Friendship

Friendship

Friday, March 31, 2006

kenny's impressions


I mentioned in my last post that my colleague Kenny Ferguson was here for 2 weeks running chronic oedema training. It was a crazy couple of weeks with very sucessful training and adventures gallore. The photo shows the course participants in Calicut. Here are Kenny's thoughts;


'firstly i would like to thank mhoira and Cairdeas for the
opportunity to work in and experience India albeit for a very
short time. nonetheless this proved to be one of the most
enjoyable and important experiences of my carreer in
palliative care to date. also a big thanks to mhoira for all
the background support work she did on my behalf which
ensured the smooth running of the course and for making me
feel so welcome. all of this background work and support made
it so much easier to settle in quickly and get on with the
work. my work focused on training the trainers in the
management of chronic oedema (a significant health problem in
India).these courses were offered from two centres, Calicut
and Cochin each course running over three days.i also spent
some time observing the work of the home care service offered
by volunteers up in the Waynad district of Kerala.this was
indeed a great example of palliative care for the community
by the community.i think india has a lot to teach the west
about the importance of strong family ties and community.

in the face of huge resource difficulties i was amazed at
the morale, committment, energy and thirst for knowledge
shown by both groups of nurses. we had great fun during the
courses with much moothie playing and laughing at ourselves.
hopefully the courses went well and we certainly initially
got some very positive feedback from course participants. a
lot of thought and discussions needs now to continue with
mhoira and our indian nurse and medical colleagues as to how
best continue to support oedema work in kerala into the
future. this was a very important and enjoyable (if
exhausting) experience for me.it reminded me of why i came
into nursing and particularly palliative care.while i went
out to india in a training role i know i learned more from
the nurses and volunteers i worked with than i could ever
give. it was my pleasure and
priveledge to work with such professional and committed
indian colleagues.once again thanks to them and to cairdeas.'

Saturday, March 18, 2006

first cairdeas course


A red letter day! I was joined this week by my Scottish colleague Kenny Ferguson from Moray. He has more than 25 years experience as a palliative care nurse, the last 15 in a community Macmillan role. He has also set up a chronic oedema service and we have been planning for him to visit India to assisst in training for some years. Advanced, chronic oedema is a major problem affecting the quality of life for many patients. It is usually related to diseases such as cancer and their treatments but in this part of the world filariasis is also very common. Kenny has worked hard to prepare a training programme focusing on 'training the trainers' If there is a pool of experienced and trained nurses they can continue the sharing of expertise. We spent a few days in Cochin then off to Calicut to repeat the training. Kenny has taken to India like a natural and it has been lovely for me to enjoy his enthusiasm and company. His Scottish banter and moothie have gone down a storm. I think his years in mountain bothies have prepared him well for adapting to India - a qualification I had not considered in our Cairdeas Consultants!! Here is a picture of the Cochin nurses and I will ask Kenny to add his comments for the next blog entry.

Thursday, March 09, 2006

jaipur


Hi from Jaipur - the pink city in Rajestan, the most royal Indian state. Dr Gayatri and I were invited to take a seminar at an important oncology conference. It was the first time in Rajestan that there had been a palliative care seminar at an oncology conference so the local team were very encouraged. There is only a small service here with a need to work together and try and develop some co'ordianation in training and networking. As ever we meet people who are committed to making a difference. We visited an inspiring hospice where 5 nuns run a very good unit with such care and compassion but with very little medical support and would so welcome further training. (see photo) We have been offered a very warm welcome if we were able to return and help with training and development. Rajestan is a large, spparsely populated state with many villages that are far from city centres such as Jaipur. As ever there is so much needing to be done to improve the lot of the poorest patients. Our hosts Dr Malti and Anjum were very generous and welcoming, helping us to experience some of the cultural highlights.

Thursday, March 02, 2006

overdue update


Hi again. A whole month has gone by. Apologies for the lack of entries but I have been having real internet access problems.

It has been a busy month. I have been teaching and training at cancer centres in Hyderabad and Trivandrum as well as day to day work in Cochin. Feb 9th-11th I participated in the IAPC international conference in Chennai which had the topic of Pain and Beyond - focusing on psychosocial and spiritual issues. It was a great conference and a chance to catch up with colleagues from the UK. There is a small cohort who come each year to support training. You may know people such as Dr Micheal Minton, Dr Ian Maddoks, Dr David Frampton, Judith Smith, Gilly Burn, Jeremy Johnstone and the team from Severn Hospice ... Some of us try dressing up -we looked good in our Chennai silk saris! Above is a photo of me and the Cochin team. They are delighted that they will be hosting the 2008 conference.


At Trivandrum I was joined by colleagues Dr Rosalie Shaw and Dr Cynthia Goh from APHN / Singapore which was a great chance to talk about wider palliative care issues.

I also had the chance to travel to rural Andrha Pradesh to visit a village ministry project (Indian Village Ministries ivm@sancharnet.in) run by old friends from Aberdeen Suresh and Roja, and meet a friend from my church back home, Peter Ross. Perhaps their project will involve palliative care in the future.

Tomorrow I am off to teach in Jaipur, Rajistan - the pink city. More in the next entry!

It is hot and humid and getting hotter - I would love a few hours in the snow. Hope my fellow Scots are not suffering too much this winter.

Tuesday, January 24, 2006

Cairdeas

Hi

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 www.cairdeas.org.uk. 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.