Unusually for this time of year I am in Scotland and this morning has a wonderful frosty walk up Blackford Hill in Edinburgh. In the early morning half light passers by, many with excited dogs careering around, greeted each other and said 'is it not beautiful' and 'I'm so lucky to see this sunrise'. The joy of sharing unexpected beauty with stangers.

So many are seeing 2020 as a year to write off, to 'coorie down' under the blanket of snow and of too many challenges and losses and hardships. Many of you will have experienced so much loss and grief, fear, distress and now simply feel overwhelmed. For many these challenges will move into the next year as the impact of the COVID-19 pandemic and what is being called the syndemic of the health care and economic problems carry over and may even increase. This has been a time of global challenge yet it has not affected people equally. Our health systems in the UK and other high income places have been almost overwhelmed but what of places where the basics of health care are a challenge. We may have had more than a glimpse into these realities. In the far north of Uganda Vicky Opia has been working in a critical area with rural populations, refugees and migrants and border movements that have led to a high COVID-19 incidence. In Kampala, COVID-19 numbers were slow to rise but are peaking now but what of the numbers needing cancer treatment or even basic food when your daily wages have been lost or struggling to work in the midst of a oandemic without PPE or safe transport; thansk to the PcERC team for all they do (see earlier blog). India with so much to give this world has struggled to manage the impact of COVID-19 on it's huge and diverse population. Think of our brothers and sisters in Gaza, trampled and constrained by 13 years of siege and lockdown, and now with COVID-19 numbers rising and health systems collapsing. We have also seen amazing global solidarity as we sought to face this pandemic together and learn much more about what it means to be truly global citizens. I have shared this before but it still rings with hope; an editorial by Lukas Radbruch et al in The Lancet in April said ' The call to fully incorprate palliative care into global health could finally be realised in the urgency of this pandemic. If so the COVID-19 pandemic will have catalysed medicine to better alleviate suffering in life and death.'  

In palliative care we journey each day with those who face grief and loss at a personal level and together seek to find strength, courage and hope...while facing our own powerlessness and vulnerability. How do we hold these places of uncertainty and challenge? Where do we go to find meaning and hope? For each of us this will mean different things as we reach out to our places of resilience and strength or find new ways of making sense of life. I have so appreciated a daily Northumbrian Celtic prayer cycle with a group of like minded people to centre and reflect each day. We need those places of stillness and openness to one another.  I was discussing on a webinar recenlty the incredible thread of our common humanity throughout this historic year and my colleague from South Africa explained he has learned that it is in those places of shared vulnerability we see our common humanity. Our training programme with PalliCOVIDKerala and Pallium India (see earlier blog) has been a place where people shared their vulnerabilities; at times up to 100 people from across many states and countries yet finding and holding those places together. One saying 'I will be more compassionate to the patients and high risk groups and to myself'. Some of our Cairdeas Faculty have been teaching in a new programme with Mercy Ships and we have seen people really thirsty to learn even if internet, civil unrest, monsoon rains and a myriad of other challenges got in the way.  Our IUG medical students, whom we sadly only met online in Gaza spoke of the values that were important to them #empathy #dignity #listening #hope #trust #kindness with one student saying 'we will be as you think of us'

If we are to be vulnerable then we need to know we will be met with kindness. We have seen extraordinary and simple acts of kindness. From top chefs changing their restaurants into free food for key workers, to makeshift kitchens to feed migrant workers...from rainbows in windows to music played outside hopsital windows and in lockdown streets.to neighbours caring for the vulnerable person in their community and faith groups finding new ways to reach out to those most in need when unable to gather together. We have seen innovative and imaginative ways to share love and care and have realised how much we took a simple hug for granted. 

As this year draws to a close I wanted to share some of the images of beauty and kindness that have touched my heart this year. We go into a New Year with stillness and hope to embrace the many new opportunities opening up and the joy of working with partners accross the world in a common vision. Here is a beautiful blessing attributed to Theresa of Avila who lived in the 16th century and which I have been reading in the middle of each day this year. 'Let nothing disturb thee, nothing affright thee; all things are passing, God never changeth! Patient endurance attaineth to all things; who God possesseth in nothing is wanting; alone God sufficeth.'

One major role of Palliative care Specialist is to respond to management of complex cases of severe pain and other symptoms, sometimes in difficult to access locations. This story is from Vicky Opia, coordinator of Peace Hospice Adjumani and a Palliative Care Nurse specialist.

Usually, doctors and nurses who face challenges in the management of difficult and complicated pain, call for support of a specialist.  In June 2020, a doctor met a child diagnosed with Esarcoma who was in agony of pain. We did not only initiated him on Morphine, but also discussed the importance of surgery to avoid metastasis. Two days later, the boy’s right limb was amputated after his consent was sought.

John (not his real name) is the 3rd born among 5 siblings. At 4 years, his parents separated and he grow up with his grandmother. John's father derived his livelihood from fishing to support the family and his grandmother did the house chores. John said, ‘’My dream while in primary 2 to become a doctor came to pass when I succumbed to cancer. I experienced painless swelling at the right lower limb from 2018 which stopped me from playing and I discontinued schooling in Primary 2.  I was taken for treatment at local herbalists (painful cutting with razor and massaging) and also medical care from Obongi Health Centre IV in vain." The family of seven lives in a small dwelling house and derived their livelihood from fishing and sale of labour to buy basic necessities for daily survival.

Obongi District was separated from Moyo in 2019 to bring services nearer to the community. It is 35 km from Adjumani district including 2 km across the River Nile.  It has 14 health centers and 1 hospital where none of the health workers have benefited from any palliative care training. Hence they lack knowledge and skills in management of palliative care cases making them find their way to Adjumani district for services.

John and family live in a village 10 kms away from Obongi town, thus coming for review requires them to cover 45 kms in 4 hours due to ferry cross over time. Besides, the current heavy runs have flooded the roads and the river banks hence blocking access for services. The available means for transport is the local canoe. 

One day, I got a call in a middle of a meeting, when I picked, it was John calling me using his father’s phone. He explained, I am in severe pain and my father cannot raise any penny to transport me for review. Immediately, I reflected on his background, my heart lept with pain and passion having known how bad and risky the road is, and particularly the pain associated with the amputation, I knelt down and prayed. The prayers empowered me and I even forgot that this river has crocodiles, and other wild reptiles.  I only recalled his voice saying, ‘’Sr. Vicky am in pain……… in pain.,,, and my morphine is finished’’, Dad has gone fishing, grand mum cannot manage to carry me up to Adjumani ,please help me’’ My passion for humanity beyond self-gain, and own life disappeared. I waded in the River to save John from Severe pain.   While there, 3 other patients benefitted from our services.