One of the key principles in hospice and palliative care is: “We cannot do EVERYTHING for the patient, but we can always do SOMETHING!”

In September 2018, while caring for a man with terminal prostate cancer in our MMM Faraja Hospice and Palliative Care Programme, Singida, Tanzania,  his family informed us about a neighbour who had been bedridden for a long time. They were unsure of what was wrong with her but believed she needed help. After confirming with the woman, they told us, “Yes, she would appreciate it if you visited her.”

When we first visited, we found Anna, a woman in her mid-forties, lying in bed, completely paralysed, barely able to lift her fingers enough to shake my hand. Upon speaking with her, we learned that Anna was a single mother with two adult sons. She had been living with AIDS for several years, but for the past two years, she had been bedridden. She believed the side effects of her antiretroviral (ARV) medications had caused her condition. Despite expressing this concern to the hospital staff when she collected her medications, they had dismissed her. As Anna’s condition worsened, she had become more and more disabled, unable to move or care for herself.

When I examined Anna, I found her arms and legs stiff and paralysed, causing her great pain. It seemed obvious that the ARVs were causing these symptoms. To advocate for her care, I took her AIDS Registration Card to the Care and Treatment Centre (CTC) at the hospital where she received her medications. After speaking with the Doctor in Charge, she agreed with my diagnosis and promptly changed Anna’s medication regimen.

Our palliative care team began visiting Anna multiple times a week, getting to know her and building trust. At first, Anna had a friend who helped collect her ARVs and cooked for her. However, an alcoholic relative also played a role in her caregiving, sometimes neglecting Anna. She was entirely dependent on others.

It wasn’t easy to care for Anna, as even the slightest movement caused her extreme pain, and she would scream. We brought pain medication, incontinent pads, and gloves to ease her daily struggles, but the most important thing we offered was something much more intangible: our presence and a willingness to listen. Anna, who had once worked as a hair stylist and built her own home, had lost her source of income and was struggling with her situation. In her bedroom, she had a display of shoes — mostly high-heeled, which she longed to wear again. I remember telling her, “Anna, one day you’ll wear those shoes again. Maybe not the high heels, but the others, YES.” She looked at me sceptically, saying, “No way.” I insisted, “You WILL, if you make up your mind to work at it, do the exercises we are showing you, and pray to God for strength and patience.”

Though she didn’t believe me at first, we repeated this encouragement during each visit, like a mantra. It took nearly a year to see substantial progress. In the meantime, Anna contracted pneumonia and asthma, and I remember having to carry her out of her house with help from our driver. She was in so much pain from the movement that I feared she wouldn’t survive the trip to the hospital. Fortunately, she did, and after a three-week stay, her attitude became more positive.

During this time, we discovered that her alcoholic sister, who was supposed to be helping Anna, was neglecting her — feeding her only once a day and rarely changing her clothes or bed linen. Anna was unable to care for herself in any way. When she hired an elderly lady to help with her physiotherapy, we began to see real improvement, though Anna often complained that the woman was “fierce” and very strict. Despite her initial resistance, the physiotherapy worked. After two months, though she could no longer afford to hire the woman, Anna had gained enough strength to continue her exercises independently.

Fourteen months after we first began caring for Anna, she could sit up, turn in bed, lift 1.5kg weights with each arm, and even pull herself to the side of the bed and stand holding onto the door. Though still disabled, Anna was immensely grateful for the progress she had made. Her faith in God, her perseverance, and our team’s continued support had transformed her.

What We Learned from Anna: Without palliative care, Anna would likely have passed away soon after we met her. Through our advocacy for a change in her ARVs and our dedication to psychological support, we were able to prevent further deterioration. We realised how crucial it is to listen to the patient’s concerns and provide consistent encouragement. Anna’s faith in God became a key pillar of her recovery, and her spiritual strength carried her through many challenges. Her social support, while imperfect, also played a role, especially once we helped her navigate a difficult family situation. But most importantly, Anna’s story reinforced the palliative care mantra: NEVER GIVE UP!

Update on Anna Six Months Later: Anna’s recovery continued with its ups and downs. She discovered that her sister, who had neglected her, had expected Anna to die in order to inherit her house. Fortunately, by this point, Anna had regained enough strength to contact the village leaders, who removed her sister from the home. With Faraja’s help, Anna received food and other necessities for a short time. She had even begun using a plastic chair as a walker to move around her house and walk to her neighbours. One day, when we brought her ARVs, she surprised us: “Watch me!” she said. She stood up and walked across the room using a cane. She was overjoyed and grateful to God and to us for all the improvements.

After Another Three Months: By this point, Anna had abandoned the chair and started using a walking stick instead. She could even walk a few steps without assistance. One of her sons had found a job, and he had provided her home with electricity, making life a bit easier.

Six Years After Meeting Anna: Today, Anna is walking and living independently. She has a small business, selling clothing and household items around her neighbourhood. She is able to provide for herself and no longer depends on others for financial support. Anna’s journey from being nearly completely paralysed and dependent to becoming an independent woman with a thriving small business is a testament to her strength, perseverance, and the power of palliative care.

What We Learned from Anna:
Palliative care operates on the principle, “We can’t do everything, but we can always do something.” Those “somethings” have built up over time into significant success for Anna. Through ongoing support and encouragement, we helped her achieve independence. From encouraging her through painful exercises to listening to her concerns and advocating for her medication, each small action contributed to her transformation. This journey, while not yet finished, has shown us the profound difference that palliative care can make. Anna now walks, works, and is independent once more —and for that, we are all deeply grateful.