Taking care to people’s homesCath Davis
Palliative care doctor, Dr Cameron Bruce, chooses to care for patients away from a frenetic hospital environment where physicians run in and out of rooms, order lab tests and check results. He chooses to sit down with patients and their families, to stay longer, and offer deep care and comfort.
When curative treatment ceases to work, patients can sometimes feel hopeless, helpless and even abandoned. Palliative care provides the opportunity to focus on relieving suffering and being present for patients. The emphasis changes from fighting a disease to providing comfort for a person. Paradoxically, though the goal of a palliative care doctor may no longer be cure or prolongation of life, providing this kind of care can feel extremely rewarding. Maybe this is because the skills required – the listening, the responding to concerns, the providing relief from physical, psychological or existential suffering – feel like what doctoring is supposed to be.
And that’s what drew Dr Cameron Bruce to palliative care. After his med school studies at UCT, he spent four years working in a rural cottage hospital in Canada, with predominantly older patients. “Canada is ahead of the curve when it comes to palliative care – I was inspired by the place the discipline holds there,” he says.
Back in South Africa, and while working as a GP, Dr Bruce completed the two-year palliative care course at UCT. “The palliative model is powerful. It’s interdisciplinary, and where everyone’s voice is as valuable as the other. I like working with colleagues who each bring their area of expertise to the care.
“I also found that my ability to interact with people held its own. When you recognise that in yourself, you follow it because there’s meaning in that and it brings much reward. Palliative care brought me what I originally wanted when I signed up to med school. I really like the model of well-coordinated teamwork in a community.”
And it’s that model on which Dr Bruce started Chariot Health in Cape Town, an organisation which provides a platform that allows practitioners, from palliative care doctors, nurses, social workers, physiotherapists and even dietitians, to work in teams in a coordinated way in the community. The business side of Chariot Health provides the centralised services that the independent practitioners require. “I am both the business owner of Chariot Health, and one of the palliative care practitioners. So we can and do set up full palliative care teams.”
Being there with a family when a loved one is taking their last breaths and you’re sharing moments that are in essence part of life itself – it’s remarkable, and it doesn’t get any less so
While many would assume the work of a palliative care doctor is demotivating and depressing, Dr Bruce says it’s a huge privilege to be able to work closely with patients in a space where they are so vulnerable and they entrust their vulnerability to him and to his advice, and to his containment of their situation.
“When I’ve had a long journey with a patient and their family, they regard you as they would an old friend or family member. Sometimes we step in to a space under critical circumstances and weather a substantial storm with a patient – the intensity of all of that is quite something. Being there with a family when a loved one is taking their last breaths and you’re sharing moments that are in essence part of life itself – it’s remarkable, and it doesn’t get any less so.”
The families of Dr Bruce’s patients think he’s remarkable too – they thank and acknowledge him very personally with the most meaningful messages and letters. He receives expressions of gratitude that most people would never receive in their life.
But it’s not an easy road, financially. Palliative care consumes a great deal of your time, says Dr Bruce, and there’s a lot of complexity within cases. “Chariot Health as a business has been going for 10 years but only in the last three years things have taken off in terms of drawing in other practitioners, thanks to more formalised palliative care cover.
“The key stakeholders in this area of medicine and care are the patients and their families, the palliative care trained teams and the funders of the care. The incentives for all three need to be aligned.”
“It’s not great to have to deal with the financial side of things when a patient and their family are already in crisis, so if one can avoid that direct interaction with money, that’s a stress reliever to both parties. To be able to deal directly with medical aids and get reimbursed is so appreciated. Value based contracting, which is where Alignd comes in, is going to add to that because it acknowledges team work and the value that those team members bring. What Alignd has recognised is the value of a multi-disciplinary team delivering coordinated and typically home-based care in the palliative space, and they’ve developed a product that offers great potential.”
The key stakeholders in this area of medicine and care are the patients and their families, the palliative care trained teams and the funders of the care. The incentives for all three need to be aligned. There are incredible people who are drawn to the work but who also need to know they can make a living – that it’s a tenable lifestyle. “If you don’t get all the pillars right, people will do excellent work for four months but then not do it again. It’s the patients who lose out. We’re excited that Alignd are helping us fix this.”