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Grief, counselling and bereavement - Interview with Val Maasdorp, Island Hospice
Varaidzo Tagwireyi,
December 05, 2011

Read Inside/Out with Val Maasdorp

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Val MaasdorpIsland 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.

Kubatana interviewed Valerie Maasdorp, Clinical Manager and the Head of Community Teams at Island Hospice.

What is the current situation at Island Hospice. Have you recovered with the dollarization and improvement of the economy?

Well, interestingly, 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 financially. Listen

One 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 you going.

We've 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 lives.

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! Listen

With 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.

The positive 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 we believe!" Listen

The 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?

So, it's 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. Listen

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