As palliative care providers, leadership development is key to building our teams and expanding our reach in healthcare provision. Even more so, compassionate leadership development touches on the goals of palliative care to reduce suffering, promote dignity, fight for justice and improve quality of life.

Compassion is a paradigm we speak of in relation to our work with those needing palliative care but what about the focus on how we lead, how our organisations are run, and how we bring forward the next generation of colleagues. Thus our focus is on holistic personal transformation in order to transform our settings and increase our influence. 

The Compassionate Leadership Fellowship (CLF) has been made possible by partners Believers Church Medical College Hospital (BCMCH), Cairdeas International Palliative Care Trust (Cairdeas IPCT), Global Health Academy, University of Edinburgh (UoE), the Indian Association of Palliative Care (IAPC), and RMD Trust. We are also grateful for previous opportunities internationally for many involved including the LDI programme (thanks Frank Ferris) and innovative programmes in India and Uganda that helped shape our CLF.  

In its structure, the CLF is taught using a blended learning modular format. Modules 1 and 3 are six days held in person at BCMCH in Thiruvalla, Kerala. These modules bookend Module 2 which has monthly online sessions. In addition to the taught sessions the CLF has a mentorship programme which is key to the transformational learning design. We are fortunate to have experienced mentors who attend all the training events as well as work on to one online. They have also committed to visiting each Fellow at their place of work.  

February 18th of 2024 marked the official beginning of the CLF with an inauguration ceremony of music, prayers, and calls to compassionate care and leadership in the healthcare systems of India and beyond. We were proud to commence the first CLF cohort with 19 Fellows (16 from across India and 3 others from Rwanda, Kenya, and Nepal) and 13 Mentors, and great support from all partners involved.

The programme’s co-chairs, Prof Chitra Venkateswaran of BCMCH and Dr Mhoira Leng from Cairdeas IPCT, reminded us of the connection of previous leadership development programmes and our future to strengthen even more leaders in palliative care. We welcomed videos from our partners nationally and internationally with a warm reception from our hosts BCMCH.

The first in-person module (February 19-24, 2024) allowed us to explore the characteristics of leadership and understanding oneself as a leader. We are using the widely recognised Leadership Development Index which offers 5 exemplary characteristics for effective leadership. We explored these together including our personal integrity, how we inspire and enable others, how we effectively challenge and support change and how we do this within a compassionate supportive environment. There was plenty to reflect on and learn even for the ‘experts.’ Our Fellows used a creative approach to present “Who am I as a Leader,” helping us get to know each other but also establish our leadership strengths and areas for growth. 

A core aspect of leadership development is self-awareness, so we utilised tools with expert facilitation and then added group work, activities, and self-refection to help deepen our understanding of ourselves and how this impacts others. For example, the Myers Briggs Type Indicator gives insight on how we re-energize, interpret the world around us, make decisions and order our world. The KELP tool explores our preferred learning style, and we will use these foundational tools during the whole CLF programme to support our fellows in teaching, leading teams, and negotiating with others more effectively. 

Our time together in February 2024 culminated in a leadership development plan (LDP) which Fellows will finalise in sessions with their Mentor. In addition to planning for personal development, the Fellows are agreeing to plan leadership activities that follow the S.M.A.R.T.P.A. guidelines (i.e., Specific, Measurable, Attainable, Relevant, Time-bound, Person-responsible, and including Accountability.)

We look forward to the ongoing interactions and growing bond between each Mentor and Fellow, as they journey through transformational compassionate leadership development and as we together form a crucial community of practice. We now embark on monthly teaching session online covering topics such as strategic planning, team building and dynamics, organisational development, teaching, and research, supported by national and global experts.

Our fellows have shared feedback already, so early in the CLF programme. After the first in-person module together, fellows took turns to write and share the following:

     “It was a wonderful, fantastic self-introspective workshop. Really enjoyed the way it was scheduled and conducted.”

     “Here is a heart filled with gratitude to our Organizers and Mentors. Trust and fun filled new friendships. Experienced, learned and grew more than I ever expected. Here’s a changed me to Model the way, Inspire, Enable others, Challenge and Encourage the hearts.”

     “Just wrapped up an amazing workshop. Great learnings and looking forward to more. Thank you all.”

     “Thanks to Dr Chitra, Dr Mhoira, Dr Leejia and all those involved in careful planning and execution of 1st CLF ever. It was a great learning experience. My take home message is not to waste our energy on things we can’t change. Instead concentrate on what we can change … not to forget my mentors … all of you who will have a hand in a changed ME.”

As we look to the months ahead, there is transformational growth in our journey together from knowing who we are as a leader to becoming changemakers in compassionate care. The CLF is not in the numbers only of 19 fellows with 13 mentors, interlocking 6 countries in 2 in-person sessions, 10 online sessions, and over 190 mentorship meetings. Rather, there is boundless impact through this compassionate leadership development, in ourselves and for our teams and health systems, our patients and their families.

Quality palliative care for all is comes from the development of compassionate leaders, and now that we have begun, the sky is the limit. 

Many thanks to the blog author, Dr Dave Fearon, for his update from Mauritania; an arm of "Cairdeas Sahara."

Mauritania is positioned as a bridge between North and West Africa, bordered by the Sahara Desert on the east and the Atlantic Ocean on the west. It is a very large country but much of it is desert and one million, a quarter of the population, live in the coastal capital, Nouakchott. Mauritania is a lower middle-income country with much poverty visible throughout the country. Much of its healthcare provision lacks resources, both physical and personnel. Access to the available services is inequitable, with the majority of structures centralised in the capital, Nouakchott. National cancer services are only provided at the Centre National d’Oncologie (CNO) in Nouakchott, where chemotherapy, hormone therapy and radiotherapy are available to those who have managed to have their cancer diagnosed and have been referred. 

Cairdeas International Palliative Care Trust has been involved in the country since 2012 when I moved there with my young family. I was involved in providing palliative care, training, advocacy and research between 2012 and 2019, after which we moved to Isle of Lewis. In Mauritania, I led a small team of nurses providing home based palliative care under the authority of a local charity. We worked closely with the CNO. We trained many of their staff including sponsoring several employees’ training at Hospice Africa Uganda and attendance at international conferences. During my stay we benefitted from a range of international visitors who came to help, especially with training. Key visitors were Dr Mhoira Leng, Dr Jaques-Antoine Pfister, Dr Silvia Dive, Dr Nahla Gafer and Dr Mohja Marhoom. The latter four visited twice, with Drs Nahla and Mohja visiting in 2023, returning home only days before the start of their home country of Sudan’s troubles. 

I had the privilege of visiting for ten days in November 2023. I had very few expectations as I knew that the local charity had no plans or capacity to continue the palliative care after my leaving. I took two friends from Scotland with me, an Anaesthetist friend and financial supporter of the project, and a church of Scotland pastor from the Isle of Lewis. We had a blast and were greatly encouraged by the visible changes since 2019, all of which have been locally led and funded. 

Dr Benina became the director of the CNO in 2018. From knowing her work in the paediatric oncology prior to her appointment I knew she was a special person, knowledgeable and compassion. She is very much the driving force of palliative care in Mauritania. The following points are some of the highlights from our trip:

1.    New palliative care unit around 500 metres from the CNO, funded and staffed by CNO staff. Led by the lovely Dr Mohamed Elyatt, a medical doctor, and supported by the amazing nurse Aisha, both of whom Cairdeas sponsored to train in Uganda. They offer day hospice, wound dressings, out patients, social work assistance and home visits.

2.    Home visits – we participated on several home visits, seeing the range of cases and social settings. 

3.    Spending time with two Palestinians who are known to Cairdeas from the work in Gaza. Dr Nahla arranged for them to work at the CNO after they became trapped outside of Palestine. Humbling to spend time with them on the home visits and see their passion and compassion for patients while under such pressure, fear and uncertainty about their own families. One had not received any word from his wife for several days while we were there.

4.    The CNO continues to advance cancer care for Mauritania. They are more involved in training, research and they are making efforts at trying to make palliative care more integrated with cancer care.

5.    We caught up with Ndiaye who was my best friend, and the local palliative care champion while I was living there. He is a very special, intelligent, kind and a very capable person. It was encouraging that his attributes have been recognised by the ministry of health, and he is now highly valued (and very well paid) by the Mother and Child Hospital. Although he is not involved in palliative care day by day, he remains a passionate advocate for it, and he is still young with a young family. I am pleased he has a job which allows him to care for his family. I hope the ministry facilitates his return to palliative care in the future. 

6.    We visited the ICU department at the mother and child and able to chat with the doctors about palliative care.

7.    Another encouragement was the reminder that people are the same everywhere, whatever their nationality or faith. We were able to reflect on the similarities of beliefs and actions of Christians on the Isle of Lewis and Muslims in Mauritania, with their shared fears, worries and hopes.

8.    Mahloud, an orderly at the CNO has been involved in palliative care for over 15 years. He started cleaning the cancer wounds and ulcers at the CNO because the nurses at that time refused to do the job because of the smell and the horrors. He has continued to care for his patients and is now an integral part of the palliative care team. During our visit he was told by the director that they are paying for him to do some preliminary nursing studies in neighbouring Senegal, which will mean more knowledge, respect and pay. Definitely my biggest smile of the trip, so well deserved.  

9.    I am confident in the foundation of palliative care in Nouakchott because it is funded and staffed exclusively by Mauritanians. There is still a long, long way to go, but these are undeniable positives signs of something sustainable, culturally relevant and feasible being built. 

We are pleased to announce new trustees who have joined Cairdeas International Palliative Care Trust! Keep an eye on our Who We Are page for updates to our trustee board and staff.

Our new trustees include the following:

Marie Fallon

Marie Fallon (MD FRCP(Glas) FRCP(E) MRCGP DCH DRCOG) is Professor of Palliative Medicine at the University of Edinburgh and is an Honorary Consultant in Palliative Medicine based at the Edinburgh Cancer Centre.  She has played a significant role in research both nationally and internationally.  She has led international palliative care guidelines such as ESMO for cancer pain and ASCO for cachexia.   She has been Joint Editor of four editions of the Oxford Textbook of Palliative Medicine which is the reference textbook in the specialty.

She has edited several other books and sits on numerous grant committees, as well as being an editorial board member of the BMJ Supportive and Palliative Care. Finally, of note, much of her research in recent years and currently relates to Low and Middle Income Countries (LMICs).  She strives to help with the thorny issue of opioid availability in LMICs.

David Knight
David is a retired orthopaedic surgeon, he worked in Aberdeen from 1990. He is a born and bred Scot, but in 2011 he moved to China to work with a Christian NGO. He tried with limited success to learn Chinese and then taught foreign medical students and Chinese doctors in a big city in South-west China.

He returned to Scotland in early 2020, and soon entered lockdown. He was a Cairdeas Trustee in the early years and has now returned to the fold. He is busy with the leadership team of his local church and loves to travel and to read, sometimes at the same time.

Marian Morrison

Marian trained in Obstetrics in Glasgow and served in a Christian Hospital in Pakistan for many years, latterly as Hospital Director.  

Whilst she does not have experience in the field of Palliative Care, she does have cross cultural experience and a working knowledge of the kinds of communities Cairdeas is aiming to facilitate training and delivery of care. She is excited to join the team of Trustees, learn more of this worthwhile ministry, and contribute to the organisation.

Margaret Sutherland
Professor Margaret Sutherland, PhD is Professor of High Ability Studies and Inclusive Practice and is Director of the Scottish Network for Able Pupils at the University of Glasgow, Scotland, UK. She is a Fellow of the Royal Society of Arts. She has 42 years teaching experience in mainstream primary schools, behaviour support and latterly in higher education.

She is interested in social justice and issues relating to poverty and the role of formal and non-formal education in creating more just societies in the global north and south.

"Having lived in Lenzie," she writes,"I have known Mhoira for over 30 years and so have seen first-hand the development of Cairdeas and the difference it has made in many parts of the world. I’m honoured to bring my experiences in Higher Education to the board."