A bulge around the woman’s abdomen pokes her pink nightgown. She stands expectantly in a corner. It appears she is waiting for the doctor.

“These people are from the Observer newspaper,” the doctor says. The woman shudders a bit and partially covers her face. “And we thought you might talk to them for us,” the doctor continues.

The woman hesitates, whispering to the doctor about the use of her name, then she starts talking.

The woman is a cervical cancer patient at the Hope Institute, a cancer hospital in St Andrew, whose mission is to give care to patients with incurable cancer, and the doctor is a consultant on oncology and palliative care in charge of the hospital, Dr Dingle Spence.

The woman has been at the hospital twice before and this time she came in “bawling”, Spence says.

“Now? That pain I came in with is not with me, but I have one place where the pain not leaving. It’s not raging, but it’s there,” the woman says.

It took a while for the woman’s cancer to be diagnosed, Spence reveals.

“Unfortunately the tumour was blocking off her back passage and so she had to get surgery to free that up, and so she is the proud bearer of a bag. But she doesn’t like anybody to know about that part, but it means she is able to be with us,” Spence says.

And that is the basis of what the staff at Hope Institute are trying to do through its gradual introduction of palliative care – help patients recognise that their lives are not over just because they have cancer.

“Palliative care is looking after people whose cancer has come back and is likely incurable,” Spence tells the Sunday Observer. “Once the cancer spreads from the original site, it’s often very difficult to cure, but that does not mean that people don’t have a life. It means that you’re probably going to have ongoing problems to do with pain or shortness of breath, vomiting. all of those things that often come with a more advanced cancer diagnosis,” she says.

The point then is to help the patients enjoy a better quality of life, and equally important, a better quality of end of life.

“Most of those people are perhaps in the last year of life,” Spence says. “But what we try to concentrate on for them is their quality of life. Who is this person on this point in their journey, and what is it that we can do to make that part of their life as comfortable as possible?”

Focusing on the physical, psychological and social aspects of a patient’s needs does that. But the staff at Hope must get all of that done amid significant resource challenges.

Hope, which was started by the Jamaica Cancer Society in 1963, became a government institution about a decade later and has been one ever since.

It is part of the South East Regional Health Authority and is grouped administratively with the National Chest Hospital as its parent.

The 36-bed facility has no cancer treatment equipment, does not have a pharmacy or any designated area to mix the chemicals for chemotherapy.

“University (Hospital of the West Indies) has its chemo unit, KPH has its chemo unit, KPH has the public sector radiation machine and we have the beds,” Spence says. “We don’t have any equipment here. We don’t have any x-ray machines, we don’t have a pharmacy. We have the beds and the staff.”

The staff at Hope have therefore focused on making the environment the best that it can be for the patients.

“We try not to be pessimistic, because we realise that the health sector is strapped,” says Spence. “We’re not really blaming it. But we feel that what we’re doing is so important and the environment is important because a diagnosis of cancer can be a depressing thing.”

A lot of help has come the Institute’s way from Food For the Poor in the form of furniture and an 18-seater bus that transports the hospital’s patients to KPH for their treatment.

Before Food For the Poor’s intervention, the beds in the hospital were not adjustable and had no wheels. The hospital also had to share transportation with other hospitals, which is a challenge because often very sick patients would have to stop at Bustamante Hospital for Children or the National Chest Hospital before returning there.

“We feel like we have a mission, there are things we have to do and we’re going to find a way to do it,” Spence says, adding that the hospital has recognised that there are charitable groups or relatives of patients who are willing to help in whatever ways they can.

Many of the hospital’s patients are people who come in from distant parishes for their treatment at KPH and stay for a few days. Spence says the average stay in the hospital is two weeks.

But even while it tries to focus on perfecting its offering of palliative care, the staff at Hope recognise that the hospital does not have a perfect palliative care scenario.

“There are many members of staff that we could do with, a good palliative care team would have a psychologist, a pharmacist, a social worker, a spiritual advisor like a chaplain, a dietician,” Spence says.

Currently, there are 45 members of staff, including 12 registered nurses and seven enrolled nurses, according to Deputy Matron Keron Phillips Jackson.

But Phillips Jackson admits that the absence of specialised oncology training for nurses in Jamaica is a challenge. Additionally, it takes a special kind of nurse to work in a cancer hospital, and the deputy matron says many young, inexperienced nurses often express displeasure at being sent to Hope.

“What we find is that when they are leaving nursing schools, they want to hone their skills [in all areas],” Phillips Jackson explains.

“They build their skills in cancer care and are lacking in other areas such as surgical.”

Additionally, she says, nurses who have more life experience and not necessarily more professional experience can deal with the emotional side of the work better.

“The dying is not easy to deal with,” says Phillips Jackson. “That is the major complaint we get because we are taught to care and nurture people to wellness, not to care them to death.”

To address the training concern, Phillips Jackson says there has been some dialogue between the hospital and the South East Regional Health Authority to send more experienced nurses to Hope.

Additionally, the regional health authority is helping the hospital identify overseas training programmes in which some of their staff could enrol.

“Most of the nurses are young, so that’s why we are geared toward training at this time,” Phillips Jackson says.

In the meantime, however, Hope continues to create a home away from home for its patients.

“Let’s face it, people with incurable cancer are not going to go away,” says Spence.

In the short term, Spence wants to see the hospital have a designated space for mixing chemicals and a small pharmacy. In the long term, she wants to see it develop as a full cancer centre with all the cancer care equipment. She also wants to see the establishment of a charitable foundation for the hospital so it is not solely dependent on government funds.

Spence would also like to remove the misconception that most of the patients who enter the hospital don’t leave. In fact, she says, 65 per cent of their sicker patients go home.

While the woman in the pink nightgown did not want to go home the day the Sunday Observer visited, it was the last day for one St Thomas man.

“From yuh know you condition and yuh bend you mind to it, there is hope,” says the man, a lung cancer patient. “I think that’s why they call it Hope.”