One-man show at hospital stoma clinic

The stoma clinic at St Luke's Hospital has a vital role, caring for stoma patients, but, being a one-man show, it is swimming against the current to cope, the only stoma care nurse, Jacqueline Sammut, said.

Ms Sammut, who runs the clinic single-handedly and bends over backwards to provide a service to her patients, said the clinic was in dire need of more trained staff.

"If something happened to me who would take over? Would the clinic have to stop?" Ms Sammut wondered.

A stoma, the Greek word for opening, is formed surgically when part of the small, or large, intestine is brought through an opening in the abdominal wall, explained Ms Sammut. Such interventions are carried out for various reasons, the most common being cancer of the bowels and bladder, diverticular disease and inflammatory bowel disease.

Body waste exits through the stoma into a pouch, meaning that the body image is altered.

The formation of a stoma is a major threat to the individual in that the surgery also affects sexuality and gives rise to anxiety, resulting not only from fear of the illness but also fear of coping with everyday life.

A nurse-led clinic - which looks more like a cubicle - it was established in September 2002 to offer both physical and psychological support to ostomates.

Despite its effective efforts, the clinic has its limitations, which could be overcome if more staff received specialised education in stoma care, Ms Sammut said.

However, training required financial and human resources and although Ms Sammut could educate students and nurses other services on offer would have to be compromised.

Ms Sammut has written to the Health Department, which was aware of the situation and was considering the matter, she said.

"With more trained nurses, the service could expand into the community and include house visits and visits to homes like St Vincent de Paul," she said.

According to pharmacy records, based on the amount of stoma appliances bought, there are about 450 ostomates in Malta. Since January, 42 new patients have visited the clinic.

Stoma patients fear they cannot go out and their condition is stigmatised, Ms Sammut said.

The stoma clinic in the Surgical Outpatients is inconspicuous and has no name on the door to avoid heightening the stigma.

Another problem was that not everyone was aware that the clinic existed or of the services it offered, Ms Sammut said.

"Patients who were operated on 15 and even 10 years ago have no idea of the services available to them and think they only exist abroad."

Among the services on offer, the stoma clinic also supports the families and carers of patients. It educates them on stomas and helps them acquire appliance management skills. The idea is to instil in patients a sense of independence and control over their lives, she said.

There are no limits to the amount of time Ms Sammut dedicates to each patient and she has often spent the entire morning with a single one. Hence the need for more staff.

Patients can avail themselves of the services at the clinic for as long as they want, she said. Even just listening to them is a great help and she focuses on communication and counselling.

The idea is to offer continuity of care and avoid that patients just go straight home after an operation to find their world collapsing around them.

Another problem was the fact that only one brand of stoma appliances was available in Malta and that was not necessarily suitable for everyone.

Ms Sammut would like to introduce other appliances, which, in general, include a flange and stoma pouch, plus accessories, such as deodorising sprays, barrier creams and a belt.

Luckily, thanks to Ms Sammut's knowledge and experience, she is aware of every other existing brand abroad and has contacts with manufacturers to send over samples. The problem is the red tape, which is time-consuming, she said.

Ms Sammut has also come up with her own educational literature but claims it is not the same as providing a patient with an illustrated booklet that is distributed with appliances overseas. These leaflets do not seem to reach Malta with the products.

Nevertheless, despite its limitations, the stoma clinic is up to standard as is the information it distributes and Ms Sammut is encouraged to keep up the good work thanks to the appreciation of her patients.

Anyone wishing to contact Ms Sammut can call St Luke's Hospital, the stoma clinic, on 2595 1740, or e-mail jacklyn.sammut@gov.mt to set up an appointment. They can leave a message on 2123 4933 if no one is available.