tamil nadu

Hi from the hot and wet south of India. I arrived 10 days ago in Chennai (used to be called Madras). After meeting friends and collecting my Indian clothes I had left behind, it was on to Vellore to join the team in the palliative care unit at Christian Medical College. This famous hospital is usually known as CMC - as I will refer to it from now on. First I thought I would put in a map of India to help with orientation. Tamil Nadu is the bottom right state - with a long coastline on the Bay of Bengal. You may remember the photographs from the Tsunami as this coast was badly hit. The southernmost point of India is in Tamil Nadu; where the Arabian Sea, Indian Ocean and Bay of Bengal mingle. It has a tropical climate and a combination of beaches and coastal areas, hill stations and mountains, Carnatic music, ancient culture and language. Indeed, Tamil is one of the most ancient of the Indian languages and a source of fierce pride. With a population of 62 million, it is a predominantly agricultural state but it's capital, Chennai is the fourth biggest city in India. I arrived in Vellore on a rainy day, with the mist obscuring the hills, that was almost reminiscent of Scotland. More in my next post.

glimpses of africa

How can I sum up my short trip to Africa? I can only add to my previous posts with some glimpses of Africa that touched my heart, inspired me and will make me hope to return. I visited 3 countries over 6 weeks - South Africa, Uganda and Rwanda. I met so many people committed to palliative care and doing much to improve the access for those in need. As ever there are many difficult memories too. There are many who are hungry and trapped by poverty. There is a shocking lack of justice in how the world's share of resources are shared. There is the huge burden of illness and in particuler HIV/AIDS. Visting the genocide museum in Kigali is so essential in understanding something of the horror yet is an emotionally draining experience. What do you think of when you think of Africa? Let me give you a glimpse through my eyes.

Africa is a land rich in its natural beauty. A beauty which is at once accessible and yet wild. Seeing these giraffe up close was amazing - how did God dream up that neck? A rhino waking from it's slumber is an awesome beast; spotting the zebra so carefuly cammoflaged a delight. Beautiful sunsets, thundering rivers, peaceful lakes. I am glad to have survived my Nile kayaking adventure - and thanks to my guide through the grade 5 rapids. Amazing to think of those great explorers spending their lives finding the source of the Nile and here I am paddling down in a small piece of plastic.

Africa's richest beauty is in it's people. Warmth and smiles and help for a 'poor Mzungu' like me. Amazing colours and hair fashions. Bright, curious children; enthusiatic church services (they even asked me to preach!!); great food - especially when you can add some firey piri-piri; talented craftsmen producing work both ancient and innovative; history going back to the cradle of hunmanity yet modern and devloping. So many impressions! Let us hope that Cairderas is able to work with friends and colleagues to support palliative care developments in this amazing continent.

world hospice day, rwanda(2)

October 7th was the second World Hospice day. This is a global event that seeks to raise the profile of palliative care needs across the globe and this year had a theme of 'Access to care for all'. We had been visiting some of the support groups for people living with HIV/AIDS. Let me tell you about one group that was called - 'Trust in God' this group had approached a local pastor who also lived with HIV to ask for help. They told us that they has found hope. Hope in God and as a result hope for living. Un,like many such groups they had a sense of energy and self-help which was inspirational and infectious. Micro-enterprise projects such as shoe making, sewing and baking bread were all underway. We were invited to share the first bread and, as it was to be on World Hospice Day, we had a joint celebration. You can see the photos; and I hope sense the fun and the hope. The wee lad on my lap is pretty ill but loved cuddling the 'mzungu' and sharing the warm bread. This group are part of the area of Gikondo in Kigali which is the district where there is a possibility of a hospice service., There was real enthusiasm for this project and a willingness to be part of the community training. Their only request was that I shared their experience and asked that others would pray for them. A very moving day!

rwanda(1)

Only 2 weeks in this tiny country in the heart of Africa - le pays du mille collines. I was visiting for cairdeas at the invitation of Signpost Rwanda - a charity with it's based in Dundee, Scotland, who are involved in projects for children and vulnerable women in Rwanda. They have achieved much and have a great team in Rwanda, Here is Pastor Nathan, Karen, Doreen, Janet, Josh (the computer whizz) and little Shema - Janet's son and my play mate while visiting. The Rwanda team have been challenged by the need for hospice and palliative care in their country and I was visiting as part of the feasibility planning and research. Thankyou so much for taking me to your hearts. I was able to meet so many people who are part of the new Palliative Care Association of Rwanda and hear something of their plans and vision. They have government support and undergone initial training supported by the African Palliative Care Association. The need is very clear with around 3% HIV/AIDS prevalence as well as a rising incidence of cancer and other chronic illnesses. So far there is very limited access to oral morphine and no palliative care service. However, there is a real sense of working together. My visits included the university hospitals in Kigali and Butare (here is Dr Cwynya-ay in his paediatric ward in Butare) ,senior nursing colleagues at King Faizal hospital and some of the key networks for supporting those living with HIV/AIDS. I wish them every blessing in their planning and have offered support from Cairdeas as needed (and available). I am sure much will be done to change the face of those suffering with palliative care needs in Rwanda over these next years, so that children like this little one can have the help they so deserve.

uganda

Uganda was described by Winston Churchill as the 'pearl of Africa' I have only had a short time to explore this beautiful country but I very much hope to be able to spend more time here in the future. Here is sunrise over Lake Victoria. In palliative care history it holds a special place. In 1993 Dr Anne Merriman and her team, with the support of the government, opened Hospice Africa Uganda. This has developed into a model of care that has met the needs of so many here in Uganda but also formed the basis for training and service support across Africa. It is a busy yet welcoming place where you can be sure of excellence in clinical and educational skills, a deep sense of faith, great food from the tiny kitchen and the brightest morphine bottles you have ever seen. This picture shows how simple tools such as used water bottles, mixed with ingenuity and simple morphine powder can provide affordable oral morphine solution to those in pain. 10 days of morphine is equivalent to the cost of a loaf of bread. Patients are seen at the clinic or by one of the outreach teams. There are also 2 linked units and a network of trained community volunteers. This lady has her oral morphine at home - helped by a friend who took her to the clinic, as she had no family suuport. Her cancer pain is now under control. As in India, care can be offered at an affordable cost with the support of trained health care workers, and community support. My thanks to Drs Anne, Lydia and Ita and the rest of the team for their warm welcome and wilingness to share. I have long wanted to visit and was in no way disappointed. It is so useful to Cairdeas and so humbling personnaly to see what you have achieved and to learn of the resouces available - particularly in education. I look forward to being able to stay in touch and possibly work togetherin the future. Off to tandem kayak the source of the Nile!

south africa (2)

Following on the last post I attended the 4th multidisciplinary palliative care conference in Pretoria. This is organised and masterminded by Noreen Napper and I was part of an international speaker group that included Dr Robert Twycross and Dr Anne Merriman. You can see our photo. It was great to meet colleagues from across South Africa as well as further afield. The programme was busy and varied and included many excellent speakers form South Africa. It is good to put palliative care in an African context. The first service began inZimbabwe in 1979 with spread to South Africa, Kenya and Uganda in the 1980's and 90's. Now there is growing awareness of the need for palliative care and services are developing in other countries such as Malawi, Nigeria, Tanzania, Zambia and others... Still however, few countries have good (or any) access to oral morphine and the challenge and tragedy of HIV/AIDS remains so difficult. Perhaps nowhere is this more clear than in South Africa which now has one of the highest rates of HIV in the world. Their recent figures show that many more people re dying in their 20's, 30's and 40's than in older life. This will becime even more of a social problem as time goes on and presents an urgent challenge to the country. In 2005 the African Palliative Care Association was formed to support palliative care accross this great continent and I am looking forward to visiting their offices in Uganda today!! More about that in another post.

south africa (1)

Hi everyone - after a long pause. I am back in Africa and loving being here. As ever I have had major problems with computer access so was only able to add a post today!! I will tell you a bit about the past few weeks over the next postings.
I arrived in Johannesberg on the 14th September. Initially I was working with Dr Natalya Dinat and the Wits palliative Care team. They provide an academic base within the Witswatersrand University and a clinical service within Soweto. They are a fantastic team and it was great to see them again. I hope to add a photo soon. I addressed the grand round medical meeting and attended a seminar arranged as part of World Hospice Day (7th Oct). Dr Robert Twycross was the main speaker and it attract a wide audience including the Dean of the University and senior politicians. Let us hope it will help in raising awareness of palliative care and the need for service provision and training. This year saw the first medical students complete their palliative care curriculum at Wits, with excellent feedback. In particular the students explored areas of personal coping, emotional and spiritual distress as well as the more physical problems. Much of this work was presented in portfolios that were innovative, creative and moving to read. One student read a poem she had wrtiien inspired by her patient entiltled 'Death be Defied' - I will try and add a quote later. I took part in the 2nd Wits palliative care day which was a fun and busy day as the students worked with case scemarios and simulated patients to explore palliative care issues.

Africa is an amazing place as I am discovering each visit. I hope to share some of my impressions with you in future posts but let me quote from Archbishop Tutu, who is a great supporter of palliative care and recently celebrated his 75th birthday. 'We are made for goodness, we are made for love, we are made for laughter, we are made for joy, we are made for transcendance' Here is an African sunrise to inspire you.

bonnie scotland

As promised I am giving you a flavour of my few weeks in Scotland. I love to travel and am continually amazed at the wonder and beauty of so many places. But Scotland has a special place in my heart!! These photos are of Aberdeenshire. Aberdeen has wonderful parks and floral dis[plays - often winning City in Bloom contests. It also has an amazing coastline with fantastic beaches just perfect for a BBQ and paddle - if you are willing ti brave the cold North Sea. Highland games are a feature of the summer months complete with dancing, pipe bands, and athletic feats. My Indian friends Chitra and Shoba enjoyd a dram of whisky with the Chiefton at Dufftown. Cairdeas has its roots in Scotland and the colour of our logo reflects the purple hue of the heather. It has been great to have the chance to share with so many about Cairdeas. Thanks to all who are involved at the 'home end' - I hope to have some photos of our teams soon. We are encouraged by those who are wanting to become regular supporters and hope to see an increase in the Cairdeas 200. (see website for further details www.cairdeas.org.uk) I am delighted to have the opportunity to meet the Aberdeen Indian society soon at their independance day celebration and share about Cairdeas. I am now working for a few weeks in Shrewsbury and preparing for a trip to Africa. More in due course. Keep October the 22nd free if you can come to Aberdeen for our annual meeting.

round the world

Hi everyone and sorry for the long silence. I have been round the globe since my last posting and then back to sunny Scotland (yes it is true!!) Leaving India after 5 months was hard and those I worked with are often in my mind and thankfully often in contact. I saw my new wee godson Ruari in Sydney (son of Katherine and Rich Burnett; Katherine is a Cairdeas Trustee and treasurer). Then it was off round the globe with a brief and idyllic stop in the Cook Islands. It is a beautiful paradise in the middle of the Pacific. Great to see friends in LA then back to Scotland. We have been busy with Cairdeas work - meetings, networking and planning groups. I have been humbled by the interest of so many. Our Trustees have approved the projects in Rwanda and Vellore. We have agreed next years budget too - just need the money now! Cairdeas 200 is our vision of 200 people to support us a minimum of £10 per month and act as our founder members and advocates. Slowly this group is coming together (15 so far) If you would like to be part of this please get in touch. www.cairdeas.org.uk or info@cairdeas.org.uk Thanks to all who have and are supporting us. A special thanks Steven who did a 10km run earlier this year and to those who tried to do a parachute jump but were thwarted by the clouds. They are all scheduled for September so have fun and take care! My next posting will have pictures of bonnie Scotland!!

cochin

As you may know, my main role over the past few months was to work with the team in cochin based in the Amrita Institute of Medical Sciences. It has been a rewarding and challenging time - and a time of real upheaval and change. My thanks to the warm welcome I was offered. My involvement has included support and training for the 2 year Diploma students, clinical teaching, setting and assessing assignments, arranging examinations (the first OSCE for ?Kerala) and offering management support and mentoring. Can I pay tribute to the work done by Prof Rajagopal and Dr Gayathri Palat in the development of this service and wish them well as they move on to other roles? Best wishes too to this years Diploma graduates as they move on (Biju, Biju and Sunil). The picture shows a social gathering. It was a real pleasure to work with the students and team and learn from them. They have made a real impact in AIMS with innovative practice and sound clinical work. I look forward to seeing some published work such as the experience with 'allow natural death' orders. We shared much over these months and laughed together many a time. Dr Charu Singh with the backing of Dr Sangeev Vasudevan will be leading the department now and I wish them all the best. I have been invited back as an external examiner for the Diploma exam in January 2007 so will get an opportunity to see the students again - even if not at their most relaxed!!

home care

I want to give you a glimpse into palliative home care. You have heard from Jan and Graham about their experiences and it is always a privilge for me to join a home care visit. In Calicut, a team consisting of trained volunteers, nurse, doctor and driver go out every day. Patients are reviwed, urgent visits arranged, proceedures carried out such as IV infusions, dressings, tapping of fluids in the chest or abdomen, medication supplied, social support given and emotional and spiritual support offered. The driver's role is the most intriguing as he at starts by negotiating the rural roads like a pro, reversing up impossible lanes before changing roles and assisting in dispensing medication and is then asked to help with preceedures. The combination of local knowledge (coming from the volunteers, who often live in the area) and the health care skills is inspirational. Here is one of the volunteers being introduced to me - he is a huge support to so many families. Coping with the journey, hot and humid climate, responding to unexpected needs, supporting relatives and patients is a draining yet rewarding task for the teams. What a privilege it is to be invited into someone's home often at a very difficult and vulnerable time. The photo here shows an elderly lady who was sharing some difficult feelings. Can you see how the team is around her offering her unspoken support, listening and concern? A real picture of palliative care in action. Some families are known over many weeks and months allowing real relationship building and trust. Othere are referred very late - though the network of local volunteers is helping prevent this. The teams offer an opportunity for training and mentoring as well as care for patients and their families. Areas of particular need have been identified such as psychiatric and psychological support, rehabilitation for spinal injuries; and these areas targeted for training and service development. A dynamic and responsive service - and an inspiration.

visiting impressions from Jan and Graham

"Gods Own Country"

Just back from India we wanted to say a few words about our time with Mhoira in Kerala....

This trip was only for two weeks but in that short time we were challenged,inspired,suprised and blessed in ways we had not expected by this wonderful place and people. Kerala is a beautiful place,as are its people.Mhoira's descriptions can give you a real flavour,but going out to see for yourself you experience the sights sound and smells will challenge any preconceptions about India and in our case has left us humbled and much richer for our time there.

Mhoira organised much of our trip for which we are grateful and highlights of Kerala included a boat trip on the beautiful waterways which criss cross Kerala(called the Backwaters), travelling in old white "Ambassador" cars and crazy auto-riskshaws(the only way to travel!) a stay in a coffee and vanilla plantation in the hills of Wynaad complete with a bush safari and elephants,and lovely meals out with Mhoira's friends sampling the yummy South Indian food,and the warmth and ready smiles of the locals .We could go on!!...but the real highlight was seeing some of the work Mhoira is involved in and meeting some of the great people she works with.

In Calicut,like Kenny, we had a chance to see first hand how the original vision of pioneer Prof Rajagopal, and his team has continued and grown into an impressive and unique model of community involvement in assessing,treating and supporting people in need of Palliative Care.Graham and I come from a shared professional background of psychiatric nursing,engineering,statutory and voluntary social work and were overwhelmed by the sheer numbers,as well as skills and commitment of local volunteers who are an integral part of the project,and in some areas take a lead role.They come from a variety of backgrounds including, on our trip, a local primary school teacher and retired engineer.This level of community involvement is unique in my experience,and our time out with Mhoira and one of the home care teams,visiting patients in the rural areas around Calicut,was both moving and humbling.
If only we had this kind of commitment in our communities back home! We were also impressed by the commitment to training,and I was delighted to meet one of the psychiatrists involved in teaching volunteers psychological skills,particularly as he has worked in the same psychiatric service as me in Edinburgh!

The opportunities for training,as Mhoira has described already, are there,and having seen the commitment and enthusiam for it, as well as the potential to change whole communities we have come back challenged about our own work,and inspired by what Mhoira and others have and could achieve. Do go see if you can...and meantime get behind the work of Cairdeas. These are real people,like Praveen, who need support for training and equipping so that they can make a difference. Oh and if you do go....watch out....those homecare drivers will take you on a journey you won't forget!

Jan and Graham Beckett (Mhoira's sister and brother-in -law)

calicut

You may have noticed how often I mentioned Calicut in my posts and newsletter. Let me tell you a little of the history of this pioneering service in Northern Kerala. In 1993 Prof Rajagopal, Dr Suresh Kumar and a small team formed the Pain and Palliative Care Society (PPCS) and began to develop a palliative care service based in the government medical college. A busy OP, with the words 'listen' pinned to the walls, was the focus with home care teams and link centre clinics. Negotiations with government made morphine available and a unique model of empowering faimiles and training volunteers developed. This was recognised with WHO demonstration project status as a model of palliative care for developing countries. Over the ensuing time this service has continued to evolve. In 2002 a movement known as NNPC (Neighbourhood Networks in Palliative Care) mobilised whole communities where the service was owned and run by the volunteers with input from health care workers. Perhaps I will tell you of this in a separate BLOG post. In 2003 a centre for education, training and in-patient care was opened - the Institute of Palliative Medicine. Much of the training is for volunteers with staggering numbers completeing basic and advanced training. This includes an innovative project to train trainers in offering psychological interventions as part of their therapeutic care. The nurse with a young patient on the left is Mina - one of the original team . Her smile and skilled care speak volumes. Praveen is a volunteer who has worked for 13 years in the PPCS and is involved in many of the training programmes. Here he is teaching communication skills. I have been involved in Calicut since my first visit to India in 1999, and it is always like coming home. This trip I have contributed to the BCCPM - a 6 week training programme for doctors (see picture)and the Fellowship programme for distance learning. The slogan for the PPCS sums it up - 'People for People in Pain' It is a place of ideas, energy, skill, inspiration and compassion. I am delighted to say that Cairdeas will continue to have a working partnership here and I will continue as visiting faculty to the Institute.

visit to vellore

As I mentioned in a previous post I was able to make a trip to Christian Medical College(CMC), Vellore recently. This is a famous hospital and nmedical school in Tamil Nadhu started by a missionary doctor (Ida Scudder) over 100years ago. It has always had a vision to minister to the poor and suffering and is renowned both in India and internationally for it's excellence in medicine and education but also it's service to the community. Patients still travel from long distances to recieve treatment. As an illustration, I attended an oncology round where 4 out of 16 patients were from Tamil Nadh and another 4 from neighbouring states. The remainder were from distant places like West Bengal, Sikkim, Banglagesh, Assam, Mizoram and Bihar. (you might want an atlas to check these out!)
Palliative care services started 3 years ago and the small department is led by Dr Reena George. The picture shows the rest of the team, and my thanks for their warm welcome. Already there is an active inpatient and outpatient service with home care to the surrounding villages 3 times a week. An exciting new development is the building of a hospice and education unit a few km away. You can see the contruction work in the photo, with an expected opening date of August 2006. We had some great discussions as to the development of CMC as an educational hub for palliative care. It is well placed to offer an excellent and credible training base that can reach many areas where palliative care is in it's infancy. I am delighted to say we have agreed a joint project to support these developments and I will be dicussing these plans with the Cairdeas Trustees soon. As ever issues of practicalities and finance come into the equation but am optomistic that we will be able to proceed.

Easter Greetings

Easter in India is very different. No daffodils or spring lamb or familiar church traditions. Especially as the Hindu New Year coincded with Good Friday. It was for me a chance to stop for a brief monent and consider the true meaning of life and salvation. I missed being able to be at church but was able to read the Easter story sitting on a beach overlooking the Indian ocean and watch the sunrise over the Kerala backwaters. Swimming at dawn, I was remembering that ancient dawn when Mary found the stone rolled away and the truth of Christ's resurrection began to be made known. What an amazing moment. My sister, Jan and her husband Graham arrived on Easter Sunday complete with M@S hotcross buns and chocolate eggs for the teams here. They are spending 2 weeks here and seem to be enjoying every moment.
I hope you all had a special time in whatever way you celebrate and sense the hope of a new spring and new life.

ASHA slum project

I have had the privilege of visiting this project in Delhi on several occaisions and thought you might like to hear more. It is a community empowerment and development project bringing 'hope to those who need it most' Each Slum Colony starts a programme of empowerment and primary health care, education and community development with training and support from the ASHA society. Over the past 15 years the project has grown to include >250,000 people and is a resounding success. Figures for child health, immunisation, family planning, TB control, school attendance and maternal health are well above the national average for India - never mind the usual picture in a city slum. ASHA is based on sharing the love of Christ in action and as such shares much in common with Cairdeas. Dr Kieran Martin, the founder was challenged to support those who have so little future and hope and has been awarded the Padmashree for her services to the poor. Issue of chronic disease such as mental health and diabetes are now being addressed and we hope to work together on a palliative care needs assessment next year. Here are some photos that illustrate the environment and the sense of hope. They were taken on my most recent visit last week. The wee baby is being held with her road to health chart - a WHO method of monitoring child health. The water pump is one of 50 for a population of 50,000 - previuos to ASHA's support there were only 5!

glimpses of india

I thought I would post a few pictures to give you a feel of life in India - just some of my observations about this facinating country. In fact, I will only give you some glimpses of Kerala this post. India is home to one of the oldest civilisations and more than 1 billion people. It is also a very young country, both in its population and it's recent independance. Kerala is a socialst state (the only state previously to democratically elect a communist government) with high literacy and an active civil society. It's language is Malayallam and is home to 35 milion people squeezed into a small land mass. It has a range of mountains (Western Ghats ), a narrow strip of land then the Indian Ocean. Known as 'Gods Own Country' the name Kerala means 'land of coconuts'. The backwaters region is unique and beautiful as seen by the first photos. Elephants might be seen in the game reserves, temple 2 festivals or even the street! Kids attend school smartly dressed - even if the transport is crowded. Food is light, tasty and unlike any 'Indian' takeaway you have tasted. Here is masala dosa - one of my favourite breakfasts. Lfe is always colourful, often frustrating, run on IST (Indian stretchable time) and invarably surrounded by warmth and friendlieness. Close your eyes and imagine hot moist air, spinning fans, scents of jasmine and spices, endless coconut palms, sunset over the Indian Ocean, tooting horns, crazy traffic, a cow causing a traffic jam, no personal space, ready laughter, bustling cities, vibrant colours of saris and the smile of a beautiful woman, and you have a glimpse of where I am. Come and see for yourself sometime!!