How did your new decade begin? I was privileged to be exploring the south west of this beautiful country then down into Rwanda. Beautiful Lakes Bunyonyi and Lake Kivu, paddling in a dugout to church, climbing cloud covered Mount Muhavuru volcano to almost 4000m, exploring Ishaha national park with tree climbing lions, hippos, buffalo.....Living and working here in Uganda is a real privilege. My thanks to my friends and colleagues who share this journey with me and who inspire and encourage and who share the laughter, the tears and the joy.
Back from my holiday it was down to work to prepare for the launch of the Degree programme at Makerere and Hospice Africa Uganda then off to India for a whistle stop trip. Delhi was cold for a lass from Africa! I was delighted that Ruth Wooldridge, an experienced palliative care nurse who has helped develop palliative care services in many countries including Delhi and Nairobi (as well as a friend), joined me for a mentoring visit in partnership with Pallium India. After a great day at the Cansupport foundation training course in Delhi we traveled to Lucknow in Uttar Pradesh.

We joined the team at Canceraids society and at Sanjay Gandhi Postgraduate Institute to review the progress since my last visit 6 months ago. The clinic was steadily growing with good relationships across the hospital and with current training of a nurse there will be better support for Dr's Shakeel and Sanjay. We were delighted to meet another nurse who has experience in palliative care and who immediately volunteered her help. Canceraids society has finished the building of a day care centre and now planning the service. We also saw real progress in encouraging others to develop palliative care and visited the medical colleges in Lucknow and Kanpur. There is such huge need in this state; 160 million people, a handful of places where oral morphine is available, rural agricultural economy with the majority living below the poverty line and so few palliative care developments as yet. We are planning to continue our mentorship and training support. In Kanpur I saw my first glimpse of the holy river Ganges - here a silted, sluggish brown shadow due to industrial pollution. Lucknow is an ancient and beautiful city and we sampled the architecture old and new and the food delights. If you visit make sure you taste malai mukkan and the chhappan bhog sweet shop!

Off to the warm south and a brief visit to my friends at CMC Vellore. I stayed at Sneha Deepam in the hospice and education centre and reminisced about being the first faculty to stay here. The gardens are now grown and beautiful and the service to many of the poorest continues to grow.
It is especially exciting to see young colleagues and former students grow and flourish. Bangalore is seeing growth and development in palliative care and the new head of department at St John's College is Dr Shoba Nair. With sincere and interested support from the management in this prestigious institution this enthusiastic department are developing training for HIV and palliative care as well as providing a clinical service. I took part in a writing workshop with Dr Chitra Venkiteswaren and others and gave an invited lecture. Then there was wonderful times of sharing with colleagues and friends across Bangalore, seeing 2 other former students, Dr Praveena and Dr Ravi Livingstone, now leading services in other hospitals and enjoying wonderful Kerala hospitality with Shoba's family.
On to the VXVII IAPC conference in Tiruchirapalli, a south Indian city full of ancient temples and Tamil history. With the overall theme of 'Twilight years' we looked at the particular problems of the elderly as well as sharing what has been happening across India. As ever I was overwhelmed by the warmth of the welcome, the wonderful food, outrageous compliments when wearing a sari and the inspirational commitment of my Indian colleagues. It has been a joy to see the growth and developments over the past decade and a privilege for myself and Cairdeas to be able to continue to support for this new decade. India has still so much need for many many of its people who live and die in preventable suffering and pain.
Come to India sometime with me and be inspired, challenged, intoxicated - I promise you first visit will not be your last.
Back now to Uganda for th start of the Degree programme - and that will need to wait till my next post.

Listening to my neighbours singing carols round my door last night made me nostalgic for frosty evenings, Christmas trees straight from the forest, sparkling lights in the early darkness, the eerie stillness of snow falling and time to celebrate with friends and family the wonderful joy and hope of Christmas. Maybe I am overlooking the busyness, shopping frenzy and choked roads though the latter is very much a reality here in Kampala. Uganda loves Christmas and there have been slightly strange Santas and endless carols in the supermarket for some weeks now. Hospice Africa Uganda hosted a wonderful Christmas party for patients attended by many friends including the Irish ambassador shown here with Dr Anne. The children had a crazy time on the bouncy castle which kept threatening to deflate - something to do with the hoards of kids all jumping at once. You may remember the story I told of a young woman from Congo called Josephine who features in my last BLOG post. Here she is enjoying the celebrations with her family and she sends her love to all the Cairdeas family.
These past few weeks have been busy with visits to Tanzania and Sudan for cancer conferences. There is more and more interest in developing comprehensive cancer control programmes and integrating palliative care. Governments are becoming involved as they realise that non-communicable diseases such as cancer will become major threats to health in the African region over the next few decades. Francophone and North Africa have new initiatives to develop palliative care and it was inspiring to spend some time in Kampala with colleagues from Senegal, Egypt, Morocco and Sudan. It can be a tremendous encouragement and support to meet like minded colleagues who can advise and support and it is a huge privilege to help in this way. This photo shows the small palliative care delegation at the Sudan conference; Dr Nahla from Sudan, Esther a UK nurse working in Sudan, Dr Omar Shamieh from Jordan and working in Saudi Arabia and yours truly.

Back in Kampala we are hard pressed to finish the planning for the degree in palliative care but it has been great to have some volunteers and visitors to our team. Dr Jo over from the UK for a year, Willemien from the Netherlands, Dr Elaine from Ireland and others from the USA and beyond. They bring energy, skills,love enthusiasm, ideas and fun. Thanks to all.
So what are some refections at this festive time. There are the panoramic pictures in my mind of Khartoum at sunrise overlooking the confluence of the White and Blue Niles, the beauty and tranquility of the Indian ocean and joining with over 700 delegates in Tanzania to fight cancer. Then there are the intensely private moments we are privileged to witness and share; 16 year old Viola pictured here, very ill and telling us how much she loves her jaja(grandmother); singing a favourite hymn on the ward with Jackie, a young mother, sharing a cuddle with Ben who is 5 and enjoying the party; listening to Joyce's father tell us how much he will miss her; making sure Annet will get her pain controlled and get home for Christmas; seeing Josephine's beautiful smile despite her uncertain future.

We celebrate the Prince of Peace coming into a hurting and needy world with a message of love and hope for all peoples. Thankyou so much for all your love and support and wishing you a wonderful Christmas.
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