We have been privileged to welcome mentors to Uganda as part of a Nurse Leadership Development programme which is supported by a partnership led by the University of Edinburgh and Makerere University (Palliative Care Unit) and funded by UKaid (DFID) through THET. Berit came for several months and contributed to the life of the MPCU team as well as her specific mentees. Here she talks of her experience.

'The opportunity to work in a completely different environment came right at the end of my working life. I have worked as a specialist palliative care nurse in London since 1989 and have retired three times! On my retirement from the NHS I said that my dream was to work in Africa.  I never thought the dream would become true.

But here I am in Kampala. It is certainly both a professional and personal challenge. At a personal level it is about daily living – shopping, travelling, risk taking, being in a minority, time keeping and just being here without my family. At a professional level there is a range of challenges, such as the balance between being supportive and paternalistic, adapting the UK knowledge and experience with so far only quite a superficial understanding of the Ugandan reality.

It would be easy to focus on the lack of resources, training needs, perceived inefficiencies and lack of planning.  However, as we talk about shared learning in mentorship relationships I would like to reflect on the learning I can bring back to the UK. I will leave the personal learning aside in this blog. Maybe in my next blog?

I strongly feel UK nurses could learn a lot from the Uganda. I am so impressed with the knowledge and experience the specialist palliative care nurses have of research, presenting papers and posters. In the UK we often say we don’t get the time to do this, but it is clear that it is a question of priorities. As many specialist nurses in the UK feel that there is a lack of career progression this could be a way forward. The investment in staff training and support in palliative care at all levels is remarkable.  You visit a small hospital far from Kampala. The palliative care office is the size of a cupboard and there are the palliative care training certificates of the staff on the wall!

The nurses also have a huge sense of pride in their work. One particular image comes to mind of a palliative care nurse in small hospital proudly showing us the locked wooden cupboard for the morphine. Their resilience to work with  limited resources with patients who are very ill, far from hospitals is outstanding.  As a visitor you think the presenting patient and his/her needs are overwhelming, but after a consultation with the palliative care nurse you realize that a lot can be done and you see the relief of the patient and the family. This could be prescription for morphine, information about the illness, support available at home.

Finally, and I never thought I would say this as a nurse without a faith, but the prayers and in particular, the singing at the beginning of a working day or meeting is powerful. It gives you time to reflect, focus and feel part of that particular group.

A big thank you to all the nurses, clinical officers, doctors and volunteers I have met in Uganda.'

Thanks so much Berit; haste ye back!!!

Aicha is a nurse who works part-time in the palliative care project in Mauritania, West Africa. She visits patients in their homes, helps to train others and is a local advocate for palliative care. She also works as a dialysis nurse in the renal unit of the National Hospital. 'I have worked for Cairdeas Sahara, the Cairdeas project in Mauritania, for around one and a half years. I have learned a lot of things in this time and I now think of others as I have never done before. We, as a team, work hard to reduce the pain of patients and their families. It is a privilege to be present in people’s lives at the moments when they have need for palliative care. The relationships I have with my patients are more personal than ever before. I have learned how to relieve suffering of the patient and their family. I accompany the patients until the last moments of life, all the while striving to reduce their pain and comforting them in all ways possible. I have learned much about how to appropriately advise people to reduce them wasting their money on pointless acts concerning their health. We comfort them and teach them how to live with one another. We give a helping hand to the family when there is need. Before our involvement, they were isolated because of several factors - many of these reasons are because the others do not understand the illness and are frightened, or because of the nausea inducing smells. We re-establish the position of the patient in their family and community. This means to explain their condition according to what they want to know and in a way in which they can understand and accept. We try to teach the family how to cope in difficult situations, and sometimes just treating the smell of the wound can change their whole situation in the family.'

Mauritania is located where the Sahara desert meets the Atlantic ocean and it wasd a pirivlege to visist Dr Dave Fearon and the palliative care team earlier this year. It is a resource poor country and is four times the size of the UK, with a population of 3.5 million. As part of the partnership between Cairdeas International Palliative Care Trust and the Mauritanian association ‘ASSIDE’, a recent grant from THET has facilitated palliative care training events. Twenty-five health care workers travelled from the interior of the country to the capital; the furthest distance travelled was 680 miles. Ten of these participants were selected to stay for a second week to be trained as partners. The training was interactive, with a mix of short lectures, small group work, interactive activities, role play, video recording and playback of communication skills, and visiting actual palliative patients in their homes. Here is a quote from one of those traiend '‘Before the training I thought I was good at communicating with my patients, rating myself as perhaps 9 out of 10. After watching the video recording of my role play, I realised that I was really only functioning at around 4 out of 10.’

Great work being done and we will have more information and stories from Mauritania in the future including some fascinating anthropological studies. Check out the facebook page Cairdeas Sahara.

              Over the summer I took the unusual decision with my girlfriend to travel to Uganda and volunteer. This was something Lucy had thought about for years but was new to me. I assumed IT skills weren’t in the skillset of a volunteer in Africa, Lucy’s medical training being more of the stereotypical CV. Nevertheless I was encouraged that IT skills would be of use to the Palliative care charity Cairdeas we were going to work with.

              I spoke with my managers and received support to apply for a leave of absence and to enjoy my time in Uganda. We began saving and paying for inoculations in preparation for the 7 weeks in Africa.

                We arrived in July and our first impressions were getting picked up at the airport and the chaotic drive to Kampala, I had never seen, and probably won’t see, traffic as bad as Kampala’s traffic. Any odd ideas like “giving way” or “queuing” are clearly not on the driving test here. We’d soon get used to it though and were driving Ugandan style to work most mornings.  Cairdeas aims to build a Palliative Care capability in developing countries, this was a great thing to be part of as I felt the team was making a lasting difference rather than a stop gap solution.

                I was mainly organising the relaunch of this website which had been down for a relaunch for over a year. I spent much of my time in the office at the hospital working on the website or helping the nurses with their smartphones or PowerPoint, but on my last day in the office asked one of the volunteer coordinators Ivan if I could join him on a walk around one of the cancer wards. In Uganda most personal care for patients in hospital is actually performed by a friend or family member of the patient, 24/7. Most of the attendants sleep on the floor of the ward or under the patient’s bed. Nurses work across large wards and spend much of their time assessing symptoms and providing medication. The volunteers are people from the community who want to help patients who may not have someone to attend for them or need help getting prescriptions. These volunteers were the most inspiring thing I saw whilst I was there, they did so much good by listening and comforting the patients. It was truly humbling to see their dedication.

                The health system in Uganda is limited by the standards I was used too, there were some free drugs available to patients but only a limited selection and a lot of pressure is put on the patient and family to come up with large sums of money for treatments. These commitments to treatments could often bankrupt families when terminal or long term illnesses were diagnosed. I found this so sad, especially when put into context by the corruption stories we would hear from the locals. The corruption in Uganda has got to such a stage that aid is delivered direct to not for profit organisations rather than to the government.

                Looking back on it all I feel the best investment Lucy and I made and probably will ever make was the time we took to go to Uganda and to work with the talented and dedicated people of MPCU. We spent time working and teaching some brilliant people who will continue doing brilliant work whilst we are back at work in the UK. We saw lots of what Uganda had to offer, including a safari in Murchison Falls National Park and a trip white water rafting down the Nile.  I would encourage anyone to take the opportunity to invest your time in something new, challenging and truly worthwhile.

                As I type this back at my desk after our trip, getting used to the 9 to 5 and loving my bike ride to work again,  I know that I’ve learned and experienced so much that will benefit me, and hopefully left some more IT literate nurses in Kampala! I'd like to thank the amazing MPCU team for being so welcoming. For anyone interested in knowing more about the work Cairdeas does, please look around the site and contact us.

Cheers, John