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Unveiling the heroes: A look behind the scenes of integrating palliative care into SA's public health system
14 Mar 2024
It is estimated that approximately 120,000 people are diagnosed with cancer annually in South Africa and, as these numbers look set to double by 2030, cancer is expected to become the leading cause of death, not only in this country but on the African continent.
Source: 123RF.
With 80% of the nation's population relying on public health services for cancer treatment, and 80% of cancer healthcare professionals and treatment facilities situated in the private sector, the expected pressure on public healthcare systems to deliver cancer care appears daunting.
Moreover, while physicians concentrate on addressing the physical aspects of the disease, the palliative-care requirements of cancer patients are at risk of being overlooked.
Clint Cupido, a senior lecturer in UCT’s Department of Medicine and head of medicine at Victoria Hospital in Wynberg, Cape Town, says, “As healthcare providers we need to focus on the physical side of health. We have a professional, evidence-based approach to our care. We first ensure the correct diagnosis.
“Once confirmed then the staging and assessment of the severity [of the patient’s illness] needs to be done. This approach improves physical care as we drive doctors to make the best assessment before referring for palliative care.
“When receiving a diagnosis which is life threatening, clearly the psychological impact [of the illness on the patient] is significant. Whether you are old or young this is important. But, doctors are often so busy that we "do not find the time" [to address their psychological care]. The cancer patients are referred to St Luke’s Hospice for end-of-life care. But sadly, others get lost in the system.”
Supporting patients and loved ones
Enter Abundant Life Palliative Care: a pilot palliative care programme overseen by Victoria Hospital, a UCT teaching hospital.
After the patient is discharged from the hospital, and with their consent, the Abundant Life Palliative Care team extends an invitation to the patient and their families to attend bi-weekly meetings and information-sharing sessions at its centre in Wynberg, located near Victoria Hospital.
The meetings are led by sister Elizabeth Pitout and supported by a team of skilled nurses as well as UCT 3rd, 4th and 6th year students who use the Abundant Life Palliative Care centre as a teaching site.
The objective is to assist family and friends in coping with and managing their loved one's terminal diagnosis, while also helping them prepare for their eventual passing.
During these sessions, clinicians address various pertinent topics, including the significance of heart- and renal failure, and proper care protocols for patients requiring palliative care.
Key subjects such as preventing pressure sores in bedridden patients and essential information about bed baths are routinely discussed. Furthermore, the sessions encompass caring for patients with dementia and the complexities of assisting patients with behavioral challenges.
Cupido highlighted that Abundant Life Palliative Care also prioritises the wellbeing of caregivers, fostering dialogues on preventing burnout, managing caregiver fatigue, and understanding the underlying reasons for patient behavioural issues.
Urgent need for system integration
Since 2009, when Victoria Hospital’s internal medicine division recorded many deaths due to various cancers, HIV/Aids and TB, these meetings have been in high demand.
From just 30 patients attending in 2009 and 100 in 2010, this number skyrocketed to 850 referrals in 2023. Last year, Abundant Life Palliative Care had provided care for a sum total of 10,000 patients. As cancer rates continue to rise indiscriminately in South Africa, approaching their 2030 projected target, it is evident that these figures are poised to escalate even further.
While there are non-profit organisations dedicated to palliative care, the need, to integrate palliative care into the public health system, cannot be overemphasised.
“Palliative care in hospitals in South Africa is not the norm. We are encouraging patients to raise awareness, and our Abundant Life Palliative Care support group has decided it wants to encourage other hospitals to develop [similar] support groups."
Thanks to the programme’s success, other hospitals in the metropole are in the process of trialling similar programmes among their patients to gauge its effectiveness.
“This is wonderful news as our terminally ill patients and their families are changing their perspective on life. Having come to us for support, they now want to change healthcare.”
Spreading the impact
The launch of these initiatives, while still in their infancy stages, could not have come sooner.
Amid rising cancer numbers and health-system failures in South Africa, their rollout is a response to a growing problem, and Abundant Life Palliative Care is rising to the challenge.
“2024 is the year of improvement and integration into Victoria Hospital, with us moving towards our goal of having a 95% referral rate,” Cupido said.
“[Can you believe that] when we started this programme, some thought it would be unsuccessful and that no one would attend our sessions?
“Changing societal norms is never easy, but we’re doing it.”
