Friday, May 01, 2015

Transforming practise; transforming lives; transforming societies

Degree students visiting MPCU
One of the great privileges of mentorship and modelling palliative care is seeing the way the experience can transform lives. In Cairdeas and through the Makerere Palliative care Unit we love to have visitors and volunteers who all contribute to the life and work of the unit and leave their mark on our team. Working in palliative care provides opportunities to challenge and change values, to affect our clinical practise but also our attitudes, to develop character and resilience and to reflect on the big issues of mortality, hope and meaning. Daily I am encouraged by those who grasp opportunity with both hands and allow the experience and the time with patients and their families to change their lives. Perhaps in the next post I will include comments and experience from mentors but this time listen to the voice of some of our students and colleagues who have shared the day to day roller-coaster of emotions and the privilege of offering palliative care alongside our team.
Christine with our volunteers on
 Easter Thursday washing our patients' feet
Christine Brennan and Alasdair Pears are both medical students from Aberdeen University who came to do their electives within the Department of Medicine at Makerere University and attached to the palliative care unit. We met in 2014 when I was speaking about Cairdeas at our shared church; Gerrard St Baptist. Elective students have visited us from many universities and countries and we are happy to try and make this a good experience all round. Christine and Alasdair were also joined by Emma New from Oxford Uni and made a great team; including having a lot of fun exploring the beauty of Uganda.
'I am never going to forget what an absolute privilege it has been to work alongside the palliative care team at MPCU. The work that they do has been such an inspiration and encouragement and has changed how I will practice medicine in the future.  The team have shown what true patient centred medical care and empathy is as they strive to provide the best end of life care for their patients.
The skills that the team have are irreplaceable and daily they are improving patient’s knowledge
Alasdair with a small relative

about their illness but also invaluably meeting spiritual needs and support for their family. I have enjoyed being in a different medical setting, especially learning more about palliative care in Africa and how prevalent the need is for this speciality, but also the growth and development occurring aiming to fulfil to meet this need across the country.
The volunteers whom willingly donate their time to listen and pray with patients and their families are precious to both the team and the lives of patients that they reach. Holistic needs of patients are vital and MPCU really do go the extra mile to achieve this.

Team ward round
I would like to thank Dr Mhoira Leng, for this opportunity to come and be a part of the amazing work she does in leading the team at MPCU and the development of palliative care that is coming forth for the availability in other areas of Uganda and other countries within Africa. I would like to encourage support for this work, to enable it to keep moving forward.   It has been a life changing experience that I will treasure, shaping my medical practice and my heart for my future career.'

Emma took the chance to really encourage our team as well. 

'You are a group of wonderful, beautiful human people and your work is so precious and valuable. You have taught me both medicine and life skills and I really, really hope to be able to return to Mulago to work with you in the future.'

Alasdair,Christine and
Emma with our church friends
 at Lugogo Baptist 
Here are the reflections from some of our Ugandan students showing how their palliative care placements and training bring about transformation.

'This has been a wonderful experience. It has taught me to be a better doctor in the future. 5th year med student, Makerere

'The palliative care training has made a huge impact; I now see the patient as a person and not a disease, I don't avoid difficult conversations, I don't order unnecessary investigations, I see them as part of a family, I do holistic care. It was not like that before.' MMed doctor in training, Makerere.

All this must be underlined by the way we teach and care for each other. In the words of a Ugandan nurse in specialist training and placed with MPCU.

 'I have learnt that palliative care is not a team but a family'.

Rwandan MOH with Dr Liz Grant and Diane Mukasahaha
(and me behind the camera)
We have been partnering with colleagues across India, Africa and the UK to strengthen health systems to and bring about transformative change. In particular a 3 year project with the University of Edinburgh and the African Palliative Care Association funded by THET and DFID has enabled us to partner with colleagues in Uganda, Kenya, Rwanda and Zambia. If you want to read more check out We will also be sharing a unique day conference between Cairdeas International Palliative Care Trust and the Global Health Academy at the University of Edinburgh along with colleagues from DFID and PRIME. Mark the date,come and join us June 19th. Register via The previous weekend and following day (June 13th and 14th and 20th) will also be opportunities in Aberdeen and Glasgow to hear more about our work (and meet Christine and Alasdair!) We will also be counting down to an awareness raising event soon; watch this space and see us get a bigger social media profile!! One tip; think purple.

Can these individual transformative experiences change systems and even societies? Can palliative care be a vehicle not just for compassionate care but also for strengthened, compassionate health care systems and communities? I firmly believe we are seeing this happen and am humbled to be a part of this along with Cairdeas, MPCU and so any many others in the worldwide palliative care family.
We have been blessed to have a number of colleagues from Rwanda (and many other countries) come
Magnus and  Dr Martin Nyundo from CHUK
 and team members at MPCU
to MPCU to learn about models for integrating palliative care as they seek to develop services in their own country. Thank you Magnus Gasana for all the skills you bring as a clinical psychologist and for your encouragement and vision. I will give you the last word.

'I really highly appreciate the enthusiasm and quality of hospitality you've shown us. This reflects the heart of humanity in health providers. Learning from you empowers us to transform the whole Rwandan society in having a therapeutic culture. We don't doubt that other countries can learn from us as we have learned from you. Yours in solidarity....'

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