One of the names given to the tiny baby born in a stable in Bethlehem over 2000 years ago is Prince of Peace. This message was emblazoned accross the skies as angelic beings sang the good new of hope and peace for the world to a terrified but excited group of shepherds...one of the most socially invisible groups in society. Who would believe a shepherd was chosen by God for a worldwide message of peace...and who would be similarly excluded in our societies!

In palliative care we have the honour and responsibility to support values based health care that respects the dignity of each person and family and seeks to relieve suffering and support quality of life. I think of palliative care as bringing this message of hope and peace to people and families who are struggling, fearful, hopeless and in pain...and to seek to ensure this care is available regardless of the poverty, geography, lifestyle, setting or illness...truly palliative care for all as part of health care for all.

Earlier this year I was sitting in Bethlehem a short distance from Manger Square, Star Street and the beautiful Church of the Nativity where so many pigrims and tourists flock. Instead I was gazing at the dividing wall cuting accross this land like a terrible scar and representing such fear, anger, injustice, hopelessness and lost opportunities. I was reflecting on the lack of peace in the Midde East  and the sadness for those divided and hurting in so many ways.  This wall continues to grow and yet some adorn it with grim humour and statements for unity and peace. I meet so many people working to survive, to make a difference, to seek justice and peace.

I was privileged to be in Gaza twice this year. Firstly with Medical Aid for Palestine on a scoping visit for breast cancer support along with several Scottish colleagues inlcuding Dr Phillipa Whitford UKMP. (see https://www.map.org.uk/news/archive/post/747-mapas-breast-cancer-care-in-gaza-aliaas-story) We hope this will become a formal multidsciplinary prgramme incorporating palliative care.  I was also able to work with amazing colleagues from IUG (Dr Fadel Naim and Dr Khamis Elessi) and the UK (Dr Janet Gillett and Dr Kathey Myers) to deliver the second undergraduate training in palliative care and celebrated the work of Cairdeas through #cairdeaspurpleparty on World Hospice and Palliative Care Day. I was also able to joinng the steering group discussions led by IUG, MOH, WHO, UNRWA, PMRS and others and discuss ways to support in the future. Next up is a new Diploma in palliative care which is almost finished the development stage and we look forward to supporting in partnership.

However the situation in Gaza is a humanitarian disaster deteriorating each day. Electricity may be available only a few hours a day and this affects basic services such as sewage management and of course affects hospitals. Essential medications are often low or stocked out..60% of cancer medications and NO ORAL MORPHINE at all. Travel permission may be given for travel outside Gaza for essential treatments such as radiotherapy in East Jerusalem or the West Bank but in pratice more than half who would benefit are denied. In Gaza people are simply trying to survive and praying for peace or at least for basic freedoms to travel and receive health care. In Bethlehem, the city is beng dwarffed by the settlements (illegal in international law) and choked by the snaking wall. 

Let me tell you a couple of stories. Abdul (name changed) was talking with the medical students about his experience of living with advanced sarcoma and clearly in significant pain when suddenly the door burst open and he was given his permission papers for travel to East Jeruslem and Ramallah. In the happy, frustrated, noisy chaos he desparately asked...'do I need pain control and radiotherapy or surgery more?' As he got ready television cameras arrived and in between filimng (which included me) we gave him some advice re pain medication and tried to ensure he would see someone who could help. In fact his cancer is now very advanced but at least he will get good palliative care interventions. His words 'I feel I have been given back some dignity'

Another young woman has delayed coming with her breast cancer as she was so scared of having a mastectomy. She has not long delivered her youngest child but knew the risks as several members of her family have died of breast cancer including her mother (in her forties). After some counselling and support for her and her husband from the Gaza and MAP teams she agreed for further treatment for her now advancing disease and we are hoping and praying she will be allowed to travel for radiotherapy after her surgery. The surgeon learnt from the encounter as his initial reaction had been 'This is one young woman who does not want surgery and I dont feel comfortable discussing it' yet he was able to see good communication and take part in the discussion and treatment decisions.

An older lady has just found our her breast cancer diagnosis and was looking sad, sitting quietly with her sister. The clinics are busy with no nurse specialists and most trainied to offer physical support and not psychosoial or spiritual.  We spoke together, supported by translation, and she talked of her sadness at never having children, her husband who has already died, her frail mother with diabetes needing amputaton and now this cancer diagnosis. 'I feel so sad but I am trusting in God, Hamdulilah'

There is a new report on palliative care, the Lancer Commission (see Resources section), that shows once again the overwhelming need for palliative care and coins a new term, serious health related suffering. New ways looking at this age old issue of suffering and pain are needed but most of all we need to mobilise individuals, communities, civil society, faith communities, social entrepreneurs and governments to address this huge need. In Cairdeas we are privileged to work to build capacity, raise awareness and develop training to do our part in ensuring that one of the most excluded groups in our society has the care they need and deserve in 2018 and beyond. This includes refugee and migrants groups such as those affected by chronic conflict in Gaza and the huge refugee camps for South Sudanese in Northern Uganda.  We are glad to be part of a network seeking to find solutions PALCHASE.  

My thanks to all we have partnered with in 2017 and to the privilege of visiting and working in Uganda, Rwanda, India, Nepal, Gaza, West Bank and to our friends in Mauritania with Cairdeas Sahara. Thanks to the amazing team in Makerere and Mulago Palliative Care Unit and Palliative care Education and Research Consortium where I am based much of the year. Thanks to IAHPC for their amazing work and the honour of being a board member. Many thanks to all our supporters and those who volunteer their time and expertise.  Please remember our Christmas Appeal which will allow our partners to become sustainable, to care for refugees and to be trained. Follow us on Twitter @CairdeasIPCT and on FB or sign up to get more involved.

Visiting the places so familiar in the Christmas story was a privilege ...and also to visit and think beyond the nativity scene to the life and example of Jesus as he lived and died and brings to fulfillment this message of hope and peace to all men. May all wall’s come down...the ones within ourselves componded by grief and loss and pain...dividing walls functional and physical all over the world between races, religion, societies, resources and nationalities...may Jerusalem be a city of faith and peace radiating to the end of the earth....may 2018 allow us all the privilege to know how to be peacemakers.