Physical Health Zimbabwe Project #24223

Island Hospice & Healthcare

by Island Hospice and Healthcare

Project Report | Apr 19, 2021
MY UNEXPECTED JOURNEY WITH CANCER

By Lovemore Mupaza | Monitoring, Evaluation and Research Officer

Island Hospice and Healthcare Zimbabwe (Island) is an organisation that was established in 1979. Island’s main mandate is to provide palliative care and bereavement service to patients and clients who need our services in Zimbabwe. As Island we emphasise on quality of care to our patients and their families and it is from our day to day interaction with patients and clients that the following story of change was picked from, of one of our beneficiary.

It was during the lockdown, on the 23^rd of November 2020 when I took my Dad to hospital after he had suffered another stroke. The doctors ordered a series of tests which included a chest CT Scan as they suspected that he had Cancer. I was not concerned at all as my Dad had had Pulmonary Embolism the year before and had pulled through. The CT scan results confirmed that he had cancer tumours in his lung. A second CT scan of the abdomen showed a tumour in the liver of 12cm diameter and that the ones in the lungs were growing. It was presumed that the tumours were secondary to Colo-rectal Cancer.

On discharge, my Dad could not eat much, and he started to lose weight. The Oncologist that we saw confirmed that the Cancer was now in Stage 4 and that he would not benefit from surgery. She advised us to contact Island Hospice and Healthcare for palliative care. I was not ready for this and we therefore sought a second opinion with another doctor who ran some more tests and concluded that he would try chemotherapy once dad was a little stronger.

In the meantime, we did contact Island and their team pf nurses, social worker and doctor attended to my dad, my mum and me. They always called or physically came in to see how we were doing and by this time my dad was deteriorating so fast it was as if the cancer was literally starting to eat him and due to our fear of losing him, we often called an ambulance to take him to the hospital casualty department. At night l would get up to turn him and to attend to his needs therefore l was not getting much sleep. He, however, never complained and always said “thank you”.

The Island team tried to explain to us that my Dad was in his last stages of life, but we did not want to hear that and were not ready to accept it. They were however patient and kept trying to get through to us.

I remember the Friday the 5^th of February 2021, we went to the Island offices where they

sat us down for counselling, by this time, my Dad was on oxygen continuously and we were not getting sleep at all. On this day, I must say, we finally listened to what they had been trying to help us understand.

What l took with me on that day-

We need to remember that Dad loves us all.
That he may have accepted that he is dying and may not be happy with the frequent trips we were making to the local casualty with him and that we should allow him to make decisions about his care.
He may have worries and concerns that he was not able to share with us because we were not accepting that he is dying.
We need to spend as much time as possible with him, hold his hand and reminisce on the good memories.
That it was ok to ask for help from other people.

From that day things changed for the better in terms of us coping as a family and accept the condition of my father.

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Dec 17, 2020
Island Championing Palliative care

By Lovemore Mupaza | Monitoring, Evaluation and Research Officer

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 August and November 2020, Island was operating under conditions of intensified national lockdown following increased cases of Covid-19 in the country. Zimbabwe’s national lockdown was characterized by restricted movement, curfew between 6pm and 6am, call for social distancing and increased presence of security forces to enforce lockdown measures.

Island adjusted its ways of working and aligned its work to the new environment. This meant reducing one on one clinic contacts, roadside clinics, hospital visits and home visits and increasing telephone contacts. Where home visits were really unavoidable Island team adhered to who guidelines on use of personal protective equipment, social distancing and sanitization. Lockdown restrictions started to ease in August and Island subsequently started to increase contacts through roadside clinics, hospital visits, home visits and clinic visits at the same time observing COVID-19 regulations.

Selected highlights of successes resulting from agile intervention approaches include completion of palliative care integration cascade trainings for 120 health professionals (HPs) in Bulawayo province and continuation of the young carers programme. To date 504 HPs from two provinces have received intensive palliative care training and PC teams were established at each hospital to champion PC integration at their respective facilities. The capacitation of young carers to develop competencies in coping with situations and caregiving skills ensured continued care of PC patients within the home setting regardless of the COVID-19 pandemic.

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

Story of Change 1: My daughter, my carer

My name is Sharon Phiri (pseudo-name), I with my 12-year-old daughter. I am a divorcee. I became sick in 2016, my eyes were affected, and had poor eyesight. This caused me to not do a lot of chores at home and I relied mostly on my daughter to do most of the house chores. To make matters worse, I started feeling weak and having heart pains. Scans at the hospital showed that I had heart problems and I was given medication which helped. It was also revealed that I was diabetic which had caused the poor eyesight.

The situation caused me to go to the councilor where I explained my ordeal. The councilor then referred me to Island Hospice and Healthcare. It’s been more than a year since I’ve been introduced to Island and they have helped me by providing me with medication and food hampers. Island also liaised with Watershed school to finance my eye treatment, but this didn’t come to fruition because the schools were closed early due to covid-19. Island also took my daughter on a Young carers workshop where she was taught how to cope and care for me. The workshops were very emotional as she cried when she tried to explain the situation at home. She also had difficulties at school as one of the teachers said that she is more worried about me and sometimes thinks that she will come home to find me dead, but she just hopes that it’s not so. Such thoughts are brought up because she sees all the suffering I’m going through and also, she is burdened with this caring role.

My daughter was taught how to inject insulin from the hospital and she religiously and timeously does that. She also reminds me to take my medication and food before taking the medication. Other people besides Island have been assisting me. For instance, this house I am currently living in is not mine, a well-wisher gave me this place to temporarily live in, they also provided me with a diabetic testing kit. Another well-wisher has paid school fees for my daughter.

The trainings she received from Island has emotionally equipped her for this role and she has found meaning, increase of comfort and finds positive experiences during difficult times. I thank Island for all the help they have given me, without which it would have been difficult for me and my daughter. My hope is to one day have my eyes treated, my daughter to finish her education and have proper food that does not compromise my health.

Story of Change 2: I’M HAPPY AGAIN BECAUSE I MATTER....

My name is John Siri (pseudo name). I live in Natview with my six-year-old son. I am a divorcee. In 2018 my son started developing persistent headaches and sore right eye. I went to the local clinic and they referred me to Mutare Provincial Hospital where he was given pain medications with no improvement. I was later referred to an eye specialist who after several tests referred me to Parerenyatwa Hospital as he suspected cancer of the eye. This was a major blow as I least expected this on my son. I thought cancer is a disease for the elderly. At Parerenyatwa, the worst was confirmed, my son had stage two cancer of the right eye and they recommended several interventions including surgical removal of the affected eye. All this news ate me up. No one dared sit down with me to explain this heavy load.

The operation was done successfully and after nine months we went back for an artificial eye. This was the beginning of my son’s problems. By then he was now five years old and loved playing outside with other kids. Other kids started shunning him and calling him names because of the artificial eye. At times the eye would fall off and all kids would run away. This was followed by isolation. He would go for days without going out to play. My son started again complaining of headaches. I knew his condition was also stressing him as well as myself. I enrolled him at a local preschool and he faced the same problem, other children didn’t want to play with him when they noticed he had an artificial eye. Wamwe wana wanga waakutorovha chikoro kutya mwana wangu. (Other children were no longer coming to school because they were afraid of my son’s condition). My son’s headaches continued, and I visited the local clinic again.

The clinic sister after taking my son’s history referred me to Island for palliative care. The Island nurse who attended to me was so welcoming. We both felt accepted because of the compassion. She assessed my son and took a detailed history. She attended to his headache after rating his pain. We both felt accepted. The Island team explained to me the importance of attending to reviews on time as the artificial eye gets smaller after some time and would slip off the socket hence scaring other children. All this information was important, and no one had bothered to explain this to me. I did not have enough money to pay for Island services, but I got all the support and services I needed.

The Island team started visiting my son at home to assess progress and support us. I was surprised how they engaged my neighbors and my son’s preschool teachers through the Island community home-based carer to educate them on my son’s condition. The Island team educated the community especially my neighbors on how they could be a support system. They also did the same to my son’s teacher and all children at the preschool. The teachers were also taught on how they can safely clean the eye and put it back in case it falls off. They are another powerful support system for my son.

Today I am proud to say Farai my son lives a normal life although he has a life-threatening condition. He is pain-free as he gets a constant supply of pain medications for his periodic headaches which doctors said are caused by cancer. He is now accepted by the community including the school because of Island interventions. His quality of life has been improved because of Island. Indeed, Island is a place of rest.

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Aug 20, 2020
Walking The Palliative Care Journey Together

By Lovemore Mupaza | Monitoring,Evaluation and Research Officer

Introduction and background

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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