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Angels

Dr Mhoira Leng
26th December 2013

What has been the best story for you this year or in your family and country? People who bring news are important and in the Christmas story angels play a significant part. They announce the message of the coming baby to Mary and to Joseph, they told that this baby would be the saviour of the world, they then announced to the whole world in a heavenly choir the great news , peace on earth and goodwill towards men.
I have been thinking about the message of the angels and also how angels can become a symbol of hope and protection. I am sitting on Christmas eve on a balmy evening looking forward to a warm, tropical Christmas without the crispy snow and frost that is so familiar in Scotland. I hear this year there are even storms and severe weather. But then that first Christmas there was no snow, despite our many Christmas cards carols that say otherwise.
I have a banana fibre Christmas tree hung with African angels and several other beautiful angels made from local materials including bark fibre, safety pins and local fabric. We also have shared beaded angels on our Cairdeas stalls for some years made in South Africa and Uganda. 
There have been some precious stories of ways these simple symbols have represented love and care. One of my friends showed me the wee angel I had given when her husband was dying. She has carried in her purse as a reminder of God's care for several years. Another friend shared how her very sick friend asked to her to give an angel to each of her family so they can hang it on the tree and remember her.
We had a party with our patients at Mulago last week and so enjoyed singing in several languages, eating cake and piled high plates of Uganda food. I was sharing one of the names given to Jesus and often given as a name to boys here in Uganda. Emmanuel which means God with us. This was the profound message of the first Christmas. it is also the amazing message still here today. My Rwandan colleagues then spoke of us being little Emmanuel. Being the presence of God in each other's lives and in the lives of those who have little good news and even less peace. We think of our brothers and sisters in South Sudan and Syria and many other places of conflict this Christmas. We think of the many people ill in hospital or at home, those who are missing loved ones, those who do not have food or clothes, who do have choices over their lives.  Many of us will have an symbolic angel in our homes or on our Christmas trees this year. Perhaps we can take the good news the angels sang to heart and let it change our lives but also let it change how we relate to the world around us.  As one of the greatest global leaders said; 'Our human compassion binds us the one to the other - not in pity or patronizingly,but as human beings who have learnt how to turn our common suffering into hope for the future'.  Nelson Mandela
Wishing you 2014 full of hope.



WWLD and WWJD

Dr Mhoira Leng
14th November 2013

Last evening I was privileged to attend a celebration of the life of David Livingstone in the soaring and chilly beauty of Glasgow Cathedral. I was then asked to be part of a debate on what would Livingstone (WWLD) do if he were alive today. All the suggestions were persuasive and compelling (eradicating HIV/AIDS; Ms Mphatso Nguluwe , ending modern human trafficking;Sir Kenneth Calman, mobilising churches; Rev CB Samuel and addressing the global pandemic of untreated pain and lack of access to palliative care; yours truly) I have included the whole of my 4 minute speech for you to review. Sorry you can't vote for the others as well. At Cairdeas we are particularly delighted to partner with EMMS International https://www.emms.org/ who are the main support behind the palliative care developments in EHA, India, that we also support, as well as in Malawi. Now to finish packing in time to catch my plane back to the tropical heat of Uganda.....
 
'My thanks to my fellow debaters for their moving and persuasive presentation, to EMMS and the organisers of this event and to Dr David Livingstone for his inspirational life and example which we have come here to honour and celebrate.
 
5 billion people in our world do not have access to pain relief and palliative care, many of these with chronic, debilitating, life limiting illness. HIV AIDS as we have already heard but also rising numbers of those with cancer, growing problems with heart disease, rapidly increasing numbers with poorly controlled diabetes, kidney failure with little access to dialysis and multiple respiratory problems due in part to cooking fires in huts with poor ventilation.
 
This burden of disease has an incalculable effect on individuals, families, communities and even national economies as it disproportionately affects those in low and middle income countries exacerbating poverty and creating a trap for many more to fall into, where meager resources are used in a futile search for help and future generations denied opportunities and hope. This global pandemic of untreated pain affects hundreds of millions of people in our world and is described by the World Health Assembly as an urgent, humanitarian responsibility.
 
 
 
Oral morphine, one of the mainstays of pain relief is simply unavailable in most of the world. Of all the morphine legally produced and used every year 94% is used by countries that represent only 15% of the world’s population. One of Livingstone’s achievements was to ensure that a simple medication made from Peruvian tree bark would be available in a safe and effective formulation. These ‘Livingstone’s Rousers’, which combined quinine and  rhubarb, were a significant advance and I think he would use same energy and determination to champion the provision of another God given medication; the extract of opium we call morphine.
 
Imagine the anguish of medical colleagues seeing patients in such severe pain yet unable to help, imagine the distress on a mothers face when her tiny daughter injured by severe burns when she pulled over paraffin lamp screams in pain without relief, imagine the quiet endurance and silent agony of a young mother whose breast cancer has spread to her bones and dares not move lest it hurt, imagine the nurse who avoids dressing the wounds of her patient as she cannot bear to hear the shouts of pain, imagine the elderly man who prays that God will take him soon to spare him further anguish and stop draining the family finances.
 
Palliative care is about quality of life and holistic support addressing the physical problems such as pain but also the isolation and financial drain of chronic illness, the loss of hope and meaning, the powerlessness and despair. It is about empowering communities, restoring dignity, relieving suffering, walking alongside those who face darkness and despair with all our medical skills and also a message of hope and promise of presence.
Livingstone engaged with some of the greatest causes of suffering and injustice in his day but above all he was concerned with what would Jesus do. WWJD leads to WWLD.
 
Livingstone was an ambassador for Christ. Taking the good news of reconciliation with God, with one another, with ourselves and with a world that is beautiful, exciting with untold riches to be explored. Livingstone was also a beacon to challenge and inspire others to be involved in this God ordained work of bringing reconciliation and healing and an end to needless suffering. Livingstone was not afraid to challenge and convict others, to stand against the prejudices of his day and to live his life in the extreme for the cause he believed in.
 
Many years ago I sat under a baobab tree in Malawi and made a decision to engage in this cause in Africa and India. It has been a wonderful adventure and tremendous privilege for me filled with challenges and blessings. This tree was over 200 years old and local legend has it that Livingstone would sit there; perhaps also contemplating the calling God has put on his life.
  
Ladies and gentleman; lack of access to pain control and palliative care is one of the most significant global injustices facing our world today.  I put it to you that freedom from pain, restoring dignity and relieving suffering would have been a concern, a motive, an imperative and a journey of untold adventure for Livingstone; as it is for each one of us.'
 

Inspiring leaders

Dr Mhoira Leng
22nd October 2013

Amazing LDI family
One of the greatest privileges of my life is to be a mentor; to see and support others to explore themselves and to develop and grow. I meet and work alongside inspiring and committed people who are open to learn, eager to develop new skills, thirsty for knowledge and willing to share something of their life's journey with me. To see a young and perhaps faltering student manage to develop clinical judgement; to watch a young physician in training realise the impact of holistic care; to help colleagues do their first research project; to see clinical skills honed; to facilitate the journeys of self awareness and self acceptance; to support national leaders take up their roles with confidence and to listen as colleagues struggle to balance the commitments and dedication to palliative care with family and personal needs and demands is demanding yet such a blessing.
Anjum and Dinesh with their sleepy mentor
I have just returned from the Leadership Development Initiative course now hosted by Ohio Health. 21 leaders along with the innovative and hard working faculty, the visionary funders and gifted mentors spent an amazing week together sharing their stories, learning how to communicate our messages and encouraging one another in our journeys internal and external to be leaders in palliative care.https://www.ipcrc.net/news/category/international-leaders/ This initiative seeks to grow leaders in order to advance palliative care and to make a difference for the many many people who are in need across our globe. It was incredible to hear tales from 5 continents and to listen to how often it is a personal tragedy or experience of loss or pain that acts as the spur to be involved with this demanding yet rewarding path that so deeply connects with the pain in our world yet also brings hope and joy to the places of despair and sadness.  We also heard of incredible achievements; Nepal now has access to affordable oral morphine
thanks to the work of Dr Bishnu. Dr Eva wrote the first ever morphine prescription in Guatemala. Dr Chitra is pioneering the need for holistic care within chronic mental health. Dr Odontaya is now a TV celebrity in
Team building last course
Mongolia integrating palliative care in that resource limited situation. Dr Israel is preparing to start the first postgraduate training for palliative care in Nigeria. Dr Dinesh plans to have a message that 'pain can be helped by choosing palliative care' screened in the cinemas of Assam and even available as a ring tone. Dr's Snezana (Serbia) and Dilsen (Turkey) are making their vision for integrating palliative care in oncology centres a reality.
Dr and Mrs Israel Kolawole
Dr's Shoba and Anjum are establishing their hospital as centres of excellence for training in Jaipur and Bangalore. Dr Nicholas, Marta and Leonardo are changing the face of palliative care in Latin America. Dr's Ali, Narine and Silviu face huge challenges in Albania, Armenia and Romania and can feel overwhelmed yet are helping build their societies and make a significant difference. Dr Rumana is one of very few palliative care clinicians working in her nation of Bangladesh. Dr's Sam and Charmaine, you are reaching out to some of the most vulnerable in Uganda and South Africa and Dr Esther is working in our sister hospital in Kenya and now has a mandate to represent the needs to her Ministry of Health. To all of you and to the amazing faculty and fellow mentors; thank you for the sacrifices and commitment; thank you
for sharing your journey with me and each other, thank you for blessing my heart and for being a blessing to so many.

These next few weeks I will have the opportunity to share more of the work of Cairdeas and our partners at meetings and conferences in the UK. Please come and join if you can.  https://www.facebook.com/events/687542981262603/. There will also be a UK based conference to look in more depth at mentoring and sharing with colleagues involved in the THET palliative care project as well as Palliative Care Works and an opportunity to share at the Scottish CMF conference. I'm looking forward to meeting many folk after a long gap and sharing some of the blessings I receive as a world citizen and representative for Cairdeas and reflecting the Gaelic meaning; friendship and fellowship. I quoted from Tennyson's famous poem Ulysses when he says 'I am a part of all that I have met'. In this global age we are still brothers and sisters; sharing in the joys and the pains. The boundaries of nation, faith and ethnicity serve to enrich but should not divide. Each meeting, each experience, each challenge serves to enrich our lives and help us grow in love and service. As the man of wisdom says in the book of Ecclesiastes; 'there is a time for everything under the sun; a time to weep, a time to laugh, a time to mourn and a time to dance'
Let me finish this post with a quote from one of my colleagues and former students who summarised the role of a mentor in a way that humbles and inspires me. A mentor is 'the one created by God to wear another's shoes'.
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