Monsoon and mentoring

Dr Mhoira Leng
10th July 2010

 After some big challenges regarding permits and weather and illness the team of Grahame and Cheryl Tosh from the UK, Hamilton from Vellore and myself made it to the beautiful and remote state of Aizawl. Over an eventful 10 days we spent time with colleagues from Durtlang Presbyterian Hospital in Aizawl and Serkawn Baptist Hospital in Lunglei. The journey between the two places involves precipitous drops, hairpin bends, near misses, amazing views from tea stalls, stunning early morning mists, some travel sickness and even a beautiful waterfall on the way back. I have even found a mountain called 'leng' - maybe to climb on the next visit. We celebrated my birthday with typical Mizo breakfast and hours of singing! It was very encouraging to see how the principles of palliative care are being incorporated into these excellent hospitals. Dr Sanga at Durtlang has a significant role in caring for young men affected by substance misuse and there is an HIV/AIDS hospice aptly called Grace Home. Dr Lalramzauza, medical director of Serkawn,  attended the Toolkit training last year along with the senior nurse tutor. They have formed a small palliative care team seen here and we had the privilege of meeting some of their patients. One very ill elderly man spoke of the incredible hope and comfort he now knows because of the touch of God in his life. We shared and prayed with him and his wife. Mizoram is a Christian state where church support is central to peoples lives. How is this for good advice in a prayer garden? It says 'Listen to God'.
Mizoram's monsoon kept us a few days longer than planned but I was able to visit Bangalore and take part in the first HIV Palliative Care course at St John's Hospital led by Dr Shoba Nair. It was great to teach with Prof Rajagopal again and to see the great work of Snehadan HIV center led by Father Matthew Perumpil.
Off to Delhi in the 45+ degree heat and on to Lucknow with our team for the first ever Palliative Care Toolkit training in Uttar Pradesh. Jo Dunn from the UK works with Hospice Africa Uganda and was on her first trip to India, Chitra is of course my dear friend and colleague and senior palliative care and psychiatry doctor in India and Nicholas Mellor from the Palliative Care Partnership joined us to see the Toolkit training in action. We worked with our local colleagues Sanjay Diraj and Shakeel Ahmed from SGPGI and Piyush Gupta and his team at Canceraids society. We had an amazing week. The participants were enthusiastic and open and shared so much with us as well as seeming to really gain from the training. They came from 6 institutions and organisations in Lucknow as well as other parts of the state. We were also able to raise awareness in medical institutions in Lucknow, hold a press conference, share with senior colleagues in Lucknow and Agra and meet some patients. The press conference achieved  great media coverage and there are now many patients asking for help that is sadly very scarce in this huge state. As ever the needs are for continued support and mentoring but we wish all our participants every blessing as they seek to put their training into practice. here are a few quotes;  'It was excellent training and definitely it will be helpful to our work' 'I am really thankful to the organising committee for allowing us to be a part of this wonderful experience. I will do my best to practice my knowledge for the patients from today itself'
India of course offers so much to tantalise the body and saturate the senses. We ate wonderful food; Mogul shami kebabs; creamy buffalo butter in buns, melt in the mouth samosa, succulent bamboo shoots from the mountains, crisp dosai for breakfast, sweet sticky jellabies, burning hot parenthe in the back streets of Old Delhi washed down with spicy chai. We experienced something of the ancient culture - not least the most famous monument to love, the Taj Mahal.
Talking of culture; in the famous city of poetry, Lucknow, I had a poem written and recited to me by one of my students - in Hindi!

Hope and courage

Dr Mhoira Leng
4th June 2010

Many thanks for all the messages of encouragement about our Degree students. They are sitting exams at the end of their first semester and mostly doing well. We have now selected 20 more for the August intake with 8 countries represented; very exciting. I had the privilege of meeting up with 3 of our Malawi students on a recent visit. Let me introduce you to Davie Mpate. He is a clinical officer at Mulange Mission Hospital which nestled at the foot of the Mulange Massif. Davie became interested in palliative care through his work with HIV/AIDS and is brimming with enthusiasm. Here he is with the new vehicle for
home visits that has been bought by Hospice Africa UK. The small palliative care team see patients from a 40km radius of the hospital which also offers health care to very poor and rural villages. Presently there is no resident doctor at the hospital and it is clinical officers like Davie and nursing staff who do the majority of clinical work in many such centres. Davie is passionate about palliative care and supporting those in need and excited about the training opportunities offered by the Degree programme. It was so encouraging to meet him as well as 2 others students; Chris at Ndi Moyo in Salima and Fred at the paediatric wards in Queen's Hospital in Blantyre. Mentorship visits like this can be an important source of encouragement and support for students as well as
giving us a real feel for the challenges and achievements of our students and I hope to be able to make such visits annually supported by Cairdeas. These students will be the leaders for palliative care and give us great hope for the future. I also had the chance spend a few days climbing Mulange (you can see why it is called the 'island in the sky') and then relaxing by lake Malawi with my friend Geoff.  What an amazing privilege to be able to explore such beautiful places.

Back in Mulago we have been busy with the undergraduate and postgraduate exams with a communications exam included for the first time. Our clinical team is busy with increasing numbers of referrals. Let me introduce you to a young woman we met recently on the wards.Angela has a bone disease that means she is liable
to fractures and recently broke her hip which cannot be mended surgically. She is in constant pain and her family were praying they would find some help. When our nurse Regina came the next day and was able to give support and prescribe oral morphine Angela slept for the first time in weeks. What a difference yet morphine is not available to so many millions and even in Uganda we are struggling with a regular supply  and in serious risk of running short this month. Angela could not thanks us enough and despite her continuing pain and
disability she has such a grace and peace. Her mother cried as she shared about their fears and Angela's courage and again thanked the 'angels who helped in their hour of need' . Here is Angela sharing some verses from Psalm 41v1-3 which talk of the blessings for those who help the sick and the protection and healing that comes from God. We left her room encouraged and humbled.
Thanks as ever for your support. I am back to India soon to follow up on previous visits and of course see great friends and colleagues, eat spicy food and gaze at the mountains of Mizoram once more.

Building for the future

Dr Mhoira Leng
31st March 2010

Is there anything more rewarding than mentoring and supporting committed, enthusiastic, compassionate colleagues and seeing them grow and develop? It is perhaps the greatest gift we offer in Cairdeas and one of my personal privileges. The new BSc in palliative care has been long been a dream, had a tricky and demanding gestation. But finally we have our 'Degree for Africa' and the prospect of training many many future leaders for palliative care in Africa. Here is a truly inspiring group of palliative care colleagues. Some are part of the team from Hospice Africa Uganda and Makerere University who have developed and now teach this new Degree programme. The rest are some of our first group of 21 students who started year 1 in February. They come from Uganda, Kenya, Namibia, Malawi, Swaziland and Tanzania. We have mothers, poets, government workers, mission hospital staff; they speak different languages and come from different cultures;  yet all have such a commitment to learn and to make a difference for the many many who are in need in their countries. They have completed an intense 4 weeks of face to face teaching and now have gone back to their own countries to work at a distance completing assignments and exams and then clinical placements. Those leaving after Year 1 with a pass will be awarded a Diploma and others will stay on till Years 2&3 to complete their BSc. We have a further 13 coming straight into Year 2 in August who already hold a relevant Diploma. What an exciting opportunity for all of us! Here are the 5 students from Malawi where palliative care developments go from strength to strength. Do you like our team tee-shirts? I think wee Hannah is a bit too young for now. Why do we need this Degree? The majority of those in need in sub-Saharan Africa who face life limiting illness with pain, distress, loneliness and financial desperation do not have access to help. Most will not be able to have even basic pain relief with oral morphine. Families will struggle without support. These students and all those they in turn will teach and train will help to make a difference; please pray for them.
One last visit for this post. I have not only the privilege of seeing students train but also to be able to support and offer expertise to more senior colleagues. A fascinating conference recently in Riyadh, Saudi Arabia brought together many from across the Arab world as well as international experts form the WHO, USA, UK, Europe and yours truly! This Initiative to Improve Cancer Care in the Arab World (IICCAW) had the ambitious aim of eliciting the current stare of services and planning and brining together a strategic planing process for the next 10 years. We worked hard and there were impressive results - now to put it into action. I was especially pleased to meet palliative care colleagues from Saudi Arabia, Jordan, Sudan, UAE, Qatar, and interested others from a wider field. Riyadh is a very different place; full of the usual warm open Arabic hospitality yet also seems a world apart. It is respectful for women to be covered in public so I had my first experience of wearing an abayah. Who would have thought!
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