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  http://integratepc.org/. 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  http://www.eventbrite.co.uk/e/global-perspectives-for-palliative-care-integration-and-health-systems-strengthening-tickets-16784466792. 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....'

Soul's worth

Christmas is full of tradition; food, magical memories of Christmas past, food, parties, presents, more food, singing, joy, laughter and even more food. This is true here on the equator even though there has never been a 'bleak mid-winter' and the sun shines daily. I have my angels on the banana fibre tree, sung carols and eaten mince pies. Listening to an advent podcast I was struck by a meditation on the words of a well known and loved Christmas carol;
O holy night the stars are brightly shining, it is the night of the dear Saviour's birth. Long lay the world in sin and error pining till he appeared and the soul felt its worth.' 
What a wonderful picture; soul worth....a sense of value and validation and affirmation and grace in a world where there is so much pain and sorrow and conflict and grief. Again we are in a time where around the world there are disasters and conflict; many still dying of ebola, children killed in a school in Pakistan and the grinding reality of homelessness, poverty and loss.

Volunteers. MPCU and hostel party

A ward round in Mulago also shows the gamut of human emotions. We have just finished the examinations for our undergraduates and postgraduates in Makerere; nerves, hard work and the pleasure of seeing young colleagues grow and learn as well as the camaraderie of my examiner colleagues. We climb the hill to visit Betty who has been in hospital for many months but so wants to get home to see her young children this Christmas. She should finally get home tomorrow. Then there is Aloysius who needs treatment but how do we get him across the hospital site when he is so sore with the slightest

Enjoying our love feast Acholi food

movement and there is no ambulance available. Thanks to our volunteers who work tirelessly to help. Charles cant move his legs any more but has a caring family who need to learn how to nurse him and give his painkillers as they take it in turns to sleep under his bed. Little Kamau is full of smiles when we have our Christmas party even though he is getting his treatment for cancer daily. Women from across the region who are all having cancer treatment  joining Kamau and our MPCU team singing, dancing and of course eating food. My Lugogo church family share a love-feast with guest appearance from gospel music star Joyce Babiyre and of course sharing food (I love malakwang and sweet potato from our Acholi friends).

Sophie and Rachel in Kerala

Press in Guwahati

I am spending the next few weeks in Kampala and appreciating a new home (moved across the compound) and freedom from airports for a few weeks. I am reflecting on an amazing year. The past 2 months I have been in 7 different cites in India meeting old friends and colleagues and seeing how much they have achieved; huge congratulations Chitra Venkateswaran and the Mehac team, MR
Rajagopal and the Pallium India team and Dr Gayatri Palat and the MNJ team. Thanks too to Rachel and Sophie on their medical electives from Edinburgh who wanted to learn about palliative care

Moolchand parantha

BCH team Tezpur

in India and took time to float on the backwater with Auntie Mhoira. I was then joined by Dr Gursaran Purewal and Grace Kivumbi (MPCU), Dr Dan Munday (INF Nepal) and Dr Dinesh Goswami (GPPCS) and we travelled to Tezpur in Assam to evaluate the palliative care
programme in Baptist Christian Hospital. Inspiring and encouraging. Thanks Dr Jerine and your team and to the leadership and vision of Dr George Koshy and Dr Ann Thyle. Back to Delhi for a busy research workshop - you cant do better than a colleague saying it was 'perfect'. My favourite part was doing some practical research on the famous Moolchand parantha - mixed views on the hygiene but resounding positives from all who took the taste test.
What is at the heart of all we are doing in palliative care? What is at the heart of what we celebrate at Christmas? What is on our hearts? We search for meaning and purpose. We need to feel we have a role, that we belong, that we have significance, that we are loved. We want to say with our actions and our words you deserve our professionalism, our service, our friendship, our love because you have value and worth. When

Kamau's party time

our volunteers spend hours trying to get a patient the care they need working with the ward staff and families they are saying 'you are valuable and loved'. When our nurses share a quiet moment with a family as they realise this might be the last time Christmas is shared we are saying 'your life has meaning and you will be missed' When our doctors go the extra mile for someone who is in need and suffering we say 'you are made in the image of God; of infinite worth'. When we see and build the skills of our colleagues to enable them to offer values based care and model this in our team we say 'you can change the world one step at a time' When we see each member of our team as different, unique and valued we say ' together we can make a difference' We are also so conscious of the care and love from many across the globe for our work in Cairdeas as well as the wider work of palliative care. Our Christmas appeal this year focuses on building capacity through scholarships for Dr Jack Turyahikayo and Ivan Onapito. Please click on this link if you can support or link it to your friends. https://www.justgiving.com/Richard-Morrison3

Kerala beach

What gives your soul its worth? Perhaps you will be spending time with special 'people sharing, remembering and making new memories. Perhaps you will have moments of wonder; a snowflake, a

Sunset on the Zambezi

sunset, a smiling child, candles glowing glowing in the dark; child's voice singing 'Away in a manger'. I know I can get to this time of year and feel pretty weary; when the day to day frustrations combined with the pressure and busyness of life and cumulative burdens can seem overwhelming. I am so often aware of how often we fail to live up to our expectations and ideals and even just to keep up with the busy agenda. Yet this is a time of grace and renewal and hope. A time of hope and rejoicing because the Saviour has come and our souls have felt their worth...May you have a wonderful Christmas and full of hope for all 2015 will bring.
O holy night the stars are brightly shining, it is the night of the dear Saviour's birth. Long lay the world in sin and error pining till he appeared and the soul felt its worth. A thrill of hope the weary world rejoices, for yonder breaks a new and glorious morn. 

Refreshment in a dry land

Imagine 45 degree heat and 7 hours of teaching per day when all of your participants have not eaten or drunk anything since 3am. Add some of the most hospitable and generous people you have met with a heart to make a difference for the suffering and needy in their country along with amazing culture, colourful markets and fantastic food (after 730pm) and you have sense of my recent experience in Khartoum, Sudan during Ramadan. Dr Nahla Gafer, clinical oncologist and palliative care champion at RICK (Radiation Isotope Centre Khartoum), along with Dr Ahmed Elhaj, Dr Mohja Khair Allah, Mr Alfaki Suliman (from Soba hospital) and the rest of the team arranged the first palliative care training for oncology staff. This was in partnership with the Comboni College led by the inspirational Fr Beppino Puttinato and Fr Jorge Naranjo
 (http://www.combonikhartoum.com/short-courses/palliative-care.html)

They invited facilitators from the Makerere Palliative Care Unit to share their experience and to join the Sudanese team to teach and advocate for palliative care.  More than 20 students from 4 hospitals, representing several disciplines and levels of experience worked hard with a willingness to share and consider how they will implement their learning. We had key discussions and offers of support from the Ministry of Health non-comunicable diseases department and the WHO representatives. We met committed hospital directors  from the Khartoum Breast Cancer Center, RICK and Medani and heard of the progress in access to oral morphine and the hope to integrate palliative care throughout the hospital setting even beyond oncology and to dream of how this can be available in the rural settings of this large and varied country. We heard too of the challenges with high inflation, geographical distances, lack of training options available in

Sudan and the many upheavals politically in the region. For Mwazi Batuli and myself as well as student and Sudan enthusiast Emilie Myers it was an amazing 2 weeks. We miss the baobab and karkadi drinks, the rugag soaked in milk, the guiding skills of young Yousif, Arabic henna, bustling night markets, the sound of the muzzein folllowed by mouth watering  fatur and the deep

faith of Sudan's people but feel privileged to be part of this palliative care journey and look forward to being able to work together in the future. I return with my Sudanese name; Dr Mohira, a beautiful Dafuri basket on my wall, some Arabic henna, a few more Arabic words, a new tribal dagger to cut the haggis at my Burns night celebrations and the joy of renewing friendships, building new relationships and

see people transformed to influence and change their health systems. Shukran. Maybe next time we will get to explore more of this amazing country but to all the palliative care friends we wish you well and know you are going to do great things inshallah.

Anyone reading this and near Scotland this week we would love to share more of the work of Cairdeas 4th or 5th October.https://www.facebook.com/pages/Cairdeas-International-Palliative-Care-Trust/288455601217080 

Daily life in Kampala

Often these posts are about travels and adventures rather than the day to day clinical rounds. Some of you asked for another wee peek into a typical day and some of the people who make life so rich, unexpected and challenging.

The traffic in Kampala gets worse and worse but if you get up before dawn, arm yourself with a large mug of spicy Indian tea and leave as the sun is just rising you can almost keep your sanity. The beauty of a soft red sun rising above the busy morning activity and the smart youngsters on the way to school makes getting up early worth it (almost). The small team office fills up as one by one everyone arrives though as it is rainy

season they can be delayed. For the past few years we have been privileged to have UK volunteers working with us and they add to so much to our great MPCU team. Anna has just left but Eilidh and Gurs are with us right now and have joined me on the early start. Each day our priority is the patients and families we support on wards throughout the Mulago site. Last year we saw more than 600 patients and their families and many many more were also supported through the volunteer and link nurse programmes. Today Mulago is as busy as ever but has got some smart new beds, mattresses and even hand sanitiser containers (not always full but a good step forward). The nurses look smart in their uniforms and red belts and seem to keep going even when the number of patients seems overwhelming. Let's visit some wards together. Here is a young girl from the west of the country who has had very traumatic events in her childhood and now has an unusual type of cancer and is receiving chemotherapy. Her parents are with her constantly to do all of her personal care and at least she is sleeping quietly today. We can now go and see a young man of 23 who has been diagnosed with liver cancer that is very uncommon in the UK but sadly common here. It is associated with hepatitis B and

perhaps one day vaccination can stop this cycle of infection, inflammation and cancer. Today we need to speak with him and his family and break the news about how far the disease has progressed. At least his pain is well controlled today with the help of oral morphine that is presently in good supply. Our next patient has several problems that are linked; stage 4 HIV/AIDS which drops the immunity and leaves people vulnerable to other problems such as the advanced TB he is being treated for and now a kind of cancer, Kaposi sarcoma. We have some  colleagues with us today who are going to be pioneers of palliative care in their Francophone countries; Tunisia, Senegal, DRC and Benin. Chedly from Tunisia has never seen a patient with KS which shows the huge difference in this continent of Africa. They are adding a whole new dimension for the round and stretching my rusty French language skills. Come with us too and see a young girl that has advanced heart disease (called endomyocardial fibrosis) that is fairly common here but very rare in the UK. She has responded to treatment overnight but remains very ill. We have suggested to her mother that we ask for Hospice Africa Uganda to help with her care at home and the mother claps her hands. Why? She is also a patient at Hospice and knows how much care and love they will offer. Still sad for this lovely family but glad Octivia from Hospice is on our round today as she is several times a week. Lastly we prepare to lead a clinical meeting, called the grand round, to talk about difficult conversations at the end of life to help our colleagues think about how to handle these situations and to explore the ethical issues   involved.  We are going to tell the story of a courageous little girl we looked after recently who agreed to let us share her words. She was very ill with advanced lung fibrosis and had many questions. Am I going to be OK? Why do other children get better and go home but not me? She also got

very frightened at night and asked 'Is Satan coming to get me?' 'Can you help me go to a church?' She was too unwell to go to church but we listened to her fears, supported her family, prescribed some medication to help her breathing and then suggested we brought church to her thanks to our great volunteers. They came with songs, stories, a radio, some ice cream, a children's bible and prayers. Holistic care in action. It was also encouraging to see how many came to the teaching session and were willing to explore and learn how to respond to these very important questions. It underscores how much our colleagues appreciate palliative care and are willing to develop their own skills with enthusiasm and compassion.
Its been a busy day and now we have plenty paperwork, examinations to set and mark, panicked students to support who are trying to get their research work in for marking, planning for our next THET project support visits to Uganda, Zambia, Kenya and Rwanda, looking to see how we can manage the budgets this year, answering the hundreds of emails and of course the prospect of battling with the Kampala traffic to get back home to my wee house.

Odisha experience, chilly Delhi and Assam adventures

Mentorship participants

Warning; Delhi in January is really quite chilly. Picture me going to sleep with a wooly hat and wrapped like a parcel in scarves. What was not chilly was meeting again with the Emmanuel Hospital Association palliative care colleagues and sharing together about mentorship.  I think

Himalayas by air

Baptist Hospital, Tezpur

this is one of the most crucial areas in building capacity. Mentorship helps another become more self aware, builds confidence, challenges and supports the identification of areas needing growth and facilitates mobilising resources and making changes. As ever Chitra and I worked together joined by Ann Thyle and Marion Mathias who is a GP from Herefordshire. We are seeking to support the development of mentorship within EHA and to offer some further external mentorship support though colleagues such as Marion. Straight away we visited one of the dedicated and visionary leaders and her team at Baptist Hospital Tezpur, but this will be retold more in a future post. However, Marion is soon doing another big challenge; the Paris Marathon. Please consider giving to Cairdeas through her justgiving page. Many many thanks Marion and power to your knees!! http://www.justgiving.com/Marian-Mathias

Claire and Beci

With Anjum, Dinesh at IAPCON

We then travelled to our 3rd state of Orissa, joined by a team from MPCU, Beci, Claire, Alastair, Julia and Ivan. I was so so proud of our team presenting 7 abstracts and 1 paper and being recognised with several prizes. EHA also presented and also shared prizes (well done Ann)and Chitra's team presented some innovative work in the area of mental health with similar recognition. It is not just about prizes of course but the opportunity to share, have work appreciated and affirmed, encourage others and continue to see palliative care developed and lives changed. Thanks to the teams from AIIMS and Bhubaneswar for organising a great conference.
For Ivan it was a journey of first experiences, not least being the sole black man at the conference. He tells me he now knows how difficult it is when people stare at you all the time because your skin colour looks different!! He has shared some of his experiences for this post.

Ivan

MPCU team in Bhubaneswar

'I was in India from the 11^th-20^th of February 2014 to attend the 21^st Indian Association of Palliative Conference as part of the Team from Makerere Palliative Care Unit. I coordinate the team of volunteers at MPCU who are invaluable in providing practical psychosocial and spiritual support to the patients with palliative care needs. There were so many firsts for me; it was my first time to travel by aeroplane, first time to present a paper at a palliative care conference of any kind and overall it was a lifetime experience for me. I presented a paper on “Integration of Volunteers within a Hospital setting” giving the experience of Mulago Hospital where I am based. I was quite nervous since it was my first time to make a presentation at a conference of such a magnitude. I was even more shocked at the awards ceremony when I won joint first prize for my presentation. I enjoyed interacting with palliative care practitioners from various countries and India especially that has good volunteer palliative care services. It was a rich experience for me.

Ivan and Alastair at the Taj

It was not only work, together with my colleagues, we were able to experience and see some of the historical monuments of India, eating their delicacies and experiencing bits of their culture. My highlight was our visit to the magnificent Taj Mahal which left me in awe.  India is a very wonderful country, the people were warm and friendly. Overall it was an experience of a lifetime that I will live to tell my children about, and I want to appreciate all those who made it possible for me to attend the

conference and special thanks to my Boss who has been a good mentor to us all at MPCU'
As you know Ivan is one of our team members who is receiving a Cairdeas scholarship to continue his theological studies and to attend this conference. Thanks to all who contribute so faithfully in so many ways. 

Angels

What has been the best story for you this year or in your family and country? People who bring news are important and in the Christmas story angels play a significant part. They announce the message of the coming baby to Mary and to Joseph, they told that this baby would be the saviour of the world, they then announced to the whole world in a heavenly choir the great news , peace on earth and goodwill towards men.

I have been thinking about the message of the angels and also how angels can become a symbol of hope and protection. I am sitting on Christmas eve on a balmy evening looking forward to a warm, tropical Christmas without the crispy snow and frost that is so familiar in Scotland. I hear this year there are even storms and severe weather. But then that first Christmas there was no snow, despite our many Christmas cards carols that say otherwise.

I have a banana fibre Christmas tree hung with African angels and several other beautiful angels made from local materials including bark fibre, safety pins and local fabric. We also have shared beaded angels on our Cairdeas stalls for some years made in South Africa and Uganda. 

There have been some precious stories of ways these simple symbols have represented love and care. One of my friends showed me the wee angel I had given when her husband was dying. She has carried in her purse as a reminder of God's care for several years. Another friend shared how her very sick friend asked to her to give an angel to each of her family so they can hang it on the tree and remember her.

We had a party with our patients at Mulago last week and so enjoyed singing in several languages, eating cake and piled high plates of Uganda food. I was sharing one of the names given to Jesus and often given as a name to boys here in Uganda. Emmanuel which means God with us. This was the profound message of the first Christmas. it is also the amazing message still here today. My Rwandan colleagues then spoke of us being little Emmanuel. Being the presence of God in each other's lives and in the lives of those who have little good news and even less peace. We think of our brothers and sisters in South Sudan and Syria and many other places of conflict this Christmas. We think of the many people ill in hospital or at home, those who are missing loved ones, those who do not have food or clothes, who do have choices over their lives.  Many of us will have an symbolic angel in our homes or on our Christmas trees this year. Perhaps we can take the good news the angels sang to heart and let it change our lives but also let it change how we relate to the world around us.  As one of the greatest global leaders said; 'Our human compassion binds us the one to the other - not in pity or patronizingly,but as human beings who have learnt how to turn our common suffering into hope for the future'.  Nelson Mandela

Wishing you 2014 full of hope.

WWLD and WWJD

Last evening I was privileged to attend a celebration of the life of David Livingstone in the soaring and chilly beauty of Glasgow Cathedral. I was then asked to be part of a debate on what would Livingstone (WWLD) do if he were alive today. All the suggestions were persuasive and compelling (eradicating HIV/AIDS; Ms Mphatso Nguluwe , ending modern human trafficking;Sir Kenneth Calman, mobilising churches; Rev CB Samuel and addressing the global pandemic of untreated pain and lack of access to palliative care; yours truly) I have included the whole of my 4 minute speech for you to review. Sorry you can't vote for the others as well. At Cairdeas we are particularly delighted to partner with EMMS International http://www.emms.org/ who are the main support behind the palliative care developments in EHA, India, that we also support, as well as in Malawi. Now to finish packing in time to catch my plane back to the tropical heat of Uganda.....

'My thanks to my fellow debaters for their moving and persuasive presentation, to EMMS and the organisers of this event and to Dr David Livingstone for his inspirational life and example which we have come here to honour and celebrate.

5 billion people in our world do not have access to pain relief and palliative care, many of these with chronic, debilitating, life limiting illness. HIV AIDS as we have already heard but also rising numbers of those with cancer, growing problems with heart disease, rapidly increasing numbers with poorly controlled diabetes, kidney failure with little access to dialysis and multiple respiratory problems due in part to cooking fires in huts with poor ventilation.

This burden of disease has an incalculable effect on individuals, families, communities and even national economies as it disproportionately affects those in low and middle income countries exacerbating poverty and creating a trap for many more to fall into, where meager resources are used in a futile search for help and future generations denied opportunities and hope. This global pandemic of untreated pain affects hundreds of millions of people in our world and is described by the World Health Assembly as an urgent, humanitarian responsibility.

Livingstone's Rousers

Oral morphine, one of the mainstays of pain relief is simply unavailable in most of the world. Of all the morphine legally produced and used every year 94% is used by countries that represent only 15% of the world’s population. One of Livingstone’s achievements was to ensure that a simple medication made from Peruvian tree bark would be available in a safe and effective formulation. These ‘Livingstone’s Rousers’, which combined quinine and  rhubarb, were a significant advance and I think he would use same energy and determination to champion the provision of another God given medication; the extract of opium we call morphine.

Imagine the anguish of medical colleagues seeing patients in such severe pain yet unable to help, imagine the distress on a mothers face when her tiny daughter injured by severe burns when she pulled over paraffin lamp screams in pain without relief, imagine the quiet endurance and silent agony of a young mother whose breast cancer has spread to her bones and dares not move lest it hurt, imagine the nurse who avoids dressing the wounds of her patient as she cannot bear to hear the shouts of pain, imagine the elderly man who prays that God will take him soon to spare him further anguish and stop draining the family finances.

Palliative care is about quality of life and holistic support addressing the physical problems such as pain but also the isolation and financial drain of chronic illness, the loss of hope and meaning, the powerlessness and despair. It is about empowering communities, restoring dignity, relieving suffering, walking alongside those who face darkness and despair with all our medical skills and also a message of hope and promise of presence.

Livingstone engaged with some of the greatest causes of suffering and injustice in his day but above all he was concerned with what would Jesus do. WWJD leads to WWLD.

Livingstone was an ambassador for Christ. Taking the good news of reconciliation with God, with one another, with ourselves and with a world that is beautiful, exciting with untold riches to be explored. Livingstone was also a beacon to challenge and inspire others to be involved in this God ordained work of bringing reconciliation and healing and an end to needless suffering. Livingstone was not afraid to challenge and convict others, to stand against the prejudices of his day and to live his life in the extreme for the cause he believed in.

Many years ago I sat under a baobab tree in Malawi and made a decision to engage in this cause in Africa and India. It has been a wonderful adventure and tremendous privilege for me filled with challenges and blessings. This tree was over 200 years old and local legend has it that Livingstone would sit there; perhaps also contemplating the calling God has put on his life.

  

Ladies and gentleman; lack of access to pain control and palliative care is one of the most significant global injustices facing our world today.  I put it to you that freedom from pain, restoring dignity and relieving suffering would have been a concern, a motive, an imperative and a journey of untold adventure for Livingstone; as it is for each one of us.'