The overwhelming sentiment expressed by the care team is that of helplessness. Of being unable to assist patients with their physical and emotional needs during this time. Some members of our care team had patients die and they were unable to be with them.

In one instance a family member of a patient called one of our Enrolled Nurse’s to ask them to come and check if the patient was still alive. This during the height of road closures and looting. The nurse was unable to get out their own home let alone across town. The impact on the nurse is devastating, the impact on the family can not be measured. As much advice and counsel was provided over the phone as possible. Another nurse received a message to call a patient. The call was made and the patient was threatening suicide. The nurse was trying to assist the patient to the best of their ability. The patient lives alone and has no one who could come and be with them. The Patient was completely dependent on the care that we provide. Once again members of the care team were unable to visit this patient. Thankfully the nurse concerned was able to provide sufficient support over the phone to avoid the patient taking their own life. Helpless and hopeless are words that are not often used, but during last week these best describe the feelings of the Care Team from Msunduzi Hospice. Another nurse described how, after the worst of the looting, just being able to get into the office to make some calls lifted some of the sense of despair. Just being able, for a short period of time, to interact with other care team members restored a touch of normality in a completely un-normal time. This nurse came in, opened up various patient files and made calls for about three hours and then took relevant contact information home so that the process could continue from home. Even short calls to offer support made a difference in the lives of the care team. Msunduzi Hospice allowed the purchase of air time so that calls could be made from the security (what there was of it) of their own homes. Another deep area of concern (more so for managers) was that some members of the care team did not respond to the messages that were sent out. Messages sent out to keep the care team informed and to keep them up to date with what could be done and how to do, and they did not respond. As the CEO, I found this deeply concerning and stressful. A number of patients died during the week of unrest and this caused additional stress on the care team. In one instance an entire family was killed when their shack burnt down (we do not know if this was deliberate or not). Shortly before this happened the patient had called one of our nurses to say that the area was safe and that she was in need of various items. The nurse responded that she was unable to visit due to the road closures and unrest. Later that same day she received a message saying that the shack had been burnt and that most of the family killed. The despair on the part of the nurse can not be described. The pain on the part of the family is beyond our ability to explain here. The surviving members of the family have subsequently received some support from the community and other members of the family. Emotional support will be provided to the nurse, and the family will receive the standard bereavement support in due course. Subsequent to the unrest we are receiving a number of calls for assistance from our families. Many of them are requests to change the dates of their next doctor/hospital appointments. For obvious reasons most procedures at hospitals were postponed during the unrest and appointments needed to be rescheduled. It is unfortunate but completely understandable. A further common request is for medication. Patients and their families are frighted to go out and collect medication. The impact on our care team and the impact on our patients will be long lasting. One of our care givers was saying, “My community did this.” This echoes deep concern about our community. Who are we without community? Yet do we still want to belong to a community who is capable of such random acts of violence and looting. This unrest has created fear in the community and a great deal of work is required to alleviate this fear. People frightened to go to work – what happens if something similar happens while at work. People knowing the perpetrators of looting (these are our neighbours, friends, hopefully not colleagues). How do we live together in the aftermath? The caregivers initially did not believe what was going on. It was only after the Edendale Mall was in flames that the reality sunk in. They were deeply concerned for their patients who were affected by the unrest. Some patients who did manage to attend a clinic were turned away if they had minor ailments. Some patients were unable to obtain their medication either because the clinic was closed, or they could not get there. Some patients have defaulted on their ARV’s as a consequence and our caregivers will now need to provide additional care and support until such time as they are able to obtain their medication (we do not anticipate this taking too long). On the positive side (and we must always try to find this), a number of patients were in contact with the caregivers asking questions and seeking support. This highlights the incredible impact that the care team make in the lives of our patients and their families. There are so many other areas that need to be reflected on. What is the impact on children? Our care team have not yet spent considerable time with children subsequent to the unrest and I am sure that details of their tensions will come to light in due course. What about the impact on the aged? The aged are seldom visited by their children as it is, during the unrest no visits were allowed. How is this going to impact on their care? However, like with most things in life we must look for the lesson, the learning, the directions towards a brighter future. Repeatedly I hear that families have pulled together during this time of civil unrest. Countless accounts of children taking in their parents and staying together (sometimes, as there was no choice). Is this a learning for us? Numerous images in the news showing the community banding together to clean up the devastation. Can we rebuild our communities once again? My thanks to our wonderful team here at Msunduzi Hospice. In particular to the care team who, despite the stress and despair, continued to provide support to our patients and their families during this difficult time. ‘The happiness of your life depends on the quality of your thoughts: therefore, guard accordingly, and take care that you entertain no notions unsuitable to virtue and reasonable nature.’ – Marcus Aurelius. As we spend time reflecting on what happened and how it impacted us individually, or as community, or as business these words from Marcus Aurelius should guide our thoughts. It is too easy to be drawn into the negative and the critical. We must find those thoughts which are virtuous and of a reasonable nature.