Browsing by Author "De Vries, Elma"

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    An evaluation of palliative care in rural Tanzania where availability of oral morphine is intermittent or absent
    (2011) Hartwig, Kristopher; De Vries, Elma
    In Tanzania, palliative care is relatively new, and faces the common challenges of access to services, crucial medications, and education. Since 2004, an initiative within the health system of the Evangelical Lutheran Church in Tanzania (ELCT) began to promote and develop palliative care, using as a model the Selian Hospice and Palliative Care Programme. The hospitals which are the sites for team development and service delivery are widely scattered throughout rural Tanzania. Access to oral morphine was only a dream, as it is for much of the rural population of the world. In 2007, a program called CHAT (Continuum of care for people living with HIV/AIDS in Tanzania), funded by the U.S. government, allowed the up-scaling of these palliative care programs, resulting in 13 strong and mature teams by 2011, though still lacking oral morphine. Part of the monitoring and quality assurance of the program has been use of a tool developed by APCA: the APCA African Palliative Outcome Scale (POS). Hundreds of people living with cancer and HIV were subjected to the questions of the tool, which was always sent on to the core supervising team for assessment and feedback. Tramadol was the strongest analgesic available to the teams throughout the study time. 145 APCA African POS results on cancer patients were assessed, looking at differences in pain scores (0 to 5 scale) over time as well as assessing the other domains of care (psychological, spiritual, social, and family). 11 Palliative care nurses were also interviewed, asked to reflect on specific cases from their experience with both good and bad pain control. 5 of the nurses came from Selian, with access to oral morphine, while 6 of them came from the CHAT hospitals. Significant improvement in pain scores over 4 weeks was noted (3.83 to 2.31, p < 0.0001). All other domains assessed in the POS also improved significantly. Nurse interviews revealed an emphasis on the holistic approach and a strong preference for having access to oral morphine. In this rural Tanzanian environment, effective palliative care services – including pain control - were delivered even in the absence of oral morphine. Such services can become a strong advocacy at the government level for achieving breakthroughs in palliative care, including access to oral morphine.
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    A quantitative and qualitative audit evaluation of a provincial hospital service for hospice patients
    (2003) Alderton, Norman; De Vries, Elma; Gwyther, Liz
    Hospice-in-the-West is situated in Krugersdorp on the West Rand. There is no hospice dispensary and the patients must, of necessity, obtain their terminal care medications from the Yusuf Daddoo Provincial Hospital. The hospital has a policy protocol in place that must be followed by all patients attending the hospital in order for them to obtain their monthly supply of medications. This policy has been in place for the past eight years. An evaluation of the provincial hospital's policy protocol was undertaken in an attempt to identify areas for possible improvement.
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    Routine cranial CT before lumbar puncture in HIV positive adults presenting with seizures at Mitchells Plain Hospital in Cape Town
    (2015) Moolla, Salma Abdulkadir; De Vries, Elma; Rajkumar, Ashmitha
    Current international guidelines recommend that a cranial computed tomography (CT) be performed, on all HIV positive patients presenting with new onset seizures, before a lumbar puncture (LP) is performed. In the South African setting, however, this delay could be life threatening. This study sought to measure the number of cranial CTs that contraindicate an LP and to predict which clinical signs and symptoms are likely to pose an increased risk from LP. Methods: The study was performed at a district level hospital in the Western Cape. Data was collected retrospectively from October 2013 to October 2014. Associations between categorical variables were analysed using Pearson's Chi-squared test. Generalised linear regression was used to estimate prevalence ratios. Results 100 out of 132 patients were studied. Brain shift contraindicated an LP in 5% of patients. Patients with brain shift presented with: decreased level of consciousness, focal signs, head ache and neck stiffness. 25% of patients had a space occupying lesion (defined as a discreet lesion that has a measurable volume) or cerebral oedema. Multivariate analysis showed a CD4 count < 50 (p=0.033) to be a statistically significant predictor of patients with a space occupying lesion (SOL) and cerebral oedema. Univariate analysis showed focal signs (p=0.0001), neck stiffness (p=0.05), vomiting (p=0.018) and a GCS<15 (0.002) to be predictors of SOL and cerebral oedema.
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    Sexuality issues in patients attending antiretroviral clinic at Embhuleni hospital in Mpumalanga Province (South Africa)
    (2008) Mkhabela, Mandlenkosi Rex; De Vries, Elma
    People living with HIV/AIDS experience many losses, one of which may be loss of sexual expression. Sexuality has a broader meaning than mere sexual intercourse; it encompasses intimacy and impacts on psychosocial and spiritual realms. Despite the broader meaning of sexuality and that HIV is mainly a sexually transmitted disease; carers generally avoid real issues of sexuality. This study explored issues of sexuality in people living with AIDS who are given an optimistic outlook to life by the availability of HAART.