October 2019 – Palliative Care in South Africa
I spent the last 25 years of my career in Iowa working as a pain specialist. In doing this work, I became interested in palliative care and received some extra training in this specialty as well. These particular patients often required in-home visits. The last few years of my practice in Iowa I did many home visits for my patients during the last days of their lives. I would often take my wife, Beth, with me on these visits and they were usually more social than clinical. We moved to South Africa about 14 years ago and the first 10 years here have been spent developing our ministry base. Early on we focused on the biggest needs that we saw for the children here. We set up nutritional and agricultural programs to help with food insecurity issues. We have planted two churches to address people’s spiritual needs. Our water and sanitation projects address these needs in our communities here in South Africa.
Four years ago, I finally got back to one of my main interests in hospice and palliative care. I began assisting patients with terminal cancer. We started doing this program helping just one patient at a time, putting together a team for each patient. I found other physicians, pastors, nurses, social workers, and general volunteers interested and willing to assist me. There are no hospice care centers in our rural province of Limpopo. There are no pain specialists or palliative care specialists in our area. I have been fortunate to find a few other physicians interested in learning more about this. My specific area of interest in assisting these patients is in pain management and spiritual counseling. Many of my patients have a fear of suffering and death that they know is coming soon. Having sat with a few dozen patients during this final phase of their lives, I have acquired a bit of skill in opening up discussions with them. I help them verbalize their concerns and share a little bit of the wisdom I have gained. I can also give them some assurance that, most of the time with medication and anesthetic procedures, we can handle much of their pain and suffering. I have had many moving discussions with dying patients about their lives, their belief in God, and what they may or may not experience after they take their last breath.
The extreme poverty that many of my patients here in Africa live with makes bringing them comfort care much more difficult than it is in the USA. A few of them live in a home with no electricity or running water. Many of their homes are overcrowded with multiple people sleeping in the same room and same bed. Very few of them have automobiles and very few of the doctors here make home visits, even for their patients with terminal illness. Often the supporting family members are unemployed and there is not enough food available for good nutrition.
I loved the work I did in America and I was well paid for the work that I did there. I find even more joy working here in Africa where my patients never pay me, but I sense their great appreciation for everything that I am able to assist them with. For me, I have the best job in the world. It never really feels like work and I never plan to retire.