Yini i-Epoprostenol: Ukusetshenziswa, Umthamo, Imiphumela Eceleni nokuningi

I-Epoprostenol iyimithi enamandla esiza ukuvula imithambo yegazi emaphapheni akho uma isinciphe ngendlela eyingozi. Kuyinguqulo yokwenziwa yento yemvelo umzimba wakho oyenzayo ebizwa ngokuthi i-prostacyclin, esebenza njengomthunywa omnene okhuluma nemithambo yakho yegazi ukuthi iphumule futhi yande. Le mithi isetshenziswa ikakhulukazi kubantu abanomfutho wegazi ophezulu emaphapheni, isimo esibi lapho umfutho wegazi ophezulu emithanjeni yamaphaphu kwenza kube nzima kakhulu ukuthi inhliziyo yakho ipompe igazi ngempumelelo.

Yini i-Epoprostenol?

I-Epoprostenol iyimithi kadokotela elingisa i-prostacyclin, i-hormone yemvelo umzimba wakho oyikhiqizayo ukuze ugcine imithambo yegazi iphilile futhi ivulekile. Cabanga ngayo njengokhiye okhethekile ovula imithambo yegazi eqinile, ikakhulukazi emaphapheni akho, okuvumela igazi ukuthi ligeleze ngokukhululeka. Le mithi ingeyeqembu lezidakamizwa ezibizwa ngokuthi ama-prostaglandins, okuyizinto ezinamandla ezisiza ukulawula imisebenzi eminingi ebalulekile yomzimba.

Imithi iza njengempushana okumele ixutshwe nesixazululo esikhethekile futhi inikezwe ngokuqhubekayo ngomugqa we-IV. Ngokungafani namaphilisi ongawathatha kanye noma kabili ngosuku, i-epoprostenol isebenza ubusuku nemini, igeleza ngokuqinile emgudwini wakho wegazi ukuze igcine imiphumela yayo evikelayo emithanjeni yakho yegazi.

Isetshenziselwani i-Epoprostenol?

I-Epoprostenol ikakhulukazi inikezwa ngoba umfutho wegazi ophezulu emaphapheni (PAH), isimo esisongela impilo lapho imithambo yegazi emaphapheni akho iba mikhulu, incane, futhi iqina. Uma le mithambo ingakwazi ukuthwala igazi ngempumelelo, inhliziyo yakho kumele isebenze kanzima kakhulu, ekugcineni kuholele ekuhlulekeni kwenhliziyo uma ingelashwa. Le mithi isiza ukunciphisa lowo mthwalo ngokuvula lezi zindlela ezibalulekile.

Umuthi ngokuvamile ugcinelwe abantu abane-PAH eqinile abangazange basabele kahle kwezinye izindlela zokwelapha. Udokotela wakho angase ancome i-epoprostenol uma uhlangabezana nokuphefumula okunzima kakhulu, ukukhathala, noma ubuhlungu besifuba obuphazamisa imisebenzi yansuku zonke. Isetshenziselwa futhi abantu i-PAH yabo iba yimbi ngaphandle kweminye imithi.

Ezimweni ezingavamile, odokotela bangase babhale i-epoprostenol ezinye izimo ezihilela izinkinga zemithambo yegazi, njengezinhlobo ezithile zezifo zenhliziyo noma ngesikhathi sokuhlinzwa okuthile kwenhliziyo. Kodwa-ke, lezi zindlela zokusebenzisa azivamile futhi zidinga ubuchwepheshe bezokwelapha obukhethekile.

Isebenza Kanjani I-Epoprostenol?

I-Epoprostenol isebenza ngokuhlosisa ngqo amaseli emisipha abushelelezi aqeda imithambo yakho yegazi, ikakhulukazi emaphashini akho. Lapho la maseli emisipha ethola isignali yomuthi, ayakhululeka futhi avumele imithambo yegazi ukuthi yande, inciphise ingcindezi nokumelana inhliziyo yakho ebhekana nakho lapho ipompa igazi emaphashini akho.

Lona umuthi onamandla kakhulu okhiqiza imiphumela esheshayo. Ngemizuzu nje embalwa ngemuva kokuqala ukufakwa, imithambo yakho yegazi iqala ukuvuleka, futhi inhliziyo yakho akudingeki isebenze kanzima. Umuthi futhi usiza ekuvikeleni ukwakheka kwamahlule egazi kule mithambo evulwe ngokushesha, enikeza isendlalelo esengeziwe sokuvikela.

Imiphumela ye-epoprostenol yesikhashana, ihlala imizuzu embalwa nje ngemuva kokuthi ukufakwa kuyeka. Yingakho umuthi kufanele unikezwe ngokuqhubekayo ngohlelo lwepompo. Umzimba wakho uhlukanisa umuthi ngokushesha okukhulu, ngakho-ke ukugcina amazinga aqinile egazini lakho kubalulekile ukuze uzuze ngokuqhubekayo.

Kufanele Ngiyithathe Kanjani I-Epoprostenol?

I-Epoprostenol inikezwa kuphela ngokufakwa ngokuqhubekayo emithanjeni, okusho ukuthi igeleza ngqo emgudwini wakho wegazi ngomugqa okhethekile we-IV amahora angama-24 ngosuku. Kuzodingeka ukuthi ufake i-catheter ye-IV ehlala njalo emthanjeni omkhulu, ngokuvamile esifubeni sakho, oxhumeka empompini encane ephathekayo ozoyithwala nawe.

Umuthi uza njengempushana okumele ixutshwe nesixazululo esikhethekile esingenazo izinto eziphilayo ngaphambi kokusetshenziswa. Ithimba lakho lezempilo lizokufundisa wena noma umnakekeli wakho ukuthi ulungiselele kanjani umuthi ngokuphepha futhi usebenzise uhlelo lwepompo. Le nqubo idinga ukunaka ngokucophelela ubuchwepheshe obungenazo izinto eziphilayo ukuvimbela izifo.

Udokotela wakho uzoqala ngomthamo ophansi kakhulu futhi awunyuse kancane kancane ezinsukwini ezimbalwa noma emasontweni aze athole inani elifanele lesimo sakho esithile. Umthamo ulinganiswa ngama-nanograms ngekhilogramu yesisindo somzimba ngomzuzu, futhi kubalwa ngokucophelela ngokuya ngempendulo yakho nokubekezelelana kwakho.

Kuzodingeka ukuthi ugcine umuthi ubanda ngesikhathi sokugcinwa nokuthuthwa, njengoba ungawohloka ezingeni lokushisa elivamile. Isixazululo esilungisiwe ngokuvamile sidinga ukushintshwa njalo ngamahora angu-8-12, futhi kuzodingeka ukuthi ugcine izinto zokusekela nemishini uma ipompo lihluleka.

Ngingathatha isikhathi esingakanani i-Epoprostenol?

Abantu abaningi abaqala i-epoprostenol bazodinga ukuqhubeka beyithatha unomphela, njengoba i-PAH iyisimo esingamahlalakhona esidinga ukuphathwa okuqhubekayo. Umuthi awelaphi isifo esiyisisekelo kodwa usiza ukuphatha izimpawu futhi unciphise ukuqhubeka uma usetshenziswa ngokuqhubekayo ngokuhamba kwesikhathi.

Udokotela wakho uzoqapha impendulo yakho emuthini njalo ngezivivinyo ezinjenge-echocardiograms kanye nezivivinyo zokuhamba ngemizuzu eyisithupha ukuze abone ukuthi inhliziyo namaphaphu akho asebenza kahle kangakanani. Uma uphendula kahle futhi izimpawu zakho zithuthuka, ukuqhubeka nomuthi isikhathi eside ngokuvamile kuyindlela engcono kakhulu yokugcina izinga lempilo yakho.

Kwezinye izimo, udokotela wakho angase acabange ukukushintshela kweminye imithi ye-PAH okulula ukuyithatha, njengemithi yomlomo noma ukwelashwa okuhogelwayo. Kodwa-ke, lesi sinqumo sidinga ukuqapha ngokucophelela nokulungiswa kwemithamo kancane kancane, ngoba ukuyeka i-epoprostenol kungazelelwe kungaba yingozi.

Uma ungumuntu ofanele ukufakelwa amaphaphu, i-epoprostenol ingase isebenze njengokwelashwa okuyibhuloho ukukugcina uzinzile ngenkathi ulinde ilungu lomnikeli. Ithimba lakho lokufakelwa lizosebenza ngokubambisana nochwepheshe wakho wamaphaphu ukunquma isikhathi esingcono kakhulu sokwenza noma yiziphi izinguquko zemithi.

Yiziphi Imiphumela Eceleni ye-Epoprostenol?

Njengayo yonke imithi enamandla, i-epoprostenol ingabangela imiphumela emibi, nakuba abantu abaningi bethola ukuthi izinzuzo zidlula izingozi uma bebhekene ne-PAH enzima. Ukuqonda ukuthi okulindelekile kungakusiza ukuthi uzizwe ulungile futhi wazi ukuthi ungaxhumana nini nethimba lakho lezempilo.

Imiphumela emibi evame kakhulu ongase uyithole ihlanganisa ubuhlungu bomhlathi, ikakhulukazi lapho uhlafuna noma ukhuluma, kanye nekhanda nokubomvu kobuso nentamo yakho. Lezi zimpawu zivame ukuthuthuka njengoba umzimba wakho ujwayela umuthi emasontweni ambalwa okuqala okwelashwa.

Nansi imiphumela emibi ongase uhlangabezane nayo ngesikhathi sokwelashwa:

• Ubuhlungu bomhlathi nobuhlungu bemisipha, ikakhulukazi lapho udla
• Ikhanda elingaba lithambile noma liphakathi nendawo
• Ukubomvu kwesikhumba nokuzwa ufudumele
• Isicanucanu nokuhlanza ngezikhathi ezithile
• Ukuqunjelwa noma izitulo ezixekile
• Ubuhlungu bonyawo nemisipha yomlenze
• Isiyezi, ikakhulukazi lapho usukuma

Iningi lale miphumela emibi ejwayelekile ivame ukuba ngaphansi kokuphazamisa njengoba umzimba wakho ujwayela umuthi. Udokotela wakho angase futhi alungise umthamo wakho noma ancome ukwelashwa okusekelayo ukusiza ukuphatha lezi zimpawu.

Imiphumela emibi engathi sína ingenzeka, nakuba ingavamile. Lokhu kudinga ukunakekelwa kwezokwelapha ngokushesha futhi akufanele kunganakwa. Kufanele uthinte udokotela wakho ngokushesha uma uhlangabezana nobuhlungu obukhulu besifuba, izimpawu zokutheleleka endaweni yakho ye-IV, noma izimpawu zokwehla kwegazi njengokuquleka noma isiyezi esikhulu.

Izinkinga ezingavamile kodwa ezingathi sína zingabandakanya ukwehla kwegazi okubeka impilo engozini uma umuthi uyekiswa ngokuzumayo, izinkinga ezinkulu zokuphuma kwegazi, noma izifo ezingathi sína ezihlobene ne-IV catheter. Lezi zingozi yizona ezenza uzodinga ukuqapha njalo nezinhlelo zokusekela eziphuthumayo zesistimu yakho yamaphampu.

Ubani Ongafanele Athole I-Epoprostenol?

I-Epoprostenol ayifanele wonke umuntu, futhi udokotela wakho uzohlola ngokucophelela ukuthi ingabe iyona engcono kakhulu esimweni sakho esithile. Abantu abanezimo zenhliziyo ezithile noma ezinye izinkinga zempilo kungenzeka abafaneleki kahle kulolu hlobo lwelashwa oluqinile.

Akufanele uthathe i-epoprostenol uma unehluleka kwenhliziyo ngakwesobunxele noma izinkinga ngomsebenzi we-ventricle yakho yenhliziyo engakwesobunxele. Umuthi ungenza lezi zimo zibe zimbi ngokwandisa umsebenzi enhliziyweni esivele ilwa. Udokotela wakho uzokwenza izivivinyo zenhliziyo ukuze aqinisekise ukuthi inhliziyo yakho ingakwazi ukubhekana nokwelashwa.

Abantu abanezinkinga ezinkulu zokuphuma kwegazi noma labo abathatha imithi yokunciphisa igazi kungenzeka abafaneleki ngenxa yengozi eyengeziwe yezinkinga zokuphuma kwegazi. Ulayini we-IV oqhubekayo ubuye ube yingozi yokutheleleka engase ibe phezulu kakhulu kubantu abanezinhlelo zokuzivikela ezibuthakathaka kakhulu.

Udokotela wakho uzobuye acabangele ikhono lakho lokuphatha isistimu yamaphampu eyinkimbinkimbi nokulungiswa komuthi. Lokhu kwelashwa kudinga ukuzibophezela okukhulu nokusekelwa ngamalungu omndeni noma abanakekeli, njengoba ukwehluleka kwemishini noma amaphutha emithi kungaba yingozi empilweni.

Ukukhulelwa nokuncelisa kufuna ukucatshangelwa okukhethekile, njengoba imiphumela ye-epoprostenol ezinganeni ezisakhula ingaqondakali ngokugcwele. Udokotela wakho uzohlola izingozi nezinzuzo ngokucophelela uma uhlela ukukhulelwa noma usuvele ukhulelwe.

Amagama Omkhiqizo we-Epoprostenol

I-Epoprostenol itholakala ngaphansi kwamagama amaningi omkhiqizo, okujwayelekile kakhulu yi-Flolan ne-Veletri. Lawa magama omkhiqizo abhekisela ezingxenyeni ezihlukene zesithako esifanayo esisebenzayo, ngasinye esinezidingo zokugcina nokulungiselela ezihlukile kancane.

I-Flolan yayingumkhiqizo wokuqala we-epoprostenol futhi idinga ukuqandiswa kanye nemiyalelo ethile yokuxuba. I-Veletri iyindlela entsha ezinzile ezingeni lokushisa legumbi futhi ingase ibe lula ukuyilungisa nokuyigcina, okwenza kube lula ukuyisebenzisa ekhaya.

Udokotela wakho uzokhetha umkhiqizo othile ngokusekelwe ezidingweni zakho, indlela yokuphila, nokuthi iyiphi ingxenye yomshuwalense wakho oyihlanganisayo. Zombili izinhlobo zisebenza ngendlela efanayo emzimbeni wakho, kodwa umehluko ongokoqobo ekugcineni nasekuzilungiseleleni ungase uthinte ukuthi iyiphi esebenza kangcono esimweni sakho.

Ezinye Izindlela Zokwelapha ze-Epoprostenol

Eminye imithi eminingi ingelapha i-PAH, nakuba isebenza ngezindlela ezihlukene futhi ingase ingabi namandla njenge-epoprostenol ezimweni ezinzima. Udokotela wakho angase azame lezi ezinye izindlela kuqala noma azicabangele uma i-epoprostenol ingasebenzi kahle kuwe.

Imithi yomlomo efana ne-bosentan, ambrisentan, noma i-sildenafil kulula kakhulu ukuyithatha futhi ayidingi imigqa ye-IV noma amaphampu. Nokho, ngokuvamile ayisebenzi kahle ku-PAH enzima futhi isebenza kangcono kubantu abanezinhlobo ezilula zalesi simo.

Ukwelashwa okungeniswa ngomoya okufana ne-iloprost noma i-treprostinil kungaba ezinye izindlela eziphumelelayo ezigwema isidingo sokufakwa kwe-IV okuqhubekayo. Le mithi iphefumulelwa ngokuqondile emaphashini akho izikhathi eziningana ngosuku ngedivayisi ekhethekile ye-nebulizer.

I-treprostinil ejovwayo ngomunye umuthi we-prostaglandin ofana ne-epoprostenol kodwa unganikezwa ngentambo encane ngaphansi kwesikhumba sakho kunokuba ngentambo ye-IV. Le nketho inciphisa izingozi zokutheleleka kodwa ingase ibangele ubuhlungu obuningi endaweni yokujova.

Kwabanye abantu, ukwelashwa okuhlanganisiwe kusetshenziswa imithi eminingi ndawonye kusebenza kangcono kunomuthi owodwa kuphela. Udokotela wakho angase angeze eminye imithi yokwelapha ku-epoprostenol noma akuqhubekisele ekuhlanganisweni kwemithi elula ukuyithatha.

Ingabe i-Epoprostenol Ingcono Kune-Treprostinil?

Kokubili i-epoprostenol ne-treprostinil yimithi ye-prostaglandin esebenza ngendlela efanayo ukwelapha i-PAH, kodwa banezinto ezibalulekile ezibenza bafaneleke kakhulu kunomunye kubantu abahlukene. Akukho noyedwa ongcono ngokujwayelekile - ukukhetha kuncike ezidingweni zakho ezithile zezokwelapha kanye nezici zokuphila.

I-Epoprostenol ngokuvamile ithathwa njengeqine kakhulu futhi isebenza ngokushesha kune-treprostinil, okuyenza ibe yindlela ekhethwayo kubantu abane-PAH enzima kakhulu abadinga ukwelashwa ngokushesha, okunamandla. Isetshenziswe isikhathi eside futhi inocwaningo oluningi olusekela ukusebenza kwayo ezigulini ezigula kakhulu.

I-Treprostinil inikeza ukuguquguquka okwengeziwe ngendlela enikezwa ngayo - inganikezwa nge-IV infusion njenge-epoprostenol, ijovwe ngaphansi kwesikhumba, noma ifakwe ngisho. Lokhu kuguquguquka kungakwenza kube lula ukukuphatha kwabanye abantu, ikakhulukazi labo abafuna ukugwema izingozi ezihambisana nama-catheter e-IV unomphela.

Inzuzo enkulu ye-epoprostenol umlando wayo oqinisekisiwe ekwelapheni iziguli ezigula kakhulu nge-PAH. Kodwa-ke, i-treprostinil ingase ibe lula ukuphila nayo usuku nosuku ngoba izinzile kakhulu futhi inesigamu sokuphila eside, okusho ukuthi ukuphazamiseka okufushane ekwelashweni akuyingozi kangako.

Udktela wakho uzocabangela izinto ezifana nokuthi i-PAH yakho inobukhulu obungakanani, izidingo zakho zokuphila, ingozi yakho yezinkinga, nezintandokazi zakho lapho enquma phakathi kwale mithi. Abanye abantu baze bashintshe besuka kwenye baye kwenye ngokuya ngendlela isimo sabo esishintsha ngayo ngokuhamba kwesikhathi.

Imibuzo Evame Ukubuzwa Mayelana ne-Epoprostenol

Q1. Ingabe i-Epoprostenol iphephile kubantu abanezifo zenhliziyo?

I-Epoprostenol idinga ukuhlolwa ngokucophelela kubantu abanezifo zenhliziyo, njengoba ingathinta ukusebenza kwenhliziyo ngezindlela eziyinkimbinkimbi. Ngenkathi isiza ukunciphisa umsebenzi enhliziyweni yakho ngokuvula imithambo yegazi yamaphaphu, inganciphisa nomfutho wegazi futhi ikhulise izinga lokushaya kwenhliziyo, okungase kungaphephile kuzo zonke izimo zenhliziyo.

Abantu abanenhliziyo yehluleka ngakwesobunxele noma izinkinga ezinkulu zamavalvu enhliziyo kungenzeka bangabi ngabantu abafanelekayo be-epoprostenol ngoba umuthi ungenza lezi zimo zibe zimbi kakhulu. Udktela wakho uzoqhuba izivivinyo zenhliziyo ezinemininingwane, okuhlanganisa ama-echocardiograms futhi mhlawumbe i-cardiac catheterization, ngaphambi kokuqala ukwelashwa.

Uma une-coronary artery disease noma umlando wokuhlaselwa yinhliziyo, udktela wakho uzokala izinzuzo ngokumelene nezingozi ngokucophelela kakhulu. Umuthi ungase usafaneleka uma i-PAH yakho inkulu futhi ezinye izindlela zokwelapha azisebenzanga, kodwa uzodinga ukuqapha okuseduze.

Q2. Kufanele ngenzeni uma ngisebenzisa i-Epoprostenol eningi ngengozi?

Ukuthatha i-epoprostenol eningi kungabangela ukwehla okuyingozi komfutho wegazi, ikhanda elibuhlungu elibuhlungu, isicanucanu, nezinkinga ezingase zibe yingozi empilweni. Uma usola ukuthi uthole umuthi omningi, xhumana nodktela wakho noma izinsiza eziphuthumayo ngokushesha - ungalindi ukubona ukuthi izimpawu ziyavela yini.

Izimpawu ze-epoprostenol overdose zihlanganisa isiyezi esikhulu, ukuquleka, isicanucanu esikhulu noma ukuhlanza, ikhanda elibuhlungu elibuhlungu, kanye nezinga lokushaya kwenhliziyo elisheshayo. Uma uhlangabezana nanoma yiziphi zalezi zimpawu, lalela phansi ngezinyawo zakho ziphakanyisiwe futhi funa usizo lwezokwelapha ngokushesha.

Ithimba lakho lezempilo lizokunikeza imiyalelo enemininingwane yokuthi yini okufanele uyenze uma kwenzeka ukweqisa umthamo, okuhlanganisa izinombolo zokuxhumana eziphuthumayo nezinyathelo okufanele uzithathe ngenkathi ulinde usizo lwezokwelapha. Gcina le miyalelo ifinyeleleka kalula futhi uqinisekise ukuthi amalungu omndeni wakho ayazi ukuthi angayitholaphi.

Q3. Kufanele Ngenzeni Uma Ngeqa Umthamo We-Epoprostenol?

Njengoba i-epoprostenol inikezwa njenge-infusion eqhubekayo, awu "geqi imithamo" ngomqondo ovamile. Kodwa-ke, uma iphampu yakho iyeka ukusebenza noma umugqa wakho we-IV uvinjelwa, udinga ukuthatha isinyathelo ngokushesha ngoba imiphumela yomuthi iyaphela ngemizuzu.

Uma iphampu yakho ikhala noma iyeka ukusebenza, hlola izinyathelo eziyisisekelo zokuxazulula izinkinga ezakufundiswa yithimba lakho lezempilo, kodwa ungalibazisi ukuthola usizo. Xhumana nomhlinzeki wakho wokunakekelwa kwezempilo ekhaya noma udokotela ngokushesha, njengoba ungase udinge ukunakekelwa kwezokwelapha okuphuthumayo uma ukuphazamiseka kuthatha ngaphezu kwemizuzu embalwa.

Njalo gcina imishini yokusekela nemithi etholakalayo, futhi ube nohlelo lokufika esibhedlela ngokushesha uma kudingeka. Udokotela wakho uzokunikeza imiyalelo ethile yokuthi ungahlala isikhathi esingakanani ngaphandle komuthi ngokuphepha nokuthi yiziphi izinyathelo eziphuthumayo okufanele uzithathe.

Q4. Ngingayeka Nini Ukuthatha I-Epoprostenol?

Ukuyeka i-epoprostenol kudinga ukugadwa kwezokwelapha ngokucophelela futhi akufanele kwenziwe kungazelelwe, ngoba lokhu kungabangela imiphumela eyingozi ebuyayo okuhlanganisa ukwanda okusongela impilo ekucindezelweni kwegazi emaphapheni. Abantu abaningi abane-PAH badinga ukuqhubeka nokwelashwa unomphela ukuze bagcine ukuthuthuka kwabo.

Udokotela wakho angase acabange ukuyeka noma ukushintsha ukwelashwa kwakho uma ungumuntu okufanele afakelwe amaphaphu, uma isimo sakho sithuthuka kakhulu, noma uma uthola imiphumela emibi engaphezu kwezinzuzo. Noma yiziphi izinguquko ohlelweni lwakho lokwelapha zizokwenziwa kancane kancane emasontweni noma ezinyangeni.

Uma uhlangabezana nemiphumela emibi noma uthola ukuthi ukwelashwa kunzima ukukuphatha, khuluma nodokotela wakho mayelana nokulungiswa okungenzeka noma ezinye izindlela zokwelapha esikhundleni sokuyeka wedwa. Kungase kube nezindlela zokwenza ukwelashwa kwakho kube lula ngenkathi kugcinwa izinzuzo.

Q5. Ngingahamba Ngesikhathi Ngithatha I-Epoprostenol?

Ukwenza uhambo nge-epoprostenol kudinga ukuhlela nokulungiselela okukhulu, kodwa kungenzeka ngosizo olufanele nezinhlelo zokusekela. Uzodinga ukuxhumana nethimba lakho lezempilo, izinkampani zezindiza noma zokuthutha, kanye nabanikezeli bakho bezempilo lapho uya khona kusenesikhathi.

Uzodinga ukuthwala imishini yokusekela, imithi eyengeziwe, kanye nemibhalo evela kudokotela wakho echaza izidingo zakho zezokwelapha. Abantu abaningi bakuthola kuwusizo ukuhamba nomuntu oqondisisa imishini yakho futhi ongamsiza ezimeni eziphuthumayo.

Udokotela wakho nenkampani yakho yokunakekelwa kwezempilo ekhaya bangakusiza ukuthi wakhe uhlelo oluningiliziwe lokuhamba oluhlanganisa oxhumana nabo abaphuthumayo lapho uya khona, imininingwane mayelana nezibhedlela zendawo, kanye nemiyalelo yokulawula imishini yakho ezindaweni ezahlukene. Abanye abantu bakhetha ukuhlela ukuqashwa kwabantu abaqeqeshwe kwezokwelapha lapho baya khona ohambweni olude.