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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!

A beautiful world

Dr Mhoira Leng
21st February 2010

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.
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