By HECTOR BANDA -
JULIUS Caesar in Shakespeare?s Julius Caesar says: ?Of all the wonders that I yet have heard, it seems to me most strange that men should fear death, seeing that death will come when it will come.?
This is a conducive setting for the discourse this week: Hospices. Hospices are small residential institutions for terminally ill patients, focusing on the patient?s well-being rather than cure.
The relief of pain and spiritual counseling are the main thrust. This care for the dying may include home visits by professional personnel such as nurses and clergy to provide for the person?s physical and emotional needs.
In olden times hospices provided refuge for pilgrims, travellers, and the homeless were offered lodging, usually by a religious order.
Indeed the Lord Jesus Christ gives the Parable of the Good Samaritan in Luke 10: 29-35 where the man who fell among robbers was reposed at an inn.
The term ?hospice? stems from the same linguistic root as ?hospitality?. It can be traced back to medieval times when it referred to a place of shelter and rest for weary or ill travelers on a long journey.
The name was first applied to specialised care for dying patients by physician Dame Cicely Saunders.
Starting in 1948 Dame Saunders began her work with the terminally ill and eventually created the first modern hospice, St Christopher?s Hospice, in a residential suburb of London.
Saunders introduced the idea of specialised care for the dying to the United States during a 1963 visit with Yale University.
She gave a lecture to medical students, nurses, social workers and chaplains about the concept of holistic hospice care, included photos of terminally ill cancer patients and their families.
The dramatic differences before and after the symptom control care were also depicted.
This lecture resulted in the development of hospice care as we know it today.
These developments resulted in? Florence Wald, then Dean of the Yale School of Nursing, inviting Saunders to become a visiting faculty member of the school for the spring term.
In 1967 Wald took a sabbatical from Yale to work at St Christopher?s and learn all she could about hospices.
However, it was the book based on more than 500 interviews with dying patients published in 1968 titled On Death and Dying written by Dr Elisabeth Kubler-Ross that most highlighted the concept of hospices.
Within it, Kubler-Ross makes a plea for home care as opposed to treatment in an institutional setting and argues that patients should have a choice and the ability to participate in the decisions that affect their destiny.
In 1972 Kubler-Ross testified at the first national hearings on the subject of death with dignity, which are conducted by the US Senate Special Committee on Aging.
In her testimony, Kubler-Ross states, ?We live in a very particular death-denying society. We isolate both the dying and the old, and it serves a purpose. They are reminders of our own mortality.?
Kluber-Ross pleaded for families to be given more help with home care and visiting nurses, giving the families and the patients the spiritual, emotional and financial help in order to facilitate the final care at home.
By 1974 Wald, along with two pediatricians and a chaplain, founded Connecticut Hospice in Branford, Connecticut.
In 1974 the first hospice legislation was introduced by Senators Frank Church and Frank E Moss to provide federal funds for hospice programmes. It failed to be passed into law.
In 1977 in England, a dying boy was refused hospice care due to his age. Following that situation, an epoch for hospices began.
In Zambia, the five main providers of palliative care within an inpatient setting include:
Mother of Mercy Hospice, Jon Hospice, Ranchhod Hospice, Our Lady?s Hospice, Martin Hospice and Cicetekelo.
Most have an additional home care service because the dying are too sick to stay at home.
Yet traditionally and biblically, it is more dignified and peaceful to die at home surrounded by one?s kith and kin.
There are several reasons for dying away from home as hospice in-patient units in Zambia: The inconvenience of informing the hospital and police of a death at home and costly procedures for BIDs (brought in dead), 20 per cent of urban employees have no social safety network normally provided by the extended family system (families reject the dying and orphans).
Mother of Mercy Hospice: The programme was established in 1992 in Chilanga, 16 kilometres south of Lusaka. Most patients are HIV positive. More than 520 inpatients occupy the 22 beds.
An out-patient clinic and a school for children affected by HIV/AIDS operate alongside it.
The small day centre is now a large community school, Guardian Angel School, with about 130 pupils.
The outpatient clinic attends to up to 60 patients daily. About 300 patients from the home-based care programme receive food from the World Food Programme.
Less than 10 per cent of in-patients are on ARV therapy. A local doctor specialised in ARV treatment allocates two to four hours weekly.
The donor picks up the bill for treatment during the patient?s life.
Patients are counselled for 15 minutes or more daily to discuss the importance of regular taking of medication.
Up to 100 patients are visited in their homes each month by the home care team. All in-patients are screened for HIV, have a full blood count, and urine and stool analysis.
Donations in cash or kind are made by the local community, international donors, individual benefactors and local companies to purchase school uniforms and materials.
The hospice is primarily funded by the Archdiocese of Lusaka, nothing comes from the Government.
Jon Hospice: Run by Kara Counselling, the hospice was founded in 1999 and covers greater Lusaka. Initial funds for its establishment came from Pola van der Donck, a Dutch benefactor.
It is now being sustained by a combination of donors. The hospice itself also receives operating funds from the Diana, Princess of Wales Memorial Fund.
Local donations include 25 kilogrammes of beef to contribute towards food costs.
The day care centre for children is funded by Firelight Foundation and AIDS Alliance.
In addition to a 26-bed hospice unit, it operates a mobile hospice service, primarily for children, in the community.
A day care centre for children also operates there. Of the approximately its 500 admissions in 2003, nearly 40 per cent died.
In April 2004, there were 56 admissions. The multidisciplinary mobile hospice team works closely with other home-based care programmes, thus avoiding duplicating services.
Other Kara Counselling programmes include Hope House (life skills training and
VCT), Umoyo Training Centre (skills training and literacy classes for orphaned girls),
Martin Hospice and Ranchhod House (palliative centres).
Ranchhod House: This is named after the Asian businessman who donated the house; it incorporates a 15-bed adult hospice unit that opened in 2003.
It acts as a drop-in centre for HIV counselling and testing.
A street children?s programme is also being established as a preventative measure for vulnerable children.
These services are financially managed by Kara Counselling in Lusaka although local and international donations are sourced by Kabwe directly.
Funding has come from Irish Aid (water system), Abbot Pharmaceuticals (HIV test kits), local farmers and businesses (foodstuffs) and the Zambian NGO ? Community Response to HIV and AIDS (extension of the women?s ward). It is twined with Hospice of Illinois (USA).
Our Lady?s Hospice: This training and outreach programme started in 2001 and the custom-designed 22-bed in-patient unit opened in 2003.
It comprises 4 houses, each with 3 rooms that are furnished with 2 beds.
Acute day patients are stabilised and then transferred to an 8-bedded special care/observation unit/wards.
Trained volunteers visit patients in their homes. Relatives support work of the hospice.
Our Lady?s Hospice: The main funding for this service comes from the Catholic Church. Franciscans in the USA made the start up payment of US$10 000 for the feasibility study for hospice model. The UTH provides free ARVs.
Funds from the Catholic Church in USA supported the building of a laboratory for HIV testing.
Martin Hospice: Located in Choma, about 5 hours drive from Lusaka, this programme offers a 12-bed in-patient unit, a day care centre for 25 children and an outreach programme using already existing Catholic Church diocese home based care programmes.
Cicetekelo Hospice (Ndola Hospice/Ecumenical Hospice Association: It serves both urban and rural Ndola.
It also runs businesses to generate income. There is a 25-bedded inpatient unit for cancer patients and HIV patients. There is also home based care for 200 registered patients and 1200 orphans.
The World Food Programme provides food. Funding comes from both local and international: the Nuffield Foundation; the Diana Fund; Irish GPs (who raised 27,000 Euros following the recording of a Band-Aid type Song in my Heart CD) and the Irish Government?s Joint Committee on Foreign Affairs. It is run by Sr Eileen Keane of the Holy Rosary Sisters.
The University Teaching Hospital (UTH): Officially there are 1500 beds but unofficially close to 2,000 patients, many of them on the floor. It has called a ?departure lounge?.
NATIONAL AND PROFESSIONAL ORGANISATIONS
Some of national and professional organisations that are involved in various ways to support the work hospices in Zambia include: Catholic Archdiocese of Lusaka (52 home based care services); Zambian Palliative Care Association (an informal national association mainly linking Mother of Mercy Hospice and Jon Hospice); Power of Love Foundation (USA-based NGO aiming to minimise the impact of HIV/AIDS and is undertakes projects in Zambia and works in associate on with the Anglican Children?s Project); and The Diana, Princess of Wales Memorial Fund (works in 9 sub-Saharan Africa countries and committed an initial ?5 million over 5years).is sparse. Enthusiasm from government has been lacking, until last week when it undertook to fund hospices.
CHALLENGES FACED BY HOSPICES IN ZAMBIA
The main challenges faced by hospices in Zambia can be summarised as: paucity of funds to meet running costs, inadequate and poorly trained staff, lack of transport, insufficient supply of palliatives (drugs), absence of policy and the ambivalence of political dispensation, and the breakdown of the extended family system that has lead to many patients being abandoned.
BENEFITS OF PARTNERSHIPS
Benefit from partnering with other hospice fraternities in Africa and beyond include: the knowledge that they are being supported in their hospice and palliative care efforts to care for their patients, families and communities; partnerships provide financial and in-kind support hospice partners; funds can help support and expand their programs as well as in-kind donations providing medical and home care supplies, professional journals, books and training materials; partnerships can lead creation of long-lasting relationships and a deeper understanding of and access to lessons from other hospice partner?s challenges, goals and successes.
FUTURE PROSPECTS
Based on Zambia?s political economy and consideration of ethical issues, it is incumbent that a realignment of the budget be more skewed more towards health services.
A sick nation cannot be expected to be optimally productive.
Zambia?s Gross Domestic Product per capita is US$906 which falls within the range of US$8,272 (Libya) and US$346 (Democratic Republic of the Congo) in the countries of Africa.
Moreover, copper output has continued to increase and is expected to continue doing so in the coming years, due to the anticipated higher copper prices.
Also, the maize harvests doubled in 2010/2012 marketing season which helped to boost GDP by nearly 5.0 per cent.
Poverty reduction programs continue to receive support international bodies, including the IMF.
A tighter monetary policy has helped to cut inflation to single digit currently; but Zambia still needs to watch its fiscal discipline, for good health support, especially for the hospice movement in Zambia.
(The author is Executive Chairman of Sylva Group of Companies, former Principal Lusaka Campuses of Zambia Institute of Management, Zambia?s Poet Laureate 1998, immediate past president of Zambian PEN Centre, an association of writers affiliated to International PEN). Contact lanku2001@yahoo.com; 0979487788
Source: http://www.times.co.zm/sunday/?p=12936
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