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09 October 2023 | Story André Damons | Photo André Damons
A multimillion-rand grant will assist UFS to develop palliative care structures and services in FS
The palliative care team consists of (at the back, from l.t.r) Rethabile Matuka (M&E Officer), Matron Mitta Sauli and Khomotso Makhura (social worker student). In the middle: Viaan Lucas (left, social worker) and Thobeka Maziya (social worker student). In front: Sr Elizabeth Lekoeneha, Dr Dalene van Jaarsveld and Prof Alicia Sherriff.

A multimillion-rand grant will assist the Department of Oncology at the University of the Free State (UFS) to initiate the implementation of palliative care services in the Free State province and help to improve the quality of life of patients and their families living with a life-threatening disease.

The grant from the Bristol Myers Squibb Foundation (BMSF) has already improved the quality of life for patients living with advanced progressive life-threatening diseases (cancer, renal failure, heart failure, AIDS, lung disease) as well as for their families. Prof Alicia Sherriff, head of the UFS Department of Oncology, and Dr Dalene van Jaarsveld, Lecturer and Medical Specialist in the same department, are project leaders for the grant that UFS administers. The grant is for a period three years.

According to Dr Van Jaarsveld, they have also planned for a 10-bed inpatient facility at the Universitas Academic Complex that will be able to accommodate a family member of patients receiving care in preparation for their down referral for home-based care. This unit will also be used as a training facility for all undergraduate health-care students. The grant will provide staff for a limited period to assist the Free State Department of Health (FSDOF) in preparing to absorb the services. They are currently awaiting commitment from the FSDOH to start with renovation of this unit. 

Situation in the Free State 

Palliative care, explains Dr Van Jaarsveld, provides a service that improves the quality of life of a patient, and his/her family, diagnosed with a life-limited disease. “It is not only for patients who are terminally ill and should ideally be implemented much earlier in the patient's disease journey. Palliative care is a basic human right,” she says. 

“A National Policy Framework and strategy on the implementation on palliative care for South Africa for 2012-2022 was published by National Department of Health. We recognised in 2019 that there was no implementation initiated in the Free State, and no budget allocated to the implementation of this critical service.  

“Many patients in the province live with these advanced progressive diseases and experience a very poor quality of life that translates into a poor quality of death with a high symptom-burden and suffering during their last days. Similarly, the family will suffer immensely,” says Dr Van Jaarsveld. 

Prof Sherriff says they applied for this international grant to assist with the startup of these structures while the FSDOH is given the opportunity to setup the necessary budget to ensure long-term sustainability of this human right as a health-care service. 

In the Free State about 16,000 patients die every year with a high need for palliative care. Dr Van Jaarsveld says of the 15 functioning hospices in 2014 and home-based carers that were offering hospice care in most of the sub-districts in the Free State, there are only four registered hospices remaining. Of these only one has four beds where patients can be admitted. The others provide limited care to a very small area, leaving most of the districts in the Free State without any form of palliative care and support.  Most of the other provinces have different levels of palliative-care services available. The grant provides funds to initiate the implementation of this service in the Free State. 

They are working closely with the FSDOH on a provincial implementation plan that will eventually, once the grant has ended, be taken forward by the province, says Dr Van Jaarsveld. 

Impact of the grant

Through the grant a project manager, professional nurse and administrative support are employed as part of a core team at Universitas Academic Hospital with a social worker. They have received training in palliative care supported by the grant. This team, together with Dr van Jaarsveld, provides a consultation service at the Universitas Academic Hospital Complex. 

“Nearly 700 patients have been referred for palliative care in the past year and have therefore benefited (with their families) from the grant. Another two professional nurses have been employed via the grant as hub managers for the Thabo Mofutsanyane and Lejweleputswa districts. Both are currently doing training in palliative care. Once a patient is seen by the team, a palliative care plan is developed, family meetings are held, and a discharge care plan set in place. 

“To ensure continuity of care, the patients are handed over to one of the nurses managing the districts where the patients are from for further follow-up and support. This is sadly not possible in all districts,” says Dr Van Jaarsveld. 

With the grant, the palliative care team, in close collaboration with Hospice Bloemfontein, have started with accredited palliative care training for nurses and other health professionals working for the FSDOH in all districts of the province. This will help with down-referral pathways and support for patients from districts without a dedicated palliative care nurse. 

UFS and Vision 130

Dr Claire Armour Barrett, Head: Research and Development in the School of Clinical Medicine at UFS says this project is critically aligned with the second key tenet of the UFS Vision 130, maximum societal impact with sustainable relationships. Although this project is still in its early phase, almost 700 patients and as many as 2100 family members have been positively affected by this work. 

“We believe that we are bringing the UFS closer to the theme of the World Hospice and Palliative Care Day for 2023, Compassionate Communities: Together for Palliative Care. We are actively increasing awareness in communities, advocating for patients and families in need not only through service delivery, but also by education and collaboration. We are stronger together.”

World Hospice and Palliative Care Day is celebrated every year on 14 October.

News Archive

Research eradicates bacteria from avocado facility
2017-01-17

 Description: Listeria monocytogenes Tags: Listeria monocytogenes

Listeria monocytogenes as seen under an electron
microscope. The photo was taken with a transmission
electron microscope at the microscopy unit of the UFS.
Bacteriophages (lollipop-like structures) can be seen
next to the bacterial cells.
Photo: Supplied

“The aim of my project was to identify and characterise the contamination problem in an avocado-processing facility and then to find a solution,” said Dr Amy Strydom, postdoctoral fellow in the Department of Microbial Biochemical and Food Biotechnology at the University of the Free State (UFS).

Her PhD, “Control of Listeria monocytogenes in an Avocado-processing Facility”, aimed to identify and characterise the contamination problem in a facility where avocados were processed into guacamole. Dr Strydom completed her MSc in food science in 2009 at Stellenbosch University and this was the catalyst for her starting her PhD in microbiology in 2012 at the UFS. The research was conducted over a period of four years and she graduated in 2016. The research project was funded by the National Research Foundation.

The opportunity to work closely with the food industry further motivated Dr Strydom to conduct her research. The research has made a significant contribution to a food producer (avocado facility) that will sell products that are not contaminated with any pathogens. The public will then buy food that is safe for human consumption.


What is Listeria monocytogenes?

Listeria monocytogenes is a food-borne pathogenic bacterium. When a food product is contaminated with L. monocytogenes, it will not be altered in ways that are obvious to the consumer, such as taste and smell. When ingested, however, it can cause a wide range of illnesses in people with impaired immune systems. “Risk groups include newborn babies, the elderly, and people suffering from diseases that weaken their immune systems,” Dr Strydom said. The processing adjustments based on her findings resulted in decreased numbers of Listeria in the facility.

The bacteria can also survive and grow at refrigeration temperatures, making them dangerous food pathogens, organisms which can cause illnesses [in humans]. Dr Strydom worked closely with the facility and developed an in-house monitoring system by means of which the facility could test their products and the processing environment. She also evaluated bacteriophages as a biological control agent in the processing facility. Bacteriophages are viruses that can only infect specific strains of bacteria. Despite bacteriophage products specifically intended for the use of controlling L. monocytogenes being commercially available in the food industry, Dr Strydom found that only 26% of the L. monocytogenes population in the facility was destroyed by the ListexP100TM product. “I concluded that the genetic diversity of the bacteria in the facility was too high and that the bacteriophages could not be used as a control measure. However, there is much we do not understand about bacteriophages, and with a few adjustments, we might be able to use them in the food industry.”

Microbiological and molecular characterisation of L. monocytogenes

The bacteria were isolated and purified using basic microbiological culturing. Characterisation was done based on specific genes present in the bacterial genome. “I amplified these genes with polymerase chain reaction (PCR), using various primers targeting these specific genes,” Dr Strydom said. Some amplification results were analysed with a subsequent restriction digestion where the genes were cut in specific areas with enzymes to create fragments. The lengths of these fragments can be used to differentiate between strains. “I also compared the whole genomes of some of the bacterial strains.” The bacteriophages were then isolated from waste water samples at the facility using the isolated bacterial strains. “However, I was not able to isolate a bacteriophage that could infect the bacteria in the facility.

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