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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

 

Introduction and background

Island Hospice & Healthcare (Island) was founded in 1979 as Africa’s first Hospice. It pioneered the development of expert palliative care and bereavement services. The organisation’s philosophy encompasses a skilled and sensitive way of caring for those suffering from life- threatening and life-limiting illnesses, and their families. The care of patients is provided within a multi-disciplinary approach that focuses on the prevention and relief of suffering by means of early identification, correct assessment, treatment of pain and other problems; be they physical, psychosocial, cultural or spiritual.  Island uses several models to deliver palliative care services namely (i) home-based care; (ii) hospital-based care iii) Rural and community outreach iv) Roadside services (v) therapeutic and comprehensive bereavement care, including for children; and (vi) capacity-building for doctors, nurses, community caregivers and others. The bereavement service offered by Island is for those who are grieving after any type of death whether the family lost a patient who died in our care, or a sudden unexpected death such as a car accident, suicide or heart attack. The advent of COVID-19 and the subsequent national lockdown has seen Island intensifying virtual support through telephone, WhatsApp, Zoom and other electronic platforms.

Intervention and impact

Between May and July, Island was operating under conditions of intensified national lockdown following increased cases of covid19 in the country. June-July marks peak winter period in Zimbabwe and coincidentally local and imported transmission cases increased.  Zimbabwe’s national lockdown is characterized by restricted movement, curfew between 6pm and 6am, call for social distancing and increased presence of security forces to enforce lockdown dictates.

Island adjusted its ways of working and align its work to the new environment. This meant reducing one on one clinic contacts, roadside clinics, hospital visits and home visits. Where home visits were really unavoidable Island team adhered to who guidelines on use of personal protective equipment, social distancing and sanitization. The number of contacts through telephone and other electronic platforms were on and rising trajectory from May through July as shown on the graph below.

 

Telephone contacts ensured that Island continued to offer services to its patients and clients. According to current studies, people with underlying conditions are at higher risk of both contacting the virus and of fatalities. This makes Island services really necessary during this period.

Our patients fall into three broad categories namely low care, medium care and high care. Our average number of contacts increased with the level of care category. The high care patients received an average of 3 contacts out of our desired 4 per month because of covid19 disturbances. Island eventually adjusted to the dictates.

Island continued on its journey of ensuring that palliative care is integrated into the health delivery system through training of health professionals. Health professionals from 11 hospitals in one province targeted to receive intensive training were trained in palliative care. Below is a quotation from a trainee:

“We benefitted immensely from the expertise of the consultants from Island. Palliative care has taken us to a higher level and we pray that the champions be filled with the Holy Spirit so that they continue offering this essential service despite the economic and social challenges we are facing.

God bless everyone”

 The story below further depicts typical changes to people’s lives resulting from Island intervention.  

Story of Change: Walking the journey together

Sue a 53-year-old lady with cancer of the breast, walked into the counselling room. She sat on the coach and started to weep. Sue wept and calmed down after about 10 minutes. The social worker introduced herself and went on to assure Sue that they would walk the journey together.

Sue related that she was diagnosed of the cancer in 2017, had a left mastectomy in 2018 and that she was completing her 16 sessions of chemotherapy soon. Her hair had fallen off and she related that her husband hated it and was insisting she wears a wig. She complained of being distressed by the tinkling feeling in her hands and feet. “What is it?” she wanted to know.

This first session started a journey that took more than 36 weekly sessions and WhatsApp updates that occurred nearly daily and were often initiated by patient. Sue continued to sob deeply in the first 10 or so sessions, obviously in deep distress as this sobbing was accompanied by wringing of her hands. She related her anger at her husband of 28 years, and called him “grumpy the dog”. She also expressed anger at her daughters as well as longstanding anger and bitterness towards her only sibling. She was also angry at her cousins who live overseas for not reaching out to her during her battle with the cancer and the harsh treatments. Sue felt completely rejected and alone. To add to that she also complained bitterly about the situation in the country- the economy, the hospitals and general services delivery etc. She was so deeply distressed that she had several minor accidents where she bumped the car on her gate or kerb and her husband would get extremely upset with her.

In the counselling sessions it emerged that her major past pains were the death of her father and her struggle with her younger daughter’s childhood illness that caused permanent impairment. Sue was extremely close to and had great love for her dad and has longed for his care during her own illness. She felt very overwhelmed and totally unsupported as she went through the surgery, chemotherapy, daily household chores and supporting her daughter. She said that her husband and daughters were uncaring of what she was going through and although she shared a bed with her husband there had been no intimacy for years.

In most of the sessions Sue narrated stories of recent deaths of neighbors, relatives and friends, and would just breakdown and sob. She also related minute details of cancer patients she knew in Bulawayo and of those that had succumbed to the cancer. She wondered why cancer was now so prevalent.

The Clinical Social Work therapy and Sue’s Journey

In most of the sessions the social worker just sat in and normalized her feelings, gave assurance and compassionate presence therefore creating the necessary space for Sue to share her anguish. Sue was assisted to prioritize daily activities and make immediate to short term plans of action.

The medical team was brought in to clarify some of the medical questions Sue had which mainly related to the side effects of the chemotherapy such as the tingling mentioned above. Assurance and symptom management was provided in line with the patient’s goals.

With the social worker’s compassionate presence and encouragement Sue was able to face and deal with her anger, fears of death, past and present pains, the cancer and many other emotions she felt. Healthy coping mechanisms that she has used in the past and found effective were explored and she was encouraged to employ them. She was counselled on taking anti-depressants and consented.

The daughters and husband were invited to attend some of the counselling sessions and they expressed confusion at Sue’s anger and other emotions. Gradually Sue’s emotions and reactions came into perspective to her as these were normalized and assurances given by her family members. It was touching when Bob and daughters expressed their love and commitment to her and more so when they shared their own fears with her.  When her husband told her how much he loved her and shared his concerns about her illness Sue cried from positive emotions and not the anger she used to feel.

Fast forward -current state

Sue no longer weeps in sessions which are now down to once a month. Her hair has grown back and she walks with an air of confidence. She has courageously completed radiotherapy. Her younger daughter has recently graduated from a college outside the country and Sue is very proud of her.

Sue has reorganized her life and is shedding off certain activities leaving the ones she enjoys and can realistically handle. Her husband is very supportive and has assisted her to renovate their cottage for her art and dancing lessons which is where her passions lie.

Sue is now able to laugh at herself once in a while. She recently stopped herself from drowning a whole bottle of wine (the only action her husband sincerely requested Sue to stop in session with the social worker).

Her husband genuinely appreciates the work Island Hospice has done with his wife and family. He even made a promise to re-kindle “the hugs”, this he said in front of the social worker.  

Sue is now at peace and continues to affirm the positive change in her relationships with her daughters and husband. As an added bonus she now relates well with her sister so much that they even assist each other to look after their ailing mother.

Island Hospice does indeed journey along with their patients and their families on their painful journeys.

 

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Ruva (not her real name) an HIV positive patient was referred to Island Hospice and Healthcare (Island) with advanced disease, and had been told that she had two weeks to live.  Ruva tested HIV positive two years prior to the visit and was commenced on ARVs but unfortunately took them erratically and not timely as prescribed. Despite all the health education on adherence she failed to comply.  Her health deteriorated very fast and she had uncontrollable diarrhoea and became severely wasted, weak and bed ridden.

Upon follow up home visit, the Island nurse found Ruva very sick and in severe pain. It was very difficult to engage in a meaningful conversation as both patient and her mother were weepy due to the pain. On physical examination she was in excruciating pain.  The nurse’s main goal was to convince Ruva that her pain could be relieved if Ruva complied with the instruction of taking pain medication   every four hours.

Ruva hesitantly agreed to take the strong pain killers with the support of her mother. An initial dose was given instantly by injection followed up by oral morphine tablets four hourly. After a few hours Ruva felt some relief, which then encouraged her to proceed in taking her doses as instructed, and the pain killer also immediately stopped the diarrhoea which brought respite to Ruva and her mother.

As the pain subsided it paved way for discussions of other concerns. Ruva shared that she had given up on life and had no desire to live. She felt this after her husband left her and moved in with another woman and never explained why he had left. She felt rejected, abandoned and neglected and then when a year later she tested HIV positive she felt that there was no need for her to take medication.  A lot of people encouraged her to take the medication but nothing motivated her. She watched herself deteriorate and had no strength to pick herself up. She was very angry with God and got more upset if anybody tried to advise her to forgive her husband or his actions.  With further exploration she had much pain from the past.

Upon the patient’s request the nurse organised for her to get a spiritual counsellor to support her. The priest came and she shared her issues and he helped her to go through the forgiving process.  She was able to invite her ex-husband to talk about the future of their son. They agreed that their son would stay with her sister in the case of her death and her ex-husband would provide money for school fees.  She encouraged her sister to strengthen her relationship with her nephew as this would help them in bonding.  The child began to share his pain with her as he had not had an opportunity to express his feelings. He was worried that he would be transferred from his school and would need to make new friends again but he was reassured that he would remain at the same school. Ruva spent more time with her son despite that she was now weak and frail.

She managed to transfer the ownership of her two houses to her son and rental from those houses would be used for her son’s upkeep. She took her son to her sister’s house and requested her sister and the sister’s husband to adopt him. This was a painful moment but it brought a lot of relieve to her heart. She talked openly about her death.

She was able to pray to her God, and confront and deal with issues in her life with the help of the priest and nurse.   She died peacefully a year later due to complications of the disease.   Her family was very grateful for the support given by Island and the priest

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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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Organization Information

Island Hospice and Healthcare

Location: Harare - Zimbabwe
Website:
Facebook: Facebook Page
Twitter: @Island Hospice Zim
Project Leader:
Elias Masendu
Harare, Zimbabwe
$6,837 raised of $50,000 goal
 
44 donations
$43,163 to go
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