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Highlights from the 2024 PainSA Congress in Durban

The 2024 PainSA Congress recently took place in Durban (17th-19th May 2024) and was a resounding success. Esteemed colleagues from around the world gathered to share valuable insights and discuss advancements in pain management. 

PainSA, the South African chapter of the International Association for the Study of Pain, aims to enhance pain management across Southern Africa. This year’s theme, “Personalised PAINCARE,” focused on a biopsychosocial and spiritual approach to pain management. The congress featured comprehensive assessments and individualised management plans to reduce pain and reintegrate patients into society.

A significant part of the event was dedicated to palliative care, with sessions for both adults and children. These sessions were well-attended, showing a growing interest in and recognition of the importance of palliative care.

PALPRAC members made a strong impression with their presentations on various topics such as dignity in care, cancer pain management, the pain ladder, and addressing burnout in ICU and neonatal care. These discussions underscored the necessity of interdisciplinary approaches in managing severe and complex pain cases.

In addition to the enriching presentations, the congress served as a platform for networking, allowing attendees to form new relationships and partnerships aimed at advancing pain management practices. For more details on the sessions and speakers, see the full programme on the PainSACongress2024 website https://painsa.org.za/2024-painsa-congress/

This year’s congress highlighted the ongoing need for innovative approaches and collaborative efforts in pain management, ensuring that patients receive holistic and effective care tailored to their unique needs.

 

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Breaking the Barriers: Promoting “phila unethezeke” (palliative care) Awareness in Khayelitsha

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According to community members, palliative care in Khayelitsha has long been associated with death, making it a sensitive topic for the community. Cultural and spiritual beliefs about death contribute to barriers in accessing palliative care resulting in many community members avoiding discussion and options for palliative care. Our goal in Khayelitsha is to change the community’s perception and tackle some of these barriers, as many palliative care patients only receive support from immediate family members, not the wider community.

Health Promotion Day in Khayelitsha: Who Was Involved and Why?

Health promotion enables people to make informed decisions regarding their health. The health promotion event was organised by fourth-year medical students from the University of Cape Town (UCT) and Judith Mahlangu, Khayelitsha Site Facilitator and Researcher at UCT’s Department of Family, Community and Emergency Care, in partnership with The Association of Palliative Care Practitioners of South Africa (PALPRAC).

A diverse group of participants were invited to join the Health Promotion initiative. There were two components to this initiative. First, students and PALPRAC spent the morning on the live, local radio station, Zibonele FM, to introduce the topic of palliative care to listeners, who had the chance to send in their questions.

Some of the questions and concerns raised by the community:

-Palliative care is not for everyone; my child suffered and was not supported after being released from hospital. (Concern from the radio audience)

-Some families believe that if someone is serious ill, people should not be visiting the sick patient because they bring bad spirits.

-Why is it important that we are talking about caring for people who are dying?

-How do we (carers and general community) help someone who needs palliative care?

-What can we do, because we are supporting our family member who is sick, but the community is scared because they think a sick person is bewitched?

The second half of the project included an information session where community member, persons with disabilities, the elderly, carers of palliative care patients, community health workers (CHWs), and neighbourhood watch members could join the team to discuss the basics of palliative care. Bringing this community group together was crucial for raising awareness and giving marginalised, vulnerable individuals a platform to express their concerns. We aimed to promote inclusion to ensure that everyone felt heard and supported.

Goals and Achievements of Health Promotion

The primary goal was to challenge the barriers surrounding palliative care in Khayelitsha. The project created a space where the community could ask questions and discuss palliative care openly, marking a significant step towards normalising conversations about palliative care and providing better support for the community.

Our long-term goals for the Khayelitsha community includes; continuing to raise awareness about palliative care, starting support groups, and ensuring that local resources in Khayelitsha include palliative care support. We aim to have local clinics deliver essential palliative care medication to patients at home and support patients and their families emotionally and physically, addressing issues like poverty and mental health. Academically, we want to include the community’s voice in the curriculum, collect evidence on the impact of palliative care, and present our findings at conferences.

Gratitude

We extend our heartfelt thanks to Sr Shole of Khayelitsha District Hospital, Community members, Zibonele FM, PALPRAC, and UCT for their support and sponsorship. Together, we are working towards a future where everyone can, in palliative care, “phila unethezeke” –live comfortably.

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.

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