Journal of Social Development in Africa (1989), 4,1, 25-45 
Support for the Dying and Bereaved 
in Zimbabwe: Traditional and 
New Approaches 
PATRICIA SWIFT+ 
ABSTRACT 
Since dying and bereavement are basic to the human condition, all societies 
have developed ways of providing support for those undergoing these 
experiences of loss. However, the emergence of the hospice movement 
marks the beginning of the provision of organisational support beyond that 
traditionally supplied within the family and friendship network Zimbabwe 
presents an interesting situation whereby traditional support systems 
function side by side with newer voluntary organisations providing services 
for die dying and bereaved, mainly within the white community but also, 
increasingly, to those black Zimbabweans in a state of transition between 
rural and urban life. 
Both traditional and organisational support systems are analysed with 
particular emphasis on the 'holistic' approach being practised by two 
voluntary organisations in Zimbabwe. Holistic care manifests several new 
features, which distinguish it from that provided in more orthodox western 
medical settings, and which, actually, converge widi traditional African 
approaches. A brief review of problems being experienced by bereaved and 
dying people receiving assistance reveals tfiat in the changing social 
conditions in present day Zimbabwe there is potential for useful crosscultural 
fertilisation in approaches to die care of diose experiencing loss 
and some suggestions are made to this end. 
Introduction 
Dying and bereavement are basic and unavoidable aspects of the human 
condition. None of us escape deadi and few of us go through life without 
losing a close friend or relative. Yet, despite the universal nature of death 
and bereavement many people are ill-prepared for the experience and diis 
results in a level of trauma and suffering beyond that which is inevitable, 
given that loss is always to some extent a painful experience. 
However, bereavement counselling and support for die dying are 
+ Senior Lecturer, School of Social Work, P Bag 66022, Kopje, Harare, Zimbabwe.
26 Patricia Swift 
becoming increasingly available and acknowledged as important areas of 
social work practice owing to two developments - one positive and one 
negative. Firstly on the positive side, the advent of the hospice movement 
has put death on the social service map, as it were. The word 'hospice' 
originally meant a house of rest for travellers but is now used world-wide in 
referring to all aspects of skillful care for persons suffering from lifethreatening 
illnesses. Such care would include pain control, psychological 
counselling and social support as well as normal medical treatment The 
hospice movement has led to the provision of such care in many parts of 
the globe, including Zimbabwe. 
Secondly, the AIDS epidemic in Africa has challenged the public to 
consider the needs of the dying and bereaved in a way that has never been 
called for before. In Zimbabwe plans are afoot to increase counselling 
support for AIDS patients whom it is recognised have special needs for 
understanding and caring attention given the social stigma that is often 
attached to the disease. Furthermore, recent research indicates that victims 
of the HIV virus are responding well to 'holistic' therapies applied in 
conjunction with conventional medical care. These holistic therapies, 
which incidentally have'also been shown to have beneficial results with 
ordinary non-AIDS related cancer sufferers, very much emphasise the 
alleviation of stress, and a key factor in this is counselling. Consequently, 
there is a growing interest in new approaches to counselling persons with 
life-threatening illnesses. 
The seminal work of Elizabeth Kubler-Ross (1969) and others has shown 
that there are common features in the human response to loss, whether it 
be impending loss of one's own life or die loss of a loved one. These 
common features, identified as the stages of working through loss, can be 
approached in a variety of ways. In addition different cultures have 
developed means of dealing with loss in their own style, depending on the 
traditional beliefs surrounding death and bereavement 
A few decades ago in Europe and North America death tended to be' a 
'taboo' subject and the bereaved were encouraged to resume normal 
activities as soon as possible after their loss. In Africa, however, more 
emphasis is given to rituals surrounding deadi, and the bereaved are 
expected to give attention to dieir departed loved ones, through various 
traditional practices undertaken by the extended family, for a prolonged 
period. 
In both cultural contexts therefore, the process of dying and bereavement 
are no longer simply a matter of private familial concern. External social 
support is required and a number of different professionals are becoming 
involved. Furthermore a new body of literature on appropriate intervention 
is evolving. This paper aims to contribute in a small way by oudining the 
traditional support for dying and bereaved people which is typically
Support for Vie Dying and Bereaved 27 
provided in the Shona extended family, usually straddling the urban and 
rural areas. Trends in formal organisational support, which is more geared 
to urban dwellers, will also be identified. Problems arising out of changing 
social and cultural conditions will be highlighted, and some possibilities for 
new directions and suggestions for therapeutic responses will be considered. 
As a prelude to the discussion of support, a brief resume of the 
psychological needs and experiences of those undergoing loss will be 
provided, followed by an outline of the Shona traditional beliefs which 
underpin support to the dying and bereaved. The main focus is on Shona 
culture since the Shona peoples comprise the majority ethnic group in 
Zimbabwe, and the group with which the author is most familiar, outside 
her own. While there are variations in the particularities of customary 
practice relating to death and bereavement, even among Shona clans, the 
overall belief systems of the African peoples of Zimbabwe hold much in 
common. 
Psychological stages of loss 
The important work of Elizabeth Kubler-Ross (1969) on dying and 
bereavement now supported by John Hinton (1972), Stephen Levine (1982) 
and many others, has revealed that there are common feelings which arise 
in response to loss, whether the impending loss be of one's own life or that 
of a loved one. The underlying feeling is usually one of grief, but in 
addition denial, anger, bargaining, depression and finally acceptance 
commonly surface. Although these responses do not always follow a set 
pattern there is a tendency for the first response to be denial when one 
hears of a loss that has occurred or is about to occur. This means that when 
people with a life-mreatening illness are informed about their condition 
they are likely, at first, to be unable to accept the news. They might say, "It 
can't be true.. I feel' so well. There must be a mistake in the diagnosis". 
Equally in a situation of bereavement, particularly when the news comes 
unexpectedly, as in the case of an accident, a close relative such as a mother 
may deny the news by saying, "It can't be my child. I saw her a few hours 
ago and she was quite alright". 
This denial response functions as a kind of buffer to the psyche, allowing 
it time to mobilise its resources while the body gets over the shock reaction. 
It could be overwhelming to accept all at once that one is likely to die or 
that a close relative or friend has died, so denial provides the space to-ease 
into the news. 
However, denial cannot be maintained for long in the face of reality and 
very often, as the difficult news is accepted as true, the subsequent response 
can be of anger. The anger may be directed at God, "Why Me?" "What 
have I done to deserve this?' Or the anger may be directed at doctors, "You 
should have seen this coming earlier and been able to prevent it" Or the
28 Patricia Swift 
anger may be directed at others who could be blamed for the death. Or, in 
the case of bereavement, the anger might even be directed at the departed 
person, "Why did you die when I wasn't there. I needed to say good bye". 
The anger may also surface again later, and from time to time, as, in the 
experience of the author, it is one of the most difficult emotional responses 
to resolve. Everybody can understand a shock reaction resulting in denial 
and there is a lot of sympathy for sorrow and depression. However, friends, 
relatives and others find anger difficult to handle, especially as it may at 
times be displaced. The patient with a life direatening illness may be angry 
with his doctor, but find it difficult to express this in his vulnerable 
position, so instead he takes it out on his wife who has been a pillar of 
support throughout his illness. It may be hard for his wife to recognise that 
anger is a normal response and that her husband's anger is being displaced 
from the doctor onto her. In such situations counselling, which helps to 
identify the true target of anger and then facilitate its release in constructive 
ways, can be of great assistance. 
Once anger has been experienced the ensuing response may be one of 
bargaining, in other words trying to 'buy time' in some way. Some patients 
make promises to God, or ancestral spirits, or to their doctor, that they will 
reform their lives or perform certain acts if they are spared from death 
altogether or even for a few more months. Some mothers who have 
children with terminal illnesses may even say to God, "Take me rather than 
my child". Such bargaining arises out of a sense of desperation and 
reluctance to face the inevitable. 
When it becomes clear that the bargaining has failed depression may set 
in. Part of the depression is a sense of sorrow and grief which is fully 
experienced when there seems to be no escape from the loss. A more 
harmful aspect of depression may be anger turned inwards, resulting in 
guilt. Patients may blame themselves for not having stopped smoking when 
instructed by. the doctor, or the bereaved adult child may regret not having 
given an elderly parent more care and attention. Guilt and anger turned 
inward require especially skillful handling because, if left to fester, they may 
further impair the health of the patient and prevent the psychological 
healing of the bereaved person. There is an old saying "Sorrow which has 
no vent in tears makes other organs weep". However, if sorrow can be fully 
allowed, and if guilt is worked through, then very often calm acceptance of 
loss will occur. This acceptance is not the same as resignation or defeatism, 
for example "there is nothing I can do about it, so I have to accept it". Real 
acceptance involves coming to terms with loss in a creative and peaceful 
way. Such acceptance is based on an inward opening to whatever feelings 
have arisen - anger, guilt, frustration or fear. When these are faced in a 
compassionate, allowing way, then peaceful accommodation to loss can 
occur.
Support for the Dying and Bereaved 29 
The above overview of the stages of coping with loss has been presented 
in a sequence which, as mentioned previously, is not always true to life. 
These responses appear and disappear in any order or may even occur 
concurrendy. However, the essential qualities of the feelings have been 
described as a basis for consideration of how the needs of the dying and 
bereaved are,-or should be, met, both in terms of traditional social practices 
and also through the type of professional assistance which is provided by 
die relevant voluntary organisations. 
Shona traditional practices 
Even in towns, where tradition is being eroded, Shona practices in respect 
of dying and bereavement cannot be viewed separately from religious 
beliefs and spirituality. It is almost impossible to conceive of an entirely 
secular funeral in Shona society. It is dierefore necessary to provide a very 
brief oudine of Shona religious thinking which pervades the whole of life. 
As Hannan has put it (in Gelfand, 1977: foreword): 
"The foreigner so it seems to die Shona tends to regard religion as a 
separate compartment of life, but for the Shona diemselves religion is an 
integral, all-pervading element of dieir way of living and drinking and 
acting". 
The core of Shona religion is die belief in a creator God known as Mwari 
and. in an after-life in which those who die are seen as having a different and 
continuing existence within the spirit world, but are still members of die 
extended family. Such spirit members known as vadzimu, or mudzimu in the 
singular, are gready respected and are seen as overseers of die moral 
behaviour and welfare of die living family members. 
The relationship of ordinary people to Mwari is bodi distant and 
intimate. It is distant in diat requests to Mwari are usually mediated by die 
vadzimu, who are seen as intermediaries between die living and Mwari. 
Yet, there is also an intimacy and trust, which is well described by Hannan 
(Gelfand, 1977: 8): 
"The difference between a Shona adult's feelings towards his mudzimu 
and his feelings towards his God is much die same as die difference 
between his feelings towards his father and his feelings towards his 
grandfadier. He fears his father, but while he respects his grandfadier he 
can also be familiar widi him. This attitude to God finds expression, on 
tiiose occasions, for example at a bereavement, when a shona might 
scold the almighty widi words he would never dare address to his 
micdzimu". 
From die above emerges a picture of a religious viewpoint in which diere 
is a community of die living and die dead in die care of God, but widi die 
spirit elders very much- monitoring and guiding die lives of the living. 
Where requests are made to die vadzimu for assistance, mediation or in
JO Patricia Swift 
reparation for wrong doings, these requests are always accompanied by 
gifts, in the same way that a living messenger, if asked to mediate between 
living families, as in the case of marriage arrangements, would always carry 
gifts with the request. Similarly, when requests are made to the vadzimu the 
seriousness is conveyed by an accompanying gift of beer or the killing of a 
beast Such gifts should not be mistaken for ancestor worship as they are 
signs of respect and have the same meaning as gifts accompanying requests 
to the living (Hannan, in Gelfand: 1977). 
The process of burial and its aftermath then become the means of 
ensuring a smooth transition from living membership of the family to 
membership as a spirit elder or mudzimu. In describing this process, 
however, detailed attention will not be given to the whole range of rites and 
rituals but rather the focus will be on how feelings related to death and 
bereavement are handled. One further aspect, though, of attitudes to 
vadzimu needs to be highlighted and that is that respect for vadzimu is 
extremely important because it is believed that if serious neglect of duty 
takes place, and this may be duty to the living or the dead, then the vadzimu 
may lift their protection from the offender who could then fall victim to 
witchcraft and the witchcraft could even result in death. Death, however, 
could also be caused directly by an avenging spirit, ngozi, which is the spirit 
of a person who has been murdered or even suffered an accidental killing. 
Such an ngozi could take revenge on the family of his murderer by causing 
the death of another family member. Thus it can be seen that, as 
Bourdillon (1987: 206) puts it, "death is always considered to be unnatural 
and in most areas every death is considered to demand divination", except 
in the case of an elderly person where people "might say that an old man 
died because he was 'tired' or that the death was caused by the high god 
alone". 
Therefore, the time of death is not only marked by grieving and loss but 
also by concerns about the cause of the death on a spiritual level. If death is 
preceded by an illness it is incumbent upon relatives to consult a diviner 
about the cause of the malady, in case they could make reparation for any 
wrong doing, which could then result in recovery. An illness is therefore 
not a matter to be dealt with exclusively by the patient and his doctor, but is 
very much the concern and even responsibility of the whole family. 
Furthermore, the illness is not seen as a purely somatic condition but is 
rather viewed as a reflection of some spiritual disease on the part of the 
patient or even another family member. 
Support for the dying 
This viewpoint on illness means that any seriously sick person is given a 
great deal of support from the family who, in practical terms, see the illness 
as their illness. Family members also consider it to be important for the sick
Support for the Dying and Bereaved 31 
person never to feel deserted, and will therefore visit frequently. If a patient 
is cared for at home then a relative must be present with the patient at all 
times. Most ill people express a preference for returning home as soon as 
possible, and most prefer to die at home in a familiar environment in the 
company of those to whom they feel close. There is also a practical 
consideration here, that is transporting a corpse from hospital to a rural 
home may be difficult and cosdy to arrange. 
Elderly people quite often wish to talk about their impending departure 
and may summon the family to give instructions about the distribution of 
their possessions, which is usually done by the family according to 
customary guidelines radier than in accordance with a written will. 
However, more and more of die younger generation are writing wills or 
specifying beneficiaries in insurance policies. The customary guidelines are 
also being superceded in certain instances by die new Law of Inheritance in 
Zimbabwe which leads to a rather complicated situation, about which more 
will be said later in die paper. 
Younger people who are dying do not as often talk about deadi, and 
family members will not raise the subject if the dying person does not refer 
to it diemselves. Patients who are told by doctors diat diey have terminal 
illnesses may lose heart and this in turn can lead to a quicker decline, 
particularly in the case of persons widi AIDS. On die other hand, some 
patients who are worried about certain aspects of dieir departure or its 
aftermadi may actually really need to talk to someone but find it difficult to 
open up die subject widi their relatives. This is where a trained counsellor 
may be very helpful in facilitating communication, as die author's own 
experience has revealed. 
Bereavement 
At die time of deadi of a member of a Shona family all close relatives will 
have gathered to pay their last respects to the dying person. If die deadi is 
unexpected then relatives will gadier as soon as possible, Relatives, friends, 
neighbours and acquaintances will come to visit die bereaved, kubata maoko, 
literally to hold the hand of die mourning person, but in fact to express 
condolences and give support to die bereaved for a prolonged period, 
sometimes including an overnight stay or even longer. Relatives and friends 
who are women will remain in die house with die bereaved women at times 
crying, wailing, singing and dancing, while men gather outside around a 
fire. Grief is expressed in a very open way, bodi in respect of emotions and 
verbal sentiments felt by die bereaved. As each person arrives, especially 
close relatives, fresh weeping and wailing occurs and thus sharing of die 
grief occurs diroughout die day or night. Sometimes a widow will call out, 
"What will become of me and the children?" "How will we survive?" On 
occasion, men will also be seen to weep but not as loudly as women.
32 Patricia Swift 
The repeated fresh weeping of a bereaved woman is psychologically 
healthy in that the sorrow is not at all repressed. However, it has been 
suggested by Mutandwa (Sunday Mail, 25 September 1988) that women are 
sometimes under pressure to wail when they are actually exhausted and 
would really appreciate a little quiet time by themselves. Unfortunately, 
solitary quiet time for a newly bereaved widow would not be favoured as it 
could be construed as unhealthy brooding, or else as a lack of deep 
mourning for the lost husband. In this case the widow might even be 
accused of being implicated in his death. 
The crowd of people who come to the home of the bereaved to express 
their sympathy need to be fed and given periodic refreshments. This 
burden too is shared and, particularly in high density, lower socioeconomic 
areas, people from as many as four or five groups may come to 
help with contributions in cash and kind. Such groups as burial societies, 
the local church of the bereaved, a political group, neighbours, a women's 
club or a group of colleagues from work would normally gather contributions 
for die bereaved and even come and help in practical ways. Only social 
isolates in a high density community would suffer from lack of support at the 
time of bereavement. 
The situation of middle class Shona people in low density suburbs could 
at times be more difficult, particularly if the person who died was not well 
known and did not have a large extended family. In this case the bereaved 
could feel alone and need more support. Even in die case where many 
friends and relatives come to the house a problem in catering could occur 
when many people would require bought drinks and food but would be 
less likely to provide contributions in kind. This situation could result in 
financial embarrassment for the bereaved family. In fact, all in all, death in 
a Shona family can be a very expensive event. 
A further expense usually occurs in the form of transport if the death 
occurs in town, since most families prefer to bury their dead relatives in the 
vicinity of their rural village — kumusha. Most individuals, too, in diinking 
ahead to their own death, would express the wish to be buried at their rural 
home. This of course is not possible for expatriate families who have to 
utilise city cemetries. 
The preference for a home burial is related to the need to ensure the 
smooth transition from die community of the living to a peaceful existence 
among the spirit elders who are part of the extended community of the 
living and die dead, as mentioned earlier. There is a sense that a person 
buried in a rural home is not forsaken. There will be continued caring and 
respect articulated dirough a series of ritual events. Such rituals are not as 
easily carried out in a distant city cemetry, although many families do still 
observe them and expatriate families from Malawi, Zambia and
Support for the Dying and Bereaved S3 
Mozambique have made adaptations to cater for urban life in a foreign 
country. 
When a burial does take place in a rural village there are a number of 
ritual practices which allow the mourners to express their feelings and the 
departed to feel calm and peaceful. The details of customary practices 
surrounding burial and its aftermath vary from area to area and from clan to 
clan and are too numerous to describe in this paper. However, key features 
noted by the author while attending Shona burials will be highlighted, 
particularly those relating to expression of feelings. 
Firsdy, in most areas after the corpse has been washed and prepared for 
burial, kinsmen and friends will file past to bid farewell and pay'their last 
respects to the deceased, sometime leaving a small gift and saying a few 
words. This bidding of farewell is particularly important for those who had 
not seen the deceased immediately prior to his deadi. Viewing of die corpse 
brings home the reality of death which at times is hard to face, and yet must 
be fully apprehended in order to move through the denial stage mentioned 
earlier. Furthermore, it is easier to let go after saying goodbye and expressing 
thoughts and feelings which could otherwise be a form of unfinished 
business, resulting in preoccupation with the deceased. 
When the paying of respects is completed then it will be time to carry the 
body to the grave. During this period and earlier there is a particular 
person who helps to facilitate proceedings and who has the special function 
of lightening the atmosphere and reducing tension. This person is the 
sahwira, or ritual friend, usually a person well known to the family from a 
neighbouring village. The sahwira will engage in various antics which make 
the family laugh, sometimes imitating the deceased in a clever and witty 
way. This laughter is a great antidote to the kind of heavy depressing 
atmosphere which can develop at funerals and which is very tiring and 
debilitating. The release of tension through laughter balances the atmosphere 
and gives the mourners renewed energy to complete the task of burial. 
As the family nears die graveside, and the tension and sorrow increases 
in anticipation of the final parting with the body, die sahwira may have to 
think of particular antics to lift the atmosphere. For instance, one sahwira 
told all die daughters-in-law, the varoora, when they were kneeling after they 
had put the pots of water they were carrying down near to the grave, to 
place their cloths over dieir heads. He then took a light branch and surprised 
diem with quite a sharp beating. At first the varoora were cross but then 
succumbed to the laughter of everybody else. 
Aldiough the burial marks the physical separation from the deceased it is 
by no means seen as a final parting. Those relatives who were unable to 
attend the funeral will gadier a few weeks later to mourn the deadi again, 
kuchemwa. Six mondis to a year or more later the kurova guva will take place. 
Literally, kurova guva means to beat the grave, but the ritual is actually
J4 Patricia Swift 
performed to welcome the spirit of the deceased back into the home village. 
As Bourdillon (1987: 209) describes the ceremony: 
"A large number of relatives and friends of the deceased gather to sing 
and dance in honour of the spirit through most of one night; there 
follows in the morning a procession to the grave or some other spot 
outside the homestead where various rituals are performed including 
generous libations of millet beer, and the spirit is requested to come 
home; this is followed by further music and feasting in the homestead to 
welcome, the spirit home." 
The ceremony allows relatives and friends to vividly remember the 
deceased and to give vent to a variety of emotions surrounding the death. 
At this time, mourners will speak to the deceased and may express anger 
about the circumstances of the death. If there is a suspicion that die death 
was caused by the machinations of another, die deceased might be 
encouraged "to fight back against whoever killed you". 
The combination of an abundance of beer, dancing and staying awake 
dirough die night allows for much reminiscing and contacting of feelings 
related to the deceased, and facilitates the expression of the range of 
feelings which arise. Furthermore, diere is emotional satisfaction in die 
sense that die deceased is back home in his new form. 
At die time of die kurova guva, or sometimes earlier or later, an inheritance 
ceremony takes place at which the possessions of the deceased are 
distributed among die relatives. According to Shona customary law, if the 
deceased was a married man, his widow(s) will be given die opportunity of 
being inherited by one of die brodiers of dieir late husband. The inheritance 
ceremony seems to be a time when disputes inevitably arise. These 
disputes are obviously connected to die acquisitiveness from which most 
people suffer. However, die disputes also give an opportunity tor the 
expression of anger, which is one of the natural responses to loss that is 
most difficult to work dirough as emphasised earlier in this paper. Anger is 
bound to arise at the time of loss, but it is not easily expressed in a socially 
acceptable manner. When it is repressed, if it does not cause die disputes, it 
at least makes diem all die more acrimonious. It should be mentioned mat 
disputes do not only occur about possessions, but also develop sometimes 
in connection widi ritual procedures. Various family members may hold 
strong views about die proper conduct of burials and diis again is an 
occasion for anger to be expressed. 
Generally there are ample opportunities for the venting of die various 
feelings arising from loss in Shona society. Anger still presents the most 
problems, but nevertheless is not commonly repressed totally. Widows, if 
anything are under too much pressure to express emotion and before die 
funeral do not get enough rest and peace, which are also necessary for the 
healing process to take place after loss. When die funeral is over widows,
Support for the Dying arid Bereaved 35 
and all family members for that matter, do get and need time to relax and 
recover. 
This account of the handling of the common responses to loss in Shona 
society serves as a basis for considering what kind of additional professional 
assistance is needed and what is actually being provided in Zimbabwe. 
Beginning with the latter, a review of what are considered to be the 
important aspects of organisational support currently being offered by 
three organisations in Zimbabwe will follow. 
Aspects of organisational support 
The two main voluntary organisations providing care for die dying and 
bereaved in Zimbabwe are the Island Hospice Service and the Cancer 
Association of Zimbabwe. These will shortly be joined by ACT (Aids 
Counselling Trust) which has just begun functioning and is in the process 
of registration. Within the Cancer Association the Cancer Centre Help 
Service, recently launched in Harare, will be the focus here, as this holistic 
support programme incorporates pioneering approaches to cancer care 
and is in the forefront of those being explored currendy in Britain and 
Europe. 
In fact, bodi Island and the Cancer Centre Help Service are employing 
highly innovative policies with respect to the dying. Island, the older 
organisation, was founded in 1979, and has a well-developed, progressive 
bereavement service. Full details of die programme in operation under the 
auspices of these two organisations cannot be provided in an article of this 
nature. However, certain key features will be highlighted, which distinguish 
the approach of these organisations from that which is generally adopted in 
orthodox, western medical settings caring for the terminally ill. 
Perhaps most importantly, diese two organisations propound a different 
attitude to death. This is exemplified in the viewpoint of Mary Aikenhead 
who established the first hospice in Europe. "She considered death to be 
die beginning of a journey, a thoroughfare and not a terminus" (Lameiton, 
1979). Such an attitude can diminish the sense of dread which taunts the life 
of those suffering from 'life-threatening' illnesses. Even the latter term, 
employed in preference to 'terminally ill' more common in conventional 
medicine, implies a sense of hope. The Cancer Centre Help Service 
approach does not view deadi as inevitable even in die advanced stages of 
cancer. Coundess miraculous remissions and recoveries have lead to a view 
of cancer as 'life-threatening' but not necessarily fatal. Kubler-Ross (1969) 
warns, too, about "contradicting patient's day-dreams". They may come 
true! Thus die emphasis is on living as rich a life as possible in die present, 
not anticipating death and yet opening to deadi when the dme is ripe, and 
to die possibilities of life thereafter. 
This latter spiritual dimension links into a second important feature of
36 Patricia Swift 
hospice and the new approaches to cancer care. They both maintain a 
holistic vision of the patient. To quote the first Cancer Centre Help Service 
newsletter (1987): 
"The concept of an holistic approach of Cancer patients and their 
problems is directed towards the whole person in body, mind and spirit 
and not just the disease itself. In no way does this approach seek to 
replace orthodox medical treatment, but rather to complement it and 
enhance its effectiveness by stimulating a positive attitude promoting 
self-healing and self-help." 
The spiritual and psychological life of a patient thus become equal foci of 
concern with the patient's physical well-being. 
While the role of conventional medicine is in no way discounted, the 
holistic cancer care .team would include, in addition to doctors and nurses, 
counsellors, nutritionists, art and dance therapists, spiritual healers and 
trained teachers of relaxation, meditation and visualisation. Island 
Hospice, rather than having such a range of personnel, opts for a generic 
para-professional 'care-giver' to supplement the work of nurses, social 
workers and clergy in catering for the needs of the whole person. 
Recently, in Europe and America, the holistic approach has been gaining 
credence in the treatment of AIDS patients. Williams (Sunday Telegraph 
Magazine, 23rd August 1987) reported that 
"It is to the mental attitudes of the PWA (person with AIDS) that 
practitioners who offer complementary therapies first address themselves. 
Increasingly it is accepted that die way our immune system functions is 
profoundly affected by our 'core' feelings. Dr Lawrence Leshan, who 
over diirty years has pioneered an approach to cancer patients based on 
this principal said in London recently that there was now so much 
material available on the subject that the contention that emotional 
factors play a profound part in recovery - certainly in his speciality, 
cancer - now has to be accepted as fact. . . . Put simply, misery makes 
us illness-prone and slow to recover. Its reverse, hope and joy, love and 
attention, can help sometimes miraculously, to heal". 
Concommitant with the hostilistic approach is the movement away from 
an hierarchical staff structure and die inclusion of die patient in determining 
treatment directions. The first hospice in England, St Christopher's, 
was actually conceived of and planned joindy by a patient with a lifethreatening 
illness, David Tasma, and his social worker, Cicely Saunders, 
who later studied medicine for the express purpose of implementing their 
shared vision. The patient's family are also deeply involved, and Island 
Hospice provides nursing care at home so that the patient is able to remain 
with his family rather man in hospital, and the family are given guidance 
and support in carrying out their responsibilities. 
Island Hospice administration and meeting rooms have been decorated
Support far the Dying and Bereaved 37 
in such a way as to create a non-clinical, homely atmosphere and Cancer 
Centre Help Service is in the process of doing the same. Patients and 
bereaved people are encouraged to 'drop-in' when they feel the need. They 
do not always have to wait for appointments, and both organisations 
promote not only self-help but also mutual help among clients. The 
therapeutic support that dying and bereaved people can give each other is 
fully recognised and tapped through therapeutic and social groups. It is 
acknowledged, further, that staff require group support at times. The 
regular groups for staff at both organisations, help the members of the care 
teams to share the burdens arising out of their work and to reach beyond 
the professional fagade to the caring human being beneath, who is so much 
more healing to the patient than the distant and detached professional 
operating in a strictly clinical environment. Lastly, bom organisations 
accept the challenge to educate the public about the holistic aproach, and 
die need to be open and allowing to one's own and other people's grief and 
the range of feelings arising out of loss. 
In identifying the above features of hospice and the holistic approach to 
cancer care it can be seen that there is a convergence taking place with 
Shona traditional care which never separated spiritual arid psychological 
life from physical health and where the family always played a key role in 
treatment. In general, the Shona viewed major bodily ailments as having 
spiritual causes and it was also commonly accepted that stress would have a 
negative impact on health. People were discouraged from 'thinking too 
much', ie brooding over problems in an unhealthy way. Furthermore, the 
traditional healer, like the members of the holistic team, related to the 
patient and his family in a non-hierarchical way and in an intimate, sharing 
manner. There is potential, therefore, for a creative dialogue to occur, since 
the gap between the western holistic approach and Shona traditional 
healing is much narrower than that between western orthodox medicine 
and traditional healing practices. 
Problems in experiences of loss 
Nevertheless before enthusiasm outsteps realism it may be as well to 
consider some of the kinds of problems that are being confronted in the 
work of the above organisations. Social workers and medical staff were 
interviewed in order to form a picture of the main problems mat clients 
were experiencing. It was found, in the bereavement work of Island 
Hospice, that socio-economic and cultural factors played a role in 
determining the kinds of difficulties being faced. Thus a differential pattern 
emerges among different racial groups. There is also a great deal of overlap. 
For purposes of comparison a brief account will be provided of some of the 
problems commonly experienced by white bereaved people, followed by a 
commentary on the situation of black widows in Harare. Widows tend to be
38 Patricia Stoifi 
the main client group from the black community utilising Island Hospice 
Services. The white client group is wider and was reported as having the 
following problems (Martin, 1988): 
because they have been left so helpless. They usually have sufficient 
funds to live, but have no experience running the family finance or 
getting cars serviced and licenced, etc. Younger couples usually share 
(a) Elderly white widows sometimes experience anger with their grief 
financial management more democratically. 
(b) Younger widows are often not as well provided for and so have to cope 
with financial stress as well as the additional stress of decision-making 
on their own. Having sole responsibility for major decisions which were 
previously shared, such as schooling, housing, holidays, etc, feels 
particularly burdensome. 
(c) Widows in general experience the most 'aloneness' and loneliness. 
They miss sharing the little things of life and sometimes find that they 
are socially isolated in a couples oriented social circle. Sometimes they 
are not invited out as they are seen as threats to existing marriages, 
and this exacerbates the feelings of rejection that arise when a spouse 
dies. 
(d) Bereaved people sometimes find mat their friends and family resist the 
kind of changes that are inevitable during a time of loss. They encourage 
die bereaved to 'be their old selves' and to 'let go of the past' which of 
course takes time and needs periods of sorrow, anger, etc. 
(e) Many bereaved people feel ill-prepared themselves for what they are 
experiencing. They do not realise how devastating loss of a loved one 
can be and they cannot believe that others feel the same way, which is 
why groups are so helpful. 
(f) In the case of die death of a child, which is probably the most devastating 
bereavement experience, often accompanied by guilt and .helplessness, 
diere is the problem of fathers not wishing mothers to talk about 
dieir child's death. Fathers often want the mother to forget and she is 
then faced with the double burden of bearing her grief and hiding it. 
Fathers also tend not to come to the groups for bereaved parents unless 
diey are divorced or widowed. 
(g) Lasdy, young bereaved children are often not helped to express their 
grief. They are frequendy left out of the funeral and are not shown trie 
body, although many who see die body are helped both because the 
deceased usually looks very peaceful and also because it assists them to 
recognise that the person is no longer there. 
The above problems indicate tendencies for older and younger widows
Support far the Dying And Bereaved 39 
to experience practical difficulties, but otherwise the focus is on loneliness 
and problems in opening up to feelings. A contrasting picture emerges of 
the situation of black widows: 
(a) Black widows seldom suffer from isolation as their mother or another 
close relative will remain with them in the house for a prolonged period. 
Their problems usually stem from practical matters which sometimes 
lead to family disputes. 
(b) When the death of the breadwinner occurs many widows find themselves 
without accommodation in towns because access to home ownership 
for Shona people was severely curtailed during the time of the 
previous white minority government If a widow is unemployed, she 
usually is unable to maintain rent payments and thus has to return to 
the rural areas where schooling for her children is not as readily 
available and is of a lower standard. 
(c) There is still no universal widow's or old age pension scheme and those 
widows who are entitled to a private pension or insurance benefit have 
difficulties working their way through the bureaucratic procedures and 
paper work that this involves. As in the case of older white widows, 
many black widows, across the age range, did not have full involvement 
in their husbands' financial affairs and this leaves them very vulnerable 
at the time of his deadi. 
(d) Widows frequently find themselves caught in a bind between new state 
laws and customary practices. For instance, often they are not the sole 
claimants on their husband's estate. In the past, under customary law, 
the husband's brother would inherit most of the estate and would 
inherit the widow and children as well. The wife would belong to her 
husband's family. Many widows nowadays do not wish to be inherited 
and would rather survive alone. They then have recourse to new inheritance 
laws which generally favour the children but allow the parent with 
custody some usufruct until the children reach the age of majority. 
Sometimes the husband's family are offended when the widow does not 
want to be inherited and pressure is put on her to choose one of the 
brothers, who also compete with eath other since they want access to 
the deceased brother's estate. If the husband was very poor these 
problems are less acute. Emotional blackmail of the wife is, however, 
possible because of the belief that death is unnatural. If the widow 
wants to live alone and to keep her husband's property she may be 
accused of causing her husband's death through witchcraft. It is also 
very difficult for a widow to re-marry, as Mutandwa (1988) states: 
"However, Lord have mercy on a woman who remarries even as long as 
five years after the death of her husband. She will be accused of having
40 Patricia Szuift 
'burnt her husband's grave' (kupisa guva). She will also be suspected of 
having expedited the departure of her husband from mother earth so 
she could take on a new spouse." 
Widows are dierefore caught between customary practices and the new 
state laws which better fit tfieir urban life in a more nuclear centred family. 
Although die new law offers better protecdon for widows die extended 
amily has by no means lost its power. Jabangwe (1988) related the'situation 
of one widow where, even before the husband's death, his relatives said 
hey were worried that the neighbours were bewitching the husband. Then, 
they removed die ailing husband to his sister's house widiout even consulting 
the wife who was very offended. She did not see her husband before he 
died, which was subsequendy a cause of deep grief for her. The wife refused 
:o be inherited and the husband's family then cut her off completely and 
aid she should return to the home of her parents. 
Thus we see a picture of a widow not only coping with her own loss but 
aced with family disputes and severe financial worries about the future. It 
s ironic that the Shona widow who is given so much support in expressing 
ler grief is then subjected to all sorts of practical difficulties. 
The above constitute some of the problems being experienced by 
ereaved persons seeking help from Island Hospice. The Cancer Association, 
working more with persons with life-threatening illnesses, identified 
everal problems specific to those faced with future loss of their own lives 
ather than bereavement. One of the main problems experienced by white 
ancer patients is that of guilt - blaming diemselves for dieir illness. This 
endency to take individual responsibility is very different from the Shona 
|amily-oriented perspective. Guilt is a major problem in the western 
ontext and is a clear impediment to healing in diat it causes a great deal of 
istress and negative energy turned inwards. 
Not unexpectedly, anodier common problem is anger which is less 
amaging to overall health if it is expressed. However, anger at others is not 
o easy to express as anger directed at ourselves - and patients, therefore, 
eed to be encouraged to contact and work dirough dieir anger. This 
ould apply equally to white and black patients, as does die next problem 
hich is the difficulty cancer-sufferers experience in coming to terms widi 
le fact that they have a life-threatening condition. On account of diis, they 
liay neglect dieir symptoms for a long time before seeking medical attention, 
hona patients in particular tend to delay contact with the western 
edical system for as long as possible. This is partly due to die expectation 
iat a western doctor will recommend surgery, and since many black 
atients only agree to surgery when die condition is advanced quite 
equendy deadi does follow shortly afterwards, mus resulting in further 
iuctance in odiers to undergo surgery (Weinman, 1988).
Support for the Dying and Bereaved 41 
Hopefully, the growth of the holistic approach will attract more Shona 
people to seek help earlier, especially if the Cancer Help Service could 
incorporate Shona traditional healers who already employ an holistic 
analysis in diagnosing illness and prescribing treatment. 
To summarise the problems arising out of loss in different cultural 
settings, it would seem that Zimbabwean whites suffer from loneliness and 
lack of social support at the time of loss where materially the problems are 
not so severe. On the other hand, black Zimbabweans suffer from many 
financial worries and other practical difficulties, such as housing, but the 
social support system at the time of bereavement is very extensive and if 
anything overbearing rather than lacking. It would seem therefore that 
whites could spend more time with bereaved and dying people, unless they 
indicate a preference to be left alone. Whereas black families perhaps need 
to give a little more space for self-determination among widows who have 
lived in town for a long period and have become used to functioning in a 
more nuclear family setting. 
The positive aspect of the way Shona people deal with stress and physical 
ailments is that any problem is not an individual problem, but a family 
problem and this may even involve departed members in the spirit world. 
Thus, no person need feel alone and there is recognition that a problem 
experienced by one member of the family system may be the expression of 
a wider problem within the whole system and the whole family will take 
responsibility for dealing widi it. In many western families it is hard for 
diem to recognise that the problems of one individual can be symptomatic 
if a general malaise within the family system. The negative aspect of the 
Shona approach is the sometimes oppressive nature of family demands 
which can place a heavy burden on certain members, especially those who 
function as head of the family. These burdens can be very stressful and 
themselves lead to stress related illnesses such as cancer. The other negative 
feature is the inclusion of witchcraft in the Shona belief structure. When 
people believe that their illness is caused by witchcraft they may lose hope 
and thus enter a negative spiral, ie in becoming despairing they feel worse 
physically and then conclude that the spell is working and thus become 
more despairing until they have no will left to live. Thus, it would seem 
that although the spirituality in Shona society is an extremely valuable 
feature the belief in witchcraft is not. Cultural beliefs need to catch up with 
the law which prohibits any behaviour arising out of die belief in witches. 
On the basis of this brief overview of the difficulties experienced at the 
time of loss, and some of the lessons which could be gained from crosscultural 
fertilisation, the concluding section will make a few suggestions for 
additional therapeutic techniques which could meet the needs of individuals 
and families.
42 Patricia Swift 
New directions in therapy 
One approach to therapy, which has been utilised in a limited fashion in 
Zimbabwe but could have wider applicability, is gestalt therapy. The author 
has used gestalt therapy with groups of bereaved persons and individuals 
and has found that it has a useful role in helping individuals contact buried 
feelings which are difficult to express, such as anger, and that it also offers a 
means of resolving anger and resentment. Very briefly, the approach begins 
by asking the client to focus on the body and scan it for any tension or 
disturbance. The client is then asked to be that part of the body which is 
tense and speak for it. This technique by-passes the rationalising and 
censoring qualities of the thinking process. Very often if a person with 
repressed anger is asked to think about how they are feeling they will say 
they are fine. Whereas, speaking for tense shoulders the person might say 
"We are tired of this burden we are carrying". To give an example of a 
client situation: A young woman who was having difficulties with concentrating 
on her studies on account of stomach pain sought therapy and the following 
extract of the session is provided (using a pseudonym): 
Client: (after being asked to scan the body) 
"My stomach is painful." 
Therapist: "Be your painful stomach. What does it say?" 
Client: "I am in pain." 
Therapist: "What do you want to say to your painful stomach?" 
Client: "Stop being painful. You are preventing me from working." 
Therapist: "What does the stomach reply?" 
Client: (as stomach) "I can't stop being painful because I am still feeling 
pain about the death of Tsitsi's father." 
(as Tsitsi) "What is causing you pain?" 
(as stomach) "I feel angry because he died when the mother 
was out of the room. He sent her out of the room on an errand 
and then died. She was very hurt." 
The therapy session contined with the client being asked to imagine her 
father sitting in front of her. She was then told to express her feelings of 
anger to him and then to reply as him. She thought for some time and then 
replied as the father. 
Client: (as father) "You know I was very close to your mother but I 
thought she would panic and be very upset at the actual time 
that I passed away, so I sent her out of the room on an errand. 
I am sorry she was hurt for I only wanted to protect her." 
Through dlis continuing dialogue with the client genuinely trying to 
speak for her father and then listening to him, she finally felt resolved and 
had got her feelings 'off her chest', or rather her stomach! 
This approach is useful in that it does not entail a lengthy case history but
Support for the Dying and Bereaved 43 
rather focuses on immediate feelings identified through scanning the body. 
The technique of encouraging the client to speak out feelings to the person 
to whom they are directed facilitates emotional discharge and release. 
However, the approach is geared to individual work and even when it does 
take place within a group setting it does not focus on the interactive process 
among family members, other than from the perspective of the individual. 
Consequendy, there is need for approaches which heal the wounds arising 
out of family tensions. 
Family therapy has been available for some time in Zimbabwe and its 
value is being increasingly recognised. Among whites, there is need to see 
the individual more as part of a family system and to tap the creative 
potential in that system. Within the Shona context, although the extended 
family is being eroded in urban areas it is still powerful and the power of 
that system may be channelled in negative and positive ways in the current 
changing cultural conditions in Zimbabwe. Since the norm for Shona 
families is to deal with problems dirough the extended family, therapy 
approaches may be adapted so as to utilise already operational traditional 
structures. For instance, link therapy has been developed for families in 
transition and could be applied in a bereavement situation. In this approach 
one key member of the family, such as die tete (father's sister), who 
traditiohaHy-has a counselling role, is coached to do family therapy with the 
extended family. It is easier for members of a Shona family to be open with 
an already established figure within the family than widi a stranger. Furthermore, 
the family could find it simpler to gather at a venue in a rural area 
where most of the extended family were resident rather than going to a 
family therapy office. This link therapy approach is described by Landau 
(in McGoldrick et al, 1982). 
However, in some areas even the family has been found to be too narrow 
a grouping for dierapy purposes and dius network therapy has been developed. 
Attweave (1979: 192) suggests that: 
"Network therapy seems to be based upon the concept of mobilising the 
family, relatives, and friends into a social force mat counteracts the 
depersonalising trend in contemporary life patterns. The concept appears 
to be particularly attractive to those attempting to counteract the isolation 
experienced by urban residents." 
Attweave, herself of North American Indian extraction, has suggested a 
further adaptation of network dierapy for groups of people who have an 
existing clan system such as American Indians. She calls this 'network-clan 
therapy'. The focus here is not so much on combating isolation, as on 
tapping die resources of core clan members and significant odiers such as 
close neighbours, or in the Shona context, the sahwiras referred to earlier. 
Attweave (1979: 192) recognises that: "Natural clans and networks, like
44 Patricia Swift. 
other human institutions, can focus energies in healthy or pathological 
directions." 
However, the constellation of a large number of people, who are closely 
involved in a bereavement situation and may have tensions among them, 
can be a powerful force for healing. Attweave contends that: "the dramatic 
results from the mobilised resources of the simulated clan seem to follow 
without the process involved being seen clearly". She also recognises that 
"networks and clans are made up of individuals some of whom from time 
to time need to be seen and treated as individuals". 
Thus, it can be seen that there is a place for therapy at a variety of levels, 
from the individual level right through the extended family to even the 
neighbourhood level where deep rifts have occurred. 
Conclusion 
This paper has sought to identify support structures for those coping with 
loss in Zimbabwe. The traditional Shona support system was briefly, 
describe followed by an account of the important features of the work 
undertaken by relevant voluntary organisations. Some of the problems 
experienced by the clients from these organisations revealed the strengths 
and weaknesses of traditional support practices in Shona culture and also in 
western culture. It is interesting to note that certain trends in western 
approaches to working with the dying and bereavement, particularly those 
summarised under the heading of 'holistic care', are actually moving 
towards Shona traditional patterns and away from some aspects of orthodox 
western medical care. The holistic approach treats the whole person with a 
body, mind and spirit just as the Shona traditional healer always has done, 
and in a non-hierarchical more intimate way, again in line with practice-in 
Shona traditional settings. 
In order to develop the positive aspects of this cross-fertilisation it is 
recommended mat the potential role of the Shona traditional healer in 
holistic care be further explored and also that western therapies, that can be 
adapted to the Shona context, be investigated and further utilised. 
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