IAHPC Traveling Fellow’s Report

Thanks to a Traveling Fellowship provided by IAHPC, I was able to attend the annual conference of the Hospice and Palliative Care Association ( HPCA) of South Africa, held in Johannesburg in September 2009. I was invited to visit and share our Irish experience of developing palliative care for older people in residential and long-term care settings. In addition to participating in a pre-conference workshop concerning palliative care and older people, I was also invited to visit hospice and community palliative care settings in Soweto, Pretoria and Mamelodi. It was struck by the level of commitment of the local people to their hospice communities. For example, a volunteer traveled to Soweto Hospice because he had promised to polish the floors, he had to leave his home at 4 a.m. because of a cab strike. At the same time, the cab drivers took it upon themselves to pay for a funeral of a young Zimbabwean woman who had died in the hospice without family or financial support.

As a nurse, I believe it is fundamentally important to lead in clinical decision-making and patient care at the end of life. In comparison to nurses working in many European countries, those I met in South Africa demonstrated a high level of leadership in advanced independent practice. A key challenge that faces African nurses is the distribution and transport of opioids to patients for pain relief. There is little point in challenging our governments to promote legislation for access to opioids at a national level when professional governing bodies (in this case, for nurses) lack a vision to develop professional practices that would improve the lives of patients and families. It is also important to note that this is not just a problem facing South Africa but it is an international challenge for palliative care nursing practice, one that academic palliative care nurses must address.

A key message from this conference addressed the burden of care experienced by South African women. I was deeply touched by the concern of a tearful elderly grandmother who asked what will happen to her orphaned grandchildren as her own health fails? Older women with minimal resources, and who themselves are infirm through ill-health, increasingly adopt caring roles for children. Community care workers provide a lifeline of support and act as a conduit between the care services and those in greatest need. However, alleviating the burden of care is not simply about providing better clinical services. The Soweto Hospice and Sun Gardens Hospice are wonderful examples of community programs that have transformed lives. They have much to share with developing services around the globe. Yet, where poverty and malnutrition underpin symptom burden, we must support the WHO’s call for a public health model that embraces a social dimension of good end-of-life care. Ireland has a long and distinguished history in the development of hospice and palliative care. We have much to share, but equally, we also have much to learn from our African colleagues. Our future of working together is assured.

Philip J Larkin
Associate Professor of Clinical Nursing [Palliative Care]
School of Nursing, Midwifery and Health Systems & Our Lady's Hospice Ltd,
Health Sciences Centre
University College Dublin
Belfield
Dublin
Ireland