Author: Franciscah Tsikai, MPhil, Zimbabwe & Wedzerai Chiyoka, African Palliative Care Association
Franciscah Tsikai s a Palliative Care Consultant at Island Hospice and Health Care Zimbabwe. Originally a registered nurse and midwife by profession, she is also a qualified counsellor. She shares her journey in palliative care.
“My first encounter with palliative care was in 1986 when my father had advanced cancer of the prostate and was under hospice in Harare. That’s when I learnt about and grew to like hospice work. They carried out home visits, pain and symptom management and counselling for the patient and the family. This had a profound impact on me and as a nurse, and I felt that I wanted to give back this level of support for the benefit of other families in similar circumstances.”
Five years later I joined Island Hospice and Health Care as a Home-Based Care Nurse in 1991. I received training from St Christopher’s Hospice in 1994 comprising several distance learning modules, face to face training sessions, and practical sessions where I was attending to patients under observation and was being assessed for pain and symptom management. I came out as the top student in my cohort and our trainer, Virginia, encouraged me to pursue the field of Palliative Care. However, the biggest challenge was that formal palliative care training wasn’t being offered anywhere in the Africa region at that time.
I continued to receive ongoing training from 2 of my colleagues, Dr Steve Williams and a fellow nurse who had spent some time on attachment at St Christopher’s Hospice, ensuring that I kept up to date with best practices in palliative careat a global level.
In 2002 I finally got a chance to study for the Diploma in Palliative Care in one of the earliest classes at Hospice Africa Uganda under Makerere University. I got to meet many palliative care practitioners and colleagues from all over Africa and found the multi-disciplinary nature of the classmates to be a great advantage because there was much mutual learning among the doctors, nurses, pharmacists, oncologists, psychiatrists, and other related fields. The availability of an accredited qualification was a big motivation to me, and a major milestone in palliative care development in Africa. I interacted with some of Africa’s leaders in palliative care like Dr. Merriman, Rose Kiwanuka, Harriet Kebirungi, Dr. Dorothy Odong, Dr Mhoira, Mwazi Batuli,Dr. Ddungu, Dr. Mwebesa, Helen, Frieda, etc., most whom have become colleagues and dear friends over the years.
On completing my 2-month residential course, I was afforded a placement opportunity at Hospice Africa Mbarara for 3 months, where I got to apply and enhance skills such as patient examination, differential diagnosis, etc., that I have continued to use till today. My host was a fellow nurse, Martha Rauboni, who also became my language teacher so I could interact with patients in Luganda.
Back in Zimbabwe I subsequently became a palliative care tutor at Island Hospice for both the certificate level and a module for 5th year medicine students that included Introduction to Palliative Care, Pain Management, Communication Principles and Skills, Breaking Bad News, Death and Dying, and Bereavement Awareness.
I received a scholarship from APCA to do a bachelor’s degree in palliative care at Hospice Africa Uganda which included many learning visits to Mildmay where we learnt a lot about paediatric palliative care. I was amazed how effective pain assessment tools for children were, e.g. Wong-Baker. I also got the chance to attend a palliative care conference in Uganda and was one of the presenters. Being the oldest student in my class wasn’t always easy but I was passionate about mastering PC.
Highlights and milestones
I received the Ian Jack award from Dr Barbara Jack – an Oxford Textbook on Palliative Care which has been a great resource for me as a teacher and trainer. I used it in my role as Training Manager at Island Hospice, and as a lecturer at the Women’s University in Zimbabwe where we introduced a degree in palliative care. I have also written and presented several papers on palliative and home-based care sharing on experiences that included how we integrated palliative care in the nurses training curriculum in Zimbabwe, and other on geriatric palliative care.
I furthered my education at University of Cape Town doing a Post Graduate Diploma and an MPhil in Palliative Care, and did my thesis on death and dying, interrogating the question of patient and family preparedness for end-of-life.
Other milestones in my palliative care journey include:
- Reviewing the first edition of thee Palliative Care Standards for Africa
- Many successful conference abstracts
- I was the team leader in developing the curriculum for in-service health professionals in Zimbabwe, in the drive to integrate palliative care in health delivery systems with support from the True Colours trust.
- I am an examiner/marker for Palliative Care at the Open University and Women’s University
- Capacity building for new employees at Island Hospice, and the chance to mentor them
- Exposure to palliative care training in many African Countries International
- I received the Palliative Care Trainer of the Year Award in the UK
- Attended PC training at St Jude Hospice in Memphis in the USA for Paediatric Palliative Care in 2018, passed the written exams.
I wish to do a PhD in palliative care to continue to be a relevant resource to upcoming students and young professionals.