Download Palliative Care Research Document

Report on the determination of the feasibility of establishing a Palliative Care
Centre in Vhembe District (South Africa)
EXECUTIVE SUMMARY
The report presents the findings of a study commissioned by Liz Homes Hospices region to
determine the feasibility of establishing a Palliative Care Centre (PCC) in Vhembe district,
Limpopo province, South Africa.
Key findings
The main findings of the study are as follows:
1)
There is a dire need for palliative care and support centre in the region because of the
following factors:

There are higher incidents of individuals requiring palliative care.

The hospital system is unable to carry the services of palliative care since effectively
and to the satisfaction of the communities. Most palliative services are conducted by
Home based carers on a voluntary basis.

Although home based carers in the region receives training, it is usually adhoc and
thus the impact is often not measurable.

Palliative care givers themselves require continuous training, in-service training and
support of a holistic nature. Currently they do not have a base for such support in the
region.

Limpopo, and Vhembe is a gateway for Zimbabwe, Mozambique, Botswana,
Swaziland and the rest of Southern Africa and Africa. The establishment of a palliative
care centre in the region will cater for the palliative care needs of emigrants from the
rest of SADC.

The training and support needs extend beyond CHBC programmes to include care
givers in homes and family
2)
There are more than 50 CHBC organisations in Vhembe district, all of which render
palliative care, however none of these receive focused palliative care training and support.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 1
3)
Palliative care training and support centre requires a comprehensive multidisciplinary
approach, and thus there will be a need for robust mobilization and advocacy and
collaboration with the community, government and Hospitals and clinics.
Recommendations
It is recommended that

a palliative care, training and support centre be establish to cater for palliative care needs on
individuals and CHBC programmes in the Southern African region.

palliative care curriculum be developed as informed by stakeholders such as CHBC
programmes, health professional, etc. Such curriculum should address the holistic needs of
home based carers.

Opportunities to register and certificate the training through compliance with relevant bodies
such as SAQA should be explored.

Although the centre may be established in phases, it should cater for holistic, multidisciplinary
needs of the carers and the clients.

Palliative care centre cannot be successful unless supported by government and
communities. Palliative care advocacy drive should be put in place for community mobilization
and ownership.

In addition, although the landscape of palliative care is not very clear in the SADC region,
pockets of good practice care and support centers are available that the rest of the continent
can learn from. A benchmarking visit to selected centers is recommended in this regard.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 2
BACKGROUND
Limpopo is the northernmost province of South Africa, having Southern regional borders with
Botswana, Mozambique and Zimbabwe. For example, Musina in Musina local municipality is a
small town on the northern border of South Africa in the Province of Limpopo, barely 20kms from
the Zimbabwe. Vhembe district in one of the five district in Limpopo province is a population
capacity of 1,336,493 (Statistics SA, 2010). Vhembe consists of four local municipalities which
include Musina, Mutale, Thulamela and Makhado. The Vhembe district offices are based in
Thohoyandou. The southern border of the province neighbours on Gauteng, Mpumalanga and
North West, making Vhembe district is the gateway for the Southern Africa region.
Musina continues to be a recipient of mainly Zimbabwean and largely undocumented migrants
and it is the intended destination for many (23%), second only to Johannesburg (28%). Even
those in possession of asylum and work permits choose to remain nearby, in order to be close to
home and simply unable to move along to other destinations due to poverty. The process of
migration is fraught with dangers and difficulties, opening people to incredible risk, health
problems and ongoing hardship.
The deterioration in health following this migration pattern is
apparent. Access to good nutrition, proper medical care, and sanitary living conditions are
important components of overall health and well-being. And yet all these components are lacking
upon arrival in South Africa. Respondents were living, bathing, cooking, and sleeping in the
outdoors. However, many of those who needed medical attention reported seeking and receiving
assistance. The living conditions remain largely unchanged adding to the possibility of long-term
health problems and barriers such as lack of knowledge about health care, rights of migrants, and
fear of deportation have the potential to keep many from getting the help they need.
Employment, an essential factor influencing migrants desire to come to South Africa, is
continuously thwarted through irregular, temporary and piece work employment. Almost everyone
we interviewed wanted to be economically viable in order to support family members back home.
Being unable to connect with employment and robbed and/or depleted of financial resources,
many migrants become and are reliant on the support of community-based organizations, faith
based organizations and NGO’s. They rely on these organizations to provide shelter, food, healthcare and other forms of support. And yet still, many migrants are not able to live up to any basic
standard. Shelter is limited and unsuitable for the needs of many vulnerable groups. Food is
sourced through donations or begged for through family and friendship connections. Water is
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 3
collected and food is prepared near toilets and ablution facilities, and many more are sleeping out
in the open. Such an environment leads to increased health problems such as general aches and
pains to more serious illnesses such as chronic diarrhea and tuberculosis. Health care is available
and migrants are making use of the health care facilities in Musina. However, there is continued
reliance on NGOs to provide these services as most migrants believe mobile clinics provide health
care free of charge and without fear of arrest. Barriers to services at public hospitals remain as
people again fear deportation if they access any ‘official’ government services. The elements
outlined above are especially problematic in the lives of women and children.
While violence was directed almost equally at men and women, gender based violence has
continued impacts on the lives of survivors. From the stories collected through the survey, the
migration process can be incredibly traumatic, with women and children sexually assaulted and
feeling very isolated in the host country. Shelters are at capacity and the only other option
available for shelter is in the open, often at the Showground, in unsanitary conditions.
Palliative care is an approach that improves the quality of life of patients and their families facing
the problem associated with life-threatening illness, through the prevention and relief of suffering
by means of early identification and impeccable assessment and treatment of pain and other
problems, physical, psychological and spiritual (WHO, 2002). According to the resent study
conducted by Moetlo et al., (2011), Community Home-Based Caregivers (CHBC) are largely able
to implement home-based care services but would need more support (training, financial, career
structure, and health system) to improve on their services.
There are more than 50 CHBC organisations in Vhembe district, all of which render palliative care,
however none of these receive focused palliative care training and support. Limpopo province
has a population of more than 5 million. There is a network of palliative care learning centers to
educate hospice workers in the region however they are mostly in urban areas. The nurse-patient
ratio for all of Southern Africa is about 443:1. For example, in Limpopo the ratio is about 700:1.
(South African Nursing Council (SANC), 2010). With such a high nurse to population ratio the
countries rely heavily on community workers for many health care services, including palliative
care.
THE CONTEXT/SCOPE
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 4
The shortage of healthcare professionals working alongside CHBC programs stems from the root
problem of a shortage of healthcare professionals across the board in the health infrastructure.
Therefore, this challenge is of greater magnitude, not unique to CHBC and Palliative care
programs and cannot be properly addressed within the scope of this study. There is a need for
CHBC to be given more information on their operations on how they are carried out, and who
carries this operation out.
According to the 2006/2007 Annual Report of the Department of Health and Social Welfare of the
Republic of South Africa (RSA), there were 4,300 reported cases of different types of cancers in
the country. Of these, 4000 were reported to be malignant conditions found among women with
cancer of the breast being the most prevalent.
The National Cancer Registry (NCR) contains South African cancer statistics and plays a vital
role in maintaining and developing national and international awareness of the enormous problem
of cancer in the South African population. Cancer is one of the major killers throughout both the
developed and developing world, including South Africa. According to the 2009/2010 Annual
Report of the Department of Health and Social Welfare of the Republic of South Africa (RSA),
there were twenty nine thousands (29,000) reported cases of different types of cancers in the
country. Of these, 28,700 were reported to be malignant conditions found among men and
women with cancer of the breast being the most prevalent (Denny 2009:214).
Palliative care is an essential component of a comprehensive package of care for people living
with HIV/AIDS and other life-threatening illness because of the variety of symptoms they can
experience. Palliative care is an important means of relieving symptoms that result in undue
suffering and frequent visits to the hospital or clinic. People living with life-threatening diseases
have challenges especially if they are parent and bread winners, because they won’t work during
their illness and they can’t support their children. It becomes a challenge. Palliative care services
are designed to ease situations such as this. PCC will help to enhance community health services.
Especially for patients who are living in their homes, palliative care is the best service to improve
their quality of life. Serious illness can cause physical symptoms, such as pain, nausea or fatigue.
One may have psychological symptoms like depression or anxiety. The treatments for your
disease may cause symptoms or side effects. Palliative care relieves symptoms without curing
them. Where there is no social worker, a home-based caregiver might help with practical matters
and together with the client plan to meet these. Conversations between clients and palliative care
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 5
and legal staff should be on an equal basis, where power is shared and the expertise of the client
recognized.
Health workers can provide basic medical and psychological support including necessary drugs
to control pain and other symptoms that occur as a result of HIV related disease. Family and
community caregivers can also provide palliative care. For example, when patients choose to be
at home, caregivers can be trained by health workers to effectively provide the prescribed
medications and other physical and psychological support that may be needed. Friends, relatives
and others in the community can be trained to ensure that the patient is comfortable. Medical
attention from health facility workers (home visits to support the patient and to assist the caregiver)
should be available as needed. Families and friends should be provided support even after the
death of the patient. Bereavement counselling is an opportunity to support the loss of affected
loved ones and to consider future plans.
Palliative care is an essential component of a comprehensive package of care for people living
with HIV/AIDS because of the variety of symptoms they can experience - such as pain, diarrhoea,
cough, and shortness of breath, nausea, weakness, fatigue, fever, and confusion. Palliative care
is an important means of relieving symptoms that result in undue suffering and frequent visits to
the hospital or clinic. Palliative care is an area of healthcare that focuses on relieving and
preventing the suffering of patients. Unlike hospice care,palliative medicine is appropriate for
patients in all disease stages, including those undergoing treatment for curable illnesses and
those living with chronic diseases, as well as patients who are nearing the end of life. Palliative
medicine utilizes a multidisciplinary approach to patient care, relying on input from physicians,
pharmacists, nurses, chaplains, social workers, psychologists, and other allied health
professionals in formulating a plan of care to relieve suffering in all areas of a patient's life. This
multidisciplinary approach allows the palliative care team to address physical, emotional, spiritual,
and social concerns that arise with advanced illness. Palliative care is an approach which
improves the quality of life of patients and their families facing life-threatening illness, through the
prevention, assessment and treatment of pain and other physical, psychosocial and spiritual
problems
Palliative care:
•
Provides relief from pain and other distressing symptoms;
•
Affirms life and regards dying as a normal process;
•
Intends neither to hasten nor postpone death;
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 6
•
Integrates the psychological and spiritual aspects of patient care;
•
Offers a support system to help patients live as actively as possible until death;
•
Offers a support system to help the family cope during the patient’s illness and in their
own bereavement;
•
Uses a team approach to address the needs of patients and their families, including
bereavement counselling, if indicated;
•
Will enhance quality of life, and may also positively influence the course of illness;
A lack of palliative care support and training centres results in untreated symptoms that hamper
an individual’s ability to continue his or her activities of daily life. At the community level, lack of
palliative care places an unnecessary burden on family, hospital or clinic resources.
RESEARCH METHODOLOGY
The key methods/instruments include:

Collection of qualitative data from stakeholder Community Home Based Carer, health
professionals, community leaders and individual citizens in the Limpopo province.

Assessments of training and support needs of HBC in the region
This study was relying on a systematic review of online resources. A questionnaire was distributed
to NPO group. Because of limited time, only three participants from our NPO database responded
to the questionnaire. The key question was, describe if there is a need to establish a palliative
care centre in Vhembe district? Participants were requested to mention at least two reasons. A
qualitative paradigm was adopted for this study. Polit and Beck 2006:212 as well as Stommel
and Wills (2004:442) defined qualitative research as research that focuses on interpretive, nonnumerical, narrative interpretations, and does not emphasis’ quantitative measurements at all.
This study required a rich and in-depth understanding of the PALLIATIVE CARE issues in the
region. Qualitative research aims at describing social phenomena and behaviours using rich
contextual data that emphasise the subjective experience of social actors (Malta, Maya, Clair,
Freitas & Bastos 2005:1426).
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 7
Unstructured interviews were conducted to establish what stakeholders say about the need for
establishing a palliative care centre in the region. Stakeholders included a group of 12 home
based carers, 2 nurses, 6 NGOs, 17 community leaders. Stommel and Wills (2004:445) defined
an unstructured interview as an interview style in which the flow and content of the interviews are
largely determined by the interactions between interviewer and interviewees. Such exploratory
interviews do not contain fixed response formats or predetermined questions, except for directions
concerning the general topic areas. Polit and Beck (2004:229) view the unstructured interview as
“…typical conversational, with no preconceived view of the content or flow of information to be
gathered”.
RESULTS
The results are presented according to identified objective indicated in the terms of reference.
a)
The viability of having a palliative care centre in Vhembe District
Palliative care is an essential component of a comprehensive package of care for people living
with HIV/AIDS because of the variety of symptoms they can experience - such as pain, diarrhoea,
cough, and shortness of breath, nausea, weakness, fatigue, fever, and confusion. Palliative care
is an important means of relieving symptoms that result in undue suffering and frequent visits to
the hospital or clinic. Lack of palliative care results in untreated symptoms that hamper an
individual’s ability to continue his or her activities of daily life. At the community level, lack of
palliative care places an unnecessary burden on family, hospital or clinic resources.
b) Why do we need Palliative Care training and Support centre in the community?
According to Wits Palliative Care (WPC) at least 370,290 people suffered a painful death in 2005.
Up to date, the statistics are believed to have increased. Therefore there is a need for palliative
care centre that will help with reduce the burden and crisis. Kang’ethe (2010) stressed about the
danger of involving children as family caregivers of palliative home-base-care to advance
HIV/AIDS patients.
In 1996, the new Constitution was adopted for the country. According to Clause 27.1 of the
Constitution, “everyone has the right to have access to: health care services, including
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 8
reproductive health; Sufficient food and water; and social security, including, if they are unable to
support themselves and their dependants, appropriate social support”. Palliative centre is crucial
in Vhembe district.
Palliative Care in Vhembe district is a necessity. According to Lobuono (2001:44), the period
following the diagnosis of cancer turns out to be the time when life and death predominates. It is
a crisis which emphasises the patient’s mortality. The diagnosis of cancer according to Watson
(2003:804); and Keitel & Kopala (2000:308) forces the individual into a series of crises that affect
his or her entire well-being by fear, guilt and powerlessness. A USA study of patients who had
cancer and mastectomy, reports that the cancer experience had a disruptive influence on family
relationships (Lobuono (2001:319).
This is further compounded by separation introduced by hospitalization, physical and
psychological withdrawal on the part of the patient. Lobuono (2001:223) further states that family
members had difficulties in coping with the emotional ramifications of cancer. The most difficult
and crucial time arises when the patient is waiting for the results of the biopsy and after the
mastectomy. This also makes patient and the spouse very scared when they take a look at the
scar or incision for the first time. Of greater importance is the time when the couple resolves to
resume physical intimacy and accept the changes brought by the surgery (Haskel 1995:275).
Findings of the 2011 study by Manenzhe, Netshikweta and Netshandama (2011:84) shows those
patients with cancer travel kilometers for their monthly. The researcher found that there is a lack
of information on breast cancer and mastectomy among African women residing in Vhembe
district. No previous research has been conducted to determine how these women experience
the diagnosis of cancer of the breast and subsequently the mastectomy. Of greater importance is
the fact that women diagnosed with cancer of the breast reported changes in the affected breast
long after the disease had spread to the nearby lymph nodes. Finally, the support from the family
system may be not readily available when crucially needed.
Following the research study conducted in Vhembe district by Manenzhe et al (2011:50), an
affiliation of committed individuals from the University of Venda Department of Advanced Nursing
Science, met to coordinate educational events on a regional basis for the palliative care
community. Such events included visits by the researchers as well as the encouragement on the
oncology nurses (experts) to form a place where cancers patients and the survivors with be
supported from.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 9

Dealing with distress
The key to effective palliative care is to provide a safe way for the individual to address their
physical and psychological distress, that is to say their total suffering, a concept first thought up
by Cicely Saunders, and now widely used, for instance by authors like Twycross or Woodruff.
Dealing with total suffering involves a broad range of concerns, starting with treating physical
symptoms such as pain, nausea and breathlessness. The palliative care teams have become
very skillful in prescribing drugs for physical symptoms, and have been instrumental in showing
how drugs such as morphine can be used safely while maintaining a patient's full faculties and
function. However, when a patient exhibits a physiological symptom, there are often
psychological, social, or spiritual symptoms as well.
Haskel (1995:20) also refers to it as the “existential plight”. The struggle and stress that presents,
when the diagnosis of cancer is confirmed, brings awareness of personal mortality. Thus the
newly diagnosed patient with cancer is often confronted with his/her own humanity and mortality,
and this becomes a period of despair. Keitel & Kopala (2000:15) concurs that when a member of
the family suffers from a life – threatening disease such as cancer, the effects are not only
experienced by patients, but rather they reverberate throughout the family system and the patient,
all experience the cancer crisis.
‘Yes there is a need for a palliative care in our region because of high rate of HIV/AIDS
and TB in our region. I think we need that for relief of pain, symptoms and stress’. Said
participant, during one of the interview.
The interdisciplinary team, which often includes a social worker or a counselor and a chaplain,
can play a role in helping the patient and family cope globally with these symptoms, rather than
depending on the medical/pharmacological interventions alone. Usually, a palliative care patient's
concerns are pain, fears about the future, loss of independence, worries about their family, and
feeling like a burden. While some patients will want to discuss psychological or spiritual concerns
and some will not, it is fundamentally important to assess each individual and their partners and
families need for this type of support. Denying an individual and their support system an
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 10
opportunity to explore psychological or spiritual concerns is just as harmful as forcing them to deal
with issues they either don't have or choose not to deal with.
According to Leseka (2010), findings reveal that Hospital-based palliative-care has limited
effectiveness due to the small size of the team which is working against demands from increasing
numbers of patients. Very few patients (27%) with HIV&AIDS were accessing services of the
hospital-based palliative care. Significant proportion (67%-77%) of HIV infected patients were
experiencing physical symptoms, pain and psychosocial problems requiring palliative care
interventions. This means that CHBC palliative care is more effective compared to the HospitalBased palliative care. In CHBC palliative care centers the size of a team is large, but mostly
lacking expected capabilities such as required training and available facilities.
When patients choose to stay at home, caregivers can be trained by health workers to effectively
provide the prescribed medications and other physical and psychological support that may be
needed. Friends, relatives and others in the community can be trained to ensure that the patient
is comfortable. Medical attention from health facility workers should be available as needed.
Friends and families should be provided support even after the death of the patient. Bereavement
counseling is an opportunity to support the loss of affected loved ones and to consider future
plans (WHO).
c)
Training centers: Training needs of CHBC to care for palliative care clients in the
area
There is a greater need for palliative caregivers to receive required training that will improve and
enhance their service delivery. Although the majority of members of CHBC in Vhembe district of
Limpopo have enough knowledge on what they are doing there is greater need for continuous
training and in-service training (Moetlo et al, 2011). Within the concept of integrated community
home-based care (CHBC) services 393 caregivers in Vhembe District, Limpopo Province, South
Africa responded to a questionnaire on various aspects of home-based care and service provider
characteristics. Results indicate that in most areas of the Community Homes-based Care (CHBC)
services, caregivers had skills confidence including wound dressing, health education, bet
bathing, giving prescribed medication, and management of diabetes client, and they had sufficient
knowledge received through training. Lower knowledge and confidence was noted for the
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 11
management of hypertensive and asthmatic clients, and lower knowledge (82%) was indicated
for counseling.
The most common caregiving services included health education (100%), giving medication
(98%), management of hypertension (22%), and counseling (15%). Most caregivers rated the
implementation of CHBC in their district as excellent or good (70%). The most common problems
and barriers in caregiving included (1) structural problems: none or sometimes not available
home-based care kits (54%), lack of resources (32%), lack of transport money (30%), and very
low stipend (22%); (2) problems with the supervisor such as lack of management skills (40%) and
selfishness (38%); and (3) problems with clients and community such as patients not taking
prescribed medicines regularly (45%) and not welcomed by patients and family members (35%).
Community home-based caregivers are largely able to implement home-based care services but
would need more support (training, financial, career structure, and health system) to improve on
their services.
d)
Training needs of Community Home Based Carer to care for palliative care
The most common problems and barriers in care giving included, structural problems: none or
sometimes not available home-based care kits, lack of resources, lack of transport money, and
very low stipend; problems with the supervisor such as ‘lack of management skills’ and
‘selfishness’; and problems with clients and community such as ‘patients not taking prescribed
medicines regularly’ and ‘not welcomed by patients and family members’ (Moetlo et al., 2011).
According to the study by Moetlo et al., (2011), results of their study indicate that in most areas
of the CHBC services, caregivers had confidence including wound dressing, health education,
bet bathing, giving prescribed medication, and management of diabetes client, and they had
sufficient knowledge received through training. It is very important to give required training to care
givers in order for them to care for palliative care clients.
There is a greater need for training to produce qualified palliative care givers to avoid a situation
where children are involved. The burden and crisis such as children been involved will results in
them been absent from school while caring for patients especially if patients are family or parents.
Kang’ethe’s study reveals that children often face serious problems which include being
oppressed, being engulfed by fear and denied rights through care giving; being emotionally and
psychologically
overwhelmed
and
being
at
risk
Palliative care report [Draft 1] Professor Netshikweta
of
contracting
HIV/AIDS.
On
his
20 March 2012
Page 12
recommendations, Kang’ethe said that fostering realization that relying on child care giving is a
negative score in fulfilling Global Millennium Development Goals (MDGs). Palliative care training
and support centre (PCTSC) is needed to serve as a training centre. Palliative carers faces
challenges which need serious training to handling stress, conflicts, discouragements and for
motivating them. In 2006 Hospice Palliative Care Association (HPCA) of South Africa conducted
a brief survey exploring challenges and barriers to non supervised care giving by less formally
trained palliative care personnel as well supervision and mentorship skills of professional nurses.
According to Moetlo et al, (2011), there is pervasive limitation throughout the research, with
emphasis on the lack of management skills by supervisors, the lack of sharing of updated
information, and the extreme selfishness.
The training should include:

Identify the care and support needs experienced by HIV positive patients.

Palliative care needs to provide for patients in CHBC.

Bereavement Support Care

Short Course in Palliative Nursing Care

Psychosocial Palliative Care training

Palliative care symptom management

Stress and conflict management

Professional supervision
Amongst key areas of training gaps identified above, there is a need for training on technical
expertise that is necessary for improved programme delivery and expansion, which are also
important factors to consider.
Furthermore, 'Very often when people talk about care workers in the SADC region they talk about
nurses, doctors and other people employed at health facilities. 'They do not talk about people
providing care in the shadows: home-based caregivers like mothers, wives, sisters,
grandmothers, grand children and others looking after people living with HIV, one stakeholder
indicated. With approximately two in five of all people infected with HIV globally in the past few
years, Southern Africa is now regarded the epicenter of the global HIV pandemic. Experts say
HIV and AIDS disproportionately affects women and girls, who also form the overwhelming
majority of people providing care and support to people infected and affected by the pandemic.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 13
Loosely defined, care workers are people who help the sick or infirm. The majority of care workers
in Southern Africa provide home-based care for people living with HIV, often without being paid.
Caregivers may be close family members such as children, wives or sisters socially or culturally
expected to nurse the sick, or may be associated with organizations (such as NGOs) or linked to
government-run health facilities. Thus the establishment of a palliative care centre will benefit
carers within and beyond of the primary health care programme and Community Home based
care programmes.
e)
Common pathologies in the region using Vhembe district as a case setting.
The HIV and AIDS prevalence in the region as well as tuberculosis dominate the palliative care
pathologies in the region. Furthermore, the incidences of diabetes, hypertension and other non
communicable disease are found to be the leading pathologies in palliative care.
Statistically, the leading five male cancers in South Africa in 2009 according to the NCR Report
shows that males have a lifetime risk (LR) of 1 in 6 of cancers predominating :

Prostate 1 in 23

Lung 1 in 69

Oesophagus 1 in 82

Colon/rectum 1 in 97

Bladder 1 in 108
Leading five female cancers in all the provinces of the Republic of South Africa (RSA) in 2009
according to the NCR Report shows that women have a lifetime risk (LR) of 1 in 8 of getting
cancer, as opposed to 1 in 6 in the previous report, with the following cancers predominating:

Breast 1 in 29

Cervix 1 in 35

Uterus 1 in 144

Colorectal 1 in 162

Oesophageal 1 in 196
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 14
f)
The existence of Palliative care centres in the region
Currently in Vhembe district, there are quite a number of CHBC. In situations were inadequate
provision of psychosocial and spiritual support for HIV/AIDS patients is compromised due to lack
of comprehensive and integrated holistic care, the quality of life of patients is threatened (Leseka,
2010). Lack of palliative care result in untreated symptoms that hamper an individual’s ability to
continue his/her daily-life activities. At a community level, lack of palliative care places an
unnecessary burden on hospital or clinic resources.
The university of Venda collaborates with the following NPO’s that have integrated with palliative
care program in Vhembe region:
a) Far North Community Care Development (FNCCD) based in Thohoyandou block.
b) Mapate HIV/AIDS Project
c) Munna ndi nnyi
d) Litshani Vhana Vhade Foundation (LVVDF) based in Thohoyandou, Vhembe district.
e) Centre for Positive Care (CPC) based in Sibasa, Vhembe district.
f)
Mashau Home Base Care (MHBC) based in Mashau, Vhembe district.
g) Thogomelo OVC Caregiver Support and Child Protection Training
The following is a brief synopsis of what selected NGOs does in line with palliative care in
the region.
i)
Far North Health Care Centre
This organisation is located in Thohoyandou and serves eight villages in the Vhembe District
Municipality. Its programmes include home-based care, referrals to health facilities, and
facilitation of access to treatment such as antiretroviral therapy, family health education and
training, counselling and food security. The organisation operates two community-care centers
that provide a range of services including psychosocial support and recreational activities for
OVC. The AFSA funding grant was used to support the community-care centre.
ii)
Mapate HIV/AIDS Project
This organisation operates in three villages of Thulamela Local Municipality. It targets vulnerable
populations, in particular OVC, the sick, the aged and the disabled. The organisation operates
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 15
three community-care and support centers and a number of poverty alleviation projects. The grant
from AFSA was used to support the OVC programme in the community centers.
iii)
Munna Ndi Nnyi –
Based in Shayandima in Limpopo, Munna Ndi Nnyi aims to educate initiation schools about the
sexual health of the initiates. The initiation school programme focuses on issues of hygiene, safety
and education. Supported by the AFSA grant, the programme provides peer education for the
initiates and works with parents to help them make informed decisions – including the choice
between ritual and medical circumcision and provides appropriate sanitation facilities and hygienic
surgical instruments.
iv)
Thogomelo OVC Caregiver Support and Child Protection Training
The project is funded by the US Agency for International Development, in partnership with the
Program for Appropriate Technology in Health (Path) as the prime contractor, HDA and The
International HIV and AIDS Alliance. The aim of the project was to develop training materials for
supporting the caregivers of vulnerable children in the 9 provinces and to promote sustainability
and scale up deliverables. The programme seeks to build the capacity of provincial training
service providers to deliver training as well as undertake assessment and moderation of learners
in line with the requirements of the Health and Welfare SETA. To date the project has developed
a skills development programme addressing the psychosocial wellbeing and support for of
community caregivers at levels 1 and 2 of the National Qualifications Framework (NQF).
The training incorporates two modules on developing appropriate skills in child protection. During
Year 2 a second curriculum offering more advanced child protection skills to the supervisors of
community caregivers will be piloted (levels 3 and 4 of the NQF). A further curriculum offering
Psychosocial Support Skills for supervisors is in the planning stages. The project has developed
a Good Practice Case Study on developing accredited curricula to share the lessons it has learnt
in this process. Further Good Practice Case Studies will be developed and disseminated through
a seminar series in Year Two.
Furthermore, based on the fact that many children, including orphans, are dying of AIDS, without
appropriate palliative care, Centre for Positive Care (CPC) Non Profit Organization (NPO) in
Vhembe district of Limpopo, has received a funding from the Nelson Mandela Children’s Fund
(NMCF), through the Goelama Programme since 2002, to support orphans and vulnerable
children (Rendall-Mkosi & Phohole, 2005). According to press release 2010, Mashau Home Base
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 16
Care (MHBC) in Vhembe district of Limpopo has caregivers who provide palliative care for
bedridden patients. MHBC received a funding of about $11,000. Many NPOs have palliative care
clients but do not have a program and resources to carry out. Most of these palliative caregivers
are taking care of patients suffering from chronic diseases.
“We have palliative care, but we do not have a program for it. We only offer palliative care
for patients suffering chronic diseases through our Home-based care programs” said one
of the managers for one of the NGO that has integrated palliative care in their everyday
activities.
In addition, although the landscape of palliative care is not very clear in the SADC region, pockets
of good practice care and support centers are available that the rest of the continent can learn
from.
CONCLUSION AND RECOMMENDATIONS
There is a need for the establishment of Palliative Care Centre in Vhembe to identify and some
of the problems within the district on community which would deal with counselling, health
education, management of hypertension and other field which might be identified when we visits
community based care in the Vhembe District. In low HIV seroprevalence countries palliative care
may be a routine part of hospital and clinic care.
In countries with a high burden of HIV infection, palliative care should be part of a comprehensive
care and support package, which can be provided in hospitals and clinics or at home by caregivers
and relatives. In many settings, HIV infected people prefer to receive care at home. The provision
of palliative care can be augmented significantly by the involvement of family and community
caregivers. A mix of psychosocial support, traditional or local remedies, and medicines can be
combined to provide palliative care that surpasses that found in many overcrowded or poorly
staffed hospitals.
Wherever palliative care is provided, factors to be assessed include affordability and the presence
of community care and support services. Developing guidelines and training for palliative care
should be specifically included in national guidelines for the clinical management of HIV/AIDS.
Training on the provision of palliative care should be incorporated into the curriculum for all health
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 17
care providers. Guidelines for home care services should include basic management of palliative
care by family members and community volunteers.
Training courses for family members and community volunteers can be organised and provided
by health care workers at the community level.
Palliative care is an important health phenomenon that improves the life of seriously ill patients.
It is important to note that palliative care does not cure the illness, but it support and care,
improving the quality of life of the patient. Amongst others, Bereavement Support Care is an
important tool for palliative care.
Monitoring and evaluations programs should be implemented from the first stage of establishing
the palliative care centre. Palliative care centre cannot be successful unless supported by
government and communities. This means that government and civic engagement must be
strengthened to achieve our goals.
REFERENCES
Aceves, C. Anguiano, B. & Del gado. G. 2005. “Is iodine a gatekeeper of the integrity of the
mammary gland?”. Journal of the mammary gland biology and neoplasia 10 (2): 189 – 196.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 18
Alessandro,
F.
2010.
Famous
Cancer
Survivors.
American
cancer
society.
(http:/www.mstropicalparadise.com).
Atkinson, J & Virdee. A. 2001. Promoting comfort for patients with symptoms other than pain. In
Kinghom. S. Gamlin. R (ed.) Palitative nursing: Bringing comfort and hope. Edinburgh: Bailliere
Tindall.
American Cancer Society. 2003. Cancer facts and figures. 2001-2002. Bailliere. Tindal.
Philadelphia.
Bard, F. & Sutherland. NI. 2006. Overview of nursing developments in palliative care. Journal of
Community Health. 3(1): 49-40.
Beck, S.L. & Flakcon G. 2001. Prevalence and management of cancer pain in South Africa. Pain.
94(1): 75:84.
Bloor, M. Frankland, J. Thomas, MM. & Robson K. 2001. Focus Groups in social Research.
London: Sage.
Blumenthal, P. Gaffikin, L. Deganus, S. Lewis, R. Emerson, M. & Adadevoh S. 2007. Cervical
cancer prevention: safety, acceptability and feasibility of a single-visit approach in Accra. Ghana.
American Journal of Obstetrics & Gynecology. 196:407.el-407.e9.
Bomela, N. & Stevens, M. 2009. Cervical cancer and HIV: his intimate Policy brief number 2
Durban systems trust
Boffetta, P. Hashibe, M. La Vecchia, C. Zatonski,& W. Rehm, J. 2006. “The burden of cancer
attributable to alcohol drinking”. International Journal of Cancer 119 (4): 884-7.
Bower, M. Palmier, C. & Stebbing, J. 2006. AIDS associated malignancies. Journal of Cancer
Therapeutics. vol1. Pp 221-234
Brink, H. 1999. The researcher adopted a phenomenological approach. Cape Town: Juta.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 19
Brink, H. 2005. Research methodology for health care professionals. Cape Town: Juta.
Brink, H. 1999. Fundamentals of research methodology for health care professionals. Cape Town.
Juta.
Brink, H. 2006. Fundamentals of research methodology for health care professionals. Cape
Town. Juta.
Brown, B.E. Macintyre, PT & Gilborn, M. 2008. Existential issues and coping: a qualitative study
of low-income rural women with cancer of breast. Psychology and Health. 5(2): 12-21.
Burns,N.& Grove SK. 2001. The practice of nursing research: conduct. Critique and utilization 3rd
Edition. Philadelphia: W.B. Saunders.
Burns, N. & Grove, SK. 2005. The practice of nursing research conduct, critique and utilization.
Philadelphia:WB Saunders
Burns, N. & Grove, SK. 2003. Understanding nursing research 3rd edition. Philadelphia: W.B.
Saunders.
Burns, N. & Grove, SK 2007. Understanding research, building an evidence-base. Philadelphia:
W.B. Saunders.
Cancer Association of South Africa, 1993. Breast cancer, facts and myths. (CANSA)
Cancer Association of South Africa, 2001.Your guide breast health. Cancer Association of South
Africa. Rondebosch.
Cancer of South Africa, 2004. Breast cancer. June24. 2003 http://www.cansa.org.za.
Cavalieri, E. Chakrvarti, D. & Guttenplan, J. 2006. “Catechol estrogen quinones as initiators of
breast and other human cancers: implications for biomarkers of susceptibility and cancer
prevention”. Biochemica et Biophysica Acta 1766 (1): 63 – 78.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 20
Chlebowski, RT. Blackburn, GL. & Thompson, CA. D 2006. “Dietary fat reduction and breast
canceroutcome: interim efficiacy results from women’s intervention Nutrition study”. Journal of the
National Vancer Institute 98 (24): 1767-76.
Cobb, LH. 2007. Cancer surge overwhelming and treatment. Psychology and Health. 7(2): 305310.
Collins, H 2001. Cobuild English dictionary for advanced learners. 3rd Edition. Oxford University
Press
Corner, J. 2008. What is cancer? In cancer nursing: care in context. Oxford: Blackwell.
Creswell, JW. 1994. Research design: Qualitative and Quantitative. approaches. London: Sage.
Christopher, M. Masi, MD. & Gehlert, P. 2009. Perception of Breast cancer treatment among
African – American women and men: Implications for interventions. J Gen Intern Med. 2009.
24(3): 408 – 414.
Cronjie, H.S. & Beyer E. 2007. Screening for cervical cancer in an African setting. International
Journal of Gynaecology and Obstetrics. 98:168-171.
Cronjie, HS & Grobler, CJ. 2003. Obstetrics South Africa. 2nd edition. Pretoria: Van Schaik.
De Vos, AS. 2006. Research at grassroots for the social sciences and human services profession
3rd edition. Pretoria. Van Schaick.
De Vos, AS. 2002 Research at grass roots for the social sciences and human services profession.
1st edition. Pretoria: Van Schaick.
De Vos, AS. 2005. Research at grass roots. 2nd edition. Pretoria. Van Schaick.
Denny, L. 2006.
Cervical cancer: the South African perspective. International Journal of
Gynaecology and Obstetrics. 95(1):S211-214.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 21
Denny, L. 2007. Co-morbid conditions via training course. Cape Town: University of Cape Town
Press.
Denny, L. Quin, M. & Sankaranarayynan, R. 2006. Screening for cervical cancer in developing
countries Vaccine. 24:S3/71-S3/77.
Department of Health, 2007. Report: national HIV and Cancer of cervix prevalence survey South
Africa 2006. Pretoria: Government Printer.
Department of Health South Africa, 2002 Department of Health South Africa. National guideline
on cervical cancer screening program. Department of Health South Africa.
Dixon, J.M. 1995. ABC of breast disease. London. BMJ Publishing Group
Dündar, PE. Özmen, D. Öztürk, B. Haspolat, G. Akyildiz, F. Coban, S. & Gamze, C. 2006. The
knowledge and attitudes of breast self –examination and mammography in a group of women in
a rural area in western turkey. BMC Journal doi:10.1186/1471-240-6-43.
Eduardo, L.F. 2006. Epidemiology as a tool to reveal Inequalities in breast cancer care. PloS Med
Journal 3(3): e48. Volume 3.
Farrer, K. 2001. Pain control. In Kinghorn. palliative nursing Bringing comfort and hope. Journal
of Community Health. 2(1):7-10.
Faull, C & Woof, R. 2002. Palliative care. Oxford: Oxford University Press.
Fentiman, BE. 2006. Challenges in breast cancer. Journal of Community Health. 13(4): 13-21.
Fentiman, IS. 1999. Challenges in breast cancer. London: Blackwel Series Inc.
Finlay, R & Gates, R. 2001. Pain assessment. In: Ferrel. B.R. Boyle. N. (ed.). Textbook of
palliative nursing Oxford: Oxford University Press.
Finlay, I. 2009. The management of other frequently encountered symptoms. London.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 22
Fonn, S. 2003. Human resource requirement for introducing cervical screening-Who do we need
where? South African Medical Journal. 93(12):901-903.
France, B. & Zuckerman D 2009. “5 Ways You Can Cut Your Risk of Breast Cancer” Public
Health, 4(9): 40.
Fung, S. 1996. Factors cassociated with breast self – examination behaviour among Chinese
women in Hong Kong.
Gamlin, R. 2001. Palliative nursing: past. present and future. Endinburgh: Bailliere Tindall.
Gaym, A. Mashego, M. Khasney, BM. Walldof, J. Frohlich, J. & Abdol, KM. 2007. High prevalence
of abnormal smears among young women co-infected with HIV in rural South Africa: implications
of cervical cancer screening policies in a high HIV prevalence population. South African Medical
Journal. 97(2): 120- 122.
Le OMelly, M .Glaser, C .Lynch, J.L. Keegan, T. & H West, 2004 . Breast implants following
mastectomy in women with early –stage breast cancer prevalence and on survival. licensee
BIOmed central.
Glass E. Cluxton, C. & Rancour, P. 2001. Principles of patient and family assessment: Textbook
of palliative nursing. Oxford: Oxford University Press.
Goldie, S. 2002. Health economies and cervical cancer prevention: a global perspective. Virus
Research. (89):302-309.
Goldie, S.J. Kuhn, L. Denny, L. Pollack, A. & Wright, T.C. 2001. Policy analysis of cervical cancer
screening strategies in low – resource settings. Clinical benefits and cost – effectiveness. Journal
of the American Medical Association. 285(24):3107-3115.
Gordon, S. 1999 - 2008. Mastectomy not first choice for most Breast Cancer Patient. Journal of
American Medical Association US 14th issue.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 23
Gray, R.E. Fitch, M. Davis, C.& Philips, A. 2006. A qualitative study of breast cancer self- help
groups. Psycho – Oncology (6): 279 – 289.
Green, A.
2006. Interview. Pretoria. ‘Notes in possession of author’ Hacking, B.M.
2007.
Mastectomy not first choice for most breast cancer patients. Journal of the medical association
5(10): 54-59
Hallet, M. 1999. Qualitative data analysis London Sage Publication
Haskel, C.M. 1995. Cancer treatment.4th Edithion. Philadelphia.W.B: Saunders Company.
Henderson, ES. 2005. A women’s decision. Breast care. treatment and reconstruction. 2nd
Edition. St Louis: Quality Medical Publishing Inc
Hoffman, M. Cooper, D. Carrara, H. Rosenberg, L. Stander, I. Williamson, AL. Denny, L. Du Toit,
G. & Shapiro, S. 2003. Limited pap screening associated with reduced risk of cervical cancer in
South Africa. International Journal of Epidemiology. 32:573-577.
Jerinima, J . Morales, O. Horna, J. Pariona, J. Manrique, J. Rubinos, J. & Takahashi, R. 2005.
Visual inspection with acetic acid for cervical cancer cancer screening outside of low - resource
settings. Review Panam Salud Publica. 17(1):1 – 5.
Jerzy, E. Tyczynski, TD.& Hans, J. Berkel, MD. 2006. Why do Postmenopausal African –
American women not benefit from overall breast cancer mortality decline. Annals of Epidemiology,
(16): 180 – 190.
Johnson, B 1999. Overview of nursing development in palliative care. In: Lugton, J. & Kindlen, M.
(ed.). Palliative care: the nursing role. Edinburgh: Churchill Livingstone.
Kaplan, HI. & Sadok, B. 2004. Reducing breast cancer mortality in black women. Academic
search premier,67(5): 27.
Kedziera, P. 2001. Hydration thirst and nutrition Oxford. Oxford University Press.
Keitel, MA & Kopala, M. 2000. Counselling women with breast cancer. A quide for professionals.
London. Sage publications. inc.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 24
Klee, M. Thranow, I. & Machin, D. 2000. Life after radiotherapy: the psychological effects
experienced by women treated for advanced stages of cervical cancer. Gynecology Oncology.
(76): 5-13.
Klemm, P. & Hurst, M. 2009. Cancer pathophysiology. Journal of Community Nursing. 5(6): 111119.
Lacroix, M. 2006. Significance, detection and markers of disseminated breast cancer cells
Endocrine –related Cancer 13 (4): 1033-67.
Lartey, M. Joubert, G. & Cronjie, H. 2003. Knowledge, attitudes and practices of rural women in
South Africa regarding the Pap smear. International Journal of Gynecology and Obstetrics.
83:315-316.
Lemone, P. & Burke, K. 2004. Medical Surgical nursing: Critical thinking in client care. New
Jersey. Pearson Education.
Liao, CC., Wang, H., Lin, R., Hseih, CY. & Sung, FC. 2006. Addressing Taiwan’s high incidence
of cervical cancer factors associated with the nation’s low compliance with Papanicolaou
screening in Taiwan. Journal of Public Health. 120(4):1170-1176.
Lincoln, Y.S. & Guba, E.G. 1985. Naturalistic inquiry. Newbury Park. Sage.
Lindau, S. Tomori, C. Lyons, T. Langseth, L. Bennett ,C. & Garcia, P. 2002. The association of
health literacy with cerical cancer prevention knowledge and health behaviors in a multi-ethnic
cohort of women. American journal of Obstetric and Gynecology, 23(7): 15-18.
LoBiondo-Wood, G. & Haber, J.
2002. Nursing research methods. Critical appraisal. and
utilization. 5th edition. St Louis: Mosby.
LoBiondo-Wood, G & Haber, J. 2006. Nursing research: methods and critical appraisal or
evidence-based practice. St Louis: Mosby.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 25
LoBiondo-Wood, G. & Haber, J. 2005. Nursing research in Canada: methods. critical appraisal.
and utilization. Toronto: Elsevier.
Lobuono, C. 2001. How to perform an effective clinical breast exam. Women‘s Health March 15
2003 at http/ww finatide Com.
Lubelwane, S.K. 2007. Perceived social support and adjustment to mastectomy in
socioeconomically disadvantaged black women. Social work in health care, (22):4 55-71.
Lyons, M.A. & Shelton, M.M 2004. Psychosocial impact of cancer in low-income rural/urban
women. phaseII. Journal of Rural Nursing and Health Care, 4(2): 34.
Maboko, E. & Mavundla, T.R. 2006. The experience of African women diagnosed with HIV/AIDS
and cervical cancer. African Journal of Nursing and Midwifery. 8(1): 38-42.
Maboko, E. 2005. The experiences of African women diagnosed with HIV.AIDS and cervical
cancer. African Journal of Nursing and Midwifery. 12(1):22-28.
Mafu, T. 2007. Private Hospitals called to cure nursing shortage. Business Report.http/www
busrep.co.z.a
Malta, M. Maya, LP. Clair, S. Freistas, F. Bastos, BI. 2005 Adherence to anti retrovirals therapy
a qualitative study with physician from Rio de Janero Brazil. Cadrmos de Saude PublicaRio de
Janeiro 21(5)142
Maree, S. & Wright, R. 2008. Breast cancer in black women experience at community hospital
Conquer cancer foundation cancer net. Journal of clinical oncology. Journal of oncology
Markovic, NC. Markovic, O. & Henderson, ES. 2005. BioSciCon’s Cervical Cancer Study Group.
Markpap test for cervical cancer screening. Journal of clinical Oncology (Meeting Abstracts).
23:102.
Mashau, S. 2005. Race and differences in breast cancer survival in a managed care population.
Journal of oncology, 4(2): 55-60
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 26
McWhorter, VE & Mayer, E. 2001. Black/White differences types of initial breast cancer treatment
and implications for survival. Journal of Public Health. 77(12):241-250.
Mertens, D. 1998. Reaserch method in education and psychocology. integrated diversity with
quant approaches. London.Sage.
Meuser, T. Piettruck, C. Radburgh, L. Stute, P. Lehmann, K.A & Ground, S.
2001. Symptoms
during cancer pain treatment following WHO- guidelines: a longitudinal follow-up study of
symptoms prevalence. severity and etiology. Pain, 93(3): 247-257.
Mookeng, M.J. Mavundla, T.R. & McFarland, D.M.
2010. Cervical cancer and pap smear
screening in Botswana: knowledge and perceptions. International Nursing Review 50:167 – 175.
Mosalo, J.J. & Wright, R. 2009. Health promotion through the lifespan. 5th St. Louis: C.V. Mosby.
Mouton, J. & Marais, H.C. 1996. Basic concepts in the methodology of the sciences. 5th edition.
Pretoria: Human Sciences Research Council.
Mouton, J. 1998. Understanding social research. Pretoria. J.L van Schaik
Munjanja, O.K. Kibuka, S. & Dovlo, D.
2005. The nursing work force in sub- saharan Africa.
Geneva: International Council of Nurses
National Cancer institute, 2000. What you need to know about breast cancer. An overview. U.S.
National institute of Health. April 12. 2003 at www.cancer.gov.
Nene, B. Jayant, K. Arrossi, S. Shastri, S. Bukudh, A.. Hingmire, S. Moungwe, R. Malvi, S.
Dinshaw, K. & Sankaranaranynan, S. 2007. Determinants of women’s participants in cervical
cancer screening trail. Maharashtra. India. Bulletin of the World Health Organization. 85:264-272.
Neuman, WL. 2000. Social research methods: Qualitative and quantitative approach 4th edition.
Boston: Allyn and Bacon.
Neuman, WL. 2004. Basics of social research Qualitative and quantitative approaches. Boston.
Pearson Education. Inc.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 27
Newman, F. 2008. Breast cancer and Mammography facts: Cancer facts. American Journal of
Public Health. 10(4):133-139
O’Connor, J. Wicker, K and Germino, WT
2007. Famous breast cancer survivors Ebony
magazine Johnson publishing company
Olowokure, B. Caswell, M. & Duggal, H. 2006. What women want convenient appointment times
for cervical screening tests. European journal of Cancer Care, 3(5)67.
Otto, S.A. 2001. Oncology Education. 4th edition. St Louis Mosby Inc
Oxford Advance Dictionary. 2000. 6th edition: London: Oxford University Press.
Parking, DM. Bray, FF
Bray, F & Pisani, P. 2005. Global cancer statistics. Cancer Journal
for clinician, (55): 74-108.
Pearson J. 2008. Women’s bodies. Women’s wisdom. The complete guide to women ‘s health
and well – being. London: The Bath Press.
Perry, KN. & Burgers, M. 2002. Communication in cancer care. Oxford. Blackwell Science
Peter – Golden, NK. 1998. Strategies of qualitative inquiry. Thousands Oak. Sage Publications.
Polit, D. & Beck, L. 2006. Essentials of nursing research. Methods. appraisals and utilization. 6th
ed. Philadelphia. Lippincott. Williams & Wilkins.
Polit, DE. & Beck, CT.
2004.
Nursing research: principles and methods. 7th Edition.
Philadelphia. Lippincott. Williams & Wilkins.
Polit, DF. & Hungler, BP. 2004. Essential of nursing research. Methods appraisal and utilization.
2nd edition. Philadelphia. Lippincott.
Polit, DF. & Hungler, BP. 1999. Nursing research: Principles and methods. 7th ed. evidence for
nursing practice. Philadelphia: Lippincott. Williams & Wilkins.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 28
Polit,. D. & Beck, L. 2006. Essentials of nursing research. Philadelphia: J.B. Lippincott.
Pope, C. & May, N. 2006. Qualitative research in health care. 2ndedition. Oxford: Blakwell.
Pope, C. Ziebland, S. & May, N. 2000. Qualitative research in health care- Analyzing qualitative
data. British Medical Journal. 32.
Report: National guidelines for cervical cancer screening programme. 2000. Department of
Health.
Raymond, EH. Perez, EA.& Byrant, Trastuzumab plus adjuvant chemotherapy for operable breast
cancer. New England Journal Med. 2005. 353:1673-1684 and supplementary appendix.
Report: national HIV and Cancer of cervix prevalence survey South Africa 2006. Department of
Health
Report: What you need to know about breast cancer. 2000. National cancer institute.
Rob, T. 2009. Words and well – being: how literacy affects patient health. The Journal for Nurse
Practitioners. 13(2):28 – 35.
Sankaranaranynan, R. & Wesley, R. 2003. A practical manual on visual screening for cervical
neoplasia. Lyon International Agency for Research on Cancer (IARC)Pres.
Shavers, DO. 2003. Fewer mastectomies and more breast –conserving surgery California cancer
registry
Scott, LN. 1983. Race related differences in breast cancer patients. Journal nal at cancer institute
6(9): 55-74
Scudder, L. 2006. Words and well-being: how literacy affects patient health. The journal for Nurse
Practitioners. 2:28-35.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 29
Seth, T. Kotwal, A. Thakur, R. Singh, P. & Kochupillai, V. 2005. Common cancers in India
knowledge. Attitudes and behaviour f urban slum dwellers in New Dehli. Public Health. 119. 8796.
Sheperd, JH. & Mcnerney, PA.
2006. Knowledge of breast cancer in women. Sierra Leone.
Curationis, 29 (3) 70-77.
Siegel, B.E. 2010. Breast cancer and African American women. The Ohio State University.
Consumer Health Information. 12(13):241-250.
Smith, N. Moodley, J.& Hoffman M. 2003. Challenges to cervical cancer screening in the Western
Cape Province. South African Medical Journal. 93(1):32-35.
Soanes, C. 1983. Concise Oxford Dictionary. 7th edition. Oxford: Clarendon Press.
South African National Cancer Registry..
2001: Cancer Registry epidemiology and early
detection. Tygerberg: South African Cancer Association.
South African Television News Thursday 5th 2009.
Stommel, M. & Wills, C.E. 2004. Clinical research: concepts and principle for advanced practice
nurses. Philadelphia. Lippingcott. William and Wilkins
Streubert, HJ. Speziale, SHJ. & Carpenter, DR. 2003. Qualitative research in nursing Advancing
the humanistic imperative. 3rd edition. Philadelphia: Lippincott.
Streubert, Speziale, SHJ. & Capenter DR. 2007. Qualitative research in nursing Advancing the
humanistic imperative. 2nd edition. Philadelphia: J.B. Lippincott.
Sutherland, NI. 2001. Overview of nursing development in palliative care. Journal of Community
Health. 4(1):59 – 60.
Talbot, L.A. 1995. Principles and practice of nursing research Mosby & company.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 30
Tesch, R. 1992. Qualitative research: Analysis. types and soft tools. New York: Falmer Press.
Trigg, J. 2010. National black Women’s Health Project. 9(10):230-239.
Walling, AD. 2006 Reducing Breast Cancer Mortality in Black Women. Journal Public Health,
67(5): 67-69.
Walker, ARP. Michelow, PM. & Walker, BF. 2002. Cervix cancer in African women in Durban.
South Africa. International Journal of Gynecology and Obstetrics. 79:4-46.
Walker, L. 1995. Abortion: some insight into power and patriarchy. Institute for advanced Social
Research Seminar. Witwaterasrand University: 1-19.
Walraven, G. 2003. Prevention of cervical cancer in Africa: a daunting task? African Journal of
Reproductive Health. 7:7-12.
Watson, MW. 2003. Clinical nursing and related sciences 6th edition. Oxford University Press
Watts, CF.
2009. Malpractice defense: Breast Cancer. New Jersey: Medical Economics
Company Inc.
Wellensiek, N. Moodley, M. Moodley, J. & Nkwanyana N. 2002. Knowledge of cervical cancer
screening and use of cervical facilities among women from various socioeconomic backgrounds
in Durban. KwaZulu Natal. South Africa. International Journal of Gynecological Cancer. 12:376382.
Wells, BL & Hormk, JW. 2010. Stage at diagnosis in breast cancer: Race and socio-economic
factors. American Journal of Public Health. 82(10:12-20.
Wesley, MB. 2003. Cancer surge overwhelming AIDS crisis in Botswana [Online]. Avaliable:
http://terradialy.com [8th October 2007.]
William, TR.
2009. The chronically ill person. In Nursing practice: hospital and home by
Alexander. M. Fawcett. J. & Runciman. P. 2nd edition. Edinburgh: Churchill Livingstone.
Wilson, HS. 1993. Research in nursing second addition. Redwood City California Addison.
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 31
Winkler, FH. 2000. South African Health Review. Durban: Health system Trust. Women’s Health.
March 15. 2003 at http/www finatide.com.
World Health Organisation, 2002. Women and Health: today’s evidence tomorrows agenda.
Geneva: WHO.
World health organization, 2006. Comprehensive cervical cancer control – A guide to essential
practice. Geneva.
World Health Organization, 2001. Effective screening programmes for cervical cancer in low –
and – middle – income developing countries. Bulletin of the World Health Organization. 79(10):
954-962.
World Health Organization,
2002. Cervical cancer screening for developing countries. Report
for WHO consultation. Geneva. ISBN: 9241545720.
World Health Organization,
2006. International union against cancer (2005). Global action
against cancer Geneva.
World Health Organization (WHO). Community home-based care in resource-limited setting. A
framework for action: The cross cluster initiative on home-base long-term care. Geneva,
Switzerland: WHO; 2002.
Rendall-Mkosi, K., and Phohole, M. (2005). Integrating paediatric palliative care into home-based
care: an evaluation of 3 home-based care projects. Health Systems Trust. ISBN: 1-919839-52-6.
http://www.healthlink.org.za/publications/691 (Accessed 12/03/2012)
Kang’ethe, S.M. (2010). The danger of involving children as family caregivers of palliative homebased-care to advance HIV/AIDS patients. Indian Journal of Palliative Care, Volume: 16, Issue:
31, p117-122
Moetlo, G.J., Pengpid, S., and Peltzer, K. (2011). An evaluation of the implementation of
integrated community home-based care services in Vhembe District, South Africa. Indian J
Palliative Care; 17:137-42
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 32
Leseka, M.E. (2010). An evaluation of the effectiveness of the HIV/AIDS palliative care
programme at Chris Hani Baragwanath Hospital. University of Limpopo (Medunsa Campus).
Hallenbeck, J MD.
Palliative Care Perspectives http://www.growthhouse.org/palliat.html
(Accessed 11 March 2012)
Hospice Palliative Care Association (HPCA) NPO. Registered with Department of Social
Development. http://www.hospicepalliativecaresa.co.za (Accessed 10 March 2012)
http://www.who.int/cancer/palliative/definition/en/ (Accessed 11 March 2012)
http://www.nlm.nih.gov/medlineplus/palliativecare.html (Accessed 11 March 2012)
Legal Aspects of Palliative Care. (2009). Published by the Hospice Palliative Care Association of
South Africa. ISBN 978-1-920355-15-9
Metro/District Council population estimates by gender and year (Based on 2010 projection).
Stastics South Africa. (Accessed 14/03/2011)
Community Survey 2007 by municipality, type of main dwelling and population group of
household. Statistics South Africa. (Accessed 14/03/2012)
Mohammad, N., and Gikonyo, J. (2005). Operational Challenges community home based care
(CHBC) for PLWHA in multi-country aids programs (Map) in Africa. Washington DC: World Bank.
ADDENDUM
LIST OF ACRONYMS AND ABBREVIATIONS
CHBC-
Community Home-Based Caregivers
PCC-
Palliative Care Centre
WPC-
Wits Palliative Care
CPC-
Centre for Positive Care
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 33
NPO-
Non Profit Organization
NMCF-
Nelson Mandela Children’s Fund
MHBC-
Mashau Home Base Care
MDGs- Millennium Development Goals
PCTSC-
Palliative care training and support centre
HPCA-
Hospice Palliative Care Association
LVVDF-
Litshani Vhana Vhade Foundation
Report compiled by Professor Netshikweta
Tel:
0159628239
Palliative care report [Draft 1] Professor Netshikweta
20 March 2012
Page 34