Lessons learned from providing palliative care within a hospital setting

Categories: People & Places.

Growing up with a family of teachers

Andre originally hails from Cape Town, where he grew up in a family full of teachers and a motto of always doing something for others. “My mother retired from teaching, however my father continued and so when it became my time to decide what to study it almost became a known fact that I was just going to automatically become a teacher as well” he said.  

However he had other plans, and it wasn’t in the field of teaching, but rather social work. “It wasn’t something I was exposed to very much (social work), but I always thought about it and I felt that is where my role in life would be one day” he added.

After school Andre then went to study at UWC (University of the Western Cape) and furthered his knowledge in social work. He recalls studying at UWC being an extremely enriching and good experience for him personally.

Early career work

Most of his early work in the field of social work was done working in communities where he worked for the Child Welfare Community, Nickro and in between some travelling was involved too. “I was very fortunate when I got a scholarship to go to the United States for a year where I was exposed to the Juvenile Criminal Justice System because of my involvement and affiliation with Nickro.  I completed a number of extremely enriching programs and training as well as learning a lot from my roommate who was a social worker in Sweden.” he said.

Groote Schuur

When Andre arrived back in South Africa after his years’ experience he had to find a job. Ever keen to spread his knowledge of what he had learnt he searched NGOs for available jobs but to no avail. He then recalled phoning up Groote Schuur, and can you believe it, someone had actually resigned a week prior and there was an opening for him.

He went for the interview and it was a success. “I started working at Groote Schuur in 1989 as a social worker and as the years went by I moved up the ranks to the Renal Unit. That is really where I started working more closely with bereavement and deaths, it was a very sad but learning experience as I would experience patients who were dying because they could not get access to treatment, and so a lot of my work entailed dealing with families and the bereavement that went along with that.

Palliative care within the hospital

Andre made mention to the CEO of Groote Schuur Hospital, Dr Patel that he had observed that patients were being diagnosed and treated and then maybe sent home with no further treatment, but there wasn’t much preparation for the latter. The patients find their way back to the hospital because they are uncomfortable, or because their families simply do not know what to do with the patient.

To address the above issues, she had the brainwave of introducing Palliative care within the hospital, which was a different focus of palliative care, but none the less a very important way of looking at it. The idea had stemmed from Victoria Hospital and Abundant Life who had started something similar in their hospital setting and they approached Dr Clint Cupido regarding the model they used to get thoughts and ideas from it.

At the time of implementation, instead of the actual hospital doing it, they engaged an NGO who then did it and implemented it quite well. “After about two years, because of how things work you have to go out on tender because of it being a pilot project, and all the people who tendered for it were asking for serious money and we only had a certain budget for it which we could not change” he said.

Palliative care program

“We then rather decided to employ nursing staff and two auxiliary social workers. Sr. Jennifer Arendse was the nursing sister and I was very much involved in the employment of the auxiliary social workers, as well as setting up and implemneting the palliative care program with our staff in the hospital setting, along with other stake holders including Dr Liz Gwyther to name but a few” he added.

Once the structures were put in place, Andre then said how an in-depth analysis was taken to look into training and what was realised is that the need is big and currently still is! The affect that palliative care has had in the hospital spread throughout, and it was able to get involved with all the wards in the hospital. They were able to make contact with the families of the patients, engage with them about the illness and in essence build relationships that were possibly not there.

New phases of the Palliative care program

  •          Plans to expand it into the surgical wards and pavilion
  •          Train different people in the wards so that there is a dedicated “champion” for palliative care in each ward

  •    Expose how “cost effective it is”
  •    Talks with other hospitals to implement the program

Expanding on the cost effective point, Andre elaborated on the fact that what they found out is that if a patient comes in who unfortunately we cannot do anything for, technically they should then be going down to another level of care, but because there isn’t anything, they come back to Groote Schuur because of pain management and pain control.

If a proper process is put in place that can avoid patients coming back to hospital – that is where we can save money and alleviate bed space.

Educating the communities about hospice

The association that communities have with hospice is that it is only about death. Andre made mention to the fact that when they refer patients to hospice, the patient feels like the hospital has given up on them, and that is not the case at all.

“You almost need to educate people and say that actually hospice is not about death and dying, hospice is actually about life, it’s about living well with your illness. It’s about the support. I have had patients that I have referred to hospice and they have been with hospice for 10 years! Sometimes the hospice then has to tell them that we don’t need to see you.” he said

Groote Schuur are doing fantastic work in integrating Palliative care into the hospital. We look forward to shedding further light on this topic with other hospitals as well.


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