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counselling and bereavement - Interview with Val Maasdorp, Island
December 05, 2011
Inside/Out with Val Maasdorp
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Hospice and Bereavement Service is an organization that provides
an invaluable service to our community. Established in 1979, Island
Hospice is the oldest hospice in Africa. The organization deals
with the issues surrounding death (before, during and after), offers
palliative care, (care for those who can no longer be cured), as
well as training services, counseling, and bereavement services.
Though they offer home-based care and support for all manner of
life-threatening illnesses (e.g. cancer), about 90% of the work
they do focuses on HIV & AIDS.
Valerie Maasdorp, Clinical Manager and the Head of Community Teams
at Island Hospice.
is the current situation at Island Hospice. Have you recovered with
the dollarization and improvement of the economy?
no. I think that financially, it's become, almost, even more
difficult. Because what's happened is that a lot of donors
have changed their priority areas. To some donors, HIV/AIDS is no
longer a palliative care illness, where people may not be "cured"
but can live a quality life taking anti-retro-virals (ARVs). Approximately
30% of our patient base that needs ARVs, is on them. And so instead
of funding palliative care some donors have focused on for instance
income-generating projects. . . livelihoods, and that sort of thing.
But it's very hard for somebody who's actually at the
end of their life, to get out of bed and create a vegetable garden
to sustain themselves. Also donors are keen to concentrate on treatment
and adherence issues rather than care of those who are still facing
the end of their lives despite treatment, or perhaps have AIDS related
cancers etc. So we find that we are actually possibly worse-off
would imagine that Island Hospice would be a very sad place because
you're dealing with two very sad aspects of life: "the
end" and "after the end," but somehow, you all
seem to be really warm and happy. How do you keep it this way?
Next week, I'm
going to the States, sponsored by a National Hospice organization
in Massachusetts, who have asked me to come and talk to all of their
member hospices, at their annual conference, on 'Resilience
in palliative care workers'. The organizers said, if you can
maintain your sense of optimism and joy about the work, in Zimbabwe,
when you're dealing with some of the world's worst records,
then please can you come and talk to us about what it is that keeps
got a very high rate of staff retention. We've got more than
six members of staff, who have been involved in the clinical work
at Island Hospice for more than 20 years. I've been here 25
years, and we've got five people who've been here also
for more than 10 but not yet 20 years. So, if this work grips you,
it grips you. Quite the contrary of saying 'This work is so
difficult' and 'You must be so wonderful to do it'.
Quite the contrary! I feel, I'm very lucky, because I love
my job. How many people out there love their jobs? Really? I mean
you ask kids, how many of their parents look forward to going to
work? When we were in such difficult times in this country in 2008,
the staff would come to work for the support they got. It's
a wonderful place to work so the collegiality is what keeps people
here, and the sense of making a difference. You make a difference
in this job. So we feel very lucky and privileged to be doing this
work because it has such a huge personal impact on you that you
are doing something that does make a difference to people's
It is a wonderful
place to work. It is not a miserable place to work. The hilarity
and shrieking that comes from our team room is amazing!
regard to the psychological aspects of life-threatening illnesses,
I would imagine that these patients and their families have a difficult
time accepting that they are dying. How do you help them with this?
Ok, let me tell
you that not everyone reaches "acceptance". Many years
ago, there was a woman called Elizabeth Kübler Ross, who was
like the guru of hospice care. She set out the stages that people
go through. . . either in being diagnosed with a life-threatening
illness, or going through bereavement. It was denial, anger, bargaining
. . . I can't even remember the order because they don't
actually happen in a distinct order! But the last final beautiful
stage is supposed to be acceptance. That doesn't always happen.
I find that
for the most part people go out of this life, the way they lived
their lives. So if they were a fighter, and feisty, that is how
they'll end their lives . . . but you know, for some people,
they do come to a certain calmness, and a certain reconciliation
about the fact that their life has come to an end. And that's
why it's so good to have Island Hospice there, because the
emotional issues, the psychological issues can be dealt with.
aspect about dying from an illness is that you've got time
to prepare your family and yourself. You've got time to deal
with all that unfinished business that you haven't dealt with.
People don't acknowledge that we are all going to die. I mean,
all of us have a life-threatening illness, and that is "life".
But also, there
are lots of spiritual questions. All sorts of questions come up!
This is a non-denominational, secular, organization. We have no
preference as to what our clientele's beliefs are. What is
relevant is how this will help them to work with what they are facing.
So it's not for us to say, "You ought to believe what
issue of looking after people who are dying and dealing with death
is now very common is Zimbabwe. How do you think as a country, we
could be dealing with grief better?
I would love
to get into the schools. I would like to, on a more organized basis,
get in as part of the curriculum. What I would like to do is get
it into the life-skills courses: How to care for somebody who is
seriously ill? How to communicate with a friend who is grieving?
really about good bereavement awareness orientation and training
for people. Because the whole country is suffering from bereavement
overload! I mean the losses in this country go way beyond death.
You know, if you also think about the people that have left the
country and gone to "Harare North" for example . . .
we've all lost so many friends, colleagues and family members
from our immediate circle, that we've changed best friends
ten times! So there are lots of losses here, in the whole way the
fabric in this country has changed. And I think that the people
in this country are stoic and resilient. But then sometimes they
don't quite acknowledge what's been going on. So for
some people, they're going to end up having blood pressure
problems, alcohol problems, and relationship problems. And I would
like us to not be quite so stoic and resilient but also to work
through the issues of loss and pain and grief, as a nation, in a
more proactive fashion.
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