Island Hospice & Healthcare

Introduction and background

Island uses several models to deliver palliative and bereavement 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 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 August 2021 and November 2021, Island operated under conditions of relaxed national lockdown following decrease in cases of COVID-19 in the country. Island continued to work with reduced face-to-face clinic contacts, roadside clinics, hospital visits and 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.

Successes of these interventions included holistic provision of PC services through innovative means, especially virtual (telephone, zoom, WhatsApp call) and limited one on one contacts. Island intensified tele medicine through rolling out a system for patient information collection and health outcome measurement. The system was embraced by community caregivers who are responsible for administering the tool together with Island nurses and social workers. They were particularly happy with the system for real time reporting of patient outcomes and for triggering intervention from a qualified health professional. In the last thirty days, mean patient quality of life improved 54.1% to 62.9%.  

Two stories below depict typical changes to people’s lives after Island interventions.

 Story of Change 1:

Mr. James (not real name) aged 83 was referred to Island for pain management. He had been diagnosed with cancer of the prostate. He did not understand his condition and did not want to go for surgical operation. The nurse started by explaining his condition to him. The information had to be shared slowly, repeatedly and in simple language so that he could understand. He asked many questions and he made a decision that he didn’t want active treatment but to have pain controlled so that he could go back to his homestead in the village. He also brought in his son and wife so that they could also understand his condition to enable them to support him at home. The son offered to pay for the operation, but he eventually respected his father ‘s wishes. The family was grateful for the explanation about his illness stating that it could help them plan for the future.

Pain medication was prescribed with emphasis on adherence, which greatly helped to ease the severe pain that Mr. James described as unbearable. He was pain free after a few days of commencing medication and after a week he decided he wanted to go back to his home in the village. Mr. James requested to go back to his village home and the Island team discussed care at home with the patient and family. The nurse and social worker follow up the patient telephonically every month to find out how the patient is faring at home, monitor his pain, provide counselling and provide caring support for the wife and family.

When the patient and family had any problems they would phone; for example, when Mr. James was constipated they were advised on how to manage the constipation. At one time Mr. James was depressed and the social worker provided telephone counselling weekly. Last year his condition deteriorated, and the nurse supported by giving frequent guidance and emotional support. The patient’s condition improved, and frequent follow ups continued.

 Last week the patient visited Island with his wife, daughter and son to express their gratitude for the support that had been rendered.

“When I came to island last year in April I didn’t know what was happening. I just saw the white nurse and the black nurse. I was in so much pain that I never thought I will be alive today. I decided to board a bus from the village and come here solely to thank you for the assistance that you provide me and my family. I thank you for the monthly assistance and for supporting us each time we call asking for help”

  Story of Change 2

I am a 62-year-old man who suffered a stroke in 2019. I was diagnosed with hypertension and have been taking Anti Hypertensive’s for 5 years up until the time of stroke. I used to work for the City of Mutare as a driver. In 2019, upon arrival at home, I suddenly collapsed and was rushed to the hospital, only to wake up the next morning unable to do anything at all. The doctor highlighted that the tests showed that I suffered a stroke. The doctors said that it was going to be a long time before I could walk, or even perform any activities of daily living. My life completely changed for the worst and I struggled to settle with reality as I was in so much pain, physically, emotionally and even spiritually.

I was referred to Island Hospice and Healthcare. Ever since that time, I have been working with Island Hospice team who visit me at home providing physical pain management medication as well as counselling me and my family in regard to my condition. On top of all that, Island Hospice has gone an extra mile to engage their volunteer Physiotherapist, who has been very helpful with my daily exercises as well as health education about the stroke I suffered. I was not able to afford any physiotherapy sessions as they are very expensive, and I have since been laid off from work on medical grounds.

I have seen great change physically as well as emotionally and now I’m very grateful since I can now use both hands, turn myself as well as sitting up straight without leaning sideways. Before I started working with Island Hospice, I was always in severe pain but was not able to buy any pain medication, I was depressed about my condition as no one took time to listen to my emotional, social and spiritual concerns.

 I am living comfortably, free of pain and my family is also happy and appreciates the support that we are getting from Island Hospice and Healthcare. My son has also been educated on what to do to continue with the physiotherapy and this has helped a lot towards my recovery and I am truly grateful.

• Family Conference with Patient (DOCX)

Introduction and background

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 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 April 2021 and July 2021, Island continued to operate under conditions of intensified national lockdown following increased cases of COVID-19 in the country. Zimbabwe’s national lockdown was characterised by restricted movement, curfew between 6.30 pm and 6 am, call for social distancing and increased presence of security forces to enforce lockdown measures.

Island adjusted its ways operations and aligned its work to the new environment. This meant reducing face-to-face clinic contacts, roadside clinics, hospital visits and home visits and increasing telephone contacts. Where home visits were unavoidable, the Island team adhered to WHO guidelines on the use of personal protective equipment, social distancing and sanitization.

Successes of these interventions included holistic provision of PC services through innovative means, especially virtual (telephone, zoom, WhatsApp call) and limited one on one contacts. Island embarked on intensification of tele medicine through development of a system for patient information collection and health outcome measurement. The system was embraced by community caregivers who are responsible for administering the tool together with Island nurses and social workers.

Two stories below depict typical changes to people’s lives after Island interventions.

Story of Change 1: The power of communication skills

I am a Community Health Based Caregiver (CHBC) at Island Hospice and Healthcare (Island). One of the most notable cases I worked on involved a young woman experiencing a lot of pain. Her in-laws were accusing her of infecting her husband with the human immunodeficiency virus. Also, due to her HIV status the patient was experiencing stigma and discrimination, with very few members of her family willing to care for and to assist her.

When I started seeing the patient, I struggled to build rapport and our communication was strained. I did not get discouraged though and used the skills and principles of communication I had learned through the palliative care training I received from Island. She had physical pain from the disease, experiencing severe headaches and backache that kept her in bed for days on end and unable to work. She also had emotional pain stemming from the marital problems she was having with her husband. Additionally, the patient had social pain due to her inability to work, which resulted in her children not being able to go to school due to monetary constraints. It got so bad that at one point the patient had suicidal ideation.

Using the training I received from Island, I was able to engage Island nurses in managing the patient’s pain. Island nurses visited the patient at home and assisted her with pain medication and nutritional supplements. I was also able to offer counselling for the patient and her family, working on reunification. Seeing the improvement in his wife’s well-being, the patient’s husband also agreed to counselling. Through our sessions, the patient and her husband were able to improve their communication, which enabled them to work through their marital problems. I was also able to refer the patient’s children to the Department of Social Welfare for assistance with the payment of her children’s tuition. I also recommended the children to join a support group for young carers, facilitated by Island social workers, for support, advice and information to help them cope with caring for the patient.

To this day, the patient and her husband are living a healthy life and are grateful for Island’s intervention in their life. Their quality of life has improved.

Story of Change 2: Island restored my hope

I am a 71-year-old widow and I take care of my son (David) and grandson (Tapiwa). I am blessed with 6 children who are now grown-ups and taking care of themselves in their homes. Tapiwa’s father, my seventh child, passed away, leaving Tapiwa and her mother. Tapiwa was diagnosed with a condition called hydrocephalus and unfortunately the family of Tapiwa’s mother rejected Tapiwa and forced her to give her up to me. I became Tapiwa’s primary caregiver and I had no option but to resign from work so that I could take care of Tapiwa 24/7. Life became difficult but my son David whom I stayed with would help financially to make ends meet. The situation worsened when David suffered stroke and was also diagnosed with HIV. The other 5 children rarely communicated with me and did not offer any support. Here I was, a 71-year-old granny taking care of my grandson and son, with little financial support from the place where Tapiwa once worked.

A CHBC from Island who empathised with my ordeal referred me to the organisation for assistance. They frequently visited offering counselling, palliative care advice and medications. I usually wake up early in the morning to go and find food for the family and constantly walking in the morning dew made my feet develop sores. To make matters worse, I am a diabetic and having wounds is never an option but the need to provide for the family drove me past any personal risks to my health. I had no means of buying medication for these sores. Island came through and offered me medication. They also gave medication to David who was also developing dermatitis.

The intervention of Island is greatly appreciated, and it has changed our lives as a family. The counselling sessions have given me hope, improved my coping capacities and increased social support. I always look forward to these sessions because they are a platform where I get to offload any psychological burdens that I might have. There has been improved communication with my children, especially my last two daughters, who have even promised to visit me. The medication we received and continue to receive from Island helps in pain management for David and my sores are also gone now because of the medicines I received from Island. Island, you gave us life.