Spotlight on palliative care

Nowhi Mndai, Health Committee chairwoman at Gugulethu day hospital.

When Beacon Valley resident Keith Griffiths’ wife Harriet was diagnosed with cancer, doctors gave her six to nine months to live, but within a week, she had died.

Thanks, however, to specialised palliative care, says Mr Griffiths, he had had time to say goodbye to his wife and come to terms with her “inevitable death”.

At a World Palliative Care Day event held at Lentegeur psychiatric hospital last Thursday, Mr Griffiths said he had had to take two taxis and a train to St Luke’s Hospice, in Kenilworth, where his wife died surrounded by caring medical staff whom he could not thank enough.

Harriet, 54, died of glioblastoma – a malignant tumour which had affected her brain – on Tuesday December 3, ten minutes before Mr Griffiths arrived at the facility which cares for the terminally ill and their families.

She was admitted to hospital on their wedding anniversary on November 28 and two days later she was transferred to St Luke’s for specialised medical care ahead of her cancer treatment.

“Palliative care helped us come to terms with everything… that death was inevitable. We had to come to terms with my wife dying and we had time to say goodbye and make the most of the time she had with us.

“I am an admirer of the staff, doctors and nurses, who follow processes I do not understand to best help patients,” he said.

He specifically thanked Dr Katya Evans, specialist emergency medicine physician at Mitchell’s Plain District Hospital, who explained his wife’s condition to him and helped transfer her to hospice. Mr Griffiths said there had been a medical care plan, which had included an awake brain surgery, and which they had been hopeful about, but his wife did not make it.

At last week’s event, the Western Cape Health Department’s Klipfontein and Mitchell’s Plain substructure hosted various palliative care team members, from all other substructures and day hospitals, including Gugulethu, Khayelitsha and Bishop Lavis, who shared their experiences of palliative care during Covid-19.

Dr Patryk Szymanski, a physician at Mitchell’s Plain District Hospital, said national Covid-19 lockdown restrictions and fear of the unknown made communicating with patients and their loved ones difficult.

He said Mitchell’s Plain District Hospital had 290 beds, 120 of which were medical beds, that they had a 24-hour emergency care unit but not a intensive care unit or even high care unit.

Dr Szymanski said this made dealing with Covid-19 very difficult as decisions had to be made on the “destinies of patients, which is not an easy feat by any measure”.

He said when they pandemic peaked June, more than 1 000 patients had been admitted on top of the normal medical load they received.

Physical distancing prevented families from visiting patients; doctors stood more than two metres from the edge of patients’ beds; and doctors could not meet face-to-face with family to explain the patient’s condition, an advanced care plan and offer bereavement counselling.

In addition to this, most communication had to be done telephonically. Before Covid-19 doctors would have taken their patient’s hand or stand close to family members, to create a family- or patient-doctor bond.

He said at the start of the pandemic doctors were scared of contracting the virus.

“It was very difficult providing information standing away from the patients, through a mask, the patient would also have a mask on, and with high flow oxygen machines operating in the same room,” he said.

He added that patients were scared because they saw their neighbours dying and that it was difficult to tell patients what to expect.

“Patients died before a palliative care plan could be discussed. Patients died within hours,” he said.

Health MEC Dr Nomafrench Mbombo said the department was committed to compassionate dignified care from the beginning to the end of life. “Following the principles of universal health coverage, this implies that all citizens have access to promotive, preventive, curative, rehabilitative and palliative care and in so doing ensuring the human right to health,” she said.

Ms Mbombo said the National Policy Framework and Strategy for Palliative Care was launched in the Western Cape in October 2018. It advocates for the integration of palliative care into the public health system within the existing resources and governance responsibilities.

Dr Jennie Morgan, a family physician at Gugulethu day hospital said since the launch 133 professionals had been trained in palliative care. “This has helped to prepare for the palliative care burden that comes with Covid-19,” she said.

In response to the pandemic, she added, each in-patient facility had ensured there were enough beds, including Covid-19 palliative care beds with the appropriate resources, Covid-19 end-of-life beds, as well as emotional and spiritual care, including bereavement counselling and adequately equipped human resources.

The department’s healthcare professionals have been providing palliative care services in the hospital and via home-based care to patients who are unable to attend their healthcare facility.

due to their health condition.