Phil Di Sorbo will return soon to help bring care when pain is greatest
GHENT–In a few days Phil Di Sorbo will leave for sub-Saharan Africa, again. He travels there four times a year. And while it isn’t a vacation, it is a labor of love.
One of his stops will be the troubled country of Zimbabwe, where the chaos that led to a worthless currency and stores with no food on their shelves has abated somewhat since the dictator Robert Mugabe reluctantly agreed earlier this year to relinquish some small part of his power to the democratically elected opposition. But the oppression continues, by most reliable press accounts, and while there is food for sale now, few can afford to buy it. The long struggle in Zimbabwe has taken a particularly harsh toll on people in the most rural parts of what was a fertile and productive country. In Zimbabwe, as in many other parts of sub-Saharan Africa, among those hit hardest in any type of crisis are people with life-threatening illnesses: HIV/AIDS, cancer and tuberculosis, to name only a few.
Mr. Di Sorbo will travel to rural Zimbabwe, where there are few nurses and even fewer doctors, and the services and medication commonly associated in the U.S. for palliative and hospice care are rarely found. He goes there in his role as senior technical advisor for the Foundation for Hospices in Sub-Saharan Africa, a non-profit organization with offices near Washington, D.C., and in a suburb of Cape Town, South Africa. The foundation, a part of the National Hospice organization, is helping forge new partnerships between hospice organizations in the U.S. and the growing community hospice movement in the sub-Saharan region.
“The definition of hospice is different in Africa from what it is in the United States,” said Mr. Di Sorvo, 61, during an interview last month at his home on a hillside in Ghent. He is the former executive director of The Community Hospice, which serves the Capital Region and Columbia and Greene counties, and he divides his time now between his home here, the foundation headquarters in Alexandria and the 16 countries in Africa, where the foundation has helped create 83 partnerships with hospices in the U.S.
In Africa hospice care is “mostly driven by home-based volunteers,” he said, and the foundation and individual U.S. hospices are helping train many of those workers.
Health stories from Africa often focus on the toll of HIV/AIDS, and while the epidemic remains unchecked on the continent, killing two million people last year alone, it is not the sole focus of the hospice movement. “Cancer is a huge problem,” said Mr. Di Sorbo. “Having a disease-specific program is not appropriate.”
Despite the bleakness of the statistics, he sees hope in the progress already made. As one example, he says that many African countries now permit morphine to be imported to help alleviate pain, a drug that wasn’t available to most of the population in the past.
The logistical obstacles to providing care can be daunting: bicycles are the only way to reach some outlying communities, and in parts of rural Zimbabwe the foundation is searching for a nurse to supervise and support the volunteers. The foundation already has three partnership sites in rural areas of the country, and Mr. Di Sorbo is looking to set up 13 more. He said that in effect the hospice movement is “on the front line of public health in Africa,” helping provide medical supplies, food and mosquito netting to reduce the incidence of malaria.
Part of what U.S. hospice partners like The Community Hospice provide for their African counterparts is some funding for the projects–at least $5,000 a year from each hospice. A booklet produced by the foundation addresses concerns that this could drain resources from local hospice efforts in this country, saying that’s not the pattern here. The foundation reports that hospice groups working with African partners attract new donors who “tend not to be from the same pool as the donors that contribute to the core fundraising campaigns…”
That point was underscored by Rob Puglisi for The Community Hospice, who said the “tens of thousands of dollars” his organization raises for its three hospice partners in Africa–two in South Africa and one in Zimbabwe–is money raised in addition to funds for activities here.
The foundation also emphasizes the need for U.S. partners to practice “cultural competency,” listening carefully to what the people served by the African communities need rather than assuming that what works here will prove effective or even welcome over there.
Mr. Puglisi said the local hospice assists its African partners mostly through offering mentoring and guidance, in addition to money. Local hospice workers also travel each year to the partner sites.
Health insurance has set limits on hospice care in this country, limiting its scope to a short-term period near the end of life. But Mr. Di Sorbo said that the World Health Organization offers a much broader definition: “If you have a serious illness, you need quality of life care concurrent [with] treatment.”
His job as a consultant is to manage all parts of the overall program right down to the supply chain for delivering supplies to the sites, a difficult task in the “problematic environment” of Zimbabwe.
He also visits the sites to get a firsthand view of the way they are rendering hospice services. He said most of the volunteers are women who take on the work as a calling more than a job, and it is women who are most vulnerable to exploitation, abuse and disease. “You can’t overstate the plight and victimization of women,” he said.
Nor is the task of hospice confined to providing palliative care and emotional support to sick and dying people. The concept of improving the quality of life through hospice in sub-Saharan Africa can come down to things even more basic. “You meet women who tell you: I can’t take this medication… It makes me sick because I haven’t eaten in two days,” said Mr. Di Sorbo.
For more information on the Foundation for Hospices Sub-Saharan Africa, 1731 King Street, Alexandria, VA, 22314 visit the organization’s website www.fhssa.org.