Recently, I sat down with Dr Khamis Elessi, one of Cairdeas’ longstanding partners and lead in Gaza. Specialising in Rehabilitation Medicine, Dr Elessi worked to save lives throughout the years of Israeli violence and is currently living in Norway with his family, having been forcibly displaced from their home many times over.

In June, Khamis visited Scotland to be inducted as a Fellow into the Royal College of Physicians of Edinburgh. I spoke to him about what it meant to receive this honour, the crises facing the Palestinian people and the ongoing situation in Gaza, and how people can help to support Palestinians.

Hi Khamis, it’s great to speak to you! You’re joining us from Norway but recently you were over in Scotland, receiving your FRCPE from the Royal College of Physicians of Edinburgh. Could you tell us what it meant to receive the FRCPE and become a Fellow at the Royal College?

Thank you so much for having me, and thank you for organising this interview. Actually, I was informed about this amazing news 6 months ago when I was back still in Gaza, that I was selected by the Council of the Royal College of Physicians of Edinburgh to become a full Fellow of the College. And that was amazing news, first to maybe pay back some of the sacrifice that we have made to help our people in Gaza. I have been volunteering to serve our people in Gaza City for 815 days during persistent and unprecedented bombardment inside Gaza Strip, alongside starvation and lack of medicine, lack of food, lack of salaries, lack of everything. But despite this, and with the help of our friends worldwide, their sentimental support, their support in every aspect really kept us going inside Gaza Strip.

And when I received this amazing news that I was selected to receive the Fellowship for the Royal College of Physicians of Edinburgh, that really became like a blessing down on my heart that, yes, my efforts haven’t been in vain, yes I’ve been acknowledged by this eminent college. So yes, it was a very, very emotional moment, very happy moment. Particularly when I came in person to Scotland and received the certificate myself in this spectacular celebration, it was once in a lifetime to be in such a celebration alongside my dear beloved sister Mhoira Leng and also Liz Grant, the director of the Global Health Academy. They were among the people who nominated me for this, so I’m really grateful for that and happy for that. It was a great day.

Thank you Khamis, I’ve seen some of the pictures and it looked like a really wonderful day, and we’re very pleased that Cairdeas could be part of that day with you through Mhoira.

You mentioned about feeling that support from colleagues in Scotland and around the world, could you speak a little bit about the sense of global solidarity that you feel for Gaza and Palestine?

Just imagine, you are stranded with 2 million Palestinians in this tiny enclave, and when Israeli forces ask all residents of Gaza City to leave Gaza City, they have to flee under bombardment, under shelling and go to live in tents for more than 900 days. I was among those people, with my family, to be asked to evacuate. But I decided I will stay in Gaza City, there were still 500,000 people remaining there with few doctors, few specialists, few healthcare systems, so I decided I will stay and serve my people with whatever I can do.

And in this time, when you feel you are surrounded from land, air, by bombs and starvation on the ground, lack of everything, and fear. When you receive these calls of support from your friends and colleagues worldwide, particularly my international friends, from Scotland and other places, you feel yes, I am not alone. I have brothers and sisters worldwide who think of me and support what I’m doing and they encourage me to continue. When I hear these words of many of my friends, who tell me they wake up to hear the news that comes from Gaza, and ask those people who are awake, “what happened to Dr Khamis in Gaza City, is he still alive or not?” this means a lot to me and shows true brotherhood and sisterhood from our friends and colleagues worldwide. Scottish people were amazing and are still amazing, great supporters of Palestinian people and Palestinian issues.

Cairdeas as an organisation has been very supportive in every aspect, particularly since we started the integration of palliative care and pain management into the Gaza Strip undergraduate curriculum and healthcare services. Together with Cairdeas, we were able to deliver tens of training courses and hundreds of lectures to medical students from different universities, particularly Islamic University Faculty of Medicine. With courageous support, we have managed to run courses twice online using hybrid teaching for our medical students, and even managed to ask students to visit hospitals and do practical applications of what they have learned with patients, paediatrics and others as well.

Thank you, I know we’re very happy to have done this work with you, and look forward to more work in partnership going forward.

During your visit, you also spoke at the Scottish Palestinian Health Partnership conference, focusing on the issue of traumatic disability in Gaza. Could you tell us about that issue and the challenges being faced?

When people hear about the atrocities committed in Gaza, they always hear about the number of Palestinians killed, number of Palestinians injured. Among the injured, we have more than 43,000, according to WHO, who will live with long term need for medical care and rehabilitation. Among those who need rehabilitation, we have 6000 individuals with amputations, including 3000 kids unfortunately. Children in particular, they need special kinds of prosthesis that need to be remodeled every time because they grow, and what they used to have as a prosthesis before will not fit later on, so they need refitting and reevaluation.

And this conference focused particularly on people with disabilities and people with amputations and how we can move forward. I think this is a very, very vital issues that will affect thousands of people for years to come. Thanks to the chair of the conference, Dr Phillippa Whitehead, who organised a visit to Strathclyde University Department of Prosthesis. We had a closer look at their manufacturing techniques, their equipment, some solutions for how we can deliver these techniques and strategies towards Gaza and serve them.

We can rebuild capacity in Gaza to serve the thousands of patients these, first through training and refresher courses to the current professionals inside Gaza, to give a boost and act now. Second, we need to start short term diploma courses to equip new local champions with knowledge, and they can join the prosthetists available in Gaza. Third, in the long term, is to select two or three among the current prosthetists in Gaza and provide them with a chance to study master’s degrees at Strathclyde.

I was really amazed to see in Strathclyde University that they have a new technology for measuring and gauging the prosthetic size that will fit exactly on the stump of the patient. It will save us a lot of time, money and effort in manufacturing prosthesis that is not the right size. So if we can copy this technology back to Gaza, I think we will save a lot of time and a lot of suffering for those patients.

Thank you, Khamis. For us in Scotland and the UK, the genocide in Gaza has disappeared from our news channels and headlines. Can you give us a sense of the ongoing situation in Gaza and what it’s like on the ground, and in healthcare settings.

Before the war, Gaza was considered the most densely populated area on Earth. Now Israel has destroyed so much residential units, hospitals, primary care clinics, we ended with a devastated strip of land. The people were pushed by tanks and fire and bombardment into less than 30% of Gaza. So the situation is unbearable, humanitarianly speaking.

People are suffering still from malnutrition because the food allowed in is not enough and the quality of the food is bad, it mainly consists of canned food which is not healthy. We need to have free access to food and quality food. We need to have free access to medicine and assistive devices. We need to have reconnection of electricity, Internet so people can survive and we need to start rebuilding people’s homes. So instead of people living in tents under scorching heat at the moment and extreme cold during winter, those people need to regain their dignity and regular way of living, and to consider them as equal individuals as anyone else worldwide. So we need to act and act now.

Still now, over 90% of people are living in tents and shelters, with no education because most schools were damaged, no higher education because almost all universities were targeted, and we are now teaching our students in tents. School children have lost three years of their educational life, there is a generational gap that will affect them for years and years to come.

As for the hospitals, we started to repair some of them. Shifa hospital is now operational in some parts of, especially the emergency department, the surgical department. We also renovated the eye hospital, which was the only hospital serving people with eye problems. The healthcare system is still fragile, but is it better than before during the war.

As I mentioned, humanitarian aid is still below what is needed. No electricity, no clean water, no garbage disposal system, no sewage system management. Now there is an upsurge of skin diseases among children, especially living in this dirty, unhygienic environment. Thousands of patients are suffering from Hepatitis A, skin infections, gastroenteritis, due to contamination of food and water with sewage. So people are still suffering a lot and we need to put an end to this misery.

And on the personal level, I know that some of your wider family are still in Gaza. Can you give us an idea of what their experience is like?

Yes actually, just when we started this interview, I received a call from my brother and he said there is a bombing where my mother is staying with my remaining brothers and sisters. So I had to cut this interview and talk to them. Thank God that they are alive, but the suffering they are enduring in intense.

And you know, I was maybe the only breadwinner, especially for my mother, who is a widow, and for two of my sisters who have no husbands still, they too have lost some of their loved ones. My sister lost two of her children when they were trying to get some food for their families. My brother lost his eldest, he was killed when he was going to the market to buy some food. Almost 75 other members of my close family were killed during this war by Israeli bombing; when they were in their homes, in the streets, in the markets. So the suffering is intense.

And I’m trying my best to extend a helping hand financially to them, because in Gaza there is no work, no nothing. Our main family business has been targeted, attacked completely, so we lost our main furniture factory with upholstery and everything else. Our cars also gone, and our buildings, our houses. My own clinic has been damaged during the first weeks of the war, unfortunately patients didn’t even enter that because it was bombed before it was even inaugurated.

What we say, we say praise be to Allah for everything, because we can do nothing. We know that whatever is happening is a test for our patience and our belief and our sumud, our persistence in the face of atrocities, in the face of hardship. And I hope that once again, Palestinians in Gaza will rise from under the ashes like the phoenix and grow up again and rebuild Gaza.

Yes, we hope that is what will happen, it is a great hope for the future. And then, looking to the future, for people who are reading this, how can they help to support yourself and other Palestinians and people in Gaza.

They can help in many aspects. They can help by sending medicines, by extending humanitarian support, food supply, money supply, educational supply. And also legal supply, in every international setting, including parliaments, city councils, governments, presidents, alliance in every aspect.

People will benefit from every positive move taken to end the suffering of the people, whether it is humanitarian or sentimental or medical, financial or educational. Everything, whether it is personal level, community level or in large scale level, that will help a lot to ease the suffering of the people inside Gaza Strip.

All of this is deeply appreciated from deep in our hearts and our mind. Particularly from me, myself I am grateful for my great friends in Scotland, particularly my dear friends, brothers and sisters from Cairdeas for their solidarity, their support and their love and care. Thank you so much.

Thank you.

We wanted to continue to support Khamis and the people of Gaza, and are hugely thankful to the donors who allow us to do so, and we want to do more. If you would like to contribute, either through a one time donation or a regular monthly donation, please follow this link to our donation page, where you can select Gaza as the cause you wish to give to.

One of the key areas of work Cairdeas has been investing in over the past few years is our scholarship programme in Uganda, through which we have been building up local palliative care leaders for the future. It is a key pillar of our committment to facilitating locally-led development of palliative care in Uganda, and we thank our supporters for helping to fund this programme as part of our ongoing work.

One of these scholars is Elizabeth Nabirye, who is coming to the end of her time as a Cairdeas scholar, studying for her Master’s Degree in Palliative Care. Elizabeth, or Liz as we know her, also works as the Clinical Lead at PcERC, our partner in Uganda. Recently I sat down with Liz, via Zoom, to discuss her time as a Cairdeas scholar and leader at PcERC, her research and insights from working with rural communities, her plans for the future and her exciting new life as a grandmother.

Hi Liz, thank you for taking the time to speak with me today. Our supporters will know that you are one of our Cairdeas scholars, currently studying for a master’s degree. Could you tell us a bit more about the work you’ve been doing, the research, and your experience of being a Cairdeas scholar.

Yes, thank you so much for the opportunity!

I'm called Elizabeth Nabirye and I'm the clinical lead of PcERC, which is the Palliative Care Education & Research Consortium and currently I am finishing up my Master's degree in Palliative Care. I'm glad I got the opportunity to be one of the scholars of Cairdeas and this gave me an opportunity to embark on this insightful and rewarding program. Even when I've spent more than 20 years doing palliative care, there's been a lot to learn from the program. It gave me an opportunity because already I have a bachelor's degree in palliative care and did a nurse prescribing diploma.

One of my specialties during this course has been the paediatric palliative care. There's a lot more to children than just what we think. And so with this scholarship, it gave me an opportunity to learn more about children. It gave me something to think of as a student, as a scholar. What about pediatric palliative care; who is providing it in our country, Uganda, and what needs to be done? I had a lot of questions about children because I'm passionate about them, as a mother, and now also as a grandmother. One of them [my children] struggles with a life limiting condition. So I appreciate and I know what that means for a mother but also for the children.

So when it came to choosing my topic, on what I can study to add value to the clinical practice or to policy, I thought of children. My studies are looking at the nurse prescribers or clinical officers who are in Uganda, who are working at regional referral hospitals, what is their experience [with children], who knows about them? Because the course that is done about prescribing is mostly inclined towards adults, most of the teaching is about adult palliative care. But when you go out to the field or go out to the communities, you become the consultant there and you are expected to be seeing & taking care of not just the adults, but also the children.

And in my experience, as I thought about them, I developed my proposal, got an EDCA approval, and I've been collecting data. It's been amazing to hear from these nurse prescribers in Uganda who are working in the regional referral hospitals. Regional referral hospitals are the big hubs, where complex conditions are referred to from the community, from the district or general hospitals before they get to a national referral hospital where I'm working. And what I've heard from them made me realise that, wow this is interesting, because there's a lot to add on knowledge and also maybe to inform policy in terms of different things that I found out in my study.

So currently, I'm done with collecting data. I interviewed 20 participants from 13 regional referral hospitals across the country. I've been collecting data using recorded interviews, telephone recorded interviews. And initially I didn't think it was feasible, but it's amazing to know how innovation and limited resources can produce good outcomes.

Thank you. That's great to hear. One thing I wanted to ask about was, you've previously spoken about evidence in palliative care extending beyond just the statistics and into the powerful stories of patients and professionals. Can you tell us some more about that?

So yes, the stories are many and palliative care is, just like you put it, beyond the numbers that we see. Beyond each of the statistics, there are lots of stories and most of the times they are challenging stories and this is what keeps us going as palliative care providers.

For example, I'm a mother to a child with a life-limiting condition and because of that, I get sometimes taken up or swallowed up by the emotions when every day I have to listen to parents, mothers or fathers or grandparents struggling with children living with life-limiting conditions. And it can be complex, especially in a limited resource setting.

There's complexity where there is stigma, you find a mother struggling with the child and has been abandoned by the family or the husband, just because this child has a life-limiting condition, or you find some parent has travelled from upcountry, and no one can talk to them because of a language problem.

In Uganda, we get many refugees. Sometimes you find they are by themselves, and even just being there to listen to their story, maybe that's what the best you can do. But sometimes you feel your hands are tied, given their needs, and you can't fulfill all of them.

And sometimes it can be draining, but it can be rewarding; you appreciate the meaning of life, but also you appreciate what people go through. And personally, I would say this kind of exposure, this kind of interface with people who are struggling with life-limiting conditions, whether adults or children, has strengthened my spirituality, has grown my spirituality to know that all these are made in God's image.

But because of our system challenges, you find there's a lot of inequality in terms of services, in terms of what people can achieve. And all this teaches me that every patient, every person is unique in their own ways, even when they have a similar or the same diagnosis.

Even when someone is losing their loved ones, I've appreciated or I've gotten a fulfillment when I hear someone, who lost their loved one, but they benefited from my services and or from the palliative care services and they appreciate even after the loss. Sometimes patients leave the hospital and die from home and then the family call you just to inform you that ‘my mother passed on but thank you so much.’ That alone keeps me going.

And if you can, would you be able to share with us one of those stories that's really shaped you or shaped your perspective over the years?

One particular case that really touched me was a case of a mother who I met with a child who was struggling with HIV and cancer, and the child was in a lot of pain.

This child had just lost a dad, and the mother had another two children, but the family had abandoned them because one, they were HIV positive, the child and the mother, but two, he again got cancer, so it was a bit complex.

After managing his pain, we asked this child if there were any questions he wanted to ask. And we were amazed by his questions, it was an eye-opener when it comes to communicating with children.

One of the questions that this child asked was, if it is painful when people die, whether it hurts when you're dead. And then he also asked, where do people go when they die?

This was a nine-year-old, but because of the illness, it seemed like a three or four years old. So when asked about whether it's painful, the obvious answer of me as a health care worker or as a care provider is the quick way of saying it is not painful.

And again, he asked about ‘where do people go?’ And the obvious answer is that the teaching from Sunday school, if you're a Christian, is that people go to heaven when they die.

And then he asked another question, whether his mother would be hurt when he dies? And the obvious answer was that, of course, when people lose their loved ones, they feel bad, they get hurt, they feel pain.

And then this child shook his head and said, “You're lying.”

And for me that was like, ‘excuse me, what do you mean by we are lying?’ And he said, “Are you sure when people die they go to heaven?”

And he just shared his experience. He said in his small voice, low tone, that when he lost his dad, their dad was wrapped in a cloth, and then they dug a pit and they lowered him there, and poured in soil and stones.

So, that had two folds. One: is the way to heaven underground? Because his father was buried in a grave and they keep telling him that the father went to heaven. But also his imagination is that if you're hurting now and then you die and they put you in a pit or grave, and they pour on soil or stones, it must be painful. And with that, his request was, when I die, can you buy for me a metallic box?

So for me, that was one thing that just opened my mind when it comes to communicating with children.

The other question was when he asked if the mother would be hurt [when he died] and he didn't think so because most of the times his mother keeps telling him ‘you're not dying, you're not getting better and I'm struggling. I've struggled to buy this expensive medicine and you vomited it, I've given you food and you refused to eat.’ So to him that meant that the mother will celebrate when he died.

And so what this story taught me as a clinician, it taught me that we just need to know the language, know what the question is about that our patients are asking, because we got it all wrong.

Sometimes patients ask us, am I going to die? And we are quick saying, no, we are doing our best, but when actually they are going to die or they just want information to plan, to make decisions about whether they should take the patient home and we fear to open up and talk about prognosis.

Human beings are individuals, and what that child asks, maybe it would be different from the needs of another child. So what I learned from this case, what stuck in my memory is, ‘when people ask us questions, why are they asking us? What exactly do they want?’

Well, thank you very much for sharing that. That story certainly highlights that we do learn as much from the mistakes or when we get things wrong as we do from the teaching and the successes as well.

And then also reflecting on your studies, I know you've spoken about wanting to publish findings that highlight rural perspectives on paediatric palliative care. Could you just tell us a little bit about your experience working alongside rural communities and the particular challenges that they face?

One of the things, the biggest challenge, is the resource limitation. And you find, especially when it comes to children, these are minors and the decisions are made on their behalf. When they get sick, it's not them to decide whether they should come to hospital or not. They are dependent on adults. In the community, there are many needs. There are many issues. One of them is their beliefs. You find there are a lot of beliefs in the community or society about illness and about death.

So you find when someone has a life-limiting condition, whether malignant or neurological, things like epilepsy or cardiac issues, you find that the first thinking of the parents or the community is traditional medicine or witchcraft. So that alone delays access, or delays people seeking medical intervention or seeking medical help and making it worse.

The limited resources you find that in that community, the nearest health facility could be maybe 20 kilometers. But the traditional healers or the witch doctors, they're easily accessible. So most of the time, those are the first people that the sick will go to, whether a child or adult. Because of the distances they have to travel, and when they do get to those facilities, there is a limited resource in terms of human staffing and so sometimes they have to move around a hundred kilometers to get to somewhere where they're going to get a clinical officer or a medical officer who is going to do a proper assessment and get them treatment.

So whether before diagnosis or even after diagnosis, you find that working in a community is emotionally draining because sometimes even when you know what you're supposed to do for the patient, you cannot do it.

For example, currently I work in Mulago, and I'm called to see a patient and then I assess them and do end of life care counseling and ask them whether maybe home would be the best place, and they can decide they would want to go home.

But they're going into the community where they cannot even access morphine, for example. And even when they are dying, they have the right to pain control, but they can't access that. Also because of the fact that the family or the community knows they are dying, sometimes they don't think they need care, in quotes, I would say they call it wasting.

And because most of the palliative care trained specialists are in the hospitals, or they are not in the community, or they cannot even afford to do home-based care. So you find a patient whose symptoms were managed or controlled in the hospital, they die [in the community] without dignity, with a lot of suffering.

And this impacts on not just the patient, but also the family. Because sometimes I get phone calls where they will say, the morphine got finished, for example, and we couldn't access it anywhere, and they wouldn't travel back. But also, their only wish or prayer was that they were glad that their loved one died, because that was the only way to relieve their suffering. And to me, that is terrible, I would say.

For example, when it comes to the roads, sometimes I've had to counsel families to allow the patient to die in an urban or hospital setting. Just because of their condition and how they're going to travel on the roads. Everyone doesn't own a car in Uganda and a patient cannot sit on a bike, but their home is not easily accessible.

There's a lot to be done, not just by the palliative care specialist, but there are system challenges. I mean, we need a lot of things where someone will have a choice of where they want to be cared for or where they want to die from and die with dignity and they get all that they need.

Because sometimes people have had to travel many kilometers from their community to the hospital to emergency department. Not because they expect miracles, but because they can no longer just watch their loved ones there. So even when they know they are dying, if they love them, they'll still rush to hospitals, so the patient dies where maybe they'll be able to get symptom management.

Yes, those are some really difficult challenges for those communities. And thank you again for sharing.

So we've spoken a bit about your experience as a scholar and your studies, but also, you work as a clinical lead for PcERC. Could you share with us where these two paths have met, where the scholar and the practitioner paths have linked together and how they impact on each other?

Like I mentioned before, going back to school to do this masters as a Cairdeas scholar was exciting and was a way of developing not just my professional development, but also personally.

And as a leader, there is a lot of learning. There's a lot of teaching about leadership, because at this level, it's not just about the clinical care, but other things that are taught there.

So one good thing about being both a clinical lead and also a scholar is that I'm involved, I'm placed in a clinical setting and some people don't have that privilege. They have to go from their workplace to a different place, to get the practical experience. So I've been lucky that what I learn, I can practice.

And also, I'm able to pass on the knowledge, and also to see things in a reality. What has been taught, or what I've been able to learn. I've learned that, for example, I can give an example of being a clinical lead, and also being a scholar.

So even when it comes to resources, like appreciating or delegating, I'm able to say as a lead, maybe like when I was requesting for my study day or my time, is to know that the work will be done, can I learn to delegate, can someone else do what I'm supposed to do?

But in the process, because you are both a student and also a leader, then by default you have to learn certain things. And with that, then I can talk about what does it mean being a leader and being a student? So to me, it's rewarding, but also demanding, I can say.

And it's rewarding, especially when you're putting what you're learning in practice and when you see value and relevancy of the competences you're acquiring.

That's great. Thank you very much. So, your studies are nearing completion, I think you're finishing in in August this year.

What is it you're looking forward to or most excited about as you move on to the next stage of your learning or your career in palliative care?

One thing I've noted about palliative care is that everywhere there's need for training. And I think after my masters, I need to be thinking whether I can do a PhD or a fellowship, because there's still a big knowledge gap.

So one of the things is like, how do we pass on the knowledge that we have? Because that is the way to sustain palliative care, to educate and train.

Even when you're teaching, yes we need to teach basic palliative care, but also advanced palliative care so that people are able to advocate. And also, we need to keep that confidence of being able to inform at a policy level.

The other thing is that we need evidence. This study that I've just done, when you go to literature search, you'll find there's a lot of information. But is it in the context? Is it local evidence?

So there's a lot to prove to the people we are advocating to, the policy makers, that this is here with us and these are the facts. We need to do more research or do things that really relate to our settings, especially resource limited settings, because there's a lot of literature, there's a lot of research on what has been done in developed countries, and unfortunately, it's not a copy and paste. And policymakers need evidence that is local, and specific to the needs of the local area.

Yes. Well, that's great. We’re excited to see where you go next. A PhD sounds like an exciting plan!

Thank you for sharing all of this with us Liz. I just wanted to finish on this, we know that you've recently become a grandmother for the first time with two new grandchildren! How are you enjoying that and how are you adjusting to life as a grandmother?

Yeah, it's exciting because I used to see my own grandmother as very old!

It was exciting, first of all, seeing the children, they've been babies and most of the palliative care fraternity know about my children. I joined the palliative care when they were still small and they've seen them grow.

And it's been amazing just to know that my son is married and has a baby. Of course, it comes with all its demands because when, like, for example, my daughter-in-law was big, was expecting, there were a lot of things that come with pregnancy and when they came to that time of delivering the first grandchild, she had had to be delivered before term.

And then when I came in as a mother, but also as a counselor, because there were many questions. What does it mean having a seizure? What does it mean to become weak?

And there was a lot of allaying anxiety and giving information because my son, he chose to go with the wife to theatre. So I first had to explain to her what to expect, to him what to expect. And for him, he just felt he needed to be there with his wife to support. But then eventually he collapsed while in theatre.

Oh, really?

I know. (laughing) During the c-section.

But the good news for me, what I appreciate, was how supportive he was to his wife, but also the fact that he got all the information that he needed before he made that decision.

And yeah, so it was a bit excited because I've been in school, I've been a lead and then I have two expectant mothers that really are close to me. I don't call my daughter-in-law a daughter-in-law, I call her a daughter-in-love. And I don't even think of laws because I've told them it's not about law. It's interesting because when people come to marry, they ask to be part of the family. They should be children in the family. So I'm like a mother of twins.

The first set is the son and the wife, and the second set is my daughter and the husband. And now both of them, they are pregnant, one following the other. It’s one of these things that  you look forward to, but now you also think, as I graduate, these small babies, what will they be?

My colleagues were with me in the hospital when my daughter had just delivered. It was delivered from a near hospital. It's not just about me, it's about the whole palliative care fraternity. They attended like my daughter's function, marriage function, wedding.

So being a jajja (Ugandan term for Grandparent) is like someone who, it is expected that you should be now taking care of the grandchildren. But you are in school, and you also think of being a lead, so I've had three major things that I just did not compromise. I think a jajja is a given, but yeah, I also have those other responsibilities.

So it is interesting because even when I'm taking care of the grandchildren, when they visit me, I have to put aside everything, whether academic, but also my team has been understanding. Like now I have, if I left early, then they would know this is the jajja is going to attend the grandchild.

And children are small angels. And I'm passionate about children. It's been timely because my boy and girl, they would tell me, you are the pain specialist, and can we give morphine, of course, making a joke, making a big joke of me. (laughing)

Of course, these are my children. I look at you and say, wow, it's been a journey. And now here we are.

Well, that's amazing, Liz. Thank you very much for sharing everything today and taking the time to speak with me, I really appreciate it.

Thank you, it's been a pleasure.

We would like to thank Liz again for taking time out from her busy schedule of studies, work and helping with grandchildren to speak to us. We want to continue helping to build up palliative care leaders like Liz, to continue to invest in palliative care in Uganda and help to solve some of those challenges spoken about.

We can only do this through support from donors, who allow us to fund scholarships and invest in the in-country leaders who can advocate for locally-led, sustainable palliative care. Please consider starting or increasing your donation, which you can do by following the link below, thank you.

One of our graduate scholars, Toko Friday Santiago, travelled to Botswana in September for the African Palliative Care Conference, presenting some of his research work on social protection issues for refugees. We were delighted to sponsor this opportunity for Toko and current Cairdeas scholar, Phillip Amol Kuol, who both hold such great passion and desire to give back to their communities. I asked Toko to share his experience of the conference and sharing his research, and how opportunities like these help with his continued professional development.

In September, I had the privilege of attending and presenting a poster at the African Palliative Care Conference held in Gaborone, Botswana. The conference brought together healthcare professionals, researchers, policymakers, and advocates from across Africa and beyond to share knowledge and innovations aimed at improving palliative care services. For me, this experience marked an important milestone in my academic and professional journey as an emerging researcher interested in issues of vulnerability, health equity, and social protection.

My poster focused on exploring the factors that promote social protection among the refugees in Palorinya Refugee settlement.  Refugees often face numerous challenges including poverty, trauma, limited access to healthcare services, and social exclusion. In such circumstances, social protection mechanisms such as community support, humanitarian assistance, and inclusive health programs play a crucial role in addressing both the health and social needs of these vulnerable populations. 

Preparing the poster was an exciting and challenging process. Translating research ideas into a concise visual format required careful thought and creativity. A poster presentation must communicate key findings clearly and quickly, often to audiences from different professional backgrounds. I had to think critically about what information was most important and how best to present it in a way that could spark discussion and interest among conference participants.

Designing the poster also pushed me to develop new communication skills, learning how to balance text, visuals, and data so that the message remained clear, engaging, and accessible to a diverse audience. This experience helped me appreciate the importance of communicating research in ways that are both informative and visually appealing.

The poster session was one of the most memorable parts of the conference. Researchers, clinicians, and policymakers walked through the exhibition area, stopping to engage with presenters and discuss their work. Standing beside my poster, I had the opportunity to share the motivation behind the research and explain why social protection is critical for refugee populations.

Many participants expressed interest in the topic and shared their own experiences working with displaced communities in different parts of Africa. These conversations were particularly meaningful because they highlighted how the challenges faced by refugees are shared across many contexts on the continent.

The discussions that followed were incredibly enriching. Participants asked thoughtful questions, shared insights from their own work, and reflected on how similar approaches could be applied in other settings. These conversations highlighted the growing recognition of the need to address social determinants of health within palliative care.

Presenting at the conference was a deeply rewarding experience. It challenged me to step outside my comfort zone and engage with an international audience of experts and practitioners. Interacting with professionals from different countries and disciplines broadened my perspective and reinforced the importance of collaboration in addressing complex health and humanitarian challenges.

One of the most important lessons I learned was the value of dialogue and knowledge exchange. Conferences such as the African Palliative Care Conference create opportunities for professionals from diverse disciplines and regions to learn from one another. Through these exchanges, new ideas emerge and innovative solutions to complex health challenges can be developed.

The experience also strengthened my confidence as an emerging researcher. Sharing my work on such a platform affirmed the importance of research that highlights the needs of marginalized communities, particularly refugees who often remain underrepresented in health discussions.

Participating in the conference has inspired me to continue exploring ways to strengthen palliative care services for vulnerable populations. There is a growing need to integrate social protection, community support systems, and culturally sensitive care approaches into health programs that serve displaced communities.

As Africa continues to face humanitarian challenges and population displacement, it is essential that health systems and social services work together to ensure that no one is left behind.

I am deeply grateful to organizations such as Cairdeas International Palliative Care Trust that supported my participation in the conference. Opportunities like this not only contribute to professional development but also help amplify important conversations about health equity, dignity, and compassionate care for vulnerable populations.

Attending and presenting at the African Palliative Care Conference in Gaborone was an unforgettable experience. It reminded me that research is not only about generating knowledge it is also about advocating for change and giving voice to communities whose stories deserve to be heard.

Thank you to Toko for sharing your experiences at the APCA conference, and for the wonderful work you do helping refugee populations. We are excited to see your work continue and grow, making a difference to those who need it most, and promoting the expansion of palliative care in Africa.