Palliative care patients are well recognized as a vulnerable population, whose rights need to be protected and supported to obtain justice by their care providers. These patients and families have a right to justice, even more so than the general population given their health condition that exposes them to various other vulnerabilities such as emotional and physical abuse.
In August and September 2017, HOSPAZ sensitized 40 lawyers on palliative care through an approach of onsite sensitizations based at the offices of 16 different law firms and organisations in Harare, Zimbabwe. These include: Law Society of Zimbabwe; Legal Aid Directorate; Zimbabwe Women Lawyers Association; Legal Resources Foundation and University of Zimbabwe, Faculty of Law, among others. Seventeen (17) of these lawyers have also been given an opportunity for more in-depth training on palliative care using a tailor-made curriculum and have visited and interacted hospice and palliative care sites to interact with patients and their family members. These lawyers have been able to identify their important role in health care service provision, and more so as valuable members of palliative care advocacy and service providing teams. They have had meaningful interactions and discussions with hospice and palliative care service providers on key palliative care issues that require the intervention and partnership with legal practitioners. National level, service provider and patient/family level issues affecting access to palliative care in the country were discussed and actions derived for both lawyers and palliative care providers. The main health care and palliative care institutions involved are: Ministry of Health and Child Care, Non Communicable Diseases Program, Pathology and Legal; Island Hospice and Healthcare; Seke Rural Community Hospice, Mashambanzou Care Unit, Cancer Association of Zimbabwe, Kidzcan Zimbabwe and HOSPAZ.
Resulting from awareness creation and training on palliative care, the lawyers are providing pro bono (free) services to palliative care patients and their families residing in communities in and around Harare. Social media especially WhatsApp platform has been valuable in the coordination and organization of site visits of lawyers to palliative care centers to interface and support patients and family members with legal needs. The platform is used for notifying lawyers of identified legal issues of patients to ascertain their availability to attend to the issues. A cross-section of identified patients’ legal needs which have been addressed by the visiting lawyers, include: inheritance, maintenance, succession, property grabbing, terminal benefits, eviction, school fees and polygamous marriage issues. Below are some of the experiences of lawyers supporting palliative care patients and their families in Zimbabwe.
“The patient I visited has cancer and wants assistance in the winding up of their late father’s estate. I provided legal advice to the client on how the estate is wound up and what the whole process entails and the possible outcome. There is need to educate the patients about their rights and to assist where necessary. We should have more visits so that as much as possible, be able to give the necessary legal advice”. A lawyer who visited and supported a patient accessing services at Island Hospice & Healthcare
“The patient I visited was suffering from cervix cancer. Her former husband defaulted paying maintenance for two years. Patient was seeking upwards variation of maintenance for three minor children. I am planning to approach the civil court for upwards variation of maintenance once I obtain all necessary information. Palliative care patients are in need of genuine legal assistance.” Shares another lawyer.
Some patients with unaddressed legal needs are hesitant to utilize services due to cultural issues and fear of retribution by family members or society. But with continued public education involving community leadership this challenge is fast becoming a thing of the past.
This work in Zimbabwe is proving that legal support is an invaluable aspect of palliative care services. Its provision must be carefully and purposively planned for, in order for it to be effective. Other issues which have been identified for intervention by lawyers include advocacy for better access to palliative care services in the country, including essential medicines; educating patients and their families on their rights and addressing ethical dilemmas in the provision of palliative care.
We appreciate the Open Society Initiative for Southern Africa (OSISA) for providing the funding support to the African Palliative Care Association and HOSPAZ towards this engagement of lawyers on palliative care in Zimbabwe. We congratulate Ms Julieth Musengi and Mr Shupikai Chisero, both of HOSPAZ and Ms Mackuline Atieno of APCA for spearheading the implementing of this work.