Judith and Ismay's visit

It was such a pleasure to welcome our first Cairdeas faculty of 2007 last month. Judith Smith is a very experienced Macmillan nurse who is at present working on a project to implement an end-of-life care pathway (Liverpool Care Pathway). She also spent 5 months teaching in the IPM, Calicut 2 years ago. Ismay Palmer is also an experienced Macmillan nurse who has spent a year in Tunisia and is now preparing to go back there to support palliative care training and development. Here they are after a long international flight - and immediate bonding!! Angela Pick, Judith's longtime friend from Australia, was also able to join us for a week on her travels. Here are some excerpts from Judith's thoughts and impression of her recent visit.

'The last three and a half weeks have been an exciting and memorable time...We arrived first in Cochin before travelling to Calicut. There we were joined in Calicut by Shakila Murali who is the lead palliative care nurse in Vellore and with whom we would be training in the second phase of the trip. We had three well attended and successful teaching sessions with nurses, many of whom were old friends...An overnight train trip to Vellore was such fun! We had a great time and most of us managed to sleep for some of the time, despite the frequent stops, coffee sellers and and changing passengers... Arriving at Sneha Deepam was quite an emotional experience. We were to be the first inhabitants of the building, which in the future will house up to 50 patients and their families in the hospice accommodation. There is also rooms for trainees and external faculty from around the world; as well as training and teaching facilities...We were at Vellore and CMC for 10 days and managed to conduct successful training sessions with nurses in various sites. Shakila, Ismay and I shared the teaching. Once again it felt as though real groundbreaking work was taking place as the first 1 day workshop was held at Sneha Deepam with 12 ward sisters from CMC Vellore...The Burns night was great fun not least from watching some of the slightly bemused faces observing the strange rituals we get up to in the UK! It was such fun to dance the gay gordons and strip the willow in the tropical heat!.....Words cannot explain the inspirational work of the palliative care team who operate under challenging and cost driven infrastructure. The financial constraints of both the society they serve and the organisation in which they are based, are juggled for each case. All of the treatments that are offered have to be looked at as an individual needs based package. The result is that an amazingly high level of care is delivered by the committed and highly skilled members of the team...It proved to be a successful and inspirational experience. The whole trip culminated in being the first international flight to land in the snow at previously closed Birmingham Airport last week'

My thanks to Judith and Ismay, the place is much quieter without you. Your hard work and generous friendship was a great encouragement and blessing.

celebrations and friends

January has been a busy month, not least with the visit of Judith, Angela and Ismay. They will be adding their own impressions in the next post. The rooms were ready in time and it has been such fun to stay here in Sneha Deepam as well as having the honour of being the first faculty to do so. Huge thanks to Rena, Hamilton and the team for working some miracles and making all this happen. This is a now a beautiful building and will be a great resource for the future. We wish God's blessings on all that is done here - both in training but also in the care of patients when the hospice opens.

I was also able to visit Calicut briefly, to see old friends and do a little teaching. Judith was able to se old friends and help with training. Ismay, Shakila and Angela had an opportunity to see the amazing community networks. Then it was off to Chennai to attend a wedding. Kalpena used to be involved in running the service in Calicut and it was so lovely to be invited to her son's wedding. Great too to be with old friends Chitra, Gayathri and Mallika; and to dress up for the occasion.

Burn's night was celebrated on the 27th of January - perhaps for the first time in Vellore. What an occasion! Haggis from Scotland plunged with a carved Rajestani dagger , tartan capped nurses singing 'Donald where's yoor troosers', home made oatcakes, a wee dram, ceilidh dancing and great fun!!! Thanks to all who were brave enough to come and join in the celebrations to make a Scottish lass feel at home.

New Year 2007

What were you doing this New Year? It is a time to reflect, smile at the good memories, perhaps shed a tear for the sad times, plan for the future and be grateful to God we can see in another year. I was in Kerala with friends David and Joyce Wintour, who made a stop in India after spending several months working in a hospital in rural Uganda. It was lovely to see them and to enjoy a Kerala New Year; young dancers performing an ancient Tamil dance form - bharathanattyam; watching the fisherman pulling in their catch at dawn much as they have done for centuries; sleeping under the stars on the backwaters. What an amazing world and a New Year full of promise! An old poem says; 'I said to the man who stood at the Gate of the Year, 'Give me a light that I may tread safely into the unknown' and he replied, 'Go out into the darkness and put your hand into the hand of God. That shall be better than light, and safer than known way'

Dr Reena and the team are now very busy developing the education programme at CMC. I mentioned before that the hospice and education unit was nearly finished and operational. Well, it will soon be true as our first faculty arrive in 3 hours to stay in the new unit. Hamilton and Ramu are hastily putting the finishing touches! Perhaps the train will be delayed!! It is exciting to see everything come together and my next post will tell you more about Judith and Ismay's visit. A major achievement has been the development of a one year, residential, postgraduate Fellowship in palliative care for doctors. The course is now fully approved and applications are being recieved. Here is the web link to the CMC website. The first students will arrive at the end of March.
http://www.home.cmcvellore.ac.in/admissions/admin.htm

What difference will all this make? Let me give you some thoughts. If you are a patient visiting CMC from the north and east of India there are only 3 places you can consistently get oral morphine. You may be travelling up to 800km to get a presciption for your sick relative! Often there is no one you can turn to.You are left without support and without hope. All over India and beyond this despair continues. Only 4 medical schools in India teach undergraduates about pain control and palliative care. So very few have access to palliative care in their communities. However, there are many throughout India who are working to change this situation. At CMC, the palliative care team hopes to train future leaders who can continue to make a difference. It is a privilege for Cairdeas to be a part of this vision. Thank you for supporting us .

comments

Just a quick comment about comments!! It is brilliant to hear your thoughts but please be aware that I don't get your email ID when you post a comment. So if you would like a reply - please include your email ID. I would love to respond. Thanks for reading the BLOG and being interested in Cairdeas.

Christmas greetings

Wishing you a very happy Christmas and God's richest blessings for 2007. Christmas celebrations come early in Vellore with parties galore. There is also the habit of middle of the night carol singing! I was privileged to sing in the college carol service which was very moving - and a bit panicky as we were short of practice. Hamilton, our team chaplain was the conductor, and did a great job. The picture shows him with me and Grace and Fellina. Hope you like the sari! I have been eating lots of chicken biryani - the traditional Christmas fare - as well as the many sweets on offer. These are gulab jamen - and dripping with condensed milk and sygar syrup!! We are looking forward to a busy start to the new year. The hospice will admit the first patients around the second week in January. there is still much to be done but it is exciting. Also we have plans to do some nurse training in the education unit and will be joined by Judith Smith and Ismay Palmer from the UK. The first 1 year Fellowship in palliative care for postgraduate doctors in India has been confirmed and will start in March. Adverts have gone out and we are busy with the curriculum. The time seems to be flying with so many challenges and opportunities. I feel very much part of the team here and so glad that Cairdeas can be involved in this way. Our vision is to see the growth of palliative care in the developing world. Supporting raining programmes in Vellore can have a major impact and my thanks to all of you who are supporting and interested. I was struck again by the need in this country when I met a girl of only 25 who had travelled from Nepal to Hyderabad to get help for her cancer. On the way (several days by train) she was abandoned by her husband who took all their money scraped together for treatment, leaving her with a 4 month old child and 2 other children at home. The need is so great but at least this girl was cared for by people with expertise and compassion. At this time of year when we enjoy the celebrations and the gifts and the fun - spare a thought for those far and near who are vulnerable and hurting this Christmas. It is a time of hope when we remember the promise of that first Christmas - a Saviour who would bring peace on earth and goodwill towards men. Thank you again for all you support - I will keep you in touch with what the New Year brings!!

vellore

Good morning from a warm, clear day in Christian Medical College, Vellore. This hospital, and it's medical college, is now famous across the world with a reputation for excellence in clinical care, research and education as well as a commitment to serve the needy and vulnerable. Over one hundred years ago, a dynamic and resourceful young woman was challenged by the needs of the people of India - especially women. Ida Scudder started on a long journey to make a difference that took her through medical training, many obstacles and led to the establishment of Christian Medical College Vellore - one of the first centres for the training of women doctors in India. Over the ensuing years much has been achieved here - including seminal leprosy research and surgical developments. It is now a 2000 bed multispeciality hospital with undergraduate and postgraduate training. It services the community around Vellore in Tamil Nadu with primary, secondary care and community programmes. It also has patients coming from all over India including some nearby countries such as Bangladesh and Nepal. 70% of patients travel long distances - maybe several days on the train. The palliative care team had been in place for 31/2 years and is based within the main hospital. However, very soon the first patients will come to the new in-patient hospice. We are also busy planning for the new education unit which is part of the hospice building. the main role of Cairdeas is to support the clinical team and help with the development of the education strategy. It is an exciting challenge and I will tell you more in subsequent posts. The photos show the chapel at CMC medical college which is an oasis of calm and spiritual refreshment. The other picture was taken on the way to a rural hospital clinic - a typical and beautiful view of paddy fields. My address here is; Palliative Care Unit, Christian Medical College, Vellore 632004, Tamil Nadu, India.

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.