At this time of the year in the UK the nights are ‘drawing in’ and there is the white sparkle of frost in the mornings. The season of Advent has started and Christmas soon to be celebrated.

Yet in Bethlehem, at the heart of the Christmas story, the celebrations are cancelled this year. Across this beautiful land people are in fear, sorrow, and pain. We sing the beautiful hymn O Little Town of Bethlehem whose words seem so apt right now: ‘Yet in thy dark streets shineth the everlasting light; the hopes and fears of all the years are met in thee tonight.’

Very movingly Rev Munther Isaac shows us the nativity in the Lutharan Church in Bethlehem. A baby in a manger but in the ruins of a bombed building, separated from his parents. The shepherds and wise men cannot approach. God is under the rubble and it is from this place of real suffereing and anguish that we cry out for hope at this Advent time.

Our focus in Cairdeas is in Gaza, where we have been working with partners for 10 years, and on the unfolding horrors of the humanitarian crisis.  We should have been there celebrating the graduation of the very first Professional Diploma in Pain and Palliative Care at the Turkish Palestine Friendship Hospital as well as our annual course for undergraduates within the Islamic University medical school. Instead we hear from our colleagues and friends increasingly awful and at times desperate message which can’t begin to contain the horror and loss. You, perhaps, have been finding it difficult to watch.

Listen with me to our palliative care colleagues and hear their words as I share some of the realities on the ground. I have also worked with our International Faculty to write a Statement of Solidarity and you can see the detail below.  This is a personal statement from colleagues and not organisational.

Now the cancer hospital is closed with a small number of children being evacuated but for the majority there are no treatment options. Analgesia is almost absent for chronic illness but also for burns and crush injuries. Disease outbreaks, starvation and unclean water are causing outbreaks of disease and reveal the unfolding public health disaster.  Public hospitals remain in southern Gaza; European Gaza Hospital and Nasser paediatric Hospital; both vulnerable to the resumption in bombing.

The courage of our healthcare colleagues is humbling. Many have moved five or six times to try to stay safe and many have lost their homes. All have lost family members, and all are trying to balance caring for their family while continuing to offer support for patients.  

Our colleague, Dr Hamman Alloh, a nephrologist, spoke in an interview of why he is staying with his patients - ‘What would happen to my patients? We are not animals that do not deserve healthcare. Did I train for 14 years in medical school and speciality training to abandon my patients now?’ This was Dr Hammam’s last interview before he was killed in his home by a missile strike. His head of internal medicine at Al Shifa Hospital, Gaza’s hub for healthcare, Dr Rafaat Lubbad, an inspirational colleague who was an advocate for palliative care, was killed shortly after along with his family.  
We are losing the healthcare wisdom of the past, the leaders of the present and the promise of the future.

Dr Khamis Elessi, the lead for palliative care in Gaza and our dear Cairdeas partner, published a letter in the Lancet in the first week of this crisis, warning of the grave consequences we are now seeing - ‘If the massacre continues on its current path, we will be dangerously close to witnessing a large-scale genocide of civilians and patients. I am a doctor in Gaza, and I want to survive for my family and for my patients.’

Our palliative care colleagues continue to send messages from Gaza when they can: 

‘'We are physically ok, but mentally and emotionally so far from being alive. We die hundreds of times every day. Each and every one of us has lost at least a relative, a friend, a colleague or more. God help us all.' Doctor.

‘The situation here in Gaza is worse and more difficult than what is reaching you. The occupation demolished homes, streets, schools, hospitals, churches, and healthcare centres.  They cut off electricity, water, and all the necessities of life. My hope is to die with all my children and not leave them and them not leave me. I cannot live without them, and I do not want to die and leave them here in this unjust world.’ Cancer nurse.

‘Unfortunately, we are on our way to collapsing from the horror of the scenes we see, despite our strength; but it is beginning to fade and the world is watching as if we were in a movie theatre showing a horror movie and the viewers are silent.’ Paediatric doctor. 

‘We need you and your colleagues to reach our scene of massacre to all the world. We trust you. Please be our voice outside. Gaza, the beautiful city which you knew and loved, it has become city of ghosts. All its buildings, streets, schools, trees completely destroyed. We are without any life support, and supplies. Many people are still under the collapsed building ask for help, many health workers are killed while they offer their duties.  ‘The world became blind and deaf to our suffering. We don't ask more than life with peace and dignity like all people over the world and to be considered human beings.’ Pharmacist.

You can see the request from our group of Gaza clinicians by clicking on the link HERE. 

As I write this I am reminded once again of that great Advent hymn ‘O Come O Come Emmanuel.’ Sung in some form for 1200 years with a Latin form in the 12th century and this version written in 1851. It has inspired many down through the ages with its message of hope, its message of the presence of God in our times of trouble and in our times of joy, of peace and justice for all.

I will be singing these words more fervently than usual and wishing each of you joy and peace at this in this season and hope for 2024.

O come thou Dayspring from on high, and cheer us by your drawing nigh. Disperse the gloomy shadows of the night and deaths dark shadows put to flight. Rejoice, rejoice Emanual shall come to thee.'

“O come, O King of nations, bind in one the hearts of all mankind. Bid all our sad divisions cease and be yourself our King of Peace.” (O Come O Come Emmanuel)

Cairdeas International Palliative Care Trust is pleased to offer scholarships to partnering individuals and we currently have four Cairdeas Scholars. Hear more about each of their progress and their update below!

Godfrey Oziti
Studying a Diploma of Nursing in Gulu, Uganda

I am so delighted to talk and share some updates on my school! I am in the second semester of nursing and passed all my classes well last semester. In this semester, there are several topics to cover and papers to write and one of the topics is palliative care. We have also been covering community-based healthcare, primary healthcare, disaster management, and some occupational healthcare. Four of the papers that I have been writing are based on these theories, and the last paper is practical. It’s been wonderful to formally study palliative care, to better understand it as a whole and add to what Vicky Opia has taught me at Peace Hospice Adjumani. 

Much of our palliative care course contains what we taught to the Village Health Teams, the VHTs: kinds of chronic, serious illness, holistic care, pain and symptom management, and communication like breaking bad news. I led my group members in being able to assess pain. One of the core palliative care instructors is a preacher as well, and he has taught me about assessing and addressing spiritual concerns in end of life. He gives us many “real life” examples in his teaching and has helped me better understand the role of spirituality in palliative care. 
So really, I am really, really excited to be in this nursing programme; to go to school and gain knowledge. The knowledge that I am adding on now, is what I will bring to the community. I want to give special regards to Cairdeas IPCT for this scholarship. And after the end of this semester, by the second week of December, I will be going back and working at Peace Hospice Adjumani during the holidays.

Phillip Amol Kuol
Studying a Bachelor of Social Work in Arua, Uganda

Since our last communication, I have completed the Diploma course for social work and administration, and so I am now in my first semester as a Bachelor’s student. Let me explain quickly: for students without any diploma, their Bachelor degree would be three years, but since I was able to study for the Diploma with a Cairdeas Scholarship, I am halfway through the Bachelor’s degree. Now that it has been some time after COVID-19, the university is no longer offering online classes. I now live in Arua and attend all my classes in person.

In my classes, I am finding that some of the examples given where social workers are needed touch me personally. Either in my own experiences or experiences in the community; these familiar textbook examples remind me that I am part of humanity and also makes me remember my life in South Sudan. Social workers are needed for so many South Sudanese people; due to the war there, we now have so many different crises, suffering and abuse in our community [including refugee settlement camps]. Social work also addresses and touches the way people behave, including how we are brought up and what influences us to live certain lifestyles. I see the effects of war in our communities from issues like bankruptcy, cattle stealing, and domestic violence.

The way that the Cairdeas team has supported me makes me want to support others. It began when I was in Nyamunzi Camp in Adjumani, supporting clients with chronic illnesses and working with Vicky Opia, Dr Mhoira Leng, and Godfrey Oziti in palliative care. Helping others also has led me to join an organisation this year, a community-based organisation (CBO) called Dongriin Foundation which has the main activities of supporting education and providing mentorship to the youth in refugee camps. And so that is why I continue to say that the way Cairdeas has supported me, I want to support others; through providing guidance, mentorship, books and when possible, with finances. 

Toko Friday Santiago
Studying a Masters of Social Work in Kampala, Uganda

How are my studies? I am doing well, I passed my first semester and now I am in the second semester. School is really about hard work and reading hard, and it has helped me grow in my knowledge base of social work and has given me some skills. An example is with the monthly social work reports I write for PcERC; I’ve discovered a more efficient way to report our social work activities from my classes.

Currently, my studies have given me some input on how to approach children on the ward [both paediatric patients and young family members] and one item of interest to me is play therapy. Another area of interest is advocacy in social work and how to support human rights. I am very interested in advocacy and would like to find more opportunities to do so in the team. I feel like in my undergraduate studies in social work, everything was so compressed in our syllabus, but with my Masters, I have been able to explore and go deeper in class. 

The PcERC team has been helpful and flexible with giving me times of study leave, as well as time to go complete my exams. I have been able to balance work and school. I am grateful to Cairdeas for the scholarship and this opportunity to study social work at a postgraduate level. I also want to give thanks to God; without God, things would not have been possible. While it is not always easy to juggle work and school, as well as other pressures in my personal life, I am encouraged by the work. Seeing the connections and areas of need gives me resilience and the desire to keep doing what I am doing. In my Masters of Social Work, I have realised that I am the right person for the social worker’s role.

Vicky Opia
Studying a Masters of Public Health in Gulu, Uganda

I am in my first semester and my studies are going well. During the weekend classes, we have been studying areas like research, biostatistics, epidemiology, and public nutrition. My papers and work completed so far are receiving good marks, and I am eager to incorporate issues related to prevention at Peace Hospice Adjumani. I am interested in prevention especially in the communities we work with in home hospice care, as I have been observing similar factors in some of the chronic illnesses presented, including cancer. Peace Hospice Adjumani and my studies are also correlating in an area of my course research, where I am planning a research methodology in refugee and host communities. 

The last few months have been so busy. There has been partnership work we’ve been doing with the Ministry of Health (Adjumani Hospital) and with Peace Hospice Adjumani to provide community health. I am also a Rotarian, and so we are planning a cancer run on November 25 as a Rotary Club. This cancer run is to raise awareness, support current patients with cancer and their families, and to fund those who need to travel to Kampala to visit the Uganda Cancer Institute or Mulago Hospital. In addition to all this, we are still keeping in touch with the Village Health Teams (VHTs) that were trained in palliative care. We invite more partnerships and activities in the future, and are so very grateful for the support from Cairdeas IPCT.

Inspire, Empower, Influence and Transform: this is the approach to mentor the next generation of palliative care leaders in India. In the above video for the October 2023 "Cairdeas Gathering," Dr Chitra Venkateswaran, Cairdeas IPCT Lead in India introduces the fellowship plans and work completed by herself, Dr Mhoira Leng and the rest of the steering group. 

Alongside partners Believers Church Medical College Hospital (BCMCH), Global Health Academy (University of Edinburgh), Indian Association of Palliative Care (IAPC), and the RMD Trust, Cairdeas IPCT is proud to support this year-long advanced leadership programme. 

Planning for the programme is quite well underway. In person meetings were conducted over the first week of October to finalise all content details and logistics. This has lead to an agreement with BCMCH to host the in person trainings for the fellowship, providing fellows and faculty with accommodation and a meeting hall.

The curriculum for the programme has been designed and tested in other international fellowships by steering group members Drs Mhoira Leng and Chitra Venkateswaran. Currently, there is a call for applications, from now until the 7th of December, for those practicing palliative care in India. 

Cairdeas IPCT will be supporting the programme in purchasing assessment tools, assisting in faculty travel logistics and providing administrative support. 

The Fellowship is scheduled to begin with a week of intensive training at BCMCH, Thiruvalla, Kerala from February 18th to 25th, 2024. There will be follow-up online sessions every month, and another in person training in February 2025. Mentors will guide the fellows and work together online and in person during the fellowship.

For further information, please visit the IAPC website for a detailed course description, official letter, and brochure. You can also email the fellowship administration team at clfellowship.india@gmail.com.