Vicky Opia is a registered nurse trained in palliative care who leads the work in palliative care in Adjumani district. Cairdeas IPCT has been proud to work with Vicky Opia and her organisation of Peace Hospice on several research and training projects in Northern Uganda (see more details in the video above!). We are also excited to announce that Vicky is the newest Cairdeas Scholar, and she is pursuing a Masters in Public Health. 

Vicky’s semester at Gulu University has just started this autumn when I was able to talk to her about her new studies. In her going back to school, Vicky is eager to broaden her work at Adjumani Hospital and at her organisation Peace Hospice Adjumani through the Masters degree. 

Adding public health to her current palliative care work is part of her plan to engage the community more in general wellness and prevention. “When I attained the Bachelors in Palliative Care,” she told me, “I was able to do a lot of work in my community, such as the integration of palliative care in the health systems, and training the family caregivers, VHTs and healthcare workers. But I realised that I was focusing on those who are sick; I was not focusing on the whole community and the preventive aspect of healthcare, addressing the social determinants of health. I realised that within a lifetime, poor health management can lead to someone with hypertension and diabetes, then they may become a patient who needs palliative care.”

Expanding palliative care to include prevention and community education of public health concerns are some of Vicky’s goals as she studies Public Health. Vicky noted that with public health, she will be able to explore more of the health policies and governance of Uganda. Citing a gap between the health policies currently made in Parliament and the implementation and adherence in communities, Vicky explained her approach: “We need to have policymakers who not only make policies but ensure that they are being used, like for policies to do with alcohol and cigarette smoking. The people now who are making policies are not coordinating well with the community, and so the policies are not effective. I want to bring the community into the policymakers and make the policies from the bottom-up; unless you involve the community into the policies, nothing will move and they won’t understand them.”

Lastly, we spoke about the continued need for research in the communities’ general health and with palliative care. Research is the foundation of providing accessible and quality palliative care as well as addressing community health. “In our particular community, there is a lot of liver cirrhosis, and we are realising that alcoholism is causing this,” Vicky shared with me. “Public Health can help me research, why is alcoholism occurring so much in the community? Or with the issue of abandonment; why in a community and culture that is community-based, are those with chronic illnesses being abandoned? Right now as I talk, there is a man abandoned in the hospital who has HIV; yet before he became sick, he was well placed in society and wealthy. Other issues or questions like this will come into play as I continue my studies.”

We look forward to seeing the interface of palliative care, public health and policies, as well as research with Vicky Opia. Best wishes to our newest Cairdeas Scholar in her degree!

Blog written by Jenny Hunt (MA, Dip HE Palliative Care)

Meeting up socially with Dr Mhoira Leng while in Uganda in May 2023 turned out to be a pivotal moment for me. When she asked if I would consider travelling to Gaza to train on grief and bereavement on Module 8 of the newly established diploma in palliative care, I rather hesitantly agreed. Recent reciprocal attacks between Israel and the West Bank presented some safety concerns for me; my previous humanitarian palliative care responses had been post-natural disasters. Having been reassured that all necessary security information and support was available, I was surprised how rapidly and efficiently plans were put in place for my arrival to coincide with Mhoira and Anna Voeuk, another faculty member. Our transfer from Jerusalem through Erez crossing was seamless and our arrival at our family- run guest house accommodation, a pleasant surprise.

My approach to this training was informed by many years of working as a palliative care social worker at Island Hospice Service in Harare, Zimbabwe. In particular, as the Bereavement Service Coordinator, I was responsible for developing bereavement training modules and support systems for a wide variety of populations, professional and non-professional. My training experiences during this time led to the development of the 9 cell bereavement tool* which aims to raise awareness of grief and bereavement within the context of their communities, rather than deliver didactic material based on Western theories. I’m grateful to have been entrusted to use this same approach within the Gaza context with no guarantee that it would be applicable. I designed a simple PowerPoint presentation for the first day, providing an overview of some necessary, evidence-based information shared within interactive discussions. The value of drawing on their personal experiences was emphasized to provide authenticity to theories. Support was provided for any emotions that arose during this training. 

The 9 cell tool was facilitated on day 2, beginning with active contributions to my request to hear what condolences are offered and received in this context, and which of these are considered helpful and unhelpful. Each participant then wrote a list of their own personal death losses on a strip of paper which enabled me to understand the levels and types of loss in the room. After reviewing the critical aspects of what had been covered on day 1 around the personal journey of grief lived out within social and cultural contexts, the participants were divided into 3 groups representing grief time lines from immediate to one year and beyond. Each group shared experiences of what is felt, what is shown to others and what is allowed and expected by one’s society, religion and culture. This information was then used for further discussion, identifying differences and unique stories all within a respectful, non-judgmental environment. Oral feedback confirmed that significant learning had taken place, and participants offered suggestions as to how they may now support the bereaved.

While there were so many aspects to this trip that deserve comment, the most powerful insight for me was the confirmation that despite cultural, political, economic, religious and geographical differences to contexts where this tool has been implemented elsewhere (Africa, India), it appears that improved bereavement support within communities can be achieved using this simple approach. It would also be useful to follow up this training with mentorship and modelling of some specific bereavement counselling techniques.

* Hunt J. (2002) The nine-cell bereavement table: a tool for training. Bereavement Care, 21 (3): 40-41.
 

With 53 years of experience volunteering in palliative care between them, these five social workers have seen it all.

As social worker volunteers with the Palliative care Education and Research Consortium (PcERC) in Kampala, Uganda, they provide the psychosocial support and assist the practical needs of patients receiving palliative care and their families in hospital. 

Indeed, social workers Maria, Ronald, Teddy, and the affectionately named “Vicky 1 and Vicky 2” are a large part of the PcERC team and they each spend at least two days every week on the wards of Mulago Specialised Referral Hospital and Kiruddu National Referral Hospital.

Recently, I had the privilege of spending time with each of them, as we discuss their role in the unit, the patients and families on the ward, and the impact of palliative care. 

I’ve quickly come to find out what all the social work volunteers can do in the PcERC team. They visit the patients between ward rounds and alert the clinical staff if there is any issue.

They listen, guide, and counsel the patient and family on topics from navigating around the hospital to reconciling with loved ones. While they are well acquainted with grief and bereavement, these never get easy and it can be an emotional challenge to continue their work sometimes. 

Through their time with PcERC, they have been trained to help write wills and draft formal requests – and at the same time – have grown as educators as they bring homework and other assignments to children on ward missing class.

Holistic care really can be quite practical, as I learned from the social work team, and so their work can include picking up prescriptions or a meal for the patient. They also work with the PcERC administration to allocate their patient comfort fund towards purchasing items the patient and family cannot afford themselves. 

During my time together, I kept asking, ‘Why palliative care? What keeps you volunteering with PcERC?’

For several of them, the palliative care team has become a family: one social worker’s spouse became quite unwell and needed counselling at one of the national government hospitals. Ever since that experience, that volunteer warmly remembers how the palliative care unit stood close to their family and supported them during and after the spouse’s hospitalisation. 

Another volunteer shared on about a previous cancer diagnosis and their journey towards wellness; now, they want to offer the same compassionate and quality care to others who have cancer and other chronic diseases. 

It is not a surprise, then, that the combined efforts of the social work volunteers with the clinical staff have a great impact on the patients and families.

One oxygen-dependant patient who was already hospitalised for two years, shared that she feels more “at home” at the hospital and less depressed after being referred to the palliative care unit. She even said that she has no worries at all: “I have got a special team to help me and to check on me on a daily basis … it’s to the extent of that I even forget that I am an orphan.”

Maria, Ronald, Teddy, Vicky 1, and Vicky 2 are also eager to share the impact that palliative care has had on them. Ronald, for example, cites the many trainings they have attended as well as the opportunity to learn and practice research skills. Likewise, several have observed that they’ve bettered as social workers and in their communication methods after joining PcERC. 

Maria summarised one of her favorite aspects of volunteering with the palliative care unit: teamwork.

“I like the teamwork in palliative care,” Maria told me, “Which consists of doctors, nurses, social workers, and pharmacists. This teamwork is good because it encourages everyone in the team to contribute and work shared among all in the team. Palliative care is not a one man’s show. Two or more heads are better than one.”

We have certainly seen the benefit of the whole palliative care team in our partner, PcERC. Well done to each member of the unit, including the social workers who volunteer there.