World Hospice and Palliative Care Day Celebration

Malawi commemorates WHPCD in a grand style at MAULA PRISON AND COBBE BARRACKS. 10TH OCTOBER 2015

Organised by Palliative Care Association of Malawi in Collaboration with ministry of Health

Funded by: True Colour Trust

Executive Summary

Every year Malawi joined the World celebrating World Hospice and Palliative care day. This year PACAM in collaboration with Ministry of Health and other palliative care stakeholders celebrated the event with prisoners and Wounded soldiers (War veterans). The event took place at Maula prisoners participated by 350 HIV/AIDS prisoners and 5 with Cancer. On same day another similar activity took place at Cobbe Barracks participated by 15 retired and wounded soldiers (known as war veterans). Over 500 people attended the Maula prison function in Lilongwe and 300 people attended the Cobbe Barracks function in Zomba. At both function the palliative care team sheered the prisoners and wounded soldiers. The team comprised of clinicians, nurses, chaplains and Counselors. The team spent an hour doing clinical assessment, providing treatment where need, social and spiritual support. According to the report by the prisoners and the wounded soldiers, that was the first time in their life they saw medical people spending time assessing them holistically. They enjoyed the social and spiritual support offered.

On that day each prisoner and wounded soldier received a parcel;

Prisoners parcel contained - 5 tablets of bathing soap, a tooth blush, tooth paste, a bottle of Vaseline (applying oil) and 10 bags of fortified porridge flour which was given to the in charge to make porridge for them while the parcel of wounded soldiers each contained; treated mosquito net, 5 tablets of bathing soap, a 2 litre bottle of cooking, applying oil, 4 KG packets of fortified porridge flour, 2 packets of sugar and 2 Kg packet of rice.

According to the speech by the prisoners and wounded soldiers, it was their first time to receive such care and support in their lives. Through the clinical assessment some wounded soldiers were diagnosed with high blood pressure which treated in advance. Both prisoners and soldiers appreciated the service and asked PACAM to continue supporting them. This came in following 2015’s World hospice and palliative care day theme; HIDDEN LIVES, HIDDEN PATIENTS. The function started at 8.30 in the morning and ended 1.30 in the afternoon.

Introduction

World Hospice and Palliative Care day is a unified day of action that aims to celebrate and support Hospice and Palliative Care around the world. The day allowed sharing of palliative care vision to increase the availability of hospice and palliative care throughout the world by creating opportunities to speak out about the issues. The day also raised awareness and understanding of palliative care needs of people living with life limiting illness and their families. Furthermore the day helped to raise funds to support and develop hospice and palliative care services.

Palliative Care Association of Malawi(PACAM) is a network of individuals and Organizations working together to advocate and develop accessibility and culturally appropriate and affordable palliative care services through working in collaboration with MoH, policy makers, palliative care service providers and other health related stakeholders.

This year’s theme: Hidden lives, hidden patients; focuses on promoting access to hospice and palliative care for patients living in unique conditions that often struggle to access palliative care. Such patients include: children, people with different sexual orientation, prisoners living with HIV, soldiers and those living in rural areas.

It was with this reason that Malawi realized the need for palliative care for prisoners and soldiers with life threatening illness and chose to celebrate with them at Maula prison and at Cobbe Barracks. In order to reach out to our hidden patients who are struggling to access palliative care services.

Preparations started on 1st September when members having looked at the theme of hidden lives and hidden patients, agreed that the function be conducted at Maula Prison and Cobbe Barracks. Thereafter preparatory meetings were conducted every week but in the week of the event the meetings were conducted three times.

What happened?

On this day the team comprised of health care workers, social workers, counselors and chaplains visited Maula prison in Lilongwe, central region and Cobbe barracks in Zomba southern region. Maula team sheered 350 prisoners. These were prisoners with HIV/AIDS, TB and Cancer while at Cobbe Barracks the team sheered 15 wounded war veterans’ soldiers. The activities carried out for the day included provision of palliative care services by a multidisciplinary team providers, provision of spiritual support by chaplains accompanied by the media in order to raise awareness. Services offered included holistic pain assessment, pain management, symptom control, psychosocial and spiritual support.

Gospel (Bible Sharing)

Members were blessed and inspired by the Gospel shared by Rev Joseph Chikwenga at Maula prison and Rev Maida (military chaplain) at Cobbe Barracks in Zomba. Rev Joseph Chikwenga read the following verses at Maula prison; Matthew 25; 13 – 40 which was supported by Matthew 4;4 and proverbs 4; 20 – 22 while R 895tev Captain Maida shared his gospel by reading the following verses; Isaiah 46; 3-4 psalms 37; 25 - 26 The theme was; "Moyo wa chiyembezo" (Life of hope)

PACAM board member, Pst Joseph Chikwenga shared a message from the bible that Jesus loves those in the prisons. He quote Jesus saying that Jesus said when you visited the prisoners, you visited me and members were encouraged and given hope. Members were also encouraged that God has a purpose for each one of us and if a period in prison may be for a testimony.

Spiritual leaders Provide spiritual support that provides meaning , promotes hope and peace of mind through skilled listening , encouragement and prayers

Speeches;

At each venue three people made a speech. At Maula prison speech was made by Mrs. Immaculate Kambiya, palliative care desk officer, Ministry of health, the regional prison officer and one prisoner while at Cobbe Barracks the speech was made by Lamarck Thambo, PACAM national coordinator, Major general Namwali (retired soldier) on behalf of in charge for Cobbe barracks. General Namwali is the one responsible for his fellow retired soldiers.

Speech by PACAM National Coordinator.

Lamarck said, “ladies and gentlemen, it gives me great pleasure to preside over this important occasion where Malawi is joining the rest of the world in commemorating Hospice and Palliative care Day today. The theme for this year’s event is very unique: HIDDEN LIVES, HIDDEN PATIENTS. The theme focuses on lives and patients living in unique conditions that often struggle to access palliative care services. Such patients include: children, people with different sexual orientation, prisoners, refugees, the elderly, soldiers and all patients in need of palliative care who are living in rural areas. I am humbled that this event has attracted the attention of members of different professions, the media and the health sector networking and collaborating stakeholders. The presence of this multidisciplinary stakeholders at this function, symbolizes the importance of this event as well as passion and compassion to make palliative care available and accessible to our “Hidden lives" and" Hidden patients” who are often challenged to access palliative care services. The palliative care fraternity believes , everyone matters and no-one should be invisible. As such palliative care should be made available to all in need regardless of age, race, disease, gender, sexuality, or geographical distance. Every year, Ministry of Health in collaboration with the Palliative Care Association of Malawi (PACAM) leads the nation in commemorating World Hospice and Palliative Care day as a worldwide and national event in line with themes from the international community. Finally, I wish you all the best as we celebrate this day with our "hidden lives "and "hidden patients". May God bless you all?”

Major general Bwanali is the one who looks after the war veteran soldiers. He is also a retired soldier. He started his speech by thanking PACAM and the donors who sponsored the event (True Colour Trust) for considering the wounded retired soldiers. He said that retired soldiers fought for the freedom that Malawians are enjoying in this country, "as you can see some of them are very old, sick and poor". Namwali said that PACAM was the only organisation who value them and acknowledge their effort made in this country. "As you can see most of them don't have families and are living in hostels alone". They don't have food but today you have brought them food and they will eat" I would like to ask other NGOs and well wishers to do the same as you have done today. You can see today they are smiling and are excited. You are the only hope for them and we are proud of you. Some of the challenges they face is frequent illness. Thank you gain for the medical assessment and treatment that you have provided. I'm told that some of them have been diagnosed with high blood pressure and received treatment. Please take my gratitude message to the donor who have sponsored this event.

Speech by wounded war veteran (Warrant officer Mr. Pinda)

" I feel like Jesus has come today, I don't find a word to express our feelings to let you know how happy I and my friends are. Where have you been all the years, you good Samaritans".

" I feel like today is Christmas". Mr. Pinda thanked PACAM for providing them with treated mosquito nets which would protect them from mosquito bites and prevent them from Malaria. He further thanked for the fortified porridge flour, rice and all other items offered to them. He said these items came on time when they had literary nothing to eat. He asked PACAM to continue with the support and asked other NGOs to follow suit. Finally he thanked the donors who sponsored the event (TCT).

Representatives in the task force were from the police, army, palliative care sites, PLHIV organizations, ministry of health

It was a good day out for the prisoners.

Though only about 350 attended the function, the music and the messages reached to all prisoners. The venue is demarcated by barbed wire so those that did not qualify to attend the function were on the other side of the wire fence, listening to the music and messages and speeches. There was a lot of dancing even from those on the other side.

Speech by a Prisoner

In his speech he said that he was happy that people out there are able to consider them. He thought been in prison is an outcast. He thanked for the parcels and the fortified flour for porridge as they eat one meal a day the porridge will make a second meal to them.

A representative from the lady prisoners thanked PACAM and all the organizers for such a good gesture and recommended that also learn from PACAM.

The prisoners representatives said that some of their fellow prisoners come from very far districts across Malawi and are never visited by relations. As such they have no means of getting soap since the prison does not provide such. Hence they recommended PACAM for the gifts.

On this day each client received a gift back of 5 tablets of Ufresh bath soap, 50 g Vaseline blue seal. Toothpaste and a tooth brush . Later on the invited guests and the prisoners enjoyed a snack of the popular baked snack and a cake. This was a rare treat to the prisoners who take one meal of nsima and beans per day.

The group was also given 10*50kg of fortified likuni phala and 20kg sugar on the understanding that the prison authorities will be making porridge for them regularly.

Palliative care providers set to provide the service

All roads led to Maula

Prison, where threr are over 2600 in mates with about 350 living with HIV, 38 on Tuberculosis (TB), 2 with kaposis sarcoma and 5 critically ill. On the day of celebration, 8 inmates were reported to be admitted at the central hospital

Maula Prison has a clinic, with a room for short stay and is supported by MSF. However the huge number of inmates with life limiting illnesses is overwhelming

There were over twenty service providers on the day of the event available to provide the service. Six palliative care clinics were operational on the day with two rooms for counseling. They were long quees seeking service that day but time could not allow for all to be seen by the providers. Some were sent back and only those who were very serious were attended to. Each clinic attended to an average of 7 clients giving a total of 42. Some had their vital signs taken, eg blood pressure where over thirty were attended to.

It was unfortunate that prison management did not allow for the taking of pictures but the event was colourful.

Comments by beneficiaries.

1.Wounded Soldier.

“Why today? Where have you been all the years? This must continue please”. That was the voice of one of the most aged wounded soldiers also known as War veterans who was amazed, excited and speechless soon after he had received a parcel containing soap, sugar, mosquito net, packet of rice, tooth brush, tooth paste and packets of nutritious porridge flour at Cobbe Barracks in Zomba on 10th October 2015 at World hospice and palliative care day celebration.

2.A prisoner.

“I have managed to express my concerns concerning the challenges I have with my ARVs treatment and I’m satisfied with the explanation and treatment today” That was comment from a prisoner who had severe peripheral neuropathy due to ARVs treatment during the assessment.

Acknowledgements

On behalf of management and staff of Palliative care Association of Malawi, I would like to thank the following.

1.True Colour Trust - for providing financial support to PACAM and the event. Without this support the activity wouldn't take place.

2.Ministry of Health for the collaboration and guidance.

3.The taskforce committee - for organising the event.

4.Management and staff of Maula prison and Cobbe Barracks - for giving advice and direction.

5.Prisoners and War veterans for their participation.

Pictorial focus on WHPCD 2015

Sample items that were given to the prisoners. In the background is one tent where the prisoners were seated. There were three such tents for prisoners, two for males and one for females

Official presentation of the gifts by the WHPCD task force to the prison authorities.