grateful for the kindness and generosity of our gracious hosts.