Island Hospice & Healthcare

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 14^th 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.

• Bereavement_and_Trauma_care_provided_by_Island_to_victims_affected_by_Cyclone_Idai_in_Zimbabwe.pdf (PDF)
  

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 6^th and 7^th 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 28^th 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 20^th 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.