CONCLUSION AND RECOMMENDATIONS
4.4 Recommendations
4.4.1 Recommendations Proposed By Research Participants
The participants and staff made recommendations around improving palliative care services at the prison hospital.
Both patients and staff recommended that the vacant posts at Durban Management Area should be filled as a matter of urgency, particularly with regards to nursing staff. The participants recommended that nursing assistants should be appointed to supplement the full complement of the nursing posts because of the dire need for nursing care. In this regard the nurse in the group further recommended that the posts of auxiliary nurses be re-instated as their appointment will enable the registered nurses to focus on clinical patient care rather than auxiliary services like bathing, feeding and turning bed-ridden patients.
Another recommendation from staff was the employment of an aggressive retention strategy to prevent the exodus of staff. The nurses also strongly recommended that the promotion policy should be re-visited as the lack of promotional opportunities served to de-motivate them, which also contributed to resignations. However, the filling of posts and the adoption of a retention strategy should be simultaneous actions or else the brain drain will negate the benefits of having all the posts filled.
The need for support from officials and management in implementing the volunteer offender program was highlighted in the focus group discussion with the AIDS Control Committee. It will enable the offender volunteers to work within a recognized framework and will serve to protect their human rights. The
finalization of the draft policy on correctional center based care should be treated with urgency.
The professional staff recommended the establishment of a creative balance between the requirements for the safe custody of offenders and the escorting of patients to external hospitals for specialist care. They were of the opinion that the needs of offenders should not be compromised. There was also great concern over the safety of female staff. They recommended that measures be put in place to ensure their safety, as constant fear for personal safety impacts on service delivery.
In particular the nurse recommended that clear internal guidelines and policy should be established for the provision of antiretroviral therapy. There was a strong feeling also that the policy on traditional healing needs to be revised as it created conflict with the needs of offenders.
Lastly, it was recommended that the medical release policy should be more specific. The staff recommended that clear time-frames for the conclusion of the medical placement process should be included to avoid patients dying before
4.4.2 Recommendations by Researcher
The researcher submits the following recommendations based on the above challenges and recommendations made by the participants in the study:
• A concerted and sustained strategy to reduce overcrowding is necessary in conjunction with partners in the integrated justice system, since the Departments of Correctional Services, Justice and Police Services have to agree on a combined strategy. Reduction in overcrowding will assist in improving general prison health conditions as well as ensuring the provision of quality health care services to inmates in less crowded conditions.
• A well-developed human resource strategy is required which will ensure the creation of posts as well as the speedy filling of vacant posts. This strategy should include a retention component and a personnel wellness program, which will also address the issues of burnout and support for staff.
• The Department of Correctional Services needs to develop an integrated model of care which will include all relevant role-players, and will employ creativity and innovation in taking cognizance of security and the holistic health needs of patients.
• The staff needs to be specially trained in providing palliative care services and an effort needs to be made to link up with external resources in communities who have the necessary expertise in the field of palliative care to undertake this training and provide ongoing support to staff.
• The caregivers (staff and offender volunteers) need access to support services and de-briefing sessions to prevent burnout and de-motivation due to the nature of their work and the environment, which has many stressors.
• The White Paper on Correctional Services promotes societal responsibility in corrections. It is imperative that the Department of Correctional Services establishes meaningful relationships with external organizations, for
example, the hospice movement, in order to provide an effective palliative care service to offender-patients in partnership with these organizations.
• Community volunteers could be utilized to provide companionship and support to the terminally ill patients, after undergoing a vetting process to satisfy security clearance requirements. Family members could also assist in caring for their loved ones under the supervision of the nurse.
• The patient and family should be consulted about the treatment options available and provided with the opportunity to make informed decisions about treatment and care, in line with the philosophy of palliative care.
• There should be closer monitoring, supervision and evaluating of the activities of the offender volunteers, which will ensure support for the latter whilst also protecting the interests of the patients and offender-volunteers.
• The placement policy should be amended to include minimum time frames for the processing of applications for placement on medical grounds to ensure the speedy release of patients who qualify.
• The judiciary needs to consider the utilization of community- based sentences for offenders who are diagnosed with terminal illnesses.
4.4.3 Recommendations For Future Research
As indicated in this report there has been no study conducted to determine the prevalence of HIV and AIDS in correctional centers in South Africa. It is thus recommended that a prevalence study be conducted as the results can assist in determining prevention and treatment strategies in the short, medium and long term.
Other possible related research areas include:
• Alternate sentencing for people who have HIV/AIDS when entering the correctional service system
• Models for care facilities for people who are terminally ill with AIDS
• Medical parole for patients who are terminally ill with HIV/AIDS due to the roller-coaster nature of the illness
• HIV and AIDS stigma related issues in correctional centres