Hospice at home services is the foundation of the work that we do. It is where the first assessment and counselling takes place. Many kilometres are travelled to visit patients in their homes. Along the busy urban Highway as well as dusty rural tracks. Symptom and pain control, as always, remains our over-riding focus.

Late referrals are always a challenge for the home based care teams. Changing people's perceptions about Hospice being solely end-of-life care is not an easy task. Care in the home necessitates the provision of equipment in order to facilitate nursing by the primary care giver.

Many of the patients we visit have very little or no support in their homes. Families are fragmented and many live and work in other places. Poverty and a lack of resources further add to the patients condition. The increase in the need for home based care is increasing and it is a challenge at times for us to meet this growing need.

Patients dying free of pain, comfortable and with dignity in their homes is our major focus for our teams. The many trips that we make to patients have resulted in quality interventions. The daily support - and in fact the 'always available' assistance that we receive from our medical officer, Dr Andre Nell, together with Diane Christensen our Psychological/bereavement counsellor and our social workers has facilitated this positive outcome. We are grateful for their dedicated support.

The palliative care centre with the re-furbished Inpatient unit and the day care clinic provide much needed support to patients who are mobile and who can attend for symptom control, pain management, counselling and various other therapies. Support groups can play a major role in holistic care of patients. The day care lounge support group that has been held on Tuesdays for many years, is an ideal opportunity for patients to receive moral support and to engage in occupational therapy.

spEciAL pRoJEcTs woRKiNG FOR QUALITY PALLIATIVE CARE AT "HOSPICE AT HOME SERVICES"
(KARIN WARMAN SPECIAL PROGRAMME MANAGER) 

• Multi-drug resistant TB programme - In partnership with the Department of Health, and Murchison hospital we administer daily injections and medication to patients living with MDR/TB. Included in our daily visits are education and information to household members, TB screening, infection control and general Hygiene. This is a highly infectious disease and it is a vital service to prevent the spread within our region. MDR/TB treatment has severe side effects which can become a barrier to adherence of treatment, our Social workers together with our teams do all that they can to encourage adherence. Many of the patients are unemployed and social relief is offered in the form the food parcels, clothing and blankets. It is this compassionate holistic care that has put us ahead in the delivery of quality Palliative care services. We thank Hospice Palliative Care Association through the CASIPO project for the funding.

• Orphans and Vulnerable Children's programme (OVC) - This programme offers psychological care and Support to HIV/AIDS infected and affected orphaned and vulnerable children. To assist these children, a specialised team conduct memory box workshops, which facilitate bereavement, create inter-generational dialogue and build resilience in children living in extreme poverty and who have experienced many losses at an early age. These workshops are done in partnership with schools and communities and play a very important role in unblocking barriers to early childhood development. We work closely with siblings and families in the best interest of the child. Support groups with children and their primary carer are facilitated towards disclosure of HIV status in children. Non-disclosure by the primary care giver to the infected child can cause non-adherence from a very early age. We would like to thank our local community for their assistance in food parcels and clothing for the children that are on this programme.

"Community is a sign that love is possible in a materialistic world where people so often either ignore or fight each other. It is a sign that we don't need a lot of money to be happy - in fact, the opposite."
Jean Vanier Community And Growth