Island Hospice & Healthcare

Introduction and background

Island Hospice and Healthcare (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 aimed at those who are grieving after any death whether the family has lost a patient who died in our care, or a sudden death such as a car accident, suicide or heart attack. Island witnessed a steady increase in the number of home visits as a result of relaxation of Covid-19 restrictions. Virtual contacts however continued to dominate since the advent of the Covid-19 pandemic.

Intervention and outcomes

Between July 2022 and September 2022, Island operated under conditions of relaxed national lockdown following a decrease in cases of COVID-19 in the country. Island continued to work with reduced face-to-face clinic contacts, roadside clinics, hospital visits, home visits, and increased virtual contacts. Island staff adhered to WHO guidelines on the use of personal protective equipment, social distancing and sanitization where physical contact was unavoidable.

The Island team supported 513 patients in July, 430 in August and 460 in September. A total of 3416 contacts were made with patients and clients during the reference period. Virtual contacts dominated with 2069 contacts, followed by home visits (558) and office contacts (441). Successes of these contacts included the holistic provision of PC services and improved quality of life.

The two stories below demonstrate typical changes to people’s lives as a result of Island interventions.

Story of Change 1:

My name is Peter (pseudo name) and this is a narration of how Island helped my cousin sister who had been diagnosed with breast cancer. JT my cousin sister was a single parent of two, a girl and a boy. The elder child is married with a family of her own. Notwithstanding the ins and out of being a single parent, JT was diagnosed with breast cancer. JT initially lived with her son in a single rented room. Family relatives were paying the rent. Due to financial challenges and costs of treatment she had to move to her daughter's home and her son was taken by her biological father to Harare. JT lost her job due to ill health and survived on help from family, friends, church members. I would always support JT financially and emotionally during these difficult times.

As a family we were for the first time faced with a disease which we had little knowledge of and therefore we were constantly worried about JT’s condition. JT’s festering wound, gangrene, and failure to sleep due to ever increasing and excruciating pain was our daily cause for concern. The ripple effects of JT’s poor health included but were not limited to struggles for her personal and son’s upkeep and inability to perform household chores, not to mention the emotional turmoil. We could not even afford to access specialist medical care for her health.

After years of emotional and physical pain, among other things, a friend of JT referred us to Island Hospice. JT, her daughter, and l immediately visited Bulawayo Island Hospice where we received a warm reception before she was examined by a doctor, who together with her staff, enlightened us on the help they could offer us. We were taken through counselling by the clinical team.

We started benefiting immensely from Island Hospice. JT started going for chemotherapy at Mpilo hospital, courtesy of advice from the Doctor. Many a times Island dispensed medicines and gave food parcels courtesy of their donors to the benefit and comfort of JT and her minor son. Furthermore, there were countless home visits and referrals to other medical facilities arranged by Island. There was great improvement on her condition.

The Island team, to whom we will forever be thankful, became like family, displaying true love, care and superior professional support during our greatest time of need right up to the day JT took her last breath and even beyond as they have been checking on us having informed us, they provide bereavement support if we feel we need it.

Story of Change 2: Helpful intervention despite late referral

Lydia is 38 years, a widow with 2 children - a 14-year-old son and a 13-year-old daughter, who is the carer. Lydia was diagnosed with breast cancer 5 years ago; treated with surgery (mastectomy), chemotherapy and radiation therapy. Due to financial problems, Lydia and her children moved in to stay with a distant relative with mental disability. Lydia’s mother had remarried and she cares for a wheelchair bound son born from the second marriage. The child has a back abnormality that has led him to be wheelchair bound

Lydia took care of herself and family until a year ago, when she developed progressive weakness from her cancer which had spread to her spine. She is now totally paralysed from the waist down and requires assistance with everything.

Unfortunately, Lydia was referred to Island Hospice and Healthcare very late when her condition had deteriorated. On assessment by the Island palliative care nurse, Lydia was in physical pain and very angry about her condition: she could not walk, blamed her relatives for not financially supporting her medical care, and was very worried about her children’s welfare, especially access to education.

The Island team understood Lydia’s overall condition. For example, it was recognised that Lydia did not fully understand her illness, or what the future holds for her and her children. This causes fear plus physical pain, and we call this “total pain”. Lydia was given an opportunity to air her anger - she screamed and cried. The nurse explained to Lydia and her sister how her illness had progressed by stages, explaining why she was getting the different treatment at every stage and why now, she was not receiving active treatment and what role palliative care from Island can offer at this late stage.   Island was able to supply medication to control the physical pain and trained the family on how to care for a bedridden patient. Family counselling was provided to discuss the fostering of children and Lydia’s illness. The mother’s condition was explained to the two children and their fears and concerns addressed. Lydia’s mother committed herself to take care of the children. The children were at the grandmother’s house for the school holiday to acclimatize themselves to their future home. A cousin promised to pay for the school fees and her sister to provide food. Other family members committed to buying medications and food.

She was grateful that she now understood her condition and her fears were addressed. This helped Lydia to direct her energy to spending quality time with her children and preparing them to live without her after her death.

The daughter had often missed school to take care of her mother. The Island team reached out to her extended family and requested them to relieve the daughter by hiring a maid so that she could go to school. The daughter joyously went back to school as the relatives now paid her fees.

Her church provides spiritual support and food handouts. As a Catholic, Lydia receives communion every Friday. Her fears, anger and “total pain” - issues have been addressed and now Lydia, although still bedridden and seriously ill, is peaceful and grateful of support given by Island. Early palliative care referral to Island is best and is recommended in order to address arising and changing issues for people with serious illness. Unfortunately, Lydia was referred late to Island for pain management and end of life care. She would have benefited from an early palliative care referral to improve her quality of life.

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