In the very best of hands

On one special night late last year, cancer patient Angela Manarangi was treated to a dinner party in her honour at Mercy Hospice Auckland. Humbled just to be a part of the occasion, Masterchef winner Nadia Lim offered her culinary skills, like all those involved, free-of-charge creating an unforgettable five course-meal for all to enjoy. When she was able, Angela loved entertaining others.

If the story sounds a little familiar, you may recall reading about it in a recent issue of our LifeTimes newsletter.

The story of Angela's journey with cancer may have started in New Zealand but it certainly didn't end here. Content with the company of close Kiwi friends for one last time, Angela decided to return to her place of birth, Rarotonga, to die peacefully just ten days after her discharge from Mercy Hospice.

Angela certainly touched many lives including three special guests from the Cook Islands who were recently welcomed to the Mercy Hospice Team.

On Monday 13th May, Mercy staff welcomed Dr. Nini Wynn and Liaison Officer Haumata Hosking with a powhiri. Arriving one week later, Clinical Nurse Moe Kauvarevai remained with Mercy for another week following her colleagues' return.

The purpose of the visit was quite simple: to gain experience to enable a palliative care service to be established in the Cook Islands. The methodology: a two week secondment to New Zealand arranged by the Cook Islands Ministry of Health.

With a population of 14,500 there are no palliative care services available to a growing number of patients and families dealing with life-limiting illness in the Cook's 13 inhabited islands including an increasing number of NZ-resident patients wishing to return home in the final stages of their illness.

It was caring for Angela that really cemented the women's desire to learn more about palliative care and hospice's important role in the Auckland community and establish a similar service back home.

At the request of Angela and her family, and with no formal In-Patient Unit facility available to them, Moe and the nursing team set about accommodating Angela during her last days in a side room of a busy ward.

"With visitors passing by on their way to see other patients it wasn't ideal," says Moe who cared for Angela right up until her time of death, "But Angela was comfortable."

What impressed upon all three women the most, in fact, was how at ease Angela and her family were with her imminent death. Moe says that simply having Angela's family there made for a very peaceful experience. "Even though she was dying, I enjoyed being with them," she says, "I felt comfortable."

Like in many Pacific communities, death is seldom talked about in the Cook Islands. "Traditionally families get together not so much to talk about the patient but to just be there for each other. To pay their respects," says Haumata.

"I was really surprised by the way the family had accepted that Angela was in the last days of her life," Dr. Nini says, "They were prepared and ready."

Liaison Officer Haumata learned of Mercy's care through conversations with Angela's father, mother and sister. "They just lit up when they talked about Mercy Hospice," Haumata says, "They said they couldn't have found a better place to care for Angela."

Dr. Bruce isn't sure he entirely agrees. "These people sound to me like they're doing some pretty good palliative care work already!" he says.

With the blessing and support of Cook Island's Ministry of Health which is very keen to establish a palliative service, the three women embarked on their two week journey of discovery.

Their itinerary included a full day's orientation at Mercy Hospice meeting team leaders and key staff. They then joined teams for experience in their areas of interest – Haumata with the family support team, Dr. Nini with the medical team and Moe with the nursing team. This included observation in the hospice itself and community visits with the family support, medical and nursing teams. They also had two days attached to Totara Hospice South Auckland and two days with the Cook Islands liaison and medical staff at Middlemore Hospital.

Funding for the clinical staff's visit was provided by the Strengthening Specialised Clinical Services in the Pacific (SSCSip) programme, while Haumata was able to come with support from a donation entrusted to Mercy for this specific purpose.

All three women have thoroughly enjoyed their experience and agree that establishing a specialist palliative care room at Rarotonga Hospital where patients and families can enjoy their last days together will be at the top of their to-do list when they return.

"Our main focus when we get back is to make heads turn," Haumata says, "That we mean business and we want it to happen." For Haumata a highlight of her trip was meeting Opening Doors Day Unit patients who bravely explained why they were there.

For Dr. Nini, the trip was an entirely new experience. "Palliative care is very different to a hospital's approach to care and what I'm used to. It is not just about caring for the individual but their family as well," she says, "It will be a challenge for me but with the support of my colleagues I know it is achievable. As a team we will need to work together."

While a room is secured, the immediate plan on their return is to present their findings and educate staff and the community on the importance and benefits of palliative care.

"Watch this space," they say.

Dr. Bruce doesn't view the exchange as a one-way learning exercise either. "It has created a wonderful opportunity for us (Mercy) to have open, ongoing dialogue with Rarotonga's Health Services as well," he says, "We have already had confirmation of their on-going support."

Dr. Bruce says that having the opportunity to give something back to Cook Islands medical staff has been a wonderful experience. "They looked after me for three months when I was a medical student there many years ago," he says, "I remember my time at Rarotonga Hospital well."

It just goes to show how important the role of hospitality really is: making sure your guests, whether they are patients or visitors, are in the very best of hands.

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