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Palliative care in South African prisons

Author: Jerome Samuels, Department of Correctional Services- South Africa
09 November 2012

Pastor Jerome Samuels of the S.A. Department of Correctional Services writes for the South Africa edition of ehospice about collaboration with the South African Hospice Palliative Care Association to ensure that these essential services are provided in South African prisons.

Palliative Care is a holistic approach and through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. This WHO definition the team has embraced and ensured that service of a high standard is being delivered to those entrusted in our care as the Department of Correctional Services (DCS).

As offenders upon release often regress to their previous habitual ways of committing crime, this leads to re-incarceration and results in overcrowding in the already full prisons in South Africa. Life in prison is harsh and over population leads to numerous communicable diseases such as tuberculosis, HIV/AIDS and other sexually transmitted infections. 

The Constitution of the Republic of South Africa Act 108 of 1996, chapter 2, section 35 (e) states that: “Everyone who is detained including sentenced offenders has the right to conditions of detention that are consistent with human dignity including exercise and the provision of adequate accommodation, nutrition, reading material and medical treatment.”

Correctional staff were initially sceptical regarding the introduction of palliative care into a correctional setting in the Western Cape. Staff wanted to know what their responsibility would be with the introduction of palliative care. The description of palliative care by staff of the Hospice Palliative Care association of South Africa (HPCA) enabled DCS staff to buy into the idea of palliative care and ensure the implementation of this service.

A number of meetings were held with Zodwa Sithole, HPCA Advocacy Officer for the Correctional Services Project; Pricilla Nelson, CEO St Luke’s Hospice; staff of St Luke’s Hospice; Elizabeth Scrimgeour, CEO Drakenstein Hospice; staff of Drakenstein Hospice and Department of Correctional Services staff - in particular staff from Goodwood Correctional Centre and Drakenstein Correctional Centre.

Through a well drafted Action Plan and reporting mechanism, the progress of the implementation of palliative care is continuously monitored. The Goodwood Correctional Centre management budgeted and procured six high raised beds that were purchased to open a Palliative Care Room within the Hospital Unit. A room was identified and maintenance to the room began. The room would enable DCS staff to deliver a more efficient and effective service to offenders living with life threatening illness.

Palliative care is an approach that improves the quality of life of offenders and their families facing the problems associated with life-threatening illness. Patients were to be provided with the necessary comforts with dealing with life threatening illnesses. A professional nurse was identified to oversee the palliative care room. This nurse later was trained within the eight month short course in Palliative Nursing Care for professional nurses. Training was arranged for the staff to ensure that all role-players knew what was expected of them. Through the assistance of the HPCA, the following training was provided to DCS staff:

Training was conducted on the Introductory to Palliative Care course, by St Luke’s Hospice staff. A total of 10 members at Goodwood Correctional Centre were identified and completed the 40-hour course over three-week period. (Chaplain, Spiritual & Moral Development Coordinator (SMDC), Spiritual worker, 2 Nurses, Social worker, HIV Coordinator, Special categories Coordinator & 2 Case Officers)

Two nurses at Goodwood Correctional Centre completed an eight (8) month training course for Professional Nurses.  -1 SMDC, 1 Spiritual Worker & 1 Social worker of Goodwood Correctional Centre completed a Bereavement Counselling course.

23 staff members of Drakenstein Correctional Centre attended the PC Introductory course, which included Social workers, Nurses and Spiritual & Moral development Coordinators (SMDC’s).

20 Social Workers from Goodwood and Drakenstein Correctional Centres respectively completed a one week course in Psycho-social training.

Doctor Andrews from the Department of Health renders medical care to the offenders of Goodwood Correctional Centre and has enrolled in the Introduction to Palliative Care course for doctors. Upon completion of the training the Goodwood Correctional Centre Inter-Disciplinary Team (IDT) met to outline how the IDT will function. The team consists of professional nurses, a social worker, a psychologist, a spiritual worker, a HIV/AIDS coordinator and case officers (Security staff).

The nursing staff did categorization of offenders that were diagnosed with diseases such as HIV/AIDS, Tuberculosis, and Cancer etc. Initially four offenders were identified to move to the palliative care room. The room can accommodate six patients and two care givers.

The IDT scheduled meetings bi-weekly to discuss the case load. Process notes are captured with interventions and presented by the IDT. The mentoring from St Luke’s and Drakenstein Hospices has enabled the Department of Correctional Services staff to successfully implement palliative care within a correctional setting and learning still occurs with regular interaction with the Hospices.

The IDT also contributed by assessing and writing reports for one offender for a medical parole to the medical Parole Board Team. The offender received parole and was reconciled with his family. The family was provided with a Hospice list within their closes proximity. A referral note was issued.

Another offender was placed on parole and died two hours later at his family home. The family expressed their gratitude that their beloved died in the care of his family.

These are but a few successful stories that make palliative care in a correctional setting essential and worthwhile.

A task team of chaplains in the Western Cape, DCS Spiritual Care Head Office staff and the HPCA held two meetings to discuss the training of chaplains in the Western Cape on the Psycho-social course. The training will be facilitated by HPCA during February 2012. The total of twenty four members is to be trained and this will include 10 chaplains; 10  SMDC’s; 2  Head Office Staff, 1 AC Dev & Care and the Regional Coordinator Care.

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