A GLOBAL GRANT PROJECT OF ROTARY
INTERNATIONAL
BARAGWANATH OUTREACH PALLIATIVE CARE
Global Grant Record - GG1531461
In
Association with Chris Hani Baragwanath Academic Hospital (CHBAH) Soweto
The
Centre of Excellence for Palliative Care (CEPC)
An initiative of District 9400 (South
Africa) and District 1260 (UK)
Host RC Rosebank Johannesburg District 9400 with International partner RC
Hatfield (UK) and
RC Amwell, Amersham, Chesham, Stevenage Grange, Stevenage, Potters Bar, Newport
Pagnell, Hertford Shires, Harpenden Village, Baldock, Hoddesdon, Brookmans
Park, Luton North, Hitchin Tilehouse, Barton-le-Clay ,Welwyn Garden City,
Hitchin Mimram, Brentwood a Beckett and Radlett District 1130, and Zierikee
District 1610 Netherlands.
Rotary International President John
F. Germ asked members to work together to advance the tradition of Rotary
Serving Humanity in 2016-17. This is an inspirational
story about Rotary Clubs, working together with
the leaders in Palliative Care in South Africa, to address the global issue of access to Palliative Care
as a human right, as acknowledged by United Nations’ conventions, giving
support to the decisions of the 67th World Health Assembly of May
2014, (WHA67.19) for governments to integrate Palliative Care, as part of
the continuum of care for all patients. It’s about the ultimate in sustainable
service: a project that has benefitted health care in South Africa.
Definition of Palliative Care Palliative care is an approach
that aims to improve the quality of
life of patients and their
families
facing problems
associated with
life-threatening illness, through the prevention and relief of suffering, by means of early identification, impeccable assessment, and treatment of pain and other problems – physical,
psychosocial and
spiritual. (WHO 2002)
Bophelo Home-Based Palliative
Care Project
After
identifying a need to expand palliative care to End Stage Renal Failure patients
at Chris Hani Baragwanath Academic Hospital (CHBAH) in the Soweto district of
Johannesburg, Gauteng Province South Africa, the RC of Rosebank District 9400, in conjunction with several UK Rotary Clubs from
District 1260, implemented the Bophelo Palliative
Care Project.
This was funded through Rotary International by a $98,000 Rotary Global Grant, awarded
at the end of 2015. This
project was
led by Rtn James Croswell, President Dr Neville Howes and PP Mark Franklin from
RC of Rosebank District 9400 and PP Frank Taylor, Rtn of Hatfield UK District
1260 and including Past District 1260 Governor Debbie Hodge, who led
the contribution on Pastoral and Spiritual Care, which was one of the defining components
of the palliative care model developed.
The Programme was initiated in March
2016 and ended in April 2017 after successful enrollment and management of 150 patients
in End Stage Renal Failure.
The Project was set up to provide care and support for terminally-ill
patients with kidney disease in their own homes. Provision of palliative
care for renal patients has been achieved. Pressure on the overworked
Chris Hani Baragwanath Academic Hospital was reduced with a reduction in prolonged
hospital stays and of the cost of patients’
hospital visits. The program achieved patient satisfaction, quality of
care, well-being and control of costs. Most importantly the service added value and helped develop evidence for the effectiveness of palliative care in public health. It has focused policy making decisions and added support to the development of a
national policy for public sector provision of palliative care. The newly drafted Policy
Framework and Strategy for Palliative Care (NPFSPC) has adopted the
interdisciplinary intervention model which included spiritual care as a
component of health care. Spiritual care is now officially part of
providing health care interventions. Rotary
International has been instrumental in the introduction of spiritual counselors
as a vital part of palliative care. Rotary will continue to be mentioned
when discussing models of care for palliative care, for years to come. Taking part and seeing the
WHO policy on palliative care established in South Africa has created a
positive awareness of Rotary.
HOW THE
PROGRAM WAS ESTABLISHED. A Rotarian who THINKS BIG,
thinks continuity, thinks
sustainability is none other
than PP Frank Taylor RC Hatfield (District 1260). Following the
successful introduction of the Abundant Life Pilot Palliative Care Programme in
the medical wards of the Victoria Hospital and Groote Schuur Hospital in the
Western Cape, PP Frank Taylor then turned his attention to the 3rd largest hospital
globally; a hospital with 3000 beds, the Chris Hani Baragwanath Academic
Hospital (CHBAH) in the Soweto area of Johannesburg, South Africa. Frank
contacted his South African friend PP Brain Leech, RC of Rosebank, Johannesburg.
Frank and Brian, both retired professional engineers, had co –operated together
in executing 3 sustainable water projects in rural areas in Southern Africa, funded
by Matching Grants, delivered by Rosebank and Hatfield Rotary Clubs. Frank had
been inspired by a South African Rotary Ambassadorial Scholar, Dr Lindi van Niekerk’s philanthropic
zeal regarding home-based palliative care. President –elect Dr
Neville Howes, ex Director General Health Services (NPA), supported involvement
in a palliative care project strengthening access to palliative care in the
public sector.
Rtn James Croswell of RC of Rosebank
(Chairman of the International Committee) met with Dr Charmaine Blanchard (MPhil Pall Med, MB BCh, BSc (Hons) Palliative
Medicine) Director of the Centre of Excellence for Palliative Care (CEPC) at CHBAH
in Soweto Johannesburg. The Gauteng Centre is the leader in Palliative Care in
South Africa who conducts clinical, health systems and policy research supporting
the development and implementation of a national framework for public sector
provision of palliative care. Although the Centre has run a successful model of
hospital-based palliative care, and outreach services into the community, there was no renal outreach palliative care to patients and their
families. Dr Charmaine Blanchard agreed to an involvement in a much-needed
Renal Palliative Care program to provide home care in the end stages of renal failure, to be run within the regulations applicable
to the Baragwaneth Hospital. It would be an ideal program capable of collecting
data to create reports, useful for Rotary International and for decision making
purposes to inform policy and improve interventions as the
Centre’s response to the WHO Resolution on Palliative Care was underway.
Needs Analysis
During March 2015
Rtn Frank Taylor and PDG Debbie Hodge visited South Africa to assist in designing a
detailed project with measurable goals together with plans, timelines and
costs. The RC of Rosebank
arranged a visit to Chris Hani
Baragwanath Academic Hospital,
a tertiary level
referral hospital.
Frank Taylor, together with several UK Rotary clubs from District 1260,
collected over 70 syringe drivers, valued over R1 500,000, were gratefully received
by Ms Duduzile Ngidi,
the Director of Nursing Services, to be used in both Palliative Care and in other
Wards at CHBAH.
PP Peter James Smith arranged for Ms Debbie
Hodge, an expert in spiritual care counseling, to give a radio interview on the
relevance of palliative care in Global Health. She also gave a presentation “Spirituality
and Bereavement in end of life care” to the staff at the Centre (CEPC). It was
established that there was a need to strengthen spiritual care intervention to
address the management of “total pain”. Pain is not just physical because of
illness in the body. It is also emotional, social, cultural and spiritual. (See
diagram)
Renal Unit, DG Annie Steijn District
9400, President John Symons of RC Rosebank and several Rotarians joined Dr Gloria Teckie, Specialist Nephrologist on
a conducted
tour of the Renal Unit.
Dr Blanchard, Dr Teckie, PP Frank Taylor, DG Annie Steijn, President John Symons, Rtn James Croswell, PDG Debbie Hodge a specialist in bereavement counseling. |
This unit sees some 500 renal
outpatients per month. It provides an acute haemodialysis service for patients
admitted with acute renal failure, as well as a chronic dialysis service to
some 150 patients at any one time. Patients are also prepared for and followed
up after kidney transplantation. The high costs and limited availability of
dialysis to patients residing in Third World countries means that only a small
proportion of those who would benefit from dialysis can receive this treatment.
As a result, many patients must be managed with supportive therapy, which until
now was provided solely at the Hospital Renal Outpatients Department. With
often insufficient preparation for the inevitable deterioration and death,
families and patients were left to cope the best they could, which often meant
repeated admissions to hospital and eventual death in hospital. The situation of
not
being able to access life-saving
procedures, or being removed
from a life-saving program, is distressing to patients and their families. As these patients would benefit from a
holistic palliative care program, including spiritual care, a decision was
taken to support the Gauteng Centre of
Excellence for Palliative Care and the Renal Unit at Chris Hani Baragwanath Academic Hospital.
Rotary’s program would deal with patients who became eligible for inclusion in the program
after identification at the renal clinic and in the wards at CHBAH.
Business Plan. Dr Charmaine Blanchard, Director of the Centre, together
with PP Mark Franklin prepared a business plan, which President Dr Neville Howes
and Rtn James Croswell presented to Baragwanath
Hospital Executives to gain approval
from the Gauteng Provincial Authorities. Once this was accepted, funding was
sought through a Global Grant from Rotary Foundation, the International
Charity’s financial arm of Rotary International. Frank Taylor drafted the Grant Application
with the Rosebank Committee. Rtn James Croswell and PP Mark Franklin RC of Rosebank prepared
an MOU with Wits Health Consortium (a Private Company solely owned by the
University Of Witwatersrand Faculty Of Health Science) who were to manage the
day to day employment and payment of staff salaries of the project team. PP
Mark Franklin handled the monthly payments and financial reporting.
BOPHELO' which means ‘Here is Life' became the project name based on the
tenet:
“WE
ARE NOT THE
DYING, WE ARE THE LIVING, HELP US TO LIVE UNTIL WE DIE”
Goal To provide home-based
palliative care to patients with
chronic end stage renal failure and their
families, to ensure quality of life and
dignity in death.
Objectives
·
To improve awareness and achieve
accessibility of palliative care to Renal
patients.
·
To manage the patient’s symptoms at home.
·
To assist patient with emotional, psychosocial and spiritual aspects of living
with a life threatening illness and in
time with dying.
·
To educated the family
about the patient’s illness and how
to
care for the patient.
·
To
improve the quality of life of patients and their families by providing this care and thereto reducing
the need for, and
costs of hospital visits and prolonged hospital
stays.
·
To provided bereavement care and counseling to
surviving family and friends.
Methodology
and Delivery The Project budget provided for a team of two nurses,
spiritual counsellor,
and a social auxiliary worker and team driver. A doctor, employed by the hospital, and 5 volunteer spiritual counsellors, supported the team.
Sister
Doris Radebe (Professional Nurse)
Sister
Gloria Mokwatle (Professional Nurse)
Mr
Tlou Mothata (Social Auxillary Worker)
Motlotlegi
Sebitso (Driver and Administrator)
Spiritual
Care Workers :
- Mrs Thembi Mngomezulu
- Ms Sibongile Khumalo
- Miss Lindiwe Shabalala
- Mr Eric Mazibuko
- Mrs Boitumelo Mokoena
The staff salaries, training and support resources such as cell
phone and a computer were part of the budget. A vehicle was procured to facilitate home visits.
Training
1.
Management of Renal
Symptoms Training
Dr Gloria Teckie, Specialist Nephrologist trained the Palliative
Care nurses on the presentation of end stage renal disease and
the management of
common symptoms in
renal failure patients.
2.
“Approach to Palliative Care”
Training
Sr Keletso Mmoledi
provided “Approach to Palliative Care” training to nurses in the Renal
Unit to enable them to identify and manage palliative care needs among renal patients. Sr Siza Nkosi
provided in-service training to Palliative Care nurses on how to use a syringe
driver.
3.
Five Day Spiritual Care Training
Course
The Bophelo Project had a holistic
thrust – the provision of spiritual, but non-religion-specific support, to
patients and their families facing end of life. Spiritual care
provision had been a gap
in the services provided as part of
holistic care to the
patients and their families. The need for spiritual
care training
would bridge the gap on managing total pain; which encompasses the physical, emotional, social and
spiritual aspects of pain.
During April 2016 PDG Debbie Hodge a Rotarian and Director of Chaplaincy United Kingdom, lead
the contribution on Pastoral and Spiritual Care, supported by Dr Blanchard and
Revd Amanda Ferris a Hospice Chaplain from Hertfordshire, UK who assisted with
the five day training.
Rtn Mark Franklin identified 39
volunteers from different denominations in Soweto who received training. This
enabled the Centre to have access to spiritual counseling for all patients
enrolled in the Bophelo Project.
Training
Manual The
Pastoral
and Spiritual Care training manual is based on the model developed by
Debbie Hodge, with input from Dr Blanchard.
Amanda Ferris, Dr Blanchard holding the training manual, PDG Debbie Hodge and President Neville Howes.
|
THE BOPHELO MODEL
An Interdisciplinary Intervention
Model. The assessment and management of symptoms
together with effective communication, psychosocial intervention with a spiritual
care component were the core components of the Bophelo palliative care model. Consultations with renal patients were structured differently to the Adult Palliative Care
model. The Bophelo model of managed care was an interdisciplinary
patient-centric intervention,
which enabled patients and families to receive comprehensive palliative care in
one joint consultation, with additional
questions to inform spiritual counselor or social
worker (See
diagram)
The services were structured in
such a way that the Palliative Care Renal
team became part of the
Renal Unit. They participated
in the Wednesday Renal
unit clinics
and Tuesday’s multidisciplinary teams
meetings directed by the Head of
Renal Unit, Dr Mashabane. Individual patients were discussed, with input provided from team
members.
The team conducted consultation jointly,
instead of each staff member interviewing the patients
separately. This
model was very beneficial to patients
who gave their history only once to the team who then referred to the renal doctor for advice. This time/cost saving afforded patients more home visits until their death. Patients
were visited on a regular basis to
maintain symptom control
within their homes with support for the families. Patient files recorded all aspects
of care given.
Social Intervention. As part of dealing with total
pain,
social needs were identified
during the initial consultation. The home visits enabled the team to know the reality of
what patients and families face on a daily basis.
The Social worker assisted with family therapy, poverty, social grant applications, identity documents, birth
certificates, sourcing food parcels, paralegal
matters (wills).
Spiritual Care Component. The trained spiritual
counselors accompanied the team in all consultations to provide spiritual
counseling. Follow up was provided on identified needs until the patients died.
Spiritual care extended
beyond the
death of the patients
to their families. Three types of
counseling
were provided
to families. There were 248 spiritual care consultations. Fifty-one families received individual bereavement counseling. Twice during the year there was a Group Bereavement event which
allowed the team the opportunity to assess how families were coping.
Elements of Bereavement Counseling
Cellular phone consultation.
The appropriate use of cellular phone
consultations enhanced communication, access to care, saved time and travel for
patients and increased patient and family satisfaction.
Outcomes, Major Achievements
and Sustainability
Access to palliative care in the
public sector for renal disease patients was established. Specialized appropriate medical care, pain
management, emotional and spiritual
support was
provided to the patients and their families. Not only were symptoms relieved but there was a decrease
in the overall related costs of care. The 'revolving door' sequence of repeated
admission to and discharge from hospital, for this group of patients was
greatly reduced.
Patients' and families’ spiritual and emotional needs had been
met which increased patient satisfaction. The
project demonstrated
the Bophelo model of care was effective as a model of public sector provision
of palliative care.
Integration
of Palliative Care into Government Policies and Services. South Africa was, concurrently
with Bophelo, finalizing the development of the
Policy
Framework and Strategy for Palliative Care (NPFSPC) in terms of the 2014 WHA 67.19. The
South African National Health Policy
recognized the importance of palliative
care, but there was no
policy in place. The South African National Policy and Strategic Framework for
Palliative Care was drafted by Dr Charmaine Blanchard together with Dr
Jeanette R Hunter (Deputy Director General, Primary Health Care), Ms Sandhya
Singh (Director, NCD National Department of Health) and Dr Shaidah Asmall
(Senior Technical Advisor, Primary Health Care).
Dr Mpho Ratshikana-Moloko, the
current Director at GCEPC, together with Dr Charmaine Blanchard of Wits
Health, delivered a presentation to the National Health Council and to
Provincial
and National Ministers. When Deputy Minister of Health, Dr MJ
Phaahla announced the approval of the Policy Framework and Strategy for
Palliative Care (NPFSPC), he praised South Africa for joining a handful of
countries in the world in adopting a National Policy on Palliative Care.
The findings and outcomes identified
by the Bophelo project, influenced the policy. The 6th April 2017 was an historic day for Palliative Care in South Africa, and for
Rotary International, who have made a mark in the history of Palliative
Care through supporting the Gauteng Centre of Excellence for Palliative Care. The Rotarians
felt the
significance of the occasion and were appreciative of the opportunity to
contribute towards making a difference to many South Africans.
The Bophelo model has been adopted as the
model of care for Centre’s of Excellence in South Africa and will be rolled out
to 9 other provinces. Spiritual care is
officially part of providing health care interventions.
While Rotary International
strengthens efforts to eliminate the burden of one big killer in the world
today namely, Polio, Rotary International has now helped alleviate the
suffering of those, in South Africa, with progressive illness which does not
respond to curative treatment. Rotary Foundation has established a mechanism
for cooperation and partnership among clubs and between Rotary and other leading
organizations such as the Gauteng Centre of Excellence for Palliative Care; it has enabled Rotary
clubs to be ever more ambitious in their work to reach for goals and to continue
Foundation’s long tradition of good work. This South African project has enabled
Rotary Foundation to soar ever higher in fulfilling its ongoing mission to
serve humanity. Arch Klump would be
proud!
Dr Mpho Ratshikana-Moloko with Global Grant Committee members from left:
James Croswell, Mark Franklin and Marianne Soal (President Neville Howes not present.)
|
Rotary Add-on Services Provided
·
Donations of e’Pap,
a supplemental porridge, for renal patients by D 1260 Clubs.
·
Donation of 10
wheelchairs and walkers by St Albans Priory Rotary Club UK.
·
Rtn Merle
Langenlegge ensured SDs donated by D 1260
were calibrated ready for use.
· Donation of bed
linen, toiletries, slippers to patients by Anns from Rosebank Rotary Club.
·
Ann Charlotte
Croswell handled catering of all functions and food boxes for patients.
·
AG David Bradshaw
(D 9400) arranged donation of blankets from the Blanket Drive.
Document has been based on reports by Dr
Mpho Ratshikana-Moloko, Director Gauteng Centre of Excellence for Palliative
Care at CH Baragwanath Academic Hospital and her st aff and input from Rotarians
James Croswell, Mark Franklin and Marianne Soal of the Rotary Club of Rosebank,
SA. and Rtn Frank Taylor of Hatfield, UK .
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