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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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The miracle of the maroon handkerchief

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Seventy-eight years ago, a Jewish man gave his 17-year-old daughter a maroon handkerchief as a way to remember him. She never saw him again – he died in the Holocaust. But she survived, went to America, and recorded her testimony in 1984.

Fast forward to 2020, and 14-year-old King David Linksfield pupil Noa Nerwich is asked to write a poem for a competition based on a Holocaust survivor’s testimony. She came across Ruth Halbreich’s recording, which includes mention of the handkerchief. Nerwich wrote a poem about the handkerchief and won the competition.

A year later, Halbreich passed away. Shortly thereafter, her grandson, Reg Tigerman, came across the poem in a newsletter he received, and realised it was about his grandmother. But that’s not all: soon after that, he also found the maroon handkerchief. He made contact with Nerwich [who is now 15], bringing a story that has spanned generations and continents full circle.

Speaking to the SA Jewish Report from Los Angeles, Tigerman says, “When I discovered the poem, I was shocked. Ruth, who we affectionately called Nanny, had just passed away a few months ago. The maroon handkerchief had been a topic of conversation within our family because my wife and I revisited her testimony right after she died and talked about trying to find it.

“My mom, who was going through Nanny’s things, did end up finding it. So, not only did Noa write a poem inspired by my grandmother’s testimony, which is an honour in and of itself, but she picked up on an item she mentioned at the very end of her testimony (proving that Noa was paying very close attention), and it was something that a lot of time and attention had been spent on recently. It was a series of dayenus [it would have been enough]. A true miracle. It felt like the world was telling us how important Ruth and her story is, and how important it is to continue to share her story.”

According to the United States Holocaust Memorial Museum, Halbreich was born in 1926 in Warsaw to a well-to-do family of three sisters and one brother. In 1939, their father fled with them to the Russian part of Poland, where he continued his work in the paper business. She, her father, and one sister crossed back into Warsaw, but her mother and two other siblings were sent to Siberia.

Halbreich and her family moved into the Warsaw ghetto in 1940. When the Germans started sending people from the ghetto to the camps, she and her sister were sent outside the ghetto to live in a convent. After the Warsaw ghetto uprising, Halbreich and her sister were sent to a slave labour camp in a small town in Germany. They were liberated in April 1945. She found out that her father had died in the ghetto in 1943, fighting in the underground. She met her husband, a fellow Holocaust survivor, at a displaced-persons camp. She also found out that her mother and two siblings had survived in Siberia.

In her testimony, Halbreich says, “The uprising was in April 1943. My father had left the ghetto in the trucks carrying merchandise. I met him in his office. He gave me a handkerchief of his to remember him by. My father’s biggest wish was to be able to save his children, and he was able to do this. He went back into the ghetto, and no one really knows what might have happened to him.”

A million miles away from that time and place, Nerwich entered the 21st Annual Holocaust Art & Writing Contest run annually by Chapman University and The 1939 Society (a community of Holocaust survivors, descendants, and friends). “The brief was for a piece of creative writing based on the testimony of a Holocaust survivor,” she told the SA Jewish Report.

The poem describes the handkerchief as the only thing Halbreich has left from her father as her world is destroyed, and how it symbolises the flames of destruction and her father’s deep love.

“Hearing her story and writing the piece itself was an enriching experience,” says Nerwich. “I was thrilled when I was awarded first place, a first for King David High School. I always smile just thinking about my poem. However, a small part of me always wished that Ruth would be able to read the poem and know that her story is being shared, that she is being heard.”

So, when she received the email from Tigerman on 15 July, “it changed my life. I read it and re-read it because I was sure my eyes were deceiving me,” says Nerwich.

She was shaking as she read the email. “I felt a deep sense of loss to learn that Ruth had passed away, but I was also deeply moved to learn that her family had the gift of this poem and that Ruth’s story continues to be told. Seeing the actual picture of the maroon hankie – the last memory that Ruth had of her father, the piece of fabric that guided her throughout the horrors she endured – is an image that will be permanently engraved in my mind.”

She says she chose to reflect on this story in her poem “because I could relate to Ruth. I’m a very sentimental person. Just like Ruth’s dad gave her a red handkerchief, my dad made me red roses out of Lego, which I keep in my room. So, the fact that she mentioned the maroon handkerchief that her dad gave her really resonated with me. It made it so much more real. It’s a symbol of her story, and what she and so many others went through.”

Her mother, Daniella Nerwich, says she felt breathless when she read Tigerman’s email. “All this really shows the value of Jewish education. We are so fortunate that King David creates opportunities like this [to enter the poetry contest]. This just shows how it can be so far-reaching. So huge credit must go to King David for creating this opportunity. It has been life changing.”

Because of the pandemic, Nerwich was unable to travel to the United States to collect her prize, but Tigerman’s message has made up for that disappointment. They hope to meet in person one day, and possibly even work together to share the story of the maroon handkerchief as a form of Holocaust education.

Says Tigerman, “While my grandmother didn’t often share her story (she would if you asked, but she wasn’t very proactive about it), my grandfather [Siegfried Halbreich] was a regular speaker. He was a survivor of multiple concentration camps over the course of five and a half years. He served as president of The 1939 Society, the organisation that published Noa’s poem, and was a founder of the Los Angeles Holocaust Museum. Everyone’s story is worth telling and remembering, which has made the oral histories and recorded testimonies so important.”

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COVID-19 vaccination could be compulsory at workplace

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As vaccination becomes more freely available in South Africa, questions arise such as can you make vaccination compulsory and can you dismiss someone if they refuse? Do you have to allow time off to get vaccinated, and what happens if an employee has an adverse reaction? These questions and many more are new to our labour law, and will be subject to litigation over the next many years.

In terms of the department of employment and labour’s latest regulations, the minister has recognised that employers may in terms of their own internal rules make COVID-19 vaccination compulsory.

Obviously, the compulsion must be subject to certain oversight, and must be reasonable in all circumstances. The employer would have to take into account their own operational requirements, and must be able to justify that in terms of these requirements, they would expect employees to be vaccinated against COVID-19.

Over and above this, each case must be carefully explored, discussed, and subject to proper consultation, taking into account the employee’s circumstances. These circumstances can include medical, religious, bodily integrity, and any other factor reasonably raised by the employee or the employee’s representative.

Obviously, each particular employer would develop a set of guidelines and rules which would be read with the disciplinary code and would be properly implemented after consultation with the employees or their representatives.

These rules must be made subject to the above-mentioned criteria, and would probably be differently implemented in accordance with the operational requirements of the position of the actual employee.

For instance, if a buyer for a company has the duty to travel abroad and can do so only if vaccinated, then there would be a compulsion to be vaccinated. It would be incumbent upon the employer to explore whether there are other ways of doing the job or whether an employee is willing to accept another position which doesn’t require vaccination.

It’s absolutely vital for every employer to read the regulation, and to advise all the necessary parties within the next three weeks of their intention to make vaccination mandatory and which employees will be affected.

Obviously, even once vaccination has been made mandatory, it would be subject to the employees being able to obtain the vaccination, and might require the employer to help obtain them. The employer’s policy will take into account various factors such as consultation with all the representatives at the workplace, and will respect bargaining council agreements and any other collective agreements with trade unions.

If there is an informal committee representing the staff and/or a workers forum, these bodies must also be consulted.

The minister of health has published draft regulations for the establishment of a no-fault compensation fund for injuries caused by the COVID-19 vaccination. The Vaccine Injury Compensation Fund will be established in terms of the regulations as an amendment to the regulations of the Disaster Management Act of 2002.

Although this compensation fund for vaccine injury hasn’t been formed yet, the various ministers involved are taking into account commentary from the public, and will be getting legal advice from parliament’s legal advisors.

The injury must be related to vaccination. An injured person may not institute a claim through the court process against the national or provincial government until the claim has been adjudicated by the relevant panel through the compensation fund.

Only if the person is dissatisfied with the outcome of the adjudication or the amount awarded can that person lodge an appeal, and the appeal must be determined by the relevant decision maker. Only after pursuing a claim with the scheme can a person look to the courts if that person is still dissatisfied.

Businesses are urged once again to warn their staff that protocols are in place, and breach of COVID-19 rules and regulations will lead to spread of infection and almost inevitably disciplinary action.

I’m involved in no less than a dozen cases where employers have reported and taken action against recalcitrant employees. It’s time, once again, to reiterate the fundamental, basic rules such as social distancing, mask wearing, and sanitising. Over and above this, any staff member exhibiting symptoms must report these symptoms to their health officer or senior management, and should immediately take sick leave.

The consequences of a staff member remaining silent could be loss of their position and more seriously, the spread of infection.

Employers will have to educate staff about the value of vaccination along with normal social distancing, masks, and hand sanitising. Education in these circumstances, I believe, will be the strongest factor in convincing all staff to get vaccinated.

A consolidated direction on occupational health and safety measures in certain workplaces was gazette on 11 June 2021. This contains new requirements with regard to vaccination.

It’s clear from this that an employer must give employees time off to be vaccinated. The employee may be required to provide proof of an appointment to be vaccinated. Time off shouldn’t be regarded as sick leave, but should be given as a form of special leave.

If there are negative effects from vaccination, the employer will grant paid sick leave in terms of the Basic Conditions of Employment Act. If the sick leave has been exhausted, there could be a claim in terms of the Compensation for Occupational Injuries and Diseases Act. Employees will produce the vaccination certificate thereafter, and a medical certificate if they’ve had complications.

  • Michael Bagraim is an attorney specialising in labour law, and advises nationwide on the restructuring and management of labour forces. He is also a Democratic Alliance member of parliament.

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Pop-up vaccination site sets record

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A pop-up vaccination site in Glenhazel carried out just more than 11% of the total 27 053 vaccinations administered across the country on 25 July, setting what is believed to be a record.

Three thousand COVID-19 vaccinations were administered at the volunteer-run site at The Base Shul on Sunday.

“Discovery has exceeded the number of vaccinations we did at The Base in a day, but the district manager of Joburg told me at the site that they haven’t exceeded more than 1 200 in any one of their sites in Gauteng,” said 27-year-old Dr Menachem Hockman, popularly known as “Dr Menoosh”.

Menoosh attributes the speed and efficiency of the process to the many volunteers who did the administration and all the other necessary procedures for vaccination.

“This is an initiative that we are trying to roll out at the moment, and it just shows the impact of having those extra hands to volunteer,” says Menoosh. “Bara [Baragwanath Hospital] and other sites have as many nurses as we have, they just don’t have those volunteers, and it shows what a difference they made. It was also something special at the site to show the impact of all our volunteers.”

One of the volunteers, Dalya Gerson, a dietician, said, “My role prior to the day was recruiting volunteers, organising them, showing them what they would have to do on the day, and giving them specific roles. I was also a volunteer for the day.”

According to the messages Menoosh has received, everyone was in and out within half an hour, including the 15-minute waiting time. “That’s brilliant for any vaccination site,” he said.

The speed came from the strategy of divorcing the administrative role from the vaccination role. “All the vaccinators had to focus on was administering vaccines, so they could push people through much quicker. That was our strategy.”

To help other government sites achieve a similar speed, volunteers may be dispersed through Gauteng VAX Volunteers (GiVV), a programme that operates at vaccine sites. These volunteers assist with, among other things, administrative tasks, filling out vaccination cards, registering individuals that are eligible for vaccinations, and updating and processing information once vaccinations have been administered.

“Running these sites is how we are helping the health department, which provided us with the vaccines,” said Menoosh. “We want to maintain that close relationship with it to allow us to do more. I want it to be given the credit for allowing us to do it, and it’s very important for it to continue to allow us to do so.”

  • To help out or be a part of GiVV, apply by completing the sign-up form on www.givv.co.za. GiVV can also be found on Facebook, Instagram, and Twitter.

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