The delegation stands in front of a playroom for dying children at the Clairwood Hospital in Durban. Sithandeni means “we love them.”
Discovering South Africa’s social work voice was the theme of the People to People delegation trip in August, which included NASW CEO Elizabeth J. Clark and 10 NASW members from various roles in interdisciplinary care.
The delegation co-leader was John Mastrojohn, III, senior vice president of the Office of Philanthropy at the National Hospice and Palliative Care Organization, and executive director of the National Hospice Foundation and FHSSA.
“As a delegation, we were there to learn and be NASW ambassadors,” Clark said.
Starting in Durban, the delegation wound its way through villages where they mingled with members of the Zulu tribe and became acquainted with the social work roles in South Africa.
Clark said 51 percent of the country’s population lives on less than a dollar a day. Many people in the Zulu community have no indoor plumbing and walk great distances for basic necessities. But the community thrives on spirit, she said, and they make do.
“The Zulu have a profound resiliency,” she said.
The delegation made a visit to the Bigshoes Foundation in Durban, a nonprofit organization that a group of women established to help young, vulnerable children in life-shortening situations live as productively as possible.
“It is astounding what this organization is able to do for these children,” Clark said. “Many of them have AIDS, have been abandoned by their families or have tragic physical conditions to cope with. But the idea is that the children should have the best life they possibly can, no matter how short.”
One new challenge South Africa faces, the delegation discovered, is an increase in cases of drug-resistant, HIV-related tuberculosis. During a conversation at Helderberg Hospice in Cape Town, the group learned how staff members are trained to deal with the risk.
“They are told to talk to clients in open spaces or outside, recognizing signs and symptoms, and taking precautions regarding their own health,” Clark said.
Despite the cultural differences, Clark said she quickly noticed the similarities between hospice care in the U.S. and South Africa — and the challenges both countries face.
“The hospice concept and philosophy, the use of a multidisciplinary team, and providing bereavement care were quite similar,” she said. “They also have similar workforce shortages with a great need for nurses, social workers and physicians trained in palliative medicine.”
The delegation visited hospice programs in urban and peri-urban areas where most had been in existence for more than 20 years. The rural areas, however, were not as developed, Clark said.
Palliative care is not fully understood in South Africa, and is not integrated into primary care, she said.
“In South Africa, palliative care seems to apply only to end-of-life care and it is not common in hospitals or in serious illnesses that are not life-threatening,” Clark said. “Pain control remains an issue. Morphine is readily available, but other pain medications are in scarce supply. Similar to the U.S., some physicians are reluctant to use opioids because they fear the patient will become addicted.”
Unlike the U.S., many indigenous groups in South Africa use natural healers from their own villages, which hospice staff try to take into consideration in respect to culture. Clark also noted the absence of a formal payer source for hospice care. Although insurance is sometimes accepted, it is not the normal method and makes hospice funding a continual challenge. To alleviate this, fundraising initiatives are pursued, including grants, special events and donations. Almost all CEOs and directors are optimistic funds will come in as needed, she said.
“One CEO we spoke with said they walk on faith. Another said that they did not have much in operating reserves, but that they have been in operation since 1986 — and each year they manage,” Clark said.
With 11 official languages in South Africa, communication with clients presents another challenge for social workers.
“Language and cultural differences of the indigenous group create significant barriers, and staff we met acknowledged this was a concern,” Clark said.
Despite the challenges, the NASW delegation observed some innovative programs in place.
“One program being developed is hospice care in prisons,” Clark said. “In addition to working to provide direct end-of-life care for prisoners, the Hospice and Palliative Care Association has strong advocacy efforts under way to get the problem recognized by their legislature.”
All of the individuals the delegation came into contact with in South Africa were dedicated and passionate about social work, Clark said, and most had been working in end-of-life care for many years.
“They acknowledged the challenging aspects of their jobs and of their programs, but they all appeared,” she said. “They are all totally committed to advancing palliative and hospice care in South Africa.”
Bernice Catherine Harper African Social Work Scholarship
The African Palliative Care Association and FHSSA, formerly the Foundation for Hospices in Sub-Saharan Africa, have partnered to establish the Bernice Catherine Harper African Social Work Scholarship, which gives African nurses in palliative care the opportunity to continue training.
The scholarship, made possible through endowments from the NASW Foundation, will allow the recipients to attend courses in palliative care that include theoretical training and firsthand clinical experience through universities participating in the program.
The goal of the scholarship program is for recipients to use what they have learned to continue advocacy for social work in palliative care in their respective communities and beyond.
This year’s recipients are:
- Lynette South Kitui, Kenya, pursuing a diploma in higher education in palliative care run by Nairobi Hospice /Oxford Brooks University.
- Penelope Mathe, South Africa, pursuing a course in play therapy for children offered by the Centre for Play Therapy and Training in South Africa.
- Rachel Kassam Akinyi, Kenya, pursuing a diploma in higher education in palliative care from Nairobi Hospice/Oxford Brooks University.