ABOUT DR MARGIE VENTER
2007 to 2014
Dr Margie Venter qualified as a Clinical Oncologist in 2004 at the University of Stellenbosch. After working as a consultant oncologist at Tygerberg hospital for a couple of years, she joined the Cancercare, Vergelegen practice in Somerset West in 2007. In 2014 she left the practice to join ICON, an oncology-managed healthcare organization, where she worked for 6 months.
Her journey into palliative care started in 2016 when she completed her post-graduate diploma in Palliative Medicine at the University of Cape Town. During this year she also attended the Serious Illness Care Program training in Boston under the auspices of Ariadne Labs and Harvard Medical School. This program focuses on communication in serious illnesses.
2017
In 2017 she initiated a palliative care service in private practice and established a network of health care providers in Stellenbosch who were keen to collaborate.
2018
Always curious to learn a little more about her newfound passion, she did a further 6 months training course at the Centre for Palliative Care Training, Harvard Medical School in 2018/2019 (PCEP).
She is otherwise frequently asked to assist with the palliative care training programs of oncology registrars, the post-graduate diploma at UCT and the undergraduate medical students at the University of Stellenbosch.
She volunteers her time to assist at the Stellenbosch Hospice in a clinical capacity and serves on the Stellenbosch Hospice board.
She is one of the founding members of PALPRAC, The Association of Palliative Care Practitioners of South Africa (www.palprac.org) in 2018.
CURRENTLY
Currently, she serves as Clinical Director of PALPRAC. This organisation, a healthcare professional association, strives to ensure that all Southern Africans have sustainable access to quality, integrated palliative care. PALPRAC is where she spends her love, sweat and tears.
Being able to work with a competent team, and support patients on their serious illness journey is what gives her professional purpose and meaning.
She is married to Cobus and they are raising three boys, Steph, Andreas and Jack. This means she is included in playing a weekly game of friendly soccer. She loves gardening, weekends in Betty’s Bay and swimming in the Palmiet River.
She answers some questions about her life’s work
What do you think palliative care brings to the table, especially when a patient is already seeing so many doctors?
I have become very passionate about the value that palliative care can bring to patients and their families who have to deal with a serious illness. Much of this is based on clear, compassionate communication.
There is so much to deal with during an oncology consultation for example – the diagnosis itself, treatment options, possible side effects and outcomes. Understanding and retaining all of that is a tall order. A palliative care consultation offers another opportunity to work through and understand all this complex medical information.
Decisions are also approached from a slightly different angle. What I mean by this is, time is given to understanding what each patient values in life, what they fear and what they wish for. If you want to use the battle metaphor, what are they fighting for…and then make sure that as far as possible, these values are aligned with the treatment being offered.
This is also a space of great uncertainty. Is the treatment going to work? Might I be the outlier with exceptional outcomes for my treatment? The answers to these questions are ever more difficult, what with the host of new treatments that are now available on the market.
Palliative care intends to help you navigate this uncertainty, hoping for the best and also planning for the rest, in case things do not work out as one had hoped. As far as possible I want to help avoid people saying “Had I only known, I would have….” at the end. Instead, I would want them to say “Well, I did it my way!”.
I have found that in most cases, even though these are difficult conversations to have (for the patient and the doctor!), they do not increase anxiety or destroy hope. They give the comfort that whatever the outcome, there will be support. And there is a plan in place.
Apart from informational needs, palliative care focuses very much on symptoms, be it from the treatment or the disease itself. Pain and fatigue are two big ones that take away the quality of life, but there is also nausea, constipation or diarrhoea, sleep problems and so on.
So while I leave the treatment of cancer to the oncologist or your chronic obstructive airways disease to your physician, I spend time treating the person and his/her symptoms.
Is palliative care new?
Not at all, it has been around for some time but has unfortunately been associated and confused with end-of-life care only, meaning that most people access this crucial support system too late in their journey.
Is there evidence that palliative care is helpful?
Absolutely. In recent years there have been several studies, particularly in cancer patients, that show that people live better, with fewer symptoms such as pain, depression and anxiety, that their informational needs are better met and that there is overall greater satisfaction with the care they receive.
Some people are worried that they might not live as long if they choose to access palliative care. This has been proven to be incorrect. Quite the contrary. It is not an either-or decision, you can receive treatment for your disease and benefit from palliative care.
Big international cancer organisations such as ASCO and the NCCN in the USA, and ESMO in Europe, have called for the integration of palliative care and oncology care, claiming this to be best practice.
Does accessing palliative care imply ‘giving up’?
Definitely NO! Palliative care can be given with any treatment to cure or control your disease. Some experts in the USA have compared the cancer journey to a car trip and including palliative care in this journey means making sure it is as comfortable as possible and that you have planned for all eventualities. Even if you end up choosing only palliative care and no active treatment for your disease, that still does not mean giving up hope or stopping the fight – the question is rather what are you fighting or hoping for? I believe there will always be something of value in this kind of care.
Why are you so interested in palliative care?
I suppose because I have had personal experience. Both my parents were diagnosed with cancer and that triggered my interest in cancer care and treatment. I then also realised how it impacted the person’s life and that of their family, knowing that as doctors we have a role to play in more than just treating the disease.
My parents were both educated people but were frequently overwhelmed with all the information they received. I know it gave them comfort to be able to bounce it all off me when trying to make sense of it all. The other thing was to help with the little (and sometimes bigger) niggles of pain and nausea and shortness of breath. But that is sometimes a lot to expect from one doctor and so I think it is more sensible, for all involved, to work as a team.
And then in the end, when the cancer was no longer being treated, we had a plan, and my parents could be supported and cared for at home. It was very meaningful.
And all that is what palliative care does. It makes so much sense to me.