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Malika Ndlovu

Book launch: Griefseed by Malika Ndolvu

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I recently had the privilege of attending the book launch of Malika Ndlovu’s new book, Griefseed. Many of you will remember the moving opening performance by this writer, poet, curator, and applied arts practitioner at the 2023 Palliative Care Conference in Cape Town. 

The launch, held at Exclusive Books in Cavendish, drew a sizeable crowd. From their dress and comments, it was clear they came from many walks of life, each with their own story. During the Q&A session, one audience member shared that she had originally come to buy a book and to use the quiet space to work on her MMed thesis (she is completing her MMed in Paediatrics, as I later discovered). Curiously and unexpectedly, she found herself drawn to the launch instead, explaining, “I am actually here to work on my MMed,” she repeated. But like many of us, she was deeply moved by the conversation that unfolded between Malika and author Barbara Boswell. Indeed, we are all carrying some form of grief in our hearts.

Barbara Boswell writes: “Griefseed is a gift, an offering from the pen of Malika Ndlovu that seeks to transform the ways we think about and process grief. Multidisciplinary in scope, the text includes poems, personal essays, images, and reflections on grief that punctuate the life story of the poet, offered here as medicine. These creative pieces function as both a window onto an individual woman’s life as she has journeyed with, through, and beyond grief, as well as a mirror, inviting the reader to see their own lives and losses reflected within Ndlovu’s.”

Thank you Malika, for your ongoing inspiration and invaluable contribution to the palliative care community in more ways than one.

Greefseed Mailka Ndlovu

The book is published by Karavan Press and is available at Exclusive Books.

Woman disgusted of some cough syrup she has to drink to feel better. Woman taking cough syrup on sofa at home. Ill woman with grey scarf taking cough syrup

Addressing the Gaps in Palliative Care: PALPRAC and EMGuidance Join Forces

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Rural healthcare South Africa
A Child's Radiant Smile in a Hospital Setting: A Glimpse of Hope and Healing
Expanding access to palliative care: doctors skilled to prescribe oral morphine

Palliative care remains one of the most underutilised medical services worldwide, particularly in low- and middle-income countries (LMICs). The Lancet Commission on Palliative Care and Pain Relief’s 2017 report and the WHO’s 2023 report, “Left behind in pain: Extent and causes of global variations in access to morphine for medical use and actions to improve safe access,” highlight the inadequate access to essential pain relief including oral morphine, in particular in low- and middle-income countries (LMICs). Despite being a WHO essential medicine and included in South Africa’s Essential Drugs List (EDL), morphine remains difficult to access due to procurement inefficiencies, governance issues, and misconceptions.

In South Africa, only doctors can prescribe morphine, while nurses are limited to dispensing it. Supply chain disruptions often leave hospitals and clinics without stock. Many patients and families have to travel long distances for their medication. Additionally, inadequate palliative care training leaves many healthcare providers uncertain about proper prescribing and management of side effects.

To address some of these challenges, PALPRAC has partnered with EMGuidance to develop short palliative care training modules. EMGuidance, a widely used South African digital medical information hub, serves over 34,300 doctors, 6,200 specialists, 1,170 pharmacists, and 16,500 nurses. These modules aim to enhance healthcare providers’ knowledge and competencies in the management of pain and other distressing symptoms.

The first module focuses on the basics of morphine prescribing, dispelling myths and offering practical guidance. By improving education and equipping healthcare providers with essential skills, PALPRAC and EMGuidance are working towards better pain management and enhanced quality of life for patients in need of palliative care.

Sign up for the course here: https://academy.emguidance.com/course/prescribing-oral-morphine-in-palliative-care

Share the link with colleagues!

UCT Summer School 2025

Palliative care at the UCT Summer School

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The UCT Summer School is an annual initiative by the University of Cape Town (UCT) that brings together members of the public for intellectually stimulating lectures across a variety of disciplines. This much-anticipated event aims to make academic knowledge accessible to everyone, offering a platform for learning and discussion.

One of this year’s highlights was a lecture titled “Palliative Care: A Fundamental Aspect of Universal Health Coverage,” presented by Professors Liz Gwyther and René Krause. The session shed light on the critical role of palliative care in healthcare systems, emphasising its significance in achieving universal health coverage.

In addition, PALPRAC (The Association of Palliative Care Practitioners of South Africa) and the Groote Schuur Palliative Care Service were invited to set up a stand in the venue foyer. This provided an excellent opportunity to connect with attendees, share resources, and raise awareness about palliative care. The stand facilitated meaningful interactions with the community and allowed healthcare professionals to network and exchange ideas.

A special thanks to Dr Melodie Wessels for her advocacy and dedication to palliative care, ensuring its inclusion in platforms like the UCT Summer School.

We can affect the journey

Palliative Care Awareness Day in Polokwane: A Heartwarming Success

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The PALPRAC team was excited to head to Polokwane for a Palliative Care Awareness Day, hosted on the 5th of December 2024 in partnership with the Limpopo Department of Health. This event brought together participants from all corners of the province, with some travelling from as far as Groblersdal to join the occasion. Participants were enthusiastic and friendly, setting the tone for an impactful day. (We must admit, the PALPRAC team gave themselves a little pat on the back for the smooth rollout of our new GlueUp electronic registration process!)

It was obvious that a solid foundation for palliative care had already been established in the region. Prof. Gert Markinowitz, Dr Thamba Khangale and the team have been successfully running online palliative care training sessions for healthcare professionals in Limpopo, many of whom were present at the event. Adding a splash of inspiration to the day were the vibrant t-shirts designed by Dr Rapudi Morifi, Clinical Manager of Polokwane Provincial Hospital, featuring the slogan: “We cannot change the outcome, but we can affect the journey.” Worn proudly by the team, these t-shirts effectively create awareness for palliative care in their place of work.

The turnout was encouraging, with around 72 healthcare professionals attending. Despite a packed schedule of lectures, the hall stayed full until the very end—perhaps the superb lunch helped keep everyone going!

The agenda featured expert-led discussions on essential topics, including pain management, advance care planning and ethical decision-making in palliative care. During the Q&A sessions, attendees opened up about the challenges they face in the field, including the lack of awareness about palliative care among colleagues, patients, and families, which often leads to late or missed referrals. Access to oral morphine was highlighted as another significant challenge requiring urgent attention.

Despite these hurdles, attendees displayed a strong commitment to improving palliative care services in the region. Their collaborative efforts and clinical leadership continue to advance access to care for patients in Limpopo, even in the face of resource constraints.

Palliative care isn’t rocket science, but it is complex, focusing at its core on providing compassionate support to individuals with serious illnesses. However, it can sometimes feel like an uphill battle within a healthcare system that is so heavily focused on curing diseases. Events like this are instrumental in fostering networks of support, enabling practitioners to exchange ideas and strategies, and reinforcing a sense of shared purpose. The palliative care community’s strength lies in its collaboration, resourcefulness, and dedication to patient-centered care, as this event aptly demonstrated.

The PALPRAC team extends its gratitude to our colleagues in Limpopo for their efforts in organizing this event and to all the attendees for their active participation.

If you’re interested in hosting a similar awareness day in your region, don’t hesitate to reach out to PALPRAC—we’d love to explore how we can work together to make it happen!

Watch this short video of the day’s highlights:

Breaking Barriers: Dr. Natsayi Mujuru’s Commitment to Enhancing Palliative Care Access in Zimbabwe

Breaking Barriers: Dr. Natsayi Mujuru’s Commitment to Enhancing Palliative Care Access in Zimbabwe

In our final blog series on the PG- Dip Palliative Medicine offered by UCT, we spoke to Bubbly Zimbabwean-born family physician Dr Natsayi Mujuru, who completed her PG Dip in 2019 and is currently completing her MPhil. She is an esteemed physician based in Bulawayo, Zimbabwe, working in a hospice and community-based setting. We sat down to ask her about her experience completing the diploma and its impact on her community.

Why did you decide to do the PG DIP course?

My interest in palliative care dates back to my experience during my master’s in Family Medicine, where I had a brief yet impactful encounter with the topic of palliative care. This exposure ignited my enthusiasm for a discipline that embraces a holistic patient care approach, mirroring my professional ethos. 

Pursuing the PG Dip course was a natural progression for me. Before working at a hospice in Zimbabwe, I had dedicated a year to volunteering there. While working alongside my colleagues, I observed the value they attributed to the diploma, particularly those based in Harare. However, in Bulawayo, where I worked, there needed to be more individuals with palliative care expertise.

Recognizing the potential benefits it could bring to our branch, I felt compelled to undertake the course. It was also an opportunity to enhance the quality of services and my proficiency in palliative care. 

How has the course benefited you, your community and your services?

The diploma has had a profound impact on both my personal development and the services provided to the community in Bulawayo. 

On a personal level, the emphasis on communication skills within the course has been invaluable, enhancing the relationships I cultivate with my patients, colleagues, and family. 

Professionally, I’ve been able to mentor colleagues, elevating the quality of our hospice’s services. Over the past few years, our hospice has initiated training programs for palliative care doctors and other professionals within local hospitals and tertiary hospitals across Zimbabwe.

Why did you decide to do the MPHIL?

Pursuing the MPHIL was a logical progression for me, aligning with my commitment to advancing palliative care in Zimbabwe. Despite the gradual development of palliative care services in the country, there remains a critical need for advocacy at all levels. 

Beginning the program in 2023, I recognized the potential of the MPHIL to equip me with the necessary advocacy skills. Specifically, I aim to address issues such as securing coverage for palliative care services through collaboration with medical aids and advocating solutions to the morphine shortage in Zimbabwe. By undertaking the MPHIL, I am better positioned to assume enhanced advocacy roles and drive positive change within the palliative care landscape.

Please share any comments on the challenges and benefits of palliative care in Zimbabwe.

Significant progress has been made in integrating palliative care into the public healthcare system in Zimbabwe, primarily driven by the National policy framework of 2019. Palliative care is now incorporated into various disciplines’ strategic documents, including those of surgeons, obstetricians, and anaesthetists, TB and cancer strategies, nursing curriculums, and national in-service training programmes. 

Despite these advancements, challenges persist. The shortage of morphine stock remains a pressing issue, limiting access to essential pain relief medication. Additionally, there is a critical need for heightened awareness among healthcare professionals and patients regarding the benefits of hospice care. 

The stigma surrounding hospice support still prevails among some individuals, reminding us of the importance of ongoing education and advocacy efforts to promote understanding and acceptance of Palliative care services.

Exploring Palliative Medicine: A Conversation with Dr. Rene Krause

Exploring Palliative Medicine: A Conversation with Dr. Rene Krause

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At the University of Cape Town (UCT), the Post Graduate Diploma in Palliative Medicine stands as a beacon of education, aiming to equip healthcare professionals with the knowledge and skills necessary to provide modern palliative care. We had the privilege of speaking with Associate Professor Rene Krause, Head of Division: Interdisciplinary Palliative Care and Medicine (IPCM) in the Department of Family, Community and Emergency Care (FaCE), to delve deeper into the purpose and impact of this diploma.

Addressing the Need for Palliative Care Services

Dr Krause emphasizes the diploma’s crucial role in addressing the scarcity of palliative care services in South Africa, particularly in underserved communities. “The programme is an enabler, teaching clinicians and healthcare professionals essential palliative care skills and nurturing leadership within the palliative care discipline, especially where resources are limited,” says Dr Krause.

Additionally, the diploma fosters communities of practice, providing vital support and resources, particularly for providers in rural areas.

Beneficiaries of the Programme

Beyond doctors and nurses, Dr Krause highlights the significant impact the diploma could have on a range of healthcare professionals, including social workers and health and rehabilitation workers. There is a substantial gap in the provision of palliative care within these disciplines. A robust psycho-social course is needed to address this gap effectively.

Proud Achievements of the Programme

Reflecting on the diploma’s impact, Dr Krause expresses her pride in the ethical decision-making and communication skills displayed by those who have completed the course. 

Additionally, the programme equips individuals to identify palliative care needs and effectively manage pain, enhancing patient care quality.

Building Upon Foundations: The MPhil Programme

Dr Krause also shares on the MPhil programme, which builds upon the foundation laid by the Postgraduate Diploma. Through this advanced programme, students will develop advanced palliative care skills, further leadership capabilities, research proficiency, and a more profound ability to engage with communities, not just patients, through advocacy. 

The Postgraduate Diploma in Palliative Medicine at UCT is a cornerstone in broadening access to palliative care across South Africa and neighbouring countries by empowering healthcare professionals to provide compassionate and effective care to those in need.

Empowering Healthcare Professionals: Exploring the PG Diploma in Palliative Medicine at UCT

Empowering Healthcare Professionals: Exploring the PG Diploma in Palliative Medicine at UCT

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The Post Graduate Diploma in Palliative Medicine, offered by the University of Cape Town, has become a sought-after course nationally and internationally for those interested in developing their skills as palliative care practitioners. Tailored for experienced healthcare professionals, including doctors, nurses, social workers, and others, who seek expertise in caring for patients with life-threatening illnesses, the program is designed as a distance-learning course. The curriculum emphasises adult learning principles and incorporates practice-based techniques to enhance skills within the workplace.

The primary goal of the PG Diploma is to equip healthcare professionals with a comprehensive understanding of modern palliative medicine, thereby expanding access to palliative care within communities across South Africa.

We spoke to Dr. Fiona Govender, an ICU physician based in Durban, about her experience completing the course and asked her a few questions.

Why did you decide to do the PG DIP- Pall Med?

I was working as a medical officer in an ICU in Durban, and I was counselling families of seriously ill patients. I found that I was not shying away from difficult conversations. My department head then encouraged me to approach Dr. Julia Ambler, who works in pediatric palliative care. I contacted her to shadow her at her pediatric clinics and found that I loved the idea of palliative care. Dr. Ambler directed me to the course at UCT.

How has the PG DIP benefited you, your community, and your services?

The course has helped the ICU, as now I can offer better quality counselling to families. I’m more engaged in the ethical end-of-life discussions that occur in the ICU, and I take on the responsibility of teaching the rotating registrars how to break bad news and how to provide bereavement support. 

Based on what I have implemented, the quality of care in the ICU towards families has improved significantly, and to an extent, the patients. However, most of our patients are intubated and ventilated and usually sedated when we have these conversations, therefore limiting my role in the ICU to mainly symptom control.

Why should other practitioners consider the PG-Dip?

I think practitioners in Durban need to do the PG Dip. We have a large area underserved by palliative care, and most practitioners don’t understand what palliative care is. The course would benefit those seeking to enhance their communication skills, which is crucial for addressing the emotional complexities in palliative care.

What are you most looking forward to in the MPhil/ Why have you decided to do the MPhil?

I have enjoyed learning about and understanding the literature on palliative care. It’s a fascinating part that I shied away from previously. With support and guidance, UCT has given me an excellent introduction to research and taught me how to tackle it. There’s a lot of support and engagement from the faculty, which has been a great help for me.

I decided to pursue a more specialised field in palliative care because I enjoy what I do. Still, I am very limited in the practicality of ICU and symptom management, so I’m focusing my research on the practical aspects I can apply in the ICU.

Dr Clint Cupido

BizCommunity reports: “Unveiling the heroes: A look behind the scenes of integrating palliative care into SA’s public health system.”

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Dr Clint Cupido is a trailblazer in the palliative care community in South Africa. In an interview with Dr Clint Cupido, director of Abundant Life, a palliative care programme at Victoria Hospital in Wynberg, published by BizCommunity, he explains how patients living with serious illnesses and their loved ones are supported through their programme. It is one of the first such programmes to integrate palliative care services into hospitals. As he explains in the article, this is not the norm. “From just 30 patients attending in 2009 and 100 in 2010, this number skyrocketed to 850 referrals in 2023. Last year, Abundant Life Palliative Care had provided care for a sum total of 10,000 patients.”

Read the full article here:

Unveiling the heroes: A look behind the scenes of integrating palliative care into SA’s public health system

 

palliative care pages

How does PACK bring Palliative Care closer to Primary Care?

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The Practical Approach to Care Kit
More than 30 000 health care workers are supported in clinical decision making by PACK.

The Practical Approach to Care Kit  (PACK), also known as Adult Primary Care – APC, is a health systems improvement programme designed to support the work of primary care health workers in under served communities (like doctors, nurses, midwives, health officers, community health practitioners).

Since 1999, the PACK programme has been developed, implemented and evaluated in South Africa, and scaled up across primary care reaching more than 30 000 health workers.

PACK is a comprehensive clinical decision support guide, revised annually to keep up with health priorities.

Following the publication of PACK for use in Botswana that reflected WHO guidance on palliative care, in 2016, the PACK team at the Knowledge Translation Unit (KTU) collaborated with UCT palliative care clinicians to add content to reflect latest South African palliative care policy.

Clinicians are prompted to consider palliative care alongside routine care for serious illnesses.

This included a palliative care section, prompts for the clinician to consider palliative care alongside routine  care for serious illnesses like HIV, DR-TB, dementia and stroke, as well as related training cases. Since then the content has been expanded and is updated annually, supporting health workers to identify and assist patients with palliative care needs.

Dr Camilla Wattrus, Knowledge Translation Unit, UCT (March 2020)

For more information visit https://knowledgetranslation.co.za/

Palliative care South Africa mental health Covid

Health care worker mental distress: there is help!

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At the start of the COVID 19 epidemic in South Africa I was ready to work wherever a palliative doctor was needed. However, as I started to understand more about the groups at risk of doing badly if infected, I had to have a rethink. I am 65 and feel perfectly healthy but  have several risk factors in addition to age. The prospect of having a conversation with my work colleagues about what to decide caused great anxiety and the term moral distress applied to what I was struggling with.

An email came from Medical Brief announcing help for health care workers struggling with the impact of the pandemic on their mental health. Was it fair to ask for this support when I wasn’t at the clinical coal face?

I sent the application for a psychologist to contact me. Very soon, I had a reply and the offer of up to 4 zoom consultations. I have had a really helpful and professional therapist and the semi anonymity of Zoom has been a positive for me.

There are two contradictory messages for health care workers: either “put on your own oxygen mask first”, stay at home if you are at high risk or the health worker hero who is not daunted by fear. The moral distress of facing these choices has not gone away, but I have been helped to live with my decision.

I encourage all health care workers who are facing their own distress during the pandemic to recognise when they need help and to ask for it. There are very supportive and professional people willing and able to help.

My sincere thanks to the organisations and to the psychologists who have volunteered their professional services.

Dr Janet Stanford, Knysna Hospice

 

Mental Health Support for Healthcare Workers

Dear Colleagues

Last week a communication was sent out, which requested volunteers to sign up to provide mental health support via the Healthcare Workers Care Network (HWCN). This programme is a collaboration of the South African Medical Association (SAMA), The South African Depression and Anxiety Group (SADAG), The South African Society of Psychiatrists (SASOP), The South African Society of Anaesthetics) and The Psychology Society of South Africa (PsySSA). 

The purpose of this programme is to provide mental health support to all healthcare professionals requiring care during this challenging time.

Should you require such support, please register here