- By the time a patient is referred to the palliative care team at Groote Schuur Hospital, the focus is no longer on curing disease. Their job is to help relieve suffering, which includes the patient’s physical pain as well as psychological, social or spiritual support for patients and their families. It also involves a lot of teamwork — across hospital departments, with social workers and clinics in local communities and carers in patient homes.
- René Krause, a family physician and palliative medicine specialist, leads the palliative care unit at Groote Schuur, which was recently recognised by the European Society of Medical Oncology for its integrated partnership with the hospital’s cancer unit.
- In a recent interview with Health Beat, Bhekisisa editor Mia Malan spoke to Krause about partnerships, morphine misconceptions and what dignity means for patients.
In today’s newsletter, Anna-Maria van Niekerk introduces us Groote Schuur’s palliative care team. Sign up for our newsletter today.
When am I going to die? How am I going to die? Who will look after my children when I’m gone?
These are the difficult questions that Groote Schuur Hospital’s palliative care team — who work with people living with serious, life-threatening illness — get asked every day.
By the time a patient is referred to palliative care, the focus is no longer on curing disease. Their job is to help relieve suffering, which includes the patient’s physical pain as well as psychological, social or spiritual support for patients and their families.
This work isn’t just about sitting at a patient’s hospital bedside and holding someone’s hand, though that is part of it. Palliative care requires coordination across hospital departments. It also requires a social worker in Dunoon holding family meetings, a physiotherapist in Heideveld supporting a carer at home and an entire healthcare team singing, as René Krause, a family physician and palliative medicine specialist, puts it, the same song.
Krause leads the palliative care unit at Groote Schuur, which is part of a web of relationships with oncologists, surgeons, nurses, community health workers, hospices and clinics which reaches from the hospital’s wards into homes across the Western Cape. Last year, the European Society of Medical Oncology recognised the unit for its integrated partnership with the hospital’s cancer unit, underscoring what partnerships make possible for patients and their families.
In a recent interview with Health Beat, Bhekisisa editor Mia Malan spoke to Krause about partnerships, morphine misconceptions and what dignity means for patients.
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Who ends up in your unit?
In South Africa, we have a tool that gives doctors an indication of who they should refer to palliative care. But in general, if we are worried that we are not going to cure this disease — that this patient is sick enough to pass away from this illness — then we see this disease as life-threatening.
The most common condition we see is cancer. But patients with cancer are not only lying in oncology wards — they are lying in surgical wards, internal medicine wards, neurosurgery wards. They are across the hospital. And they are in our communities.
What are the most common problems you face?
When we’re dealing with pain in a palliative care setting, we always talk about the concept of total pain. We look at physical pain, but also what is happening with the patient socially, psychologically, spiritually — all of this contributes to how a person interprets the pain they have.
The medication we use most for pain is morphine. It is a cheap, accessible medication that really manages pain well — we can treat 85% of patients with cancer pain with oral morphine syrup. But unfortunately, there are still a lot of misconceptions around it. People are scared. They worry they’re going to die from the morphine, that the hospital is giving up on them, that they’re going to get addicted. All of these things need to be spoken through with patients and families.
What does that look like in practice?
Palliative care is not just the relief of suffering — it’s the prevention of suffering. So as a healthcare worker, you need to think: what lies ahead for this patient, and what can I put in place to prevent it?
I know a patient with lung cancer is probably going to become very short of breath, so what can I do to train the family on managing that? When we see a young woman with an incurable disease, we talk about who is going to look after her children. These things are fundamental — they require a will, guardianship. Does the school know what’s happening with that child? How are we going to hold and contain that child during the turmoil in their lives?
You need knowledge about medication and how to manage complex symptoms. You need to be a very good advocate — to be able to put your hand up and say, wait, we need to do this. You need to understand the psychosocial and legal and social resources.
What does psychological support look like?
We have social workers and a bereavement centre. I work with brilliant nurses and professional sisters who sit with patients and talk about their worries and concerns. People ask: When am I going to die? How am I going to die? It requires sitting with people, holding a conversation, allowing them to be emotional, which is not always easy when you are far from your family.
The most important psychological support is simply opening the door to talk about these difficult things. And the spiritual component is really about meaning-building and legacy-building — and, if need be, referring to pastoral or spiritual support.
A lot of what we do is listening. We are not only holding your hand. That’s not only what palliative care is about. It’s about educating the family about the diagnosis and the prognosis [the likely course or outcome of an illness] in a way that meets them where their knowledge gaps are, but also where they are emotionally with the process.
One of the important principles in palliative care is non-abandonment, because when you are faced with a life-threatening illness, people feel lost. So what are we going to put in place for this family? What is possible, and what is not?
What does that spiritual component involve?
We look at things that give meaning to people. Sometimes it is a relationship with a deity, but not always. We need to hold people in a safe space where they can talk about these things — where they can explore the legacy they have left, what is important to them — and ultimately to ensure the dignity of that person, and the personhood that needs to go forward.
What does dignity look like for your patients?
Dignity is a very personal thing. What gives me dignity is not the same thing that will give you dignity. We must never assume that dignity is a beautiful hairdo and clean nails. Most people will say to you: I’m more dignified if I can go home, when I’m with my people. So most people want to die at home — but not everybody.
That means we have to train people at home to take care of them. That is why our social workers, community healthcare workers, nursing sisters in the community, and our hospices become so important.
How does your work extend into the community?
Palliative care is all about partnerships. We are very fortunate to have the Western Cape health department really supporting us; we have a provincial policy for palliative care that was signed off on in February 2026, which explains the partnerships very clearly.
These partnerships extend from specialist doctors, district health services, NGOs, hospices, community healthcare centres and family physicians.
For example, in the Heideveld area, we’ve got a palliative care clinic where we’ve got a support group running for families. In Dunoon, there’s a whole team, and the leader is a social worker doing amazing work with the support of a doctor. She holds family meetings and works alongside a physiotherapist. Together, they are holding these families through some of the most difficult experiences of their lives. That kind of leadership is what makes community-level palliative care possible.
Groote Schuur really puts emphasis on working in multidisciplinary teams, so doctors, surgeons, and, in some cases, palliative care specialists will sit in that team as well. There are partnerships here inside the hospital: nurses, administrators, managers — everybody needs to work closely, because when we are working with a patient and a family in turmoil, we’ve got to sing the same song. We mustn’t have conflicting messages.
What would you do with more resources?
I’ve got a long shopping list. We are working with the Health Professions Council of South Africa to have palliative medicine accredited as a subspecialty so we can train more doctors to be leaders in the field. We are working to get nursing accredited so our nurses can step into leadership roles. One of our big gaps is that social work curricula don’t actually have undergraduate palliative care built in. Ultimately, we can’t just have a service at Groote Schuur Hospital. We need a service in Worcester. In George. In Gqerberha. In Springbok. We need services across all of these networks.
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This interview is based on an episode of Bhekisisa’s television programme Health Beat.
Anna-Maria van Niekerk is Bhekisisa’s news editor. She joined the centre after six years as the managing editor of the investigative television show, Carte Blanche. Anna-Maria has an extensive career in in-depth health and human rights reporting and has been named both the Vodacom Journalist (2002) and Discovery Health Journalist of the Year (2010) for exposés on the selling of human body parts for muti in Limpopo and the devastating consequences of HIV denialism.
Mia Malan is the founder and editor-in-chief of Bhekisisa. She has worked in newsrooms in Johannesburg, Nairobi and Washington, DC, winning more than 30 awards for her radio, print and television work.
Jessica Pitchford is Bhekisisa's TV and multimedia editor. She's been a journalist since the early nineties and has reported on some pivotal events in South Africa’s political history, such as the country’s transition to democracy and the work of the Truth & Reconciliation Commission.
