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Dying art of caring: lessons from 34 years in a Hospice

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“Some day, we will all die, Snoopy,” is the declaration of Charlie Brown in the Peanuts cartoon by Charles Schulz. “True, but on all the other days, we will not,” is Snoopy’s famous, gentle retort. It’s this cartoon that palliative nurse Janice Malkinson carries with her as a reminder of the deeper philosophy behind her work, which spanned 34 years at St Francis Hospice in Port Elizabeth until her recent retirement.

Looking back on a career that started with training at Groote Schuur Hospital in Cape Town at the age of 17, Malkinson says she hopes to have made “whatever path the patient was on that little bit lighter or easier”.

It’s a humble reflection for a medical professional who has received international recognition for her humanitarian work by being awarded a Paul Harris Fellow through the Rotary Foundation. She also served as a past chair of the Port Elizabeth Union of Jewish Women and on the committee of the city’s Jewish Benevolent Fund.

Born in Pretoria shortly after World War II, Malkinson grew up in the small Western Cape towns of Mossel Bay and Worcester. As a child, she says nursing “was the only thing I ever thought of doing”.

In those days, student nurses immediately began working as part of their studies. She recalls feeling “overwhelmed” the first time she entered Groote Schuur Hospital.

“I couldn’t even find the ward where I needed to go. It was the surgical ward, C Ward, on the third floor, and I remember I was late because I got a bit lost. I walked in, and the sister asked me who I was. When I replied, she said, ‘G-d, een bliksem se Jood [one damn Jew] in the whole lot of student nurses, and I had to get her!’

“At the end of my three months with her, she said to me, ‘Ek wil net een ding sê: as ek hoer al ooit daar is nog ’n Jood, ek sal sê, Ek wil haar hê!’ (I want to say just one thing: if I ever hear there is another Jew, I will say, I want her!).”

When Malkinson graduated, she was still so young that she couldn’t get her epaulettes until she turned 21. By then, she was training to be a midwife in London, first at the Chelsea Hospital for Women in South Kensington and later in the countryside in Ealing, replete with her very own “Call the Midwife” bicycle.

She recalled a time that it was pouring with rain, and she was pushing her bicycle because it had a puncture. “A big truck driver stopped, and I thought, ‘Oh boy! He wants to put my bike on the back and offer me a lift!’ Instead, he stuck his head out the window, and asked if I could give him directions – everyone knew the nurses knew the area. So I gave him directions, and he left me standing in the pouring rain, still pushing my bike!

“It was great fun!” she says with a laugh. “It was about bringing life into the world.”

In the interim, she returned to South Africa and settled in Port Elizabeth, where she got married and had three children. She also studied to be a paramedic and volunteered in the field, later teaching the course to first-year-university pharmacy students.

In 1978, a friend told her about meetings that were being held at a local hospital on palliative care. Malkinson went along to a meeting, and soon started working as a volunteer. When St Francis Hospice was later formally established, she first volunteered and then later became a full-time staff member.

Her first patient was a young mother who had a brain tumour. “Her children were the age of my youngest child.”

The night before Malkinson was to visit, she remembers getting so nervous that she lost her voice. She had to be coaxed by Port Elizabeth’s Hospice founder, Lesley Lawson, to go, and it was with this gentle nudge that she began her true calling.

From that first visit onwards, she took steps to place herself in the right frame of mind to care for the terminally ill.

“Generally, I walk quickly and work quickly. I remember on that first visit, parking my car, and jumping out – and then stopping, thinking, this patient is in bed, she can hardly move. I need to slow down.”

It’s a practice she adopted over the next decades of work.

“Before each patient, I would take a moment to be aware of where I was and the patient’s circumstances.”

Malkinson worked both in the in-patient unit of Hospice when it was in operation and travelled door-to-door across the length and breadth of Port Elizabeth communities attending to patients at their bedsides.

“My job became the opposite of paramedic work. I couldn’t save or cure them. It was about making them have a life, day-by-day, as they were, and where they were. It was to make each day for them as kind and as good as it could be, to help alleviate symptoms and to listen.

“Especially in the early years, the families of patients couldn’t bear to hear the reality of their experience. People kept telling them, ‘It’s going to be okay; you’ll see, you’ll be better’. It was so hard for the patients. They needed them to acknowledge the reality, to have them say, ‘I hear what you say.’”

Malkinson has seen society grow tremendously in its ability to cope with these difficulties. However, she laughs wryly that mentioning she’s a Hospice nurse is still a definite conversation killer at dinner parties!

Yet, the truth is that the work isn’t just the doom and gloom people imagine. “There is such warmth, because in these circumstances, life is so real and kind. There are still happy times around the table as families gather. You see families grow together and come nearer. You see people take in other people who haven’t got a place to stay. I remember there was one woman who heard about a school friend she had last seen when she was 15. Her friend was now ill and not being cared for properly. She went to fetch her friend, and brought her to her home. You hear of incredible women who take back the man they divorced and care for them in their days of need.”

Overall, says Malkinson, “the work has given me much more than I’ve given”.

Nevertheless, according to her colleagues, Malkinson’s legacy is profound.

Lawson says Malkinson’s gifts lie in both her head – in her extraordinary expertise and knowledge – as well as her heart. “She is just fully present to her patients.”

Trevor Wiblin, the director of Hospice who retired alongside Malkinson after nearly two decades of service, says he has received countless letters from the families of patients in gratitude for the work she did.

He jokes that she had to often be “reigned in”, so unconditional was her sense of service and dedication.

Hospice’s Dr Niel Malan said her work could be described only in superlatives, recalling times when she went into dangerous areas and even after experiencing problems with this, still “went back because they needed her”.

He said she was, in fact, the first Jewish person with whom he had ever had close contact. “My goodness, what an example of humanity, of kindness, of sincerity!” Malan says. “She has taught me so much.”

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Big names, big conference, big hope for recovery

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We can’t talk about South Africa’s recovery without talking about Eskom, we can’t talk about Eskom without talking about the government, and we can’t talk about the government without talking about the judiciary.

This was the notion award-winning broadcast journalist Cathy Mohlahlana used to start the panel discussion during the 2021 South African Jewish Board of Deputies National Conference last Sunday, 17 October.

Mohlahlana moderated the discussion between Eskom Chief Executive Andre de Ruyter, Finance Minister Enoch Godongwana, and advocate Wim Trengove on the paths of hope and recovery in their respective fields.

De Ruyter painted a grim picture of the national electricity provider. “Eskom is a technically insolvent business that’s failing its customers on a more or less frequent basis with this phenomenon called load shedding, with capacity shortages beset by the legacy of corruption, and with old, unreliable plants. It’s difficult to spin a story of hope from that set of facts,” he said.

De Ruyter is encouraged by the fact that South Africa is endowed with some of the best wind and solar acreage in the world. “Our worst wind and solar acreage in South Africa is significantly better than the best in Germany. If the Germans can make the transition to renewable energy and invest in wind and solar, surely so can we.”

Mohlahlana asked De Ruyter if Eskom could provide load shedding timetables so South Africans could start making plans for the upcoming municipal elections and December holidays.

“The Eskom system has a way of keeping me humble,” he responded. “As soon as I make a forecast, I’m proven wrong.”

Eskom’s system is old and has endured a hard life, been poorly maintained and, in some instances, suffered abuse by being run much harder than the international norm,” De Ruyter said.

“Therefore, our proposed solution isn’t to try and fix this old car,” he said. “Our proposal is to ensure that there is a transition in our generation technologies.”

He expressed concern about a recent report that identified South Africa as having double the global average carbon emissions and being the largest emitter of sulphur oxides in the world.

Godongwana is concerned about the state not knowing the results of its own actions. “It’s all very well saying that they have given so many injections for children, but what we want to know is the mortality rate. Checking outcomes is the key thing we want to do now. Has the money spent achieved the desired outcome?”

During the pandemic, the state allocated R500 billion to set up recovery programmes that would help to cushion certain sectors of the economy against the impact of COVID-19. According to the Institute of Social Justice, only about R134 billion of that has been spent.

“Most of that money is in parliament and in publicly legally appropriated forms of adjustments. So, if it wasn’t legally appropriated forms of adjustments, it will be easy to say that it doesn’t exist.”

The lesson Godongwana takes from COVID-19 is that people and businesses in South Africa worked together without a single document being signed on how to work together. “That in itself shows that there is positive commitment among South Africans. The key question for us is how we channel that positive commitment in the right direction.”

Another positive, according to Trengove, is how the Constitution and the rule of law have evolved in this country.

A couple of decades ago, many parts of the population were sceptical or hostile to the Constitution. They regarded it as a foreign, liberal import unwelcome in Africa, according to Trengove. “I know that sentiment is still around, but the Constitution has been far more firmly entrenched and accepted by all South Africans over the past two decades,” he said.

As for the rule of law, the government launched what Trengove described as “a concerted attack on the judiciary” 10 years ago. It did this by announcing a review of the impact that the judgements of the Constitutional Court and the Supreme Court of Appeal had on the transformation of society.

Trengove recounted how senior political party officials and ministers went around making comments like, “When people go to the Constitutional Court, it’s merely to undo the government’s transformation of society.”

These weren’t just lone voices. “They were officially backed up by the government’s attack,” said Trengove. “But that attack failed, and in the past decade – the decade of state capture – the courts have prospered. The judges have asserted themselves, the rule of law, and the supremacy of the Constitution.”

However, the Judicial Services Commission (JSC) has failed South Africa in exercising discipline and in appointing judges, said Trengove.

“We have always had a range of judges, ranging from hopeless to brilliant, and that’s so in every society. But it’s important that we maintain a core of smart judges who are confident and capable. Frankly, the JSC hasn’t consistently given us those judges.

“It has, for instance, failed to appoint brilliant people – such as Jeremy Gauntlett, David Unterhalter, and Geoff Budlender. There is absolutely no rational explanation for the failure to appoint people of that kind. And it’s not an issue of racism. They have appointed many other white male judges.”

To Trengove’s mind, the lack of brilliant judges can be explained by “a resistance to intellectualism” and the identification of strong lawyers as “potential troublemakers”.

In spite of the gloom, people should stay in South Africa, Trengove said, because the rule of law is alive and well. Godongwana predicts that tackling crime is eventually going to be government’s top priority, and De Ruyter said there shouldn’t be load shedding over December as the “little lights” on Christmas trees consume very little electricity.

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Declining immunity points to need for booster shot

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Booster jabs may well become essential as it appears that antibodies to COVID-19 decline significantly six months after receiving a second dose of the Pfizer vaccine.

That’s according to a recent study by the Sheba Medical Center, Israel’s largest hospital, rated by Newsweek as one of the top-10 hospitals in the world for the third year running.

Published in the prestigious New England Journal of Medicine on 7 October 2021, the study was conducted on 5 000 of Sheba’s medical workers comprised of different populations including immunocompromised individuals who were monitored with weekly serological testing.

The findings clearly illustrate a waning response to the vaccine, with neutralising antibodies decreasing sharply in the first three months following the second dose of the vaccine, and significantly abating afterwards.

“This study tends to support the view that durable protection decreases sometime after vaccination, especially after six months,” says Professor Barry Schoub, who chairs the Ministerial Advisory Committee on COVID-19 vaccines.

Schoub, also professor emeritus of virology at the University of the Witwatersrand and the founding director of the National Institute for Communicable Diseases, points out that Sheba’s study and the observations of increasing post-vaccination “breakthroughs” aren’t definitive evidence of waning immunity after six months.

“These observations may be a reflection of the prioritisation of higher-risk individuals, such as the elderly, in the earlier stages of the vaccination programme, as, for example, in Israel. It’s important to note that the precise correlates of immune protection are still being studied and haven’t yet been definitively established. Neutralising antibodies may well be one of these components.

“However, other elements of the immune system certainly also play an important role in immune protection, such as cell-mediated immunity and non-neutralising antibodies, and these are considerably more durable than neutralising antibodies.

“Studies in South Africa and the United States have demonstrated the persistence of these components of the immune response to SARS-CoV-2 well past nine months following vaccination. Nevertheless, as an added precaution in certain vulnerable situations, such as people who are immune-suppressed or are in high-risk exposure situations such as healthcare workers, it may be appropriate to administer a booster dose of vaccine.”

As of 7 October, United States President Joe Biden is one of the about 6.4 million people who have received a booster shot in America, according to an NBC News analysis of Centers for Disease Control and Prevention data.

Meanwhile, England and several European Union member-states have already launched their own booster campaigns, and, from 11 October in Australia, severely immunocompromised individuals could get COVID-19 vaccine boosters.

Interestingly, Israel is believed to be the first country to make a valid vaccination passport conditional on having received a booster shot. On 26 September, it introduced new rules for determining coronavirus vaccination status, making a booster shot a requirement for full inoculation and vaccination passports.

Another Sheba study was one of the main determining factors in Israel’s decision to administer a booster dose of the COVID-19 vaccine. It showed an increase in COVID-19 morbidity as time elapsed from vaccination.

“These study results have great significance, especially for countries that haven’t yet administered a booster dose or for countries where six months have already passed since its citizens received the second dose,” Professor Gili Regev-Yochay, the director of the infectious diseases unit at Sheba, told the media. “We anticipate that these findings will be a significant part of decisions on vaccination protocol in the future.”

Schoub says that the following two issues are still under discussion: when the booster will become available in South Africa; and what other vaccines besides Pfizer will need a booster.

With other research coming out of Israel, the Jerusalem Post has noted, “If COVID-19 doesn‘t make you sick, diet soda might.”

According to Ben-Gurion University scientists, new research has found that certain artificial sweeteners can cause previously healthy gut bacteria to become diseased, leading to discomfort and digestive issues.

Ariel Kushmaro, a researcher from the university, noted that there’s little accurate labelling of artificial sweeteners on products, making it difficult to know how much each product contains.

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Blue plaque recognises Muizenberg Jewish community’s heritage

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Muizenberg holds a special place in the hearts and memories of many South African Jews, and its Jewish community has now been recognised for its historic significance in the area with a prestigious blue plaque.

The plaque was unveiled at a small ceremony at the beginning of September.

Blue plaques are commemorative signs placed on buildings and in locations of significance. The Muizenberg synagogue on Camp Road was one of two buildings in the area, as designated by the Muizenberg Historical Conservation Society, to receive blue-plaque status.

“I was contacted by Glenn Babb, the head of the Muizenberg Historical Society. It wanted to honour the Muizenberg Jewish community for its service and influence in Muizenberg over many decades, and thought it appropriate to put a plaque at the shul,” says Muizenberg Hebrew Congregation Rabbi Ryan Newfield.

Chris Taylor, the chairperson of the Muizenberg Historical Society, told the SA Jewish Report that the plaque was to commemorate the Jewish community’s integral role in Muizenberg history, rather than the shul building itself.

“For a couple of years, we’ve had a low-key project to erect blue plaques on buildings of historical significance or to commemorate people,” he says. “For example, Agatha Christie learned to surf in Muizenberg, so we have one for her. A great deal of the history of Muizenberg was driven by the Jewish community. At its peak, there were about 600 families living there, mainly from Lithuania. Although there has been an exodus of Jews from Muizenberg since the 1960s, they left behind a great deal of history. This blue plaque is to commemorate that past. The shul is and was the heart of the community, which is why we felt the plaque should go there.”

He notes that there are still a small number of Jews who live in Muizenberg or who come on holiday, mainly from Johannesburg. He finds it interesting that the builder of the synagogue was Charles McCarthy. Taylor dug into his history, and found that he was “an Irish Catholic Cockney, who converted to Judaism for the woman he loved before coming to South Africa from London. So, he was an Irish Catholic Cockney Jew.”

According to the book Muizenberg: the Story of the Shtetl by the Sea by Hedy Davis, the woman McCarthy fell in love with and married was Fanny Schindler. They settled in Kalk Bay, and McCarthy never accepted payment for his work on the synagogue. He served on the shul committee, and was a loyal member of the Muizenberg Hebrew Congregation until his death. He and his wife are buried in the Muizenberg Cemetery. Their story is just one of many that made up the thriving, dynamic Muizenberg Jewish community in its heyday.

Newfield says he was asked what they wanted to be written on the plaque. “I left the words to some of the oldest and most involved members of our community. They chose to keep it simple, and give its full name – the Muizenberg and Kalk Bay Hebrew Congregation – and the date of establishment. The date itself was subject to dispute, but the earliest was 1916, the first step in setting up a Talmud Torah. We went with that date, as everyone who was involved in setting up the Jewish infrastructure of Muizenberg should be honoured.”

The keynote speaker at the ceremony was Democratic Alliance federal council chair Helen Zille, who spoke about “various Jewish people who changed Muizenberg forever, like Gerald Musikanth and Mendel Kaplan, who helped to build the boardwalk to Kalk Bay, as well as many others”, says the rabbi.

“I commended the society for remembering history as the Jewish people so often remember their history, and it seems the Torah promotes looking back at the past to understand who we are in the present,” he says. “I also mentioned that in a world of numbers, where everyone is focused on COVID-19 numbers, vaccination numbers, etcetera, the Jewish people have defied numbers. The Muizenberg Jewish community is no different. Somehow, a little corner of Africa was built and largely influenced by a few hundred Jewish families that would forever change this part of the world.”

“The event itself was delightful, and Helen Zille asked to be invited to our century anniversary of the current shul building in 2024,” he says. “It was a bad week of weather, but somehow the sun came out for the event, and Glenn Babb joked to me that G-d answered my prayers.”

Ward councillor of the Cape’s Ward 64, Aimee Kuhl, told the SA Jewish Report, “I’m always enthusiastic about anything that celebrates history in my ward because I believe that only once we remember where we come from do we know where we’re going.” She made the time to attend the blue plaque unveiling ceremony at the shul, and says, “We cherish the Jewish rich cultural history that we have in Muizenberg. As ward councillor, I’m very aware of that history.”

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