Hospice Without Borders Blog ..... Updates from our international work and Amahoro House





Amahoro House: An opportunity for deep connection in each moment.


I saw her in the shelter a few days before the following conversation took place.  She had a flower in her hair and I remember thinking how much she really was like a flower.  When she allowed herself to smile, to really smile, it was as if a tight bud was bursting into bloom.  We exchanged a hug that night and I went about what I was doing.


The conversation took place a few days later while meeting with the shelter director. We were meeting to go over our presentation at this year’s National Healthcare for the Homeless symposium.  I had been aware that this shelter guest had been hospitalized twice since that brief hug early in the week.  Hospitalized, on life support briefly, then discharged and re-hospitalized on life support again, finally discharged a second time.  It hadn’t sounded optimal. 


She started the conversation by sharing her time at the woman’s bedside just before her second hospital discharge. A nurse had come into the room and engaged the woman; chastising her in a way that might only be described as “shame based care.”  It was a salient example of the very reason we were approaching this national audience.   


Our presentation   would focus on “helpful being.”  Illustrating ways to care for someone; who suffers from serious illness and chronically homelessness, which are driven out of deep compassion and awareness of our interconnectedness.  In Africa we know this as “Ubuntu-I am because we are.”  Our goal was to illuminate the possibilities in every encounter, to shine a light on the bud that can burst into a bloom with the right nourishment.


As the conversation dissolved into the room an image floated through my mind of the importance of each encounter.  Each encounter we enter into holds the potential for a type of reciprocity and deep connection.  I imagined the partnership that emerges between a bee and flower bloom.   The flower radiates the light of beauty and life.  The bee, a marvelous being, pollinating flower blooms, equally holds the power to sting. 


I wondered how many more people would encounter this young woman and choose to nourish her instead of stinging her.  I vowed to hug her the next time I saw her, nourishing her beauty and light. And I was grateful we would have a chance to take the podium and offer healthcare providers a new awareness of the opportunities each encounter holds.


Hospice Without Borders in partnership with Interfaith Works Emergency Overnight Shelter will be speaking at this year’s National Healthcare for the Homeless symposium.  For a detailed summary of our presentation follow the link below:









Save the Date: June 25th, 2016

Hospice Without Borders is having it's first ever Gala event this June. Join us for a great evening of food and community, with a fun Live and Silent auction! Help support the work of this all volunteer organization!


Tickets will be $65 per person, and will be held at beautiful Annie Wright School in Tacoma, WA.


Ticket purchasing will be available soon. Please contact us at victrinia@hospicewithoutborders.com with any questions.


We hope to see you there!






Amahoro House: Medical Respite.... a rest in the midst of things

".......I walked by the bathroom and was surprised to see her boots in the middle of the floor.  I recalled seeing them hidden under her pillow at the homeless shelter.  It must feel safe here....."


Sally came to Amahoro House for medical respite in February.  The community emergency room had treated her for bronchitis and a near catastrophic thyroid level, and discharged her to the street.  She was not resting at the shelter and thus unable to meet with housing advocate volunteers, and maintain discharge medication plan.  The morning the Amahoro House volunteer encountered her boots in the bathroom marked day three of her medical respite stay.  On this morning she was sleeping in one of two designated respite beds, and would later meet with her housing advocate volunteer.


During her short stay at Amahoro House Sally would recover from her illness and make progress towards housing, open a bank account, and begin the long process of moving her medical home to a local provider in Olympia, Washington.  With access to food, rest, and structured day she would  complete her antibiotics and steroid to assist her recovery. 


Amahoro House is one of only a handful of medical respite efforts in Washington state, and the only effort in the South Puget Sound.


Medical respite is defined by the National Health Care for the Homeless Council as " short term residential care that allows homeless individuals the opportunity to rest in a safe environment while accessing medical support and other supportive services."


The team at Amahoro House creates an intentional nurturing and safe environment to aid in guests recovery.  For Sally this meant plenty of mint ice cream, long naps and an afternoon spent with volunteer Pam online looking for her father whom she hadn't seen in over 50 years. 






Rwanda: Beating Pain Today

Tomorrow, February 4th 2015 is World Cancer Day.

Of the mottos this year, treatment for all, and focusing upon quality of life, are major themes.  


Please remember, as our global community of cancer researchers and clinicians strive to develop novel therapies and even cure cancer tomorrow, we can treat and beat cancer pain today!


Using safe and effective opioid analgesics, such as oral morphine, which costs on average 15 cents a day in an average patient, we can control pain in nearly 100% of people with cancer and HIV.   Yet every year, at least 2.4million people worldwide, living with end stage cancer, die in pain needlessly.


The good news is ~ It doesn't have to be that way!  It's well known that when we take care of cancer pain and provide comprehensive palliative care, as our nurse Peace is doing here in Kigali, peoples' lives are dramatically improved and they begin to look forward to living, rather than focus on dying.  What is not widely appreciated, is that when we take care of pain though palliative care services, people live longer!  When you stop and think about it, that actually makes a lot of sense.  No one wants to live with agonizing pain.  But when the pain is controlled, regardless of the status of the cancer, people once again make meaning, and focus on living!


Pain Relief is a Fundamental Human Right that offers the prospect of dignity and hope and an opportunity for peace, even when cure is not possible!  Please join us today!






Dina's Song Revisited Four Years Later...

Back in 2010, I went to see this lovely woman seated here, Dina.  At the time she was living with her brother in Kigali, close to a local hospital.  She was poor, from a rural village, and dying with Gastric cancer.  Like like so many people, she presented for care at a late stage in her illness, and once it was realized there was no hope for cure... She was sent home with only Acetaminophen.   At that time, there was no formal home care program in Kigali, except for the small fledgling effort of my friend "nurse Grace."  It was with Grace, and Dr. Dan that we went to see Dina.


We found Dina lying listless in the back room, moaning softly.  Well cared for and loved by her brother, but profoundly suffering.  Her beautiful sprit imprisoned by pain.  

We asked Dina what she was hoping for...And I'll never forget her words...She said in Kinyarwanda, "If this medicine can help just a little, maybe I can sit up and sing to God, and maybe...maybe I can return to my village to see my children one last time."


We gave her only a teaspoon (about 5mg) of a morphine we had managed to purchase at a local hospital where we miraculously obtained the only tablets available - just a small number of 10mg tablets. Of course we purchased as many as we could, then crushed and dissolved them in a water solution, as we had heard her swallow was worsening.    


Well, 20 minutes after the morphine, Dina's countenance lifted, she smiled a little, and then whispered softly in Grace's ear.  At that point, slowly and deliberately Dina sat up and sang, as if her spirit had been somehow liberated.  

"Imana Iman' irabize ~  Imana Iman' irabize" God will provide (what man can not)"



The bitter irony is that we human beings do know how to effectively and safely control cancer pain.  Yet as Ronald Piana so poignantly articulates in his NY Times article cited here,  


"Untreated cancer pain is a human disaster not unlike famine;

its victims are starving for relief." 


At Hospice WIthout Borders, We're doing our best to change that, and as you can read in our prior posts, after 4 years of sustained effort, the Rwandan Ministry of health is now manufacturing morphine solution for people like Dina, whose spirits are starving for relief.  Please read Mr. Piana's inspiring article, and join us in our effort insure that every human being has equal access to pain control.  No one should be "Dying Without Morphine!"