Visiting Bethlehem and the West Bank is such a privilage and yet holds many contradictions. Wandering the ancient streets and enjoying coffee with a local man who tells me stories of the old days and his faith for the future; staying at the beautiful Dar Sitti Azziza with Nabiil and Emily and hearing stories of centuries of this orthodox family; time with the faculty and Dean, Dr Mariam Awad, in the beautiful Franciscan Bethlehem University and see the students and staff thriving despite many many challenges not least those presented by 'the wall'. Exploring the back streets of Hebron to find amazing coffee and remember Abraham's decision but also see the tension and poverty of this ancient city.  Climbing Herodian Hill and thinking of the hills and valleys Mary and Jospehy navigated....when about to deleiver her first baby!!! I have an unusual nativity scene bought next to 'the wall' in Bethlehem which shows the Wise Men challenged as they try 'come and worship'.

In the midst of this let me intoduce 2 shining stars for me who are working to mprove the lives of their patients and families and the wider population. Let me tell you about Dr Amal Awad, Director General of Education in Health and Dr Rania Shahin, Director of Pharmacy at the Palestinian Ministry of Health. They have worked together to ensure availability of oral morphne in sustained released and immediate release tablet formulations as well as oral oxycodone syrup for children. They are then rolling out education and training accross West Bank usuing a guideline adapted from our work in Uganda. It has been my privilege to work with these and other colleagues and amazed at their efficiecny and efffectiveness as they listened to the evidence, changed formularies and started to institute change. I am looking forward to visiting next year and offering further support but also to know there will be many many people receieving pain relief this year because of this work.

Let me share Dr Awad's words 'Two Pain management Protocol workshops were conducted by the General Directorate of Education in Health in coordination with the General Directorate of Hospitals and the General Directorate of Pharmacy. The main purpose of the workshops was to respond to one of the main CPD Needs highlighted by physicians, midwives, nurses, and pharmacists in response to patients’ concerns of under prescription or over prescription. The workshop targeted systematic pain management according to global standards using a unified pain management protocol within hospitals to clarify misconceptions regarding pain management.
In consultation with Dr. Mhoira Leng the standard training workshops agenda for pain assessment and management was developed and conducted twice to facilitate access for health care providers. The first workshop was conducted in Ramallah for the North area of the West Bank on November 22nd , and the second workshop was done on December 9th in Bethlehem for the south area of the West Bank. The following was our agenda for the workshop:
 Welcoming and introduction
 Pain Protocol using a person-centred approach within a multidisciplinary team/ Presented by: Dr Amal Abu Awad
 Physiology, Pathology, and Assessment of Pain/ Presented by: Dr. Nizar Taraweh
 Taking pain management forward; non-pharmacological approaches/ presented by: Mr Bashar Qashu
 Pharmacologic Treatment of Pain /presented by: Dr Safa Blaibleh
 WHO ladder in the management of Pain: use of opioids including oral morphine./ presented by: Dr Layla Al-Khayyat
 Discussion and Steps Forward/ by all presenters

Many thanks goes to our supporting partners UNFPA, MAP-UK, all our presenters, and to Dr. Mhoira.
Let us always remember that together as a team we can make a difference in decreasing the suffering of our patients.'

As we see this huge step forward in West Bank we also hope and to see pain relief available for so many in need in Gaza.

It is humbling to reflect on the amazing peoeple we have worked with this year..and the many many challenges still faced to bring relief of suffering.  We will share more soon about the serious crisis of funding for colleagues in Uganda. Meanwhile, may this bright hope from Bethlehem inspire us all this Christmas season as we pray for peace and remember the Prince of Peace.