As part of our series to look at the stigma of palliative care in Africa, we interviewed Eunice Garanganga, Director of Hospice & Palliative Care Assocation of Zimbabwe (HOSPAZ).
GIPPEC: Please tell us a little bit about yourself and your current work in palliative care.
Garanganga: I am a palliative care practitioner working at the National Palliative Care Association in Zimbabwe. I have vast experience in palliative including bereavement care. I have been engaged in palliative advocacy and promotion at all levels from the ministry to community level so that palliative care is accessible at all levels. I work with palliative care and support providers through capacity building; training and mentorship, IEC materials development and distribution. I am also involved in mentorship for quality programing through determining, setting, recommending and monitoring of standards of care. In addition, as an umbrella body, we are involved in membership coordination. I represent palliative care providers at Ministry of Health and regionally.
GIPPEC: From your experience working with HOSPAZ, have you encountered any stigma in palliative care?
Garanganga: We have not encountered much stigma because somebody has a life threatening illness. The stigma is usually disease oriented for example people with AIDS face stigma because they are HIV positive as well as some cancers. At times people are stigmatized because the society thinks it is the person’s or family’s fault.
GIPPEC: How do patients and family respond to palliative care?
Garanganga: Palliative care is still not widely known in the country. Many people do not know or are not aware of palliative care services and its benefits; hence, they die in pain without seeking any help. Patients and families react to palliative care differently depending on their knowledge level. There are those who are well informed and know the benefits of palliative care, these actually use the services.There those who think palliative care medicines (morphine, radiotherapy) kills so they are not willing and at times default treatment. Others do not want or are not comfortable to talk about death and dying so they avoid palliative care completely. Religious belief that every disease can be cured through faith/traditional healing so they let the patients die in pain or seek help when it’s too late. At times patients are willing, but have no choice to make decisions because they are depended on their caregivers. For instance, for patients in remote areas, palliative care is considered expensive because they have to travel to access it. Depending on the diagnosis and stage of the disease families at time have to hire taxis to travel.
GIPPEC: Many global strategies to tackle stigma in palliative care have been suggested. What do you think are the unique challenges for Zimbabwe when tackling stigma?
Garanganga: The major challenge is self-stigma with patients thinking they are being stigmatized and these will need a lot of counselling and linkages to support groups. Advocacy on stigma is done mostly through radios, TV and flyers but for people in remote areas, all these are not easily accessible. Lack of disclosure of disease from people in power so that people do not think it’s just for the poor.