Why death is more painful, feared by poor Kenyans than the rich

By Gatonye Gathura

Kenyans, many who admired the late Bob Collymore’s preparedness for the end, are themselves highly scared of discussing death.

“This may be because of fears that such discussion may hasten the end,” suggests a recent study on the quality of death and dying in Kenya.

The study involved 129 caregivers of deceased cancer patients receiving palliative care at the Eldoret, Nairobi, and Nyeri hospices. Most said their charges had been poorly prepared for the end.

Almost all the adult patients had hardly prepared or discussed their burial arrangements, reports the study published last month (4th June 2019) in the Journal of Global Oncology.

The authors attribute the poor preparation for death or funeral arrangement possibly to local beliefs that such talk was like beckoning death.

However the study by the University of Toronto, Canada, University of Ferrara, Italy and a Nairobi based research firm, MWAPO Health Development Group says many patients had cherished time with their spiritual advisors, family, and friends.

The study had compared the quality of death in Kenya for the terminally ill with a similar group in Canada and reports a much more challenging experience for Kenyans.

“Caregivers in Kenya rated patients’ pain control as bad which is consistent with lesser availability of palliative care in the region,” says the study.

On the other hand, the study says the end of life care in the Canadian group, a wealthy county is characterized by high and effective pain control procedures.

But even among Kenyans, the poor have been found to have more fear of death and higher lack of preparedness than the rich.

“Income, age, marital status, religion and attitude to death are significant predictors of end of life planning for most Kenyans,” says Dr Stephen Asatsa a Counseling Psychologist and lecturer at the Catholic University of Eastern Africa.

Last year Dr Asatsa presented a study at a conference in Australia which indicated overwhelming unpreparedness for death among Kenyans.

The study carried out in Nairobi County involved 320 participants aged between 20 and 64 who were Protestants, Catholics, Muslims, Hindus, traditionalists, and Atheists.

The study says poor Kenyans, those earning less than Sh10, 000 per month compared to people earning Sh100, 000, reported the highest fear of death. They are also more unlikely to plan for the end of life.

While the poor and middle earners are likely to want to cheat death the study shows much higher acceptance of death among Kenyans earning more than S100, 000 who are also more likely to plan for their end.

Dr Asatsa, says the lack of planning for death may partly explain the huge wealth held by the Unclaimed Financial Assets Authority.

The authority is currently holding unclaimed cash valued at Sh13.1 billion, 1,451 safe deposit boxes and Sh555.5 million units of shares made up of unclaimed dividends, shares, wages, dormant bank accounts, gift vouchers, and life insurance policies.

On religion, Dr Asatsa says atheists, traditionalists and Catholics reported the highest fear of death compared to other faiths.

The least fearful of death, by religious faith, were Hindu, Muslims, and Protestants in that order.

“By marital statuses, single people had the highest fear of death with the least fear reported by the divorced and widowed,” Dr Asatsa told the Standard on Wednesday.

But there is a growing feeling among some sections of Kenyans that it is time to start planning about death.

“Planning for the end is a difficult, terrifying and confusing moment in one’s life especially if it is against the backdrop of a life-threatening illness,” says Dr Esther Munyoro Cege, the head of pain and palliative care services at Kenyatta National Hospital.

Dr Munyoro while addressing a past meeting on Advance Directives (AD) at Nairobi Hospital called on patients, families and healthcare professionals to engage in planning for the last days.

Advance Directives or AD are instructions conveying medical decisions to be made in the event the patient loses their decision-making capacity.

While AD in Kenya may not be routine in public health facilities, a study at the Aga Khan University Hospital, Nairobi showed almost half of the terminally ill patients had an AD.

Of 216 terminally ill patients in the study published in 2017 in the journal BMC Palliative Care about 41 per cent had AD in their records with majority giving a limitation of care they should get.  

A limitation of care can, for example, direct health personnel not to resuscitate the patient or provide life-prolonging care.

 “A point of note is that our hospital is mostly patronized by well-educated, high and middle-class clients,” says the Aga Khan Hospital study.

However, confronted with a terminal disease, most Kenya, even the poor say would not want life-prolonging procedures.

This was reported in a 2014 survey carried out on the streets of Nairobi under the African Palliative Care Association.

Their biggest concerns, the street respondents said would be effective pain control, not to be a burden to their families and with most wishing to die at home with their families.

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