EHA participants

Faculty

I cant believe it has been so long since I posted - sorry for those who like more regular updates. So a quick review of the past few months over the next couple of posts.
At the invitation of Dr Ann Thyle and the Emmanuel Hospitals Association we formed a truly international faculty to teach the Palliative Care Toolkit in Delhi November 2011. Let me introduce you to the faculty; Dr Ed and Penny Dubland from British Columbia who have been visiting India for some years but even better Ed speaks fluent Hindi as a legacy of his childhood at Woodstock school; Dr Chitra Venkieshwaren our wonderful Cairdeas friend and regular faculty who is based in Kochi where she leads psycho-oncology developments and services; Dr Jane Bates who leads palliative care in Tiyangane clinic based in Queen Elixabeth University in Blantyre, Malawi; Josephine Kabahweza who is the senior nurse from our Makerere Palliative Care Unit and wowed everyone with her African dress and enthusiasm; Dr Ann Thyle from India who is the director of EHA programmes in EHA and yours truly. Funding support came from several sources including EMMS and Cairdeas. We were a great team!

The participants came from across the EHA network and brought so much enthusiasm and dedication to develop palliative care. Teams came from MP, UP, Delhi and Uttaranchal; many working in rural settings where there are few options for care. We laughed, shared, played roles, sang, even cried and certainly learned so much together. EHA have plans to develop palliative care across their wide range of hospital and community programmes and we hope to be able to continue to offer training support.

Spcies galore

Visiting Mr S at home

I also had great fun introducing my Uganda and Malawi friends to my favourite parts of Delhi; dinner at Karims, smells and sounds of the old spice market, wonders of the Red Fort and Jama Masjid, goats with tinsel round their necks ready for Eid, rainbow colours of fabrics, momos for lunch, hot sweet spicy chai, transport by auto, metro, taxi, cycle rickshaw and then a classic Indian overnight train.The latter took most of the faculty to the Harriet Benson Hopsital in Lalitpur to evaluate the first 18 months of the first EHA palliative care service. What a lovely welcome and so encouraging to see how much has been achieved. We met several patients and their families who spoke so movingly about the care given to them. As the local health administrator (Add CMO) said about the PC team; 'these people look after those that everyone has rejected.'

Smiling or worried???

perhaps a good place to pause. Palliative care is reaching out to some of the most vulnerable who face suffering and distress due to chronic disease where the focus is on quality of life. What does that mean? Perhaps Mr S (seen above on a home visit) illustrates this well; he had treatment for cancer which left him tired and in pain and unable to work in his fields to support his family. In desperation he was told by a friend to come to HBM hospital. 1 year on he is free of pain and back working and enjoying the birth of his newest grandchild. In his own words 'my heart has become less heavy, I feel at peace, my pain is less.'

Makerere team with our new teeshirts

Back to Kampala where our team were able to have a special Christmas celebration. Thanks to everyone for hard work, love and care and welcome to our new volunteer team as well as the link nurses from Mulago Hospital and the deputy senior principle nursing officer as guest of honour. 37 people singing and eating and celebrating the end of a year and the hope of Christmas. The boat trip added adventure - particularly as most for the team had never been on open water before!!!!!So many challenges along the way this year yet also so much grace and joy. We are blessed indeed.

sunset Lake Victoria on the way home

2nd years at Mulago

2nd years at Mulago

52 students from 10 Africa countries; 10 weeks of intensive teaching; committed faculty dealing with last minute crises and problems; international faculty from the UK augmenting the expertise and adding to the rich mix; learning from an inspirational group of colleagues; singing every morning; dancing together in church; speeches, cakes, first ever clinical OCSE exam....we are nearly at the end of the 2011 face to face teaching session for the BSc in Palliative Care run by Hospice Africa Uganda and offered by Makerere University.

Charity concert with 3rd years

It is always an intense few months with many challenges but as before the inspiration of working in a committed team and with such inspirational students is humbling and rewarding. Many of the students are experienced palliative care colleagues and leaders in their own settings and bring their wealth of knowledge yet are still willing to learn and share. For some this is a new opportunity to travel and learn. Let me do some introductions. In the 1st year group are Eric and Eric from Cameroon. They had never had passports before let alone traveled by plane. Joining them from Zimbabwe is Chengerai and together they had great singing voices and joined me in our church thanksgiving service.

Malawi 2nd years

Lois

Our first Cairdeas scholarship students, Lois and Gertrude were part of this group and were proud to share in the visit to Mulago - their place of work too. In the second year were some familiar faces as well as many newcomers. 5 from Malawi showing the huge commitment to training and developing palliative care across that country and especially good to see them all back in Uganda having visited most of them last year. Christopher spoke of the way he has grown as a leader through the course. Then the 3rd years; pioneers having to manage the many glitches of a new programme with forbearance and tackle new subjects such as research and mentorship and doing so with enthusiasm. For many balancing the demands of work and family and study and finances are so challenging. Supporting one another and forming close bonds of friendship. Amos and Willy singing duets to calm the nerves before the first OCSE (Clinical ) exam; and who was more nervous; the students or the examiners most of whom were new to this style of assessment.

Prof Barbara Jack and myself relaxing

Prof Anne, Jo, Zena, myself and 1st years farewell cake

What of my fellow faculty members? Still smiling and supporting even when the challenges have been many and the many new members at Hospice Africa Uganda working well together. Working long hours and giving of themselves in many ways too. Sharing expertise especially with those from the UK who are part of  THET link project. Some old friends such as Prof's Scott Murray, Julia Downing and Barbara Jack but also new colleagues in Libby Ferguson and Ruth Adams.

2nd years and faculty

End of Children's module teaching

Prof Anne Merriman was speaking to the students at a reception in her home and reminding them that the word 'hospice' shared a derivation with the word 'hospitality'. Opening our homes and our hearts to those in need and supporting one another. It is sad to be saying goodbye to colleagues and friends yet the friendships and bonds made during these weeks will remain and grow and we are richer and more blessed for the meeting of hearts and minds and cultures. We also as a MPCU team are very sad to be saying good bye to Dr Jo Dunn  who has been such an important part of the team as well as friend for the past year. We wish her every blessing in settling back in to London life and a huge thank you for all she has given to us and to Uganda. We also welcome new members with Dr Jack (Ugandan) and Dr Lesley (UK)
Meetings and parting remind me of the motto of Aberdeen city; 'Bon accord...happy to meet, sorry to part, happy to meet again.'

Apologies for the sparse posting recently. The months have flown past but I will give you a wee taster of my work and travels. As I reflect back over

Ward round in Mulago Hospital

months I am so conscious of the privilege of working alongside dedicated and committed colleagues. There is overwhelming need in every setting with so many needlessly suffering pain and distress and also so many that need to know someone has noticed or witnessed their experience, someone cares and someone will 'be

Dr Nahla and me in Khartoum

there'. We talk about the therapeutic value of 'presence' in palliative care; offering companionship, value, meaning and hope alongside our clinical knowledge and skills. There is so much we can do to alleviate suffering and pain but we are our best 'therapeutic tool' offering ourselves in relationship and partnership with those who are in need.

Palliative care at RICK

The global palliative care movement is full of people who are activists to see policies and systems change and communities mobilised, to access training for themselves to be better equipped and then to train others, to find innovative solutions with minimal resources and  most of all to offer their skills and time and care to those in need. Dr Nahla Gafer is one such champion. She is a radiation oncologist at RICK, the national cancer hospital in Khartoum. Following on from initial training and support from Hospice Africa Uganda's international programmes including a month in Kampala, she has been developing palliative care in her hospital and supporting a wider movement in Sudan.

Pyramids at Nuri

Her team has included Esther Walker, a British palliative care nurse, and they have achieved an amazing amount since I last visited in 2009. There is a functioning palliative care unit, a country wide planning team and completed initial training. I was able to support her in visiting key colleagues in the universities and delivering some lectures. I was privileged to be asked to sign the visitors book by the Dean at in Khartoum University; green tooled leather and entitled 'Kitchener's book'. Meeting patients and their families I was struck by the gentle, compassionate, skilled care being offered. Patients often travel huge distances across this vast country to access treatment and arrive at hospitals with very advanced disease. Having access to pain relief and palliative care makes such a huge difference. A picture can only convey so much but I think you can sense the compassion and care from our Sudanese colleagues.
Being in Khartoum I even got to see an old friend (Kelly Macaulay) and see the pyramids; did you know there were amazing pyramids in Sudan?

IAHPC stall with friends!

Dr Liz Namkuwaya from our Makerere PCU and I were both able to attend the European palliative care (EAPC) conference in Lisbon and share with colleagues across the world. Inspiring and encouraging to hear of so much progress - yet still many challenges. I was delighted to participate in the International Primary Palliative Care Research group once again and to meet colleagues from the International Association for Hospice and Palliative  Care. The latter has an excellent website and resources. https://www.hospicecare.com/ We presented some of our work and were joined by Dr Jane Lewington who worked with HAU is now back in the UK and Willhemien Westerhuis, a medical student from the Netherlands who did an elective project with us.

Christopher, Batholomew and Karilyn

Last of of my reflection comes from a recent visit to Tanzania. Tanga region has seen an amazing regional development for palliative care led by Muheza Hospital and the Diana Hospice Care centre. One of our students on the Makerere/HAU BSc Degree, Bartholomew Bakari,  is a key team member and it was a privilege to see him and 2 other current students; Violet and Julius. It was great to attend the regional meeting and see the encouraging progress and commitment as well as hear about the many challenges. Palliative care skills and medications including morphine are available at district level enabling many many more to access care and there are plans to see this roll out to the village level. There have been several mentors from the UK joining this project and the partnership has been so beneficial. Team after team shared how they were reaching out to their communities and bringing pain relief and care; often with minimal resources but great dedication. Well dome Tanga region and to Dr Karilyn Collins (founder of Muheza Hospice Care) and the teams on the ground.  Violet, who leads the palliative care team at Tanga regional hospital and is also completing her Diploma from Hospice Africa Uganda / Makerere University, shared this meaningful statement; 'Palliative care or Hospice is not about having a building or funding. Palliative care is the commitment of people witnessing the suffering of people with life threatening conditions and responding to their need for pain relief and to die with dignity' Thank you to all of you who not only support Cairdeas but moreover are part of a global commitment to bringing justice with compassion to the many millions who do not have access to pain relief and dignity.

Sunrise Indian Ocean

For an excellent and moving documentary entitled Freedom from Pain' click on this link ans watch out for cameos from Dr's Mhoira, Liz and Jo. https://english.aljazeera.net/programmes/peopleandpower/2011/07/2011720113555645271.html
I have much to share about developments in our team in Uganda but will save that till my next post.