“I have a passion for patients.”

So says Nafula Prossy, a nurse practitioner, in Lucy Bruell’s engrossing film, Oli Otya?, about a palliative care team attached to St. Francia Naggalama Hospital in rural Uganda. While Prossy is the resident leader of the team, the film documents its activities during one of the annual visits of two American physicians, Dr. Randi Diamond and her husband, Dr. Howard Eison, both associated with Weill-Cornell Medical Center, and accompanied on this occasion by another physician and medical student. Consisting mostly of actual encounters with patients in the homes accompanied by commentary on the principles and practice of palliative care, Oli Otya? immediately engages viewers, transporting them to a rural African environment in which health care resources are scarce, extreme poverty is the norm, and a mother’s grieving response to a newborn’s death is verbalized as, “that’s how life is.”

It’s evident that every member of the team has a passion for caring for patients, in this case patients with highly symptomatic chronic and progressive illness. For most of these persons, their disease is incurable. Relief of suffering in its many forms—physical, emotional, familial, social—is the primary goal. For example, the team visits a 47 year old woman with stage IIIA carcinoma of the cervix who suffers from pain in her pelvic and perineal area. Dr. Diamond suggests a possible pain relieving measure (insertion of oral morphine into her vagina), but much of the discussion involves emotional support and future plans for the patient’s 11 children. In the case of a man whose legs are paralyzed by metastatic cancer in his spine, Dr. Eison considers checking a hemoglobin to see if a blood transfusion might relieve the patient’s profound fatigue. But the team also engages him in an exploration of hope and the chaplain or spiritual advisor offers a prayer that his suffering may be relieved.

In fact, Oli Otya? Illustrates principles of palliative care that are applicable in any setting, even though in this case embodied very clearly in a world without the financial and technological resources Westerners are accustomed to. In one case, a severely burned patient is in extreme pain, but the hospital has only a single bottle of oral morphine. Drs. Diamond and Eison drive to Kampala, the capital, with the appropriate requisition to obtain more. They encounter a series of bureaucratic delays that might be attributed to an underfinanced, unresponsive, and centralized system. Perhaps that specific problem would be unlikely to happen in the United States, but palliative care specialists here also encounter resistance to their services, often among fellow physicians who believe that palliation means “giving up,” and prefer to think that pain control is a simple and secondary part of their treatment plan.

Filmmaker Lucy Bruell has created a film that combines fine cinematography and engaging narrative to convey an enormously important message. When medical treatment is no longer able to control a patient’s progressive disease, the principal goal of medicine remains –the relief of suffering.

Jack Coulehan, MD, MPH

Emeritus Professor
Department of Family, Population and Preventive Medicine
Director Emeritus,
Center for Medical Humanities, Compassionate Care, and Bioethics
Stony Brook University