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 Health  Zimbabwe Project #24223

Island Hospice & Healthcare

by Island Hospice and Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare
Island Hospice & Healthcare

1.   Introduction

Island Hospice and Healthcare (Island) continued its mission of providing a positive change in the lives of many individuals faced with life threatening illnesses and the bereaved. This was achieved through capacity building and direct care. The following report provides an overview of progress for the period under review. This includes updates on direct care, challenges, and lessons learned.

 

Zimbabwean Context

Zimbabwe’s junior doctors are on a national strike since the beginning of March protesting against poor remuneration and unsatisfactory working conditions, leading to the closure of almost all central hospitals, children’s units, provincial hospitals and the cessation of emergency lifesaving procedures throughout the country, according to their representative body, the Zimbabwe Hospital Doctors Association.

This has negatively affected our patients and clients. As a result Island has experienced high demand for service from non- palliative care patients, a situation that is attributed to the problems being faced in the public health delivery system. The government has failed to provide adequate medication and other medical sundries in the public hospitals. Despite the economic downturn palliative care (PC) patients and clients have continued to receive the much needed services from Island  

Palliative Care Awareness to Private Doctors

Island provided a talk to create awareness on pc issues to private medical doctors. There was convergence of purpose on the need for Island to continuously provide sessions to the private sector on pc key issues such as breaking bad news, bereavement support, communication etc. During the awareness session it was agreed that the referral pathways for patients should be strengthened so as not to lose patients to loss of follow up. The doctors expressed their frustration with the doctors’ strike. They indicated that patients they were referring for specialist services were not getting assistance due to the on-going strike. They called upon government to address the doctors’ concerns for the sake of the patients and to remove some barriers to access such as high and unattainable fees charged for some services.

Caregivers Capacitation Programme

Island works with volunteers who provide care in various communities. These act as the eyes of Island as well as the primary health facility to alert patients and clients on the availability of service and how to access them. They also provide basic pc service to patients and clients.

Young carers are often found in sole-parent families and it appears they often provide care because they are the only ones available to fulfil this role at home. They are offered little choice about their role, but once given the responsibility, most young carers seem to embrace it and want to continue to provide care for as long as it is needed

Island holds monthly meetings to support caregivers and strengthen their caring skills.

Volunteer/CHBC Meetings

CHBCs continue to come for the monthly meetings and receive support and refresher courses on how to better help the patients that they reach. A total of 169 caregivers attended compared to 175 in October.

2.2 Outcome two: Improved quality of life of people suffering from life-threatening illnesses.

This section presents the work of Island towards improving the quality of life of people suffering from life threatening and life limiting illnesses. Several graphs below provide an overview of patients reached, disaggregated by variables such as gender, site, et cetera.

Number of patients/clients reached by gender and site

There is a downward trajectory in the number of patients and clients reached, from 613 in September to 525 in October and 469 in November.

Patient/client type by site

There was a marginal decrease in the total number of new patients, from 85 in October to 79 in November. Number of existing patients marginally dropped from 347 to 345.

Contacts by Place of Contact

Island continued to provide services through home visits, clinics, hospitals, telephone and office visits to improve the quality of life of people with life threatening illnesses. There has been a gradual decrease in the total number of contacts, from 732 in September to 592 and 524 in October and November respectively.

Trend analysis of Island patients and clients by month. 

Island’s trend analysis for patients and clients reached, aggregated by month, total deaths by month, new patients and clients and the cumulative number of Island patients and clients by month. There is need to address the gap between the number of patients being reached per month vis a vis the total number of patients reached.

 In October and November our CHBCs reached 1040 and 966 patients respectively. Three hundred and ninety eight (398) patients were homebound during the period under review. Adherence and emotional support were the most offered services followed by HIV education and counselling.

 

Patients reached in Hospitals

There was an increase in the total number of patients reached through hospitals, from 24 in October to 47 in November. The biggest increase was from Mpilo which reached 19 patients compared to 1 in October.

 

Number of Patients/Clients reached through clinics

There was a marginal increase in the total number of patients reached, from 90 in October to 98 in November.  

 2.3 Outcome three: Improved quality of life of bereaved and traumatized clients

 Island continued to help improve the quality of life of bereaved and traumatized clients through partner loss support groups. In November, two partner loss group sessions were conducted during the period under review.

 Number of Patient/Clients who received support service by site

There was a decrease in the number of patients and clients reached consequently resulted in the decrease of services offered. The only increase was from patient counselling, which recorded 292 patients and clients, up from 190 in October 2019.

Family members reached by site

Island continued to provide holistic pc services by supporting patients’ family members. There was a marginal decrease in the total number of patients’ family members supported, from 292 in October to 221 in November. This is consistent with the decrease in the total number of patients seen.

4.   Challenges

  • Unavailability of cars especially for Harare and Bulawayo branch to visit patients in homes.
  • Fuel shortages (All branches)
  • Shortage of pc essential medicines

 

5. Conclusion and recommendations

Island through its staff, supporters, programs, research, advocacy and resources, continues to touch the lives of individuals, families, and communities spanning every vulnerable group in society.Continued awareness on the need for patients to contribute towards service provision so as to make the organisation sustainable. Vulnerable patients will continued to be provided with service free of charge.


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Island Global Giving report: July-September 2019

Between July and September 2019, Island Hospice and Healthcare continued its mission of providing palliative care services to individuals faced with life-threatening illnesses and to the bereaved. This has been delivered through various models, customised to meet the unique needs of clients and patients, through home visits, walk-ins, clinic visits, hospital visits, ward rounds and through telephone contacts.

Island Hospice and Healthcare saw 1,126 patients and clients during the quarter. This comprised 628 clinic visit contacts, 542 telephone contacts, 398 walk-ins and 538 home visit contacts. Most of Island’s contacts came from clinic visits arising from the roadside clinics, which reach out to people in peripheral communities, where patients live far away from primary healthcare institutions. Hospital visits provided 120 contacts, while ward rounds accounted for 193 contacts and single consultations, for 288. Principles applied to all models of care are: a holistic approach (physical, emotional, social, and spiritual) to care.

These 2 stories of change demonstrate the impact of our work during the reporting period.

 

                                                Story of change1: Hope restored

Story collected by:           Tanaka Mudadada

 Date collected:  August 2019

 Edited by:                           Lovemore Mupaza

 “I am a woman who resides in Mufakose suburb. I was diagnosed with HIV and this overwhelmed me to the extent that I lost hope in life. As a woman, I expected to bear children but having HIV cast a shadow over those wishes – or so I thought. I was dumbfounded and dead inside. I then happened to attended the Sexual Reproductive Health and HIV education from Island. The training helped me view life from a different perspective. The key lesson I learnt was of prevention of mother to child transmission (PMTCT). This gave me the hope I had lost, of not having a child. PMTCT programmes provide a range of services which include providing women living with HIV, with lifelong ART to maintain their health and to prevent transmission during pregnancy, labour and breastfeeding.”

                           

“Today, I am dealing with the situation much better, I adhere to my treatment plan and look forward to my future. SRH/HIV education from Island empowered me to make choices about my right to health. My wish was fulfilled, I now have a child that is HIV negative. Fear of HIV-related stigma and discrimination, and in some cases, the possibility of violence, can deter people from being tested or revealing that they are HIV positive, but I am not afraid to disclose the condition I have, all because of the support I received.”

 

                                              Story of Change 2

 Date collected                                    30 July 2019

Collected by                                       Lovemore and Tanaka

Project                                                OAK

Venue                                                 Marondera

 In one of the middle-class suburbs of Marondera, a female traditional healer narrates how Island Hospice and Healthcare helped her. Life dealt her a bad hand with the passing of her mother and husband, within a short period. As a result, she wallowed into excessive intake, to avoid dealing with the grief she was experiencing. This placed her health at high risk as her blood pressure. Advise and encouragement, from friends and family, proved to be futile.

Island conducted training with traditional and faith healers, and she was part of the group that was trained. The training proved to be more important than she had anticipated. Topics such as bereavement and the death process were discussed.

This helped her to accept her situation and she was made aware that it is allowable and that it was normal to grieve. As a result of the training, she stopped drinking and her blood pressure has since returned to normal. Because of her encounter with Island, this traditional healer is now able to function proficiently, incorporating bereavement counselling and other ideas into her consultations and referring patients to hospitals and discussing, with them, the importance of palliative care.

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ISLAND STORY OF CHANGE

Introduction

Island is the first hospice in Africa, established in 1979 as a centre of excellence for palliative care and bereavement services. It discharges its services through various models customised to the needs of patients. These include clinic services, hospital visits, walk ins, telephone consultations, and home visits. Home visits are done by island nurses and social workers as well as by community based caregivers. Community home based caregivers provide home care and counselling services. They refer complicated cases to Island nurses and social workers. The importance of community caregivers cannot be over emphasised. They are an asset to the community by bringing palliative care services to their doorsteps. They have become agents of promoting social cohesion. The case of an HIV patient in Mutare below is a typical example of the role of caregivers who work with Island.

Family United and Peace Prevails in the Community

In Natville, Mutare, a mother stays with her two sons who are commuter omnibus conductors. The mother was diagnosed with HIV and dementia and she started defaulting on her HIV medication and this caused her dementia to worsen. In this state she terrorised people at a nearby bustop, entering people’s premises and vandalising property. The two sons consequently neglected their mother and couldn’t devote their time in taking care of her because of their job which needed more time also. The situation turned worse as the sons went on to despise their mother even to the extent of wishing her dead.

One trained community home based caregiver under Island, hearing of the situation went and introduced herself to the family and one of the sons narrated the whole debacle including how their mother had defaulted on her medication.

 

The caregiver counselled the two sons on the importance of taking care of their mother and she arranged with the mother’s friend to help her take her medication since the children were mostly not available and taking her for injections at the hospital. The two sons agreed to this arrangement and this saw a great change from the mother as she no longer terrorises people and is even now going to church. The two sons are even sometimes going with their mother to the hospital for the dementia injections. The restoration of a good relationship in the family has benefited the community at large as there is peace.

Conclusion

The demand for Island service from patients and clients continues to increase. The project is enabling us to provide the much needed palliative care service to those who need it in Zimbabwe. Palliative care patients are being relieved from all forms of pain thereby positively contributing to their quality of life. Island is forever grateful to all those who generously donate towards this project.

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INTRODUCTION

Island Hospice and Healthcare (Island) is a Private Voluntary Organization (PVO) which was founded in 1979 to provide palliative and bereavement care services to patients and families suffering from life threatening illnesses and bereavement. Over the years Island has provided service to patients, bereaved clients and families through various model of care: palliative and bereavement home based care, hospital care, road side care and capacity building, mentorship and support of palliative and bereavement care services. The organization has actively worked in partnership with various government departments to conduct its services. The Ministry of Health and Child Care (MOHCC) and the Ministry of Public Service Labour and Social Welfare (MoLSW) are among government stakeholders Island has been actively working with over many years.

Cyclone Idai brought strong winds and heavy rainfall which caused severe flooding in Malawi, Mozambique and Zimbabwe. In Zimbabwe, the government and civil society came together to assist the affected families with the immediate basics like shelter, food and clothes. Island realised that it could play a role in making sure that the psychosocial support needs of the affected families are met, and therefore requested to be enlisted as one of the service providers of psycho-social support in Chimanimani, Mutare and Chipinge. Working with both the MoHCC and MoLSW Island sent a multidisciplinary team consisting of four palliative care nurses and five clinical social workers to the affected province on the 19th of March 2019 to provide psychosocial support.

Executive summary

Cyclone Idai hit the Eastern part of Zimbabwe, mainly the Chimanimani and Chipinge area on the eve of 14th of March 2019, causing tremendous damage to land, roads, houses, schools and the general communities. Strong wind and heavy rain, followed by flash floods and mud slides battered towns, villages and communities. Several growth points and communities were entirely destroyed and buried. Despite early warnings of the severe weather, the magnitude of Cyclone Idai was unprecedented. The loss of homes, property, personal items, documents, livestock, food crops and above all, family members and friends means that levels of grief in these communities are extremely high, intense and complicated. Survivors require medical attention for injuries, and there is an urgent need for continuity of medication for those on medication for chronic conditions such as HIV, diabetes, heart problems, blood pressure etc. Roads are mainly inaccessible and the few helicopters available are limited in space and carrying capacity. One of the survivors said, “As a community we fear the imminent water borne disease outbreaks caused by Blair toilets which have been washed into the rivers and streams, rending all drinking water unsafe”. The immediate aim of relief teams was to ensure the wellbeing of the affected people by moving them to a secure place and urgent provision of food and shelter. Our team was aware that many survivors would not be in a position physically or emotionally to receive intensive counselling immediately, but that provision of psychosocial support will necessarily be long term. This report will discuss some of the interventions and case accounts by the Island team.

The level of destruction was unprecedented in Zimbabwe and Island staff were also involved in food distribution due to the shortage of man power on the ground to distribute food. In some areas that were inaccessible by road, when food was finally made available stampedes occurred. Help continues from government and various organisations including the UN which has provided a bigger helicopter with higher carrying capacity and is carrying food, blankets, and clothes to the affected areas. Below are some of the cases attended to by Island teams in various sites they were posted to:-

Case 1.

A 25 year old man married to his 22 year old wife with 3 children experienced the total collapse of their house. All 3 children died, buried under the mud. He recounted how both he and his wife sit daily by the remains of the house that buried all their children, although they are presently unable to communicate with each other about what has happened.

Case 2.

At Mutsvangwa rural health facility a survivor described how they were sleeping when they were alerted by a neighbour to the impending threat of rising water in Kopa. Water was entering the home when she advised her older children to exit the house and join the gathered neighbours. In the darkness and rain she guided her husband who was unwell, and strapped their six year old to her back. The family walked to the police station and joined others who were marooned by rising waters and heavy rain. “Someone swam with a rope to where we were gathered which many people used including my two sons. When I tried to use the rope to cross, the rope gave in and broke. There were many of us trying to use the rope at this time and everyone got swept away when the rope broke. The water had so much power that I could not keep on holding my husband’s hand. He slipped away from my hand and I lost him into the raging waters. The water swept me away without control. I felt the towel strapping my child on my back loosening and that I was only holding one of his legs. I later realized I had even lost his leg and that my child was gone. I was experiencing all this in the midst of strong floods sweeping me away too. Eventually I did not know where I was, nor understood what was happening. I only woke up hearing that some Good Samaritan had rescued me from the floods. This is how I survived but (in tears), I am just wondering where my child is right now. Maybe if someone just tells me where my child is even if he is dead, I just hope his body will be found.”

 

Case 3

At Mutare Provincial Hospital, a 52 year old man is married to his 43 year old wife and they have 3 sons of their own who are 19, 15, 12 and 2 other adopted sons 20 and 15. He was a large scale farmer in Chimanimani, while his wife works as a volunteer nurse at Mutare Provincial Hospital. Their whole homestead was completely destroyed and all the fields swept away. He was alone in the house when Cyclone Idai happened and he sustained a severe injury on his right leg and left arm. He had kept a substantial amount of cash in the house and this included money which was meant to pay for their son to sit for his “A” level examination.

He was traumatized by the incident and for several days after the cyclone had struck, he would have nightmares and visions of the whole Cyclone Idai experience. He says his main worry and concern is the loss of his whole life investment in farming and the only source of livelihood for him and his family. There is no more home for him and the family and says this has hit him hard as he has never had to beg in all his life.

Case 4

A 59 old man who was bitten by a snake soon after the cyclone had destroyed his homestead. He was bitten by a snake when he was moving around to assess the extent of the damage around his homestead. The snake bite has exacerbated the trauma and he questioned why ‘a snake bit after surviving the deadly cyclone’. For him, the snake bite had overtaken the events of the cyclone until he received trauma counselling. The counselling helped him to confront the events of the cyclone and he actually realized that he had not really acknowledged the impact of the cyclone itself as he was concentrating on the snake bite.

He was ready to go back to Chimanimani after being discharged from hospital. At the time of receiving trauma counselling, he was not sure whether or not he had lost any close relatives.

Case 5

An 80 year old man who sustained severe back and neck injuries. He lost a niece and a grandson. His wife survived. He received trauma and bereavement counselling at Mutare Provincial hospital before being airlifted to Parirenyatwa Hospital in Harare to undergo Neuro-surgery and further management. Island social worker and a visiting Physio-therapist conducted a follow-up visit at Parirenyatwa Hospital and found him in a stable condition. He is very appreciative of Island’s intervention as he had not had an opportunity before to relate his experience. He will continue to receive psychosocial support from Island until he leaves Harare to go back to Chimanimani.

Over and above these cases Island staff attended to many patients and families who needed our service both at Chipinge & Mutare Provincial Hospital.

 In Harare some first responder teams that were deployed by other organisations to the affected areas are receiving ongoing debriefing sessions from Island.

Debriefing sessions are also held for Island staff who responded to the l needs of survivors and relatives both in the affected areas and at both Mutare and Chipinge hospital.

Continuity of mentorship and supervision is important for counselors all concerned who were exposed to harrowing stories, providing significant support with the risk of vicarious trauma. When the team moved to the affected areas, one team member remained in Mutare at the hospital to offer ongoing support to patients, families and the Island Mutare team members.

Lesson Leant:

  • It is crucial that the Palliative Care Association in the 3 affected countries come together to share notes on lessons learned
  • The palliative and bereavement care sector to advocate for its role in times of disaster response and preparedness as it plays an important role in emotional wellbeing of the affected.
  • A guide on how palliative and bereavement care workers should respond to such disasters and there be a minimum standards in humanitarian response.
  • Promote the adoption of these various standards in humanitarian aid settings.

Conclusions

Island has noted with concern the lack of palliative care knowledge amongst humanitarian workers. Palliative care approach plays an important role especially in pain relief, psychosocial support, and medical care for patients with chronic conditions which may worsen significantly without appropriate care and spiritual support. Palliative care has a significant role to play in disaster ravaged setting hence the need for the sector to advocate for the inclusion of palliative care approach in disaster recovery plans of the country. Long term plans to support the affected families after all their living amenities have been restored to be planned together with the Ministries involved.


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The following extact is taken from an interview with Maureen Butterfield who founded Island. The interview was held in 1979;. We share this with you as we commence our 40th year celebrations. Thank you for your support of the first palliative care insititution in Africa. 

Early in 1979, word of a Symposium entitled ‘Understanding Dying and Bereavement’ held by the Pathways Institute of Thanatology  in Johannesburg reached Mrs. R.A Butterfield, whose interest stemmed  from a previous contact with the work of St. Christopher’s Hospice, London, during  a personal  experience of family bereavement, in 1977.

Subsequent attendance at the very interesting symposium at the University of Witwatersrand on 6th and 7th February, led to a second journey to South Africa in March, 1979, to hear Dr. Cicely saunders herself speak on several occasions on various aspects of terminal pain and the philosophyof terminal care.

There followed a friendly meeting with a lecturer  in the Department of Psychology at the University of Rhodesia (today the University of Zimbabwe), Mr. John McMaster, to assess  the relevance of the subject to everyday life and conditions in this country. At that meeting was born the idea of holding an exploratory symposium in Salisbury (now Harare) to uncover existing needsand the degree of interest here.

That Symposium, entitled ’Care of the Dying and Bereaved’ was held on the 28th May, 1979, in the LLewellin Lecture Theatre, University of Zimbabwe. The response was overwhelming. Over 200 people, lay and professional, of every walk of  life, occupation and race packed the hall to overflowing, to hear a panel  of speakers under the chairmanship of professor  IR Edwards, who is Professor of medicine at the Godfrey Huggins School of Medicine of the local university.

It was his deep interest and concern with the dying patient and his generous support and encouragement that made it possible to gather speakers of the calibre of the Professor of Anaesthetics, Professor A.Duthie, who leads a Pain Clinic at the Medical School; and the Government Consulting Psychiatrist, Dr W.Murdoch. A lecturer in African languages, Mr. J. Kumbirai, gave an informative lecture on the ways of the African people with the dying, and to round off the Symposium, a film of St. Christopher’s Hospice was shown, by kind permission of Dr. Saunders, and through the willing cooperation and attendance of Dr. D.E.M. Brown, Senior Radiotherapist at the Johannesburg General Hospital’s Radiation Therapy Unit, to whose care the film had been entrusted during Dr. Saunders’s visit to South Africa in March. Willing support was also given by the Head of the Department of  Psychology, under whose auspices the symposium was held.                        

The response of the public was measured by a questionnaire issued at the Symposium and showed that deep interest existed side by side with many varied needs for such services as a local hospice, a research unit, training and assistance in counselling and communication, a band of caregivers and availability of information, education and advice for those facing death or bereavement. Not only that, but all of the 70 people who filled in questionnaires (only 100 were provided because the attendance far exceeded expectations) offered their help in the form of time, experience, skills, training and qualifications, as well as in practical ways such as the provision of transport and accommodation.

Some practical action was obviously called for. Therefore Professor I.R.Edwards agreed to chair a smaller follow-up meeting of persons from various professions and with complementary roles in the care of the dying and the bereaved to assess existing facilities and present needs, with a view to initiating whatever further action seemed necessary.

This meeting was held on the 20th July, 1979, at the home of Mr. and Mrs. R.A.Butterfield and was attended by 26 people.

After wide-ranging discussion it was decided that the original Steering Committee of four should be augmented by the addition  of four more members. It now consists of:

Professor I.H. Edwards                                                                   Professor of Medicine, Chairman

Mrs P.J. Edwards                                                                            Nursing Sister

Mr. J. McMaster                                                                              Clinical Psychologist, Lecturer at U. R.

Mrs. S. Von Seidel                                                                          Social Worker

Dr. J.F. Norman                                                                              General Practitioner

Dr. O. Chidede                                                                                Paediatrician

Rev. Bryden Black                                                                          Assistant Rector

Mrs. R.A Butterfield                                                                        Co-ordinator

The objectives of the committee were defined in broad outline as being two-fold: first, to work toward the creation of a centre, preferably a hospice; second, to conduct an educational programme for  interested professionals, for lay workers selected for training in work with the dying and bereaved and for the public at large.

Steps  towards the implementation of the second have already been taken. First, a series of workshops is being planned for professional people of the various disciplines involved as well as for carefully chosen and dedicated lay workers so that the best possible care may be provided for the sick and injured and their families in Zimbabwe today.

Secondly, the idea of small, informal group meetings in private homes under the guidance of informed volunteers (such as have proved highly successful for other social organizations here) is under discussion, so that troubled or bereaved families can find advice, information, companionship and support.

Thirdly, it is proposed that the Steering Committee should form itself into an identifiable group called ‘ISLAND’  which could initiate and carry out these and future projects needed in the community and to which people in need would be referred whenever necessary.

Throughout all these activities, close contact has been maintained with the sisters of The Little Company of Mary at St. Anne’s Hospital in Salisbury who are well-known throughout Zimbabwe for their long, skilled and loving service to the people of this country. In general discussion the idea of their close involvement in the movement towards a hospice has been mooted.

If the Order here, with its special tradition of service to the dying and its established hospital in particularly beautiful and tranquil surroundings, could indeed play a basic role in setting up a Hospice Centre for Zimbabwe, it would undoubtedly   prove a unique and invaluable foundation for a whole gamut of medical, social, psychological and spiritual services for the peoples of this country, on the national, inter-racial and inter-denominational level which we all hope to attain.

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Organization Information

Island Hospice and Healthcare

Location: Harare - Zimbabwe
Website:
Facebook: Facebook Page
Twitter: @Island Hospice Zim
Project Leader:
Elias Masendu
Harare, Zimbabwe
$6,384 raised of $50,000 goal
 
39 donations
$43,616 to go
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