Palliative Care Unit closes doors to community

December 2015, the Palliative Care Unit (PCU) at Settlers Hospital in Makhanda (Grahamstown) closed its doors to some of the community’s most vulnerable residents. The PCU opened in 2006 as a collaborative effort between Grahamstown Hospice, Rotary and Settlers Hospital, with additional funding provided by FNB. The 10-bed ward provided specialised care for patients with life-threatening conditions such as HIV/Aids and terminal cancer.

“I would say 80 percent of our patients were HIV,” said Erica Gornall, a professional nurse who worked in the PCU from 2006 through 2015. “It wasn’t a palliative care looking after the elderly people: we were looking after the terminally ill and HIV patients.”

“When we first opened that ward the chances of recovery or living with HIV weren’t as good as what they are now because of the retrovirals (( because antiretrovirals were not widely available)),” said Gornall. “We turned around so many patients ,who were close to death and they walked out of there and are still walking today.”

Almost three years later, former PCU staff like Gornall are questioning the facility’s closure, emphasising that the reasons given by the Department of Health don’t add up.

“All of the reasons that were given were reasons that were there since the inception of the Palliative Care Unit,” said Gornall.

Documents shown to Grocott’s Mail state that the facility was closed due to infrastructural inefficiencies, staff shortages and a lack of transport services. Other reasons included complaints of a rat infestation and inadequate cleanliness, which Gornall stated had been attended to. “We had one rat”, said Gornall, “and we ((got rid of it)) took care of it”.

Dr Celia Jameson was instrumental in opening the PCU in 2006, and was the physician in charge through 2015. Gornall was advised and trained by Jameson in specialised care such as pain management for PCU patients. “She was brilliant, absolutely phenomenal,” said Gornall. Jameson has since passed away.

After the abrupt closure, Jameson sent numerous emails to the Provincial and National Department of Health.  She pointed out the strong alignment between the PCU model and the goals of the proposed National Health Insurance (NHI).

In January 2016, Jameson wrote an email to the provincial department stating that the unit offered a unique model “because it offered equal services to all patients no matter what their financial situation was, and thereby offers good palliative care but in addition conforms strongly to the principles behind the proposed NHI”.

The email concluded with an invitation for National Minister of Health, Dr Aaron Motsoaledi and provincial leadership to visit the PCU. Jameson also emailed Motsoaledi directly, but never received a reply.

Reportedly the facility is being repurposed into a medical ward. Patients who might have benefited from specialised palliative care have for the past three years been admitted  to the hospital’s general wards. When approached for comment, the Eastern Cape Department of Health could not offer any direct information on the PCU.

Provincial Spokesperson Lwandile Sicwetsha responded to Grocott’s Mail’s inquiries with: “The palliative care service is provided by the Hospice through home based. The department funds hospices through conditional grant. Palliative patients who need medical attention get services from the hospital.”

Our reporter has requested more information and clarification but did not receive a response at the time of publication. 

The National Policy Framework and Strategy for Palliative Care (NPFSPC) 2017- 2022 states that South Africa’s need to prioritise palliative care (PC) services was in response to WHA (World Health Assembly) Resolution 67.19 which states that PC services are crucial in managing the pain and suffering associated with life-threatening illness. South Africa is a co-sponsor of the Resolution.

The NPFSPC states that the Resolution is particularly important in a South African context given the “quadruple burden of disease”. The policy further states that proper PC services “will address issues of universal health coverage, and the need to reduce suffering and promote development and dignity for all”.

“Grahamstown lost a lot by that ward being closed down”, said Gornall. “I would just like to see that ward opened again to have patients in there.”

Our reporter will continue to investigate.

Grocott’s Mail is looking to speak to former patients and their families from the PCU. Please email ed7@ed.grocotts.co.za for information or tip-offs.

*In loving memory of Dr Celia Jameson; “my doctor, my doctor”.