This blog was written and submitted by Dr Nahla Gafer, a clinical oncologist at the Khartoum Oncology Hospital, Sudan. Today she shares about her recent visit to Mauritania and explains more about both Sudan and Mauritania. 

Background

Dr Dave Fearon or "Dr Daveed" as he is called by Dr Ekhtelbenina Zein, director of the National Oncology Center (CNO), has been known as the first one to speak of and push for palliative care in Mauritania. This is our second invitation to Mauritania by Cairdeas Sahara. The first was in 2017 working with the volunteers at the community level and training general practitioners from different states (wilayat). Dr Dave Fearon has paved the way for this visit in order to impact the palliative care services at CNO. This time, we were three trainers from Sudan with more than 10 years of experience in palliative care for oncology patients. 

Positive Aspects at the National Oncology Center

The administration and equipment exceed that of Sudan: the palliative care service has got a dedicated building, with dressing room, nurse office, counselling room, training area and offices for pharmacy, social worker, nutrition office and donating NGOs. All that in addition to the 8-bedded day care area. On the first day, we were met with the director of the hospital and the heads of the different departments. The director of the hospital struck us as amply knowledgeable and committed to providing palliative care to the patients in the center. Nouakchott Oncology Center, a 5 min walk from the Bureau of Palliative Services, provides high level radiotherapy treatments (3DRT, VAT and IMRT) as well as surgery (especially endoscopic), interventional radiology and targeted therapy.

Cultural Similarities

Across four countries in between (Sahel countries), and amongst the eleven neighboring countries for both, no two are so similar as Sudan and Mauritania in culture, nature, and landscape.  With dress, for example, the thoub distinctive to married Sudanese ladies is almost the same malhafa, dressed by all Mauritanian ladies, though fixed in a different manner. Mauritania on the Atlantic Ocean is a bridge between North Africa and the Sub-Saharan Africa, as is Sudan facing the Rea Sea on the extreme east of the continent. Similar attire, similar traditions, similar gender roles, and almost similar beauty standards. Yet to reach such a country we had to travel northeast, leave Africa to Asia (Istanbul, Turkey) and then back southwest to reach Mauritania. 

The South-South Interaction

Apart from the 12 interactive sessions given (for some candidates it was the first training they attend in palliative care), these were the highlights of the visit:

-    Fostering a holistic responsibility for the patient by each of the team members

-    Instilling the values of patient comes first, patient autonomy and patients’ rights, especially with the issue of families refusing the patient be told the diagnosis

-    Working as a team and supporting each other

-    Directing the financial aid according to socio-economic status

-    Addressing spiritual issues (with rephrased questions in Arabic), which were previously ignored for two reasons: lack of insight by the patient, questions not adapted to Islam

-    Implementing a summarized and simplified comprehensive four pages for PC clerking in Arabic (understood by the majority of the team members) compared to the French version which was 17 pages and with less than 50% of the team members able to write in French.

Future Plans

Unfortunately, the taboo surrounding cancer in Mauritania is so great that even asking about the symptoms is a problem. We, as a visiting team would like to co-ordinate further training of the treating physicians about breaking bad news, as well as an annual visit to improve the services – as mentioned by Dr Ekhtelbenina Zein, things can change step by step. Speaking more openly about cancer, we would like to help direct efforts for the early detection and screening, thus making use of the full services offered at CNO.  

This two-week training period has opened the eyes of the staff to a lot of improvements that can be made. It is with such keen administration and caring personnel that positive changes are expected. 

For us, as a visiting team, we have a lot to carry back to Sudan: this model of a stand-alone day care service; my colleague nurse who learnt how to prepare sessions and execute them in a conductive manner, and myself learning from the different aspects of care, especially becoming more proficient in convincing the families about patient’s right to know. It was great for them to attend the sessions conducted by Dr Mohja given in classical Arabic, while she made a second attempt to learn the Hassania dialect. 

Many thanks to Cairdeas Sahara for making such a visit possible, with gratitude to Dr Dave Fearon and to the Mauritanian people.

Cairdeas is pleased to work with several partnering organisations, across many continents. One long-standing country that Cairdeas has served in is Uganda, called “the Pearl of Africa.” Uganda is also the home to many of our partners, like Palliative care Education and Research Consortium (PcERC) and Peace Hospice Adjumani (PEACHOA). 

We welcome you to join us for a Journey through Uganda to explore its culture, context of palliative medicine and its development, as well as the natural beauty of this country. We’ll hold our virtual fundraiser of 180 km during the three months’ period of 15th April to 15th July. (This means, for those not living on the equator, you’ll be able to exercise while the weather is warm!)

During the 180 km covered, we’ll go through twelve different milestones of 15 km each where we will showcase the journey through Uganda in blogs, pictures, and videos. 

• Join us for some insider looks into the travel, people, and history of Uganda. 
• You will find recipes for some delicious Ugandan eats to replenish you after the exercise. 
• And you will hear from those working in palliative medicine all across Uganda. 
• Must also add a special note for avid birders! The natural beauty of the country will also be shared by a “Bird of the Day” which has been spotted and captured by our own Dr Mhoira Leng. 

The timeline for these twelve different milestones are quite flexible: you may chose to complete each 15 km each day or over a week’s time period. Your journey and visit to each milestone on the trip will be completed on the honour system.

We would like to share a bit of the journey with you and engage electronically (email, WhatsApp) as well as send you an animal key chain from Uganda once you have completed the trip. Cairdeas branded water bottles are also available in limited quanities, to be purchased by the highest donations by the end of the fundraiser. 

Your participation in the “Journey through Uganda” has only two parts! One is that, for the fundraiser, we ask that you submit your donation on our secure website or through our Just Giving page. Then, you can simply go through each milestone as you cover the distance by walking, running, jogging or cycling.

We are sure you’ll enjoy your time with us in #BuildingaWorldthatCares.

Interested? Fill in the Google Form to register and we can follow up with more information. 

What can you accomplish during a little over four days in India? For Dr Peace Bagasha, there was quite a lot to do.

Peace is a renal specialist working at Mulago Hospital who is pursuing her PhD via research at Makerere University in Kampala, Uganda, In the short time between 9th and 13th February, Peace retold her many trip activities and palliative care sessions to the Cairdeas communications team. It was a lovely, jam-packed 100 hours, she reports, yet not nearly enough time to read the book she brought! 

Peace’s short journey began in Bangalore where the Indian Association of Palliative Care (IAPC) held its 30th Annual Conference, #IAPCON2023. This conference was not your typical palliative care get together. First, for Peace, her time there was more like an annual palliative care family reunion.

Joining other palliative care specialists like Dr Mhoira Leng, Prof Julia Downing, and Dr Chitra Venkateswaran, they attended a dinner on her first night there, with other presenters and organisers of IAPCON 2023. As many at Cairdeas may know, Mhoira has been a part of this IAPC conference since its beginning, and so it was a pleasure to catch up with old friends. 

#IAPCON2023 was also unique in the theme and set up of subspeciality tracks. This year’s theme was “Metamorphosis: The Emergence of Subspeciality Palliative Medicine” and Peace explained how the conference sessions were designed to bring out each subspeciality and demonstrate the role palliative care in it.

For Peace herself, she presented for 30 minutes on nephrology and palliative care, or “renal supportive care.” Her presentation title was, “What is the evidence HRQoL, survival benefits of patients with ESKD receiving Haemodialysis, Vs. Conservative Kidney Management.”

Peace shared about the other tracks she attended, such as a session in cardiology titled “Role of nurses in managing heart failure.” The speaker, Sister Hanife, advocated nurse empowerment, which implicates nurse inclusion in patient decision making. Hanife argued that nurses are involved in so much hands-on care, and we need to appreciate their experience and support in caring for patients, especially at end of life. 

While Peace spent most of her time at the conference while in Bangalore, she had several highlights of the area itself. Bangalore was a “garden city” and the beautiful greenspaces were enhanced by the good, cool weather while she was there.

She then shared about Karunashraya Hospice, which hosted the dinner on their first night there. Not only is the hospice facility beautiful with gardens and ponds, but they are the first hospice in India to provide free home-care for terminally ill cancer patients. Their website explains more, saying, “Since the launch of home care services in 1994, we have cared for more than 3000 patients, and have around 50+ patients under our care at any point of time.”

I had to ask Peace about the delicious types of food she ate while on her trip in India. Her answer surprised me: Paratha! Like the flat chapatis you can find in Uganda, another partner country of Cairdeas, Parathas are unleavened Indian flatbreads made with whole wheat flour. I asked Peace if she only ate this tasty bread, and she laughed. “No,” she said, explaining that you can eat with curries like chicken or lamb. 

You may think the 100-hour journey stops here but there is was one more trip: after her presentation at #IAPCON2023, Peace travelled to Mumbai and some managed to participate in a workshop, tour some of Mumbai, and visit a hospital paediatric palliative care unit.

We spoke mostly on her workshop that she engaged in about renal supportive care. The workshop had several rich discussions, she said, since many nephrology groups are starting to integrate palliative care into their programmes.

The workshop was a good learning environment too, causing Peace to conclude, that for her place of work in Uganda, “I think we really need to set up a really structured renal supportive care programme.” 

How would you spend a short 4 days in India? In a little under 100 hours, in short, for Peace, she was presenting at a conference and participating in a workshop, touring the area,and visiting a hospice and a hospital, all spanning two beautiful and diverse cities. Reading that sentence can leave you a little breathless!

Even so, we wish to extend a very large thank you to Dr Peace Bagasha for her work and role in renal supportive care and for #BuildingaWorldthatCares.