Tuesday, January 24, 2006



Forgive my lack of expertise on my first BLOG post.

This is my on-line diary helping me to keep in touch and inform about my role with Cairdeas. If you dont know what Cairdeas is then check out We are a charitable trust that seeks to facilitate the growth of palliative care in the developing world. We will work mostly in supporting education and training.

As Medical Director of our new Trust I have two main roles. Firstly to help to develop the strategic planning and in doing so make connections with those involved in key positions in palliative care in the developing world. Secondly I have the privilege of offering my support in training and educational planning.

What am I doing now?

On Dec 31st I flew out of a cold and snowy UK to the country of India - arriving appropriately on the first day of the new year. I spent a few days in Delhi catching up with friends at the ASHA slum project before flying to the tropical south - Kerala.

A few words about palliative care in India. Since the 1980's there were hospice developments but these were only available to very few. In 1993 a clinic was started in Calicut, northern Kerala by Prof M R Rajagopal which sought to model a different form of palliative care delivery. Through an outpatient and home care service and more than 30 link centres 30-40% of the population were able to access help. Since then this service has been further developed by Dr Suresh Kumar and team to the NNPC (neighbourhood networks in palliative care) with the community (in the form of volunteers) running the service. More than 80% coverage has been obtained with this model.

Good news except that around 3% of India's population have access to pain relief and way less than 1% have access to a doctor working in palliative care. A recent estimate by Suresh and Dr Jan Stjernsward suggested only 100 full time doctors - that's for 1 billion population!!!!

So hence the need to get involved in training.

So what am I doing at the moment.

Cochin has sen the development of the first supervised Diploma - 2 years of structured training. I am here as visiting lecturer at Amrita Institute of Medical Sciences to support this programme and help with other courses such as the 6 week short course.

A few days after I arrived we had the first students pass the Diploma - well done to Dr's Biju, Biju(an orthopeadic surgeon!) and Sunil. It is an excellent course with tough standards so all were justly pleased. Dr's Robert Tycross and Rena George were external examiners. You can see the photo evidence.

I am busy supprting the 6 week training students. A recent review of training showed that more than 80% were leading services and teaching as well as taking referrals after only 6 weeks. Not surprisingly many feel out of their depth but the courage and committment are very impressive. I hope to be more involved with mentoring these young palliative care doctors. Incidently one current trainee is a Professor of Anesthetics so young in palliative care experience only!

Enough for now. My next few weeks involve taking part in the 13th International conference of the Indian Acssociation for Palliative Care and brief visits to help with training in Hyderabad, Calicut and Trivandrum.

When I was chatting with Jan Stjernsward (previous director WHO cancer and palliative care programme and responsible for the WHO cancer pain relief) about the desparate shortage of palliative care doctors he suggested I should 'spend the rest of my life doing something about it' That is just the essence of Cairdeas and it feels a tough challenge but still a privilege.


Dr.P.M.Saleem said...

Hi Dr.Mhoira.
Your work is very encouraging.your case diaries even more. Keep up the good work

I met you just yesterday, Trichur palliative care training,
you gave us yr email addresses today.

you might recall me telling you that I am planning to set up a centre in our hospital Divine medical centre,wadakancherry.
I am counting on you for guidence

It is nice meeting a committed person like you

good luck


emmalynne_mathieson said...

Hi Moira,
I'm not sure if you remember me- but it's Emma here from Aberdeen Medical school who did an elective at Hospice Africa Uganda. I had an absolutely fantastic time and really had hoped to send you my project but unfortunately lost your e-mail address when the university closed down my account. i am so pleased to hear that you met up with Ita- she's a fantastic person and very good at what she does. I am also so pleased to come across this site and see how well you are doing- it's fantastic! Well done on all of your hard work. I would love to hear how cairdeas is going, do you need any fundraising done from the UK? If there's anything I can do then just e-mail on I would love to hear how things are going either way. Having been in Uganda I realise what fantastic care Hospice provides but realise that there are so many other people in the world who need similar care.
Hope you are well and thank you for all of your advice before my elective,
Emma xx :-)