Reflections on four 9-Cell Bereavement Tool sessions in Zimbabwe: Authors: Tanaka S Machida[1], Island Hospice and Healthcare, Joyce Bongo, Patience Musaringo Island Hospice and Healthcare, Jenny Hunt, Independent Consultant
We understand grief to comprise a combination of both nature and culture; a blend of what comes instinctively when significant loss occurs, but which is modified by interactions with one’s surrounding culture and belief systems (Rosenblatt 1993).
Many people find it difficult to support the bereaved in the face of raw and painful emotions and reactions.
In response to the realization that families and community members could better support the bereaved, the 9 cell bereavement tool was developed in Zimbabwe in 2000. The tool was designed to provide ‘a platform for discussing, challenging and reflecting on grief issues’ (Hunt 2002) as well as identifying resources within communities to better support the bereaved.
It has been implemented in several African countries including Kenya, Tanzania, South Africa and Uganda (Namisango 2024), as well as India and Gaza. Research undertaken in Zimbabwe confirmed this is a model which can feasibly be rolled out in diverse settings (Mutedzi et al 2019).
This article provides an updated review of 4 recent sessions undertaken by Island Hospice and Healthcare (IHH) in Zimbabwe with feedback from participants.
Session 1: 29 May 2024: Chitungwiza (peri-urban): 45 volunteer caregivers (age range 32-74 years) trained in basic palliative care by IHH
Session 2: 25 July 2024: Harare (urban): 35 volunteer caregivers (age range 40-66 years) trained in basic palliative care by IHH
Session 3: 27 September 2024: Harare (urban): 30 nurse aides (age range 25 – 80 years) trained in basic palliative care by IHH
Session 4: 19 March 2025: Chikwaka (rural): 23
Feedback was elicited from all participants from sessions 1, 2 and 3 using the Kobo collect application. This is a reliable software application used to collect, analyse and manage data for surveys, monitoring, evaluation, and research. It has been regularly used by IHH caregivers.
Coding Key:
- CC- Chitungwiza caregiver
- HC- Harare caregiver
- NA- Nurse aide
4 questions were asked.
- How are you using the information/experience gained from the sessions?
- What difference has the 9 cell bereavement tool sessions made to you personally?
- Have you been able to share the information with others and to whom?
- Any additional comments or thoughts?
Out of 110 participants targeted for the feedback, 32 responded (35%). This low response rate is typical for this methodology used by IHH and is attributed to lack of finance for airtime, power outages and continuing confusion as to how to use the application.
Participants from session 4 were not included in the Kobo application process but oral feedback was captured manually on site.
Many participants reflected on the personal benefits they gained from the session, particularly in terms of increased sensitivity, understanding, and confidence in better supporting the bereaved and the communities.
Several caregivers, for example, reported that the session allowed them to offer more compassionate support, both to their clients and within their families. One caregiver expressed,
“I’ve learned to be more open-minded and sensitive to people’s experiences of grief, respecting individual emotions and reactions.”(HC4)
The session also appeared to help some participants process their own grief, with one Chitungwiza caregiver noting, “It helped me grieve my mother’s death properly.”(CC3)
Island Session
The practical application of the session’s content is evident in how participants use their new found knowledge to assist others. Many reported sharing insights with their families, communities, and workplaces.
For instance, several individuals stated that they had used the session’s experience in providing emotional support to grieving friends or family members. One Harare caregiver shared, “I now know what to say and what not to say to others when they are grieving. The right choice of words is crucial.” (HC7) Another nurse aide mentioned, “I am teaching my sons that it’s okay to cry, something I was previously reluctant to allow.”(NA9)
A key theme that emerged from the responses was the importance of understanding cultural and religious variations in bereavement. Participants highlighted that the session helped them navigate the complexities of grief, recognizing that people grieve in diverse ways.
As one nurse aide stated ”I have learned that there are so many ways, times to grieve according to your religion, culture” (NA3) One caregiver noted, “It helped me see people’s environment from their perspective, which helps me support them better.”(HC9)
The dissemination of information within the community was a central outcome of the sessions. Many participants reported that they took it upon themselves to spread what they had learned to others in their networks, including family, coworkers, and church members.
A Chitungwiza caregiver shared “It teaches me kugamuchira kuti maererano nezverufu uye kudzidzisana nehama kugamuchira. rufu ruriko” (it teaches me to accept issues of death and dying and teaching relatives that death is a reality” (CC10) Additionally, there was a consensus among participants on the importance of continued education in bereavement support, with some suggesting more frequent sessions in rural areas where grief-related stigma may be more pronounced.
Some participants reflected on the need for more targeted education on how to assist those struggling with grief, particularly in the context of epidemics and high death rates. A Harare caregiver noted “We need more information on upcoming pandemics and how to deal with grief in such circumstances.” (HC2). Others acknowledged the challenges of helping individuals who might be resistant to grief education or might feel uncomfortable sharing their emotions.
In conclusion, the feedback from these recent sessions confirms the value of this community- based approach to enhancing awareness and support within both urban and rural communities. Through a combination of increased knowledge, personal reflection, and community outreach, participants reported that their care-giving practices have improved including provision of compassionate bereavement support
Importantly these 4 sites exhibit diversity with a range in age, gender, religion, racial mix and background. This allowed for a rich exchange of ideas on bereavement practices, contributing to a more inclusive and culturally sensitive approach to grief education.
References:
Hunt, J. (2002) ‘The 9 Cell Bereavement Table: a Tool for Training’. Bereavement Care, Vol. 21, no. 3: 40-41.
Mutedzi et al. Pilot and Feasibility Studies (2019) 5:66
https://doi.org/10.1186/s40814-019-0450-5
Namisango. E. (2024) ‘A Community-led group learning intervention for grief and bereavement in rural Uganda. eHospice online https://ehospice.com/africa_posts/a-community-led-group-learning-intervention-for-grief-bereavement-in-rural-uganda/
Rosenblatt, P. (1993) ‘Cross-Cultural Variation in the Experience, Expression and Understanding of Grief’. In D. Irish et al (eds) Ethnic Variations in Dying, Death and Grief, pp. 13- 108. Philadelphia: Taylor and Francis.
