Monday, March 11, 2013

Susan's Reflections

Visiting South Africa and our sister hospice – Hospice Wits – was an incredible experience.  There were many poignant moments – visiting patients in their homes, being welcomed by patients and caregivers into their homes, sharing with colleagues, introducing the Suncoast Hospice Institute’s Learn Center, training and sharing with staff, and experiencing life changing moments with others.  Here are a few of the lessons that I learned along the way. 

Lesson One:  Keep true to your core values and take advantage of opportunities along the way.   I never thought I would have the opportunity to return to Africa.  Through my work with Suncoast Hospice and Suncoast Hospice Institute my path would lead me not only back to the place that changed my perspective on life but it would combine two life changing experiences….Hospice AND Africa.  Who would want to miss out on this?  Visiting with staff and patients in South Africa and seeing hospice in action half-way around the world from Florida only reinforces the universality of hospice.  The language of love is the connection.

Lesson Two:  Really big things can block your way in life – but you just need to adjust your path.  Don’t be afraid to try new things just because there are obstacles in the way.  Look at your situation through a larger perspective…. There is always a different way to do things. 

Lesson Three:  There are some things you should steer clear of…… like bungee jumping!  Who needs it?  Do you really need to scare yourself that much?

Lesson Four:  There is never enough education – we can learn something everyday if we just open our eyes.  Sharing  our Learn Center with our colleagues was an exciting experience.  They embraced the opportunity to use online training to enhance their learning and have made a commitment to share this with the Hospice Wits staff.

Lesson Five:  Never miss the opportunity to laugh with a friend.  I  have made life-long friends along this journey which will be with me forever.  I hope that I have made a difference in others lives, I know they have made a difference in mine.
Susan Bruno

Thursday, March 7, 2013

Valuable Learning

Post by Joy Ruwodo, Hospice Wits Marketing Manager

Joy Ruwodo
I've been at Hospice Wits now for just over two years. In that time, the relationship with Suncoast Hospice has always been something that I've heard of and felt mildly in our Skype phone calls.

The relationship and understanding of how valuable this partnership is really came to light in full force when we had your team over for a visit. I could then touch and feel the reality of our partnership and benefitted immensely from our conversations and other interactions. I learned so much about how you do things in your hospice and how we could adopt some of your ways to improve our own way of working.

Because of the amount of learning from your short time here, I really felt that it was more important for us to keep the relationship going beyond your return to the States. And hence the idea that we should find a way of getting our teams here to be in contact with their counterparts there on a needs basis. I feel that a lot of good progress could come out of that.

Total Gratitude

Post by Nigel Unwin, Hospice Wits CEO

Nigel Unwin
As a nation South Africa is still in a difficult is Hospice Wits. The visit by Stacy, Susan and Terri was energizing and uplifting for all of us. Even though we knew that they would come with so much to share and give, we were overwhelmed and humbled by their generosity from all perspectives. This included the six laptops, suitcases full of materials, Learn Center tool, team building with all parts of the organization, work with our management team and visits with our home care sisters. So much in two short weeks.

To feel that Suncoast Hospice, this time through Stacy, Susan and Terri, genuinely sees Hospice Wits as their partner is overwhelming. We feel we have so much to learn and take and not much to share, apart from our absolute commitment to excellent hospice care. Other hospices here in South Africa, which nominally are partnered with hospices in the U.S., are blown away by what our partnership means and what it achieves for Hospice Wits.

From our perspective the best thing about our partnership is that we know that you have so much more that you want to share with us. Amazingly, it doesn’t feel like a one-way street. Perhaps it's enough to give and to be received with total gratitude? Hopefully it is.

Shared Knowledge & Understanding

Post by Mark Hibbins, Hospice Wits Financial Manager

Mark Hibbins
Despite South Africa being the most advanced country in Africa, we're nevertheless fairly isolated in terms of our understanding or even awareness of worldly developments, specifically around palliative care and, to a large extent, technological advances.

Our country is a vast cauldron of many factors. We have 11 official languages, cultural differences and massive anomalies in living and education standards. Within a mile or two from the wealthy live thousands in abject, unbelievable poverty, with the majority whom are unemployed. Our government health facilities are crumbling, many barely functional.

Hospice Wits has units in Houghton, a wealthy area, and Soweto, an impoverished area. We're so fortunate to share a partnership with Suncoast Hospice.We're extremely proud of our Soweto facility and the services we offer to the community. These are only possible to continue because of the generosity of financial contributions from local and international funders.

Sadly, our USAID/PEPFAR funding terminates in March this year, and this will definitely place an additional burden on us to find alternate funding in order to continue our work in Soweto.

For me, the partnership with Suncoast Hospice represents a golden opportunity for both of our hospices to benefit from a sharing of knowledge and understanding.

Our staff who've visited U.S.A. and Suncoast have returned invigorated and filled with new ideas and enthusiasm. And their experiences have been shared with us. We're also in awe that you and your staff who've visited here over the years feel you've learned from us. We trust our mutual association will remain strong.

We're also implementing a number of Suncoast Hospices’ initiatives. We're excited about the ultimate benefits we surely will receive.

Tuesday, February 19, 2013

Quite a Spectacular Day

Today (Tuesday) Susan, Terri, and I spent the entire day in Soweto. We had an amazing day. We began our morning with the Soweto nurses and community care workers. We had 27 people all together in one room. Terri facilitated the auto bio poem activity with them. We've done this activity previously with the leadership team and the clinical staff in Joburg. We learned a lot about each other. Some of us really like chocolate (what's not to like...). Others described themselves as loving caring people (they are). Many stated they want to be remembered as making a difference in other people's lives (absolutely no doubt about that).

After that activity they presented us with a lovely tea. Tea time is very important here. The staff brought in tea, coffee, and many different sandwiches-along with a tablecloth.  It was quite lovely.  After tea we each left to make home visits with a different sister. As a surprise to the three of us we all met at the shopping mall in Soweto for a late lunch together at Nando's!  David, Deb, and Gayle (the 2011 trip members who were introduced to Nando's together) are you jealous? The food was delicious.

My day was quite spectacular. I did something I've never done before... I was spending the day with Maria. She has been employed by Hospice Wits and working in Soweto for 27 years. She is an amazing nurse. She told me we were going to an NGO (non governmental organization) meeting. I figured we were meeting with other not for profit organizations. Maria said that someone from Hospice Wits had attended previous meetings. Well, when we got there and went inside Maria showed me the agenda. I saw that we were attending a meeting of the ANC Women's Auxiliary! The ANC is the ruling party of Jacob Zuma, president of South Africa. Needless to say I wasn't quite sure what to expect!  I must say it was an amazing meeting. The attendees are very respectful of the chairperson and everyone follows proper protocol. I think we could learn a thing or two from them about how to run a meeting. Anyhow the meeting was about encouraging women to stand up against substance abuse as most cases of violence against women (of which there is much) involves substance abuse. They will be marching peacefully to the police station to deliver a petition and then ending with a prayer service. Hospice Wits will participate. The chairperson said she was humbled to have someone from America at their meeting and directed some very nice comments to me. It was a once in a lifetime experience.

We will post additional blogs about our patient visits. I wish everyone could witness the amazing work this staff does.


Excellence in Patient Care

Today I truly witnessed excellence in patient care. I know there is no way my words can truly describe what I saw today. I was struck by the depth of the patient's physical suffering  and the loving care the community care workers provided while working in a very compromised environment. Everything I am going to attempt to describe to you occurred in extreme heat (it's summer here), in extremely close quarters (we were in a very small shack), with the door closed-no ventilation.

 I had the distinct privilege of observing Maria and two of the amazing community care workers provide the most dignified and gentle care to a patient. This gentleman was 37 years old, paraplegic with AIDS and other ailments. These three staff visit him daily to provide wound care and daily dressing changes to the largest decubitus I've ever truly seen. This giant skin ulcer covered this gentleman's entire buttock region and then some. There were areas you could see muscle. Truly it was enormous. He also had other ulcers on the sides of both knees, calves, and the bottom of both heels.  Sorry to be so graphic but I think it's important you understand the nature of this man's suffering.

In extreme heat, with little space to move, these three remarkable caregivers moved around each other and gave their patient a bed bath, massaged his limbs, carefully removed yesterday's dressings, and then cleaned his wounds with saline solution they made themselves (they boiled water and added salt). They sprinkled vinegar to mask the smell and keep away the maggots he had in the wound previously. They then carefully placed powdered flagel on the skin ulcers.  After this, they placed gauze on the wounds, taped them to his skin, then placed larger gauze over that and then finally a diaper.  It was like watching poetry in motion or a carefully choreographed dance. This gentleman never flinched or cried out in pain. Finally they dressed him and placed him a wheelchair so he could sit outside.

All the while the community care workers were perspiring profusely. Eventually I took a beautiful scarf given to me by a good friend here that was tied on my purse and began wiping their faces. They were grateful for that small gesture.  I told them to keep the scarf and use it for the remainder of the day.  It was the least I could do.  The community care workers told me they were grateful someone was there to see them work and understand what they did. I don't think I've ever been so humbled.

Suncoast Hospice has remarkable staff also. Our staff provides excellent care in trying circumstances. I do not mean to imply otherwise.  I'm not sure that you can truly understand the depth of the need here until you see what I saw today, what I've witnessed my four trips here and what all our other staff who have visited our sister hospice have witnessed. 

The dollars we raise help Hospice Wits in innumerable ways. The supplies you donate are a gift they treasure. Everyone is grateful for our support. They are so proud to be our 'twin'.  I am proud to see them wearing our red Suncoast Hospice buttons.

Tomorrow we finish our support activities with the Soweto staff. We'll conduct a de-briefing meeting with the leadership team and have a final tea. We'll then leave for the airport and begin our long trip back home.

We look forward to sharing more of our stories and pictures with you. Consider inviting us to a teamwork department support.  Thank you for your support and encouragement. We have read all your comments. Knowing you're reading our blog has helped to keep us going.

With heartfelt thanks,

Monday, February 18, 2013

Reflections on the Last Two Weeks

It's hard to believe that we've been gone for two weeks. Today (it's Sunday the 17th as I write this) we spent a lovely afternoon having a long leisurely outdoor lunch hosted by Nigel and Dee (Hospice Wits CEO and his wife and my host and hostess). We ate at their outdoor bowling club (not like our American bowling).

Many of our previous Hospice Wits visitors were there including Bev, Dorcus, Ntombi, Penny, Patrick, and Ritta. Joy, marketing manager was also there with her family. It was a delightful afternoon.

We all remarked how fast these two weeks have gone. I can see the sadness in our Hospice Wits's colleagues faces. I can already feel my own beginning telltale signs of starting the saying goodbye process. This disengagement is always difficult. I feel so at home here, surrounded by friends doing similar work. At lunch we were talking about a patient Susan, Terri, and I saw with Penny last week who was admitted to the IPU in Soweto the end of the week. It was nice to be able to confirm what Penny was telling Dorcus and Bev about this patient's primary caregiver.

We've accomplished so much. We spent two half days with their leadership team sharing leadership best practices and reviewing resources available to hospice staff including our Learn Center. I don't believe I told you that Suncoast Hospice donated 6 laptops to Hospice Wits. We brought them in our luggage. These laptops will be placed in the Soweto and Johannesburg offices so staff can access the Learn Center and the Internet (for additional resources).

By the end of Monday we will have provided a day of education to all clinical staff at both locations. By the end of Tuesday we will have made visits with the homecare sisters at both locations. We also spent a day making visits in Soweto with Penny, their social worker.

We have provided support activities, team building, and a powerful activity that reinforced the connection to and importance of all their employees.

We've learned a lot also. I have pictures of a clinical room used for counseling of adults and children I'd like for us to replicate. The walls are painted using nature scenes and mythology to assist with connecting to the symbolic aspects of therapy. I have ideas of how we might use such a room on our campuses.

I have facilitated discussions with the staff and leadership team about how to continue enhancing our partnership. I'll be sharing these suggestions with all of you. First and foremost they'd like to communicate directly with their Suncoast Hospice counterparts. Much more to come.

We will send a few more posts before we leave.

Wish us well during our final three days here. We travel Wednesday night arriving back in Tampa around noon on Thursday. Another 24 hours or so of travel... Susan, Terri, and I will be back to work on Monday the 25th.

Know that we've done a great job representing all of you during these two and a half weeks.



Pieces of The Puzzle

When walking through the center in Houghton, Mark (one of the managers) called me into the office to show me a DVD project he'd just completed. Looking over his shoulder I watched footage of Mother Teresa walking the grounds of Hospice Wits with staff members, and addressing them in one of the rooms of the center. She had visited with them in the 1980's. He had no idea of the significance of the moment...

One of my tasks on our trip here is to talk with the whole staff about the importance of each person's role in Hospice Wits, as well as our connection with one another. I do this by sharing a few stories about puzzle pieces and the fact that each one of us comes as 10,000 piece jigsaw puzzle...yet, on average, we come missing about seven pieces to complete our puzzle - while, on average, having about seven extra pieces belonging to other people's puzzles needed for their own wholeness. We end the time by having everyone pin one another with lovely gold puzzle piece pins we brought with us. It is quite a sight to see everyone - from the CEO to the gatekeeper - walking around adorning their gold puzzle pieces.

At the end of this presentation with the first center's staff I shared about Mark showing me the DVD. I shared with them about the honor of being asked to pick Mother Teresa up from the airport when I was but eighteen years old. When she got into the passenger's seat and I returned to the driver's seat she looked right into my eyes and said, "So what are you doing with your life?" Needless to say, during the ride I received one of the pieces that would greatly influence my life. To the staff I said, "I cannot tell you what it means to me to be standing here with you in this very space, thirty seven years after Mother Teresa asked me that question, talking with you about caring for people at the end of life...just as she did." I am still not sure I have completely grasped the moment. I feel as if I have been honored with the sacred task of carrying forth the baton on this journey, through which Mother Teresa so shaped the world.


Friday, February 15, 2013

Constitutional Hill Visit

These steps separate the past, the prison, and the future, the constitutional
court. It's a very powerful walk.
Jacqui Kaye, Susan Bruno and Terri Peterson on the African Steps.

Mapelta Daycare Center

Mapetla is a daycare center run by Hospice Wits for children ages 2-5 who are infected or affected with HIV/AIDS. 55 children are at the crèche (school). Visiting Mapetla is always a highlight of our exchange trips. This trip was no different. Lucky, the principal, and her teachers do amazing work. The children are clean, happy, and learning. The two year olds were napping when we arrived. There's nothing more blissful than watching 13 two year olds sleeping peacefully on mats. I had to video them just to preserve the sounds of their breathing.

You should be able to click on some links to hear the oldest children sing to us (Sorry link is not working). Entertain us they did!  And, in order to be totally transparent, we entertained them too... Thanks to the financial  generosity of Paula Dilandro (Center for Loss and Healing Director) and some of her family members and Charla Fogel (Center for Learning volunteer and my mother!) I was able to purchase 10 chairs made from corrugated paper for the Mapetla classrooms. The chairs can open for storage also. The ultimate goal is to purchase chairs for every child.

So, here's the transparent piece... I asked my team if anyone was skilled in putting 'stuff' like this together as I know I'm not. One of the team members (not naming names... Susan) said she could easily do this. About 12 minutes later one chair was put together!!  I hope you're able to see the last little bit of this experience as well as some of the kids (and big kids) sitting in the chairs.

Thursday, February 14, 2013

Beautiful Portia Celebrates Win

Portia, a Hospice Wits employee the day after Nigeria won the Orange
Cup, the African football (soccer) tournament.

Home visits with Penny

I was so excited to have the opportunity to travel in the field visiting patients and families with social worker Penny.  Being a social worker by training, I had the opportunity to visit with Penny when she traveled to the US in November as a part of our exchange program - Hospice Wits and Suncoast Hospice. Today, we traveled the roads in Soweto, some paved and some not, to visit a few of Penny's patients.

The first was a woman living with AIDS, who resided with her daughter and granddaughter in a 8 x 10 hut made of cardboard, blankets and tin.  Penny assessed the patient's need for a food parcel and the possibility of moving to another location providing better shelter, while the community care worker (hospice aide) gently massaged her hands and arms to counteract the effects of her neuropathy. 

They all spoke in their native language, Zulu.  The universal language of hospice was understood by all of us, even though we never said a word, other than greetings and goodbyes.  The patient was so appreciative of everything Hospice Wits has done and could do for her... and thanked, us...the American visitors, for taking the time to visit with her.  Can you imagine...she thanked, us....just for being there. Another lesson in the power of presence.

Susan Bruno

Tuesday, February 12, 2013

A Jew, a Catholic and a Protestant

This morning Stacy, Susan and I were sitting around a table with our tea and coffee while waiting for the staff to arrive for today's presentations. There we were - a Jew, a Catholic and a Protestant sitting and discussing the resignation of the Pope. I couldn't help but say I felt as if we were on The View, save the drama! (Now the picture of the lightening striking the Vatican was something to behold!) It is interesting to listen to the news on the morning drive to work and realize that we are all dealing with the same issues. Susan gave a presentation about the resources available on the learn center this morning. (Well, actually they are available each and every morning.) When she showed the list of the vast courses and resources available, I realized it took my coming to South Africa to see how much I could be tapping into back at home! I will be taking much more than the infectious disease course upon my return!!!
Lightning strikes St Peter's dome at  on day the announced resignation, by Filippo Monteforte

An interesting aside not related to anything I am writing about. They have two nuclear power towers side by side here that are no longer in service -regarding the provision of power. So what do you do with such towers that are shut down? You bungie jump between them! Imagine watching people plunge from a platform perched between the top of them. Stacy said she hoped there would be time for her to do this...

Terri Peterson

Some South African History

"Where were you on June 16, 1976?"  I've learned while in South Africa that this question is as meaningful as "where were you when President Kennedy was shot?  Or when the second plane crashed into the second tower?" The date was the beginning of the journey South Africans took towards the end to Apartheid.  A young 13 year old boy, Hector Pieterson, was shot and killed during a peaceful demonstration in Soweto, which marked the beginning of a new day.....that culminated in the election of Nelson Mandela as President in 1994. 

Mortally wounded Hector Pieterson being carried by bystander while his sister screams and prays 

This past weekend we were immersed in South African history by visiting three museums; the Hector Pieterson museum in Soweto, the Apartheid Museum and Constitution Hill (the site of the notorious Block 4 prison and the current hall of Justice and Constitution).  The art of form and the art of storytelling joined together in each setting to paint the picture of a country damaged by segregation and deprivation to one of hope and opportunity for the future.  The journey to this end is far from being completed, but the steps toward respect, dignity, unity and cohesion are being made each day, step by step, one person at a time. 

It is an honor to witness this in on a very small scale. It is heartening to see Hospice Wits make great strides in being a part of this journey in healing, incorporating the values that all hospices hold dear: choice, dignity, respect, advocacy and honesty.   
Susan Bruno  

Monday, February 11, 2013

A Little History and Reflection

Thank you to everyone who has posted comments to our blog. We are seeing them and sharing them with Hospice Wits staff. I wish I had enough time to respond to every comment.

We had a great weekend. Although we weren't visiting with patients we were still quite busy visiting three different museums so we could learn more about South African culture and the history of apartheid and the Black African struggle. I know Terri and Susan will share some of their thoughts with you on a further post. Even though I have been to these museums before I continue to learn more about what life was like for our colleagues. Keep in mind that apartheid didn't end until 1994. Only 19 years ago!  Monday is the anniversary of Nelson Mandela's release from Robben Island where he was jailed for almost 30 years.

I must admit I often take much for granted in my life. Although I do express gratitude for what I have I do think that I expect my life will go in a certain direction and that my family will have access to so much - good healthcare, a warm and comfortable home, little fear of physical harm. I am humbled being here and being reminded the same is not true for all.  Today I learned that a good friend of mine, Nikiwe, had her house robbed at night as she and her family slept. All of her household appliances were stolen. Although that may be hard for us to understand this happens often here.

Monday we'll spend half the day with Penny, the only full time professional social worker at Hospice Wits. In the afternoon we'll visit the Hospice's daycare (or crèche-school) as they call it. I promise to take video and pictures and will post some more thoughts later in the day.

Until later,

Home Visits With Sisters

Visiting with the Sisters (nurses) has been an incredible experience.  The love and compassion extended is truly universal.  The circumstances and setting might be a bit different but the caring and love has only one voice.  Sister Joanne leans over the patient who is turned on her side facing the wall - she can't see the Sister's face and it only adds to her confusion - so Sister Joanne gently wedges herself between the wall and the patient, lying on a mattress on the floor of the living room, and crawls up until they are face to face "oh my darling, my darling", the patient whispers.... "it is you" and with that she smiles.

On another visit, I witnessed the power of the interdisciplinary team.  Sister Joanne delicately began to explain that the journey the patient was now on was one that was moving in a different direction than the past 8 years.  The patient laid in bed, rigid from years of brain inactivity, her wedding picture showing a very different vibrant woman.  Her daughter agonizing over what else she could do to keep her mother in the present.  Terri, the chaplain and I, the social worker, were able to begin to share a very different journey that her mother was approaching and so too, was the daughter.  We  communicated through our eyes and hearts as we gently walked next to this family on their journey home. 

I feel so privileged to have this honor to share my skills with our sister hospice...Hospice Wits and at the same time learn from them about caring compassion at all times and sometimes, in the face of utter poverty.  Love is truly universal.  Joy too is universal....and so is music!  The smiles, laughter, and the hope always overcome the sadness. Let us always remember that we need them all.

Susan Bruno, LCSW.... Suncoast Institute

Today Was Spectacular

Today was spectacular. I mean truly spectacular. I am so proud of the team with me. Susan and Terri are doing a wonderful job sharing their many gifts of self with Hospice Wits staff.  It's going to be hard to put into words to describe how I feel about today. I know there will be more to share once I've had a chance to be still and think.  For now I'll tell you about our day. It's almost 5:30 pm in Jo-burg.

This morning we spent 4 hours with the management team. All 6 of their leaders committed to giving up half a day (on a Friday) to be with us.  We started with an activity led by Terri. We all completed an autobiographical poem about ourselves and then shared them with each other. I then led a discussion about leadership which culminated with each of the managers and CEO completed two different leadership questionnaires. Given the amount of trust in the room, the Hospice Wits staff began sharing some feelings regarding their own leadership strengths and leadership behaviors they'd like their colleagues to help them with.  Terri then ended our time together by facilitating a very heartwarming activity.  She will blog about this herself so I won't say more.  Just one hint... It involves each manager being 'pinned' by us. The pins are jigsaw puzzle pieces. We repeated this activity in the afternoon with all the staff on the Jo-burg campus and we'll repeat this activity in Soweto.  By the time we leave every paid employee will have a pin. I'm sending a few pictures for you to see.

After all the staff left Susan, Terri, and I stayed in the room to process the day and the week. We cried, laughed, and expressed gratitude to each other, our families, and you. This trip would not be possible without everyone's support.

So my heart is full. In fact it is brimming and overflowing with love right now. Tonight we're having dinner with the management team to celebrate our first work week here (please slow down time...). We understand we're being taken to an authentic South African restaurant. I heard someone mention worms...

Tomorrow is the weekend. We'll work on more posts so you'll have plenty to read Monday.

Until then,