Friendship

Friendship

Friday, September 24, 2010

A 'Degree for Africa' reaches further

Firstly apologies for being so slow at posting once again. We will have a Facebook page soon and it should allow for a faster rate of news! These past few months have sped by as we worked hard to be ready for the next group of students on the BSc Degree. We had a further intake to Year 1 (Diploma) as well as the first Year 2 group (pictured on the left) . All the latter had already completed a Diploma in the past. What an inspirational group of students. They now represent 8 countries across the continent and have stories to tell of the sacrifices they have made to be able to take part on the course.
One student from Zimbabwe shared how she had only received confirmation of her funding in the last week of her teaching month and had come to Uganda as a 'step of faith'.

We have a mentorship programme to support the students and you can see me with my Year 1 Malawi students (Linly, Idah and Alex). Lameck is one of my Year 2 mentees and leads the palliative care association in Malawi and brings many years of experience. This is the first opportunity he has had to undertake a Degree level course and is already a leader for palliative care in his country. Notice the Scottish connection - a present from Highland Hospice on a previous visit. Elizabeth is from Nigeria and is the lead nurse at a major hospital. The faculty is led by the Director of Education at Hospice Africa Uganda, Flavia Bukandana and coordinated by Consilous who you can see here with Frida from my Mulago team and Francesca from Zimbabwe. We have a great team in partnership with Makerere University (especially our Palliative Care Unit) and the African Palliative Care Association. You can see Dr Jo with some of the men (Batholomew, Gideon, Willy and Alex). We also have a link with UK faculty via THET and it was a pleasure to welcome one of my old Scottish colleagues from Glasgow - Dr Mike Basler. He fitted right in!!  We not only learned from each other with the students working hard for a long month but we also sang and danced and even paddled in Lake Victoria. Please remember these students as they are now back in their own countries studying at a distance and sending in their course work.  At a social event in Dr Anne Merriman's home they symbolically lit one candle and gave it to her before each lighting in turn. Light spreading across Africa to bring relief to those in need. Let the flame burn brightly.....
While we were welcoming the students I also had a wonderful team visit from Gerrard Street Baptist church in Aberdeen. This deserves a BLOG post all in its own right so will add very soon.

Saturday, July 10, 2010

Monsoon and mentoring

 After some big challenges regarding permits and weather and illness the team of Grahame and Cheryl Tosh from the UK, Hamilton from Vellore and myself made it to the beautiful and remote state of Aizawl. Over an eventful 10 days we spent time with colleagues from Durtlang Presbyterian Hospital in Aizawl and Serkawn Baptist Hospital in Lunglei. The journey between the two places involves precipitous drops, hairpin bends, near misses, amazing views from tea stalls, stunning early morning mists, some travel sickness and even a beautiful waterfall on the way back. I have even found a mountain called 'leng' - maybe to climb on the next visit. We celebrated my birthday with typical Mizo breakfast and hours of singing! It was very encouraging to see how the principles of palliative care are being incorporated into these excellent hospitals. Dr Sanga at Durtlang has a significant role in caring for young men affected by substance misuse and there is an HIV/AIDS hospice aptly called Grace Home. Dr Lalramzauza, medical director of Serkawn,  attended the Toolkit training last year along with the senior nurse tutor. They have formed a small palliative care team seen here and we had the privilege of meeting some of their patients. One very ill elderly man spoke of the incredible hope and comfort he now knows because of the touch of God in his life. We shared and prayed with him and his wife. Mizoram is a Christian state where church support is central to peoples lives. How is this for good advice in a prayer garden? It says 'Listen to God'.
Mizoram's monsoon kept us a few days longer than planned but I was able to visit Bangalore and take part in the first HIV Palliative Care course at St John's Hospital led by Dr Shoba Nair. It was great to teach with Prof Rajagopal again and to see the great work of Snehadan HIV center led by Father Matthew Perumpil.
Off to Delhi in the 45+ degree heat and on to Lucknow with our team for the first ever Palliative Care Toolkit training in Uttar Pradesh. Jo Dunn from the UK works with Hospice Africa Uganda and was on her first trip to India, Chitra is of course my dear friend and colleague and senior palliative care and psychiatry doctor in India and Nicholas Mellor from the Palliative Care Partnership joined us to see the Toolkit training in action. We worked with our local colleagues Sanjay Diraj and Shakeel Ahmed from SGPGI and Piyush Gupta and his team at Canceraids society. We had an amazing week. The participants were enthusiastic and open and shared so much with us as well as seeming to really gain from the training. They came from 6 institutions and organisations in Lucknow as well as other parts of the state. We were also able to raise awareness in medical institutions in Lucknow, hold a press conference, share with senior colleagues in Lucknow and Agra and meet some patients. The press conference achieved  great media coverage and there are now many patients asking for help that is sadly very scarce in this huge state. As ever the needs are for continued support and mentoring but we wish all our participants every blessing as they seek to put their training into practice. here are a few quotes;  'It was excellent training and definitely it will be helpful to our work' 'I am really thankful to the organising committee for allowing us to be a part of this wonderful experience. I will do my best to practice my knowledge for the patients from today itself'
India of course offers so much to tantalise the body and saturate the senses. We ate wonderful food; Mogul shami kebabs; creamy buffalo butter in buns, melt in the mouth samosa, succulent bamboo shoots from the mountains, crisp dosai for breakfast, sweet sticky jellabies, burning hot parenthe in the back streets of Old Delhi washed down with spicy chai. We experienced something of the ancient culture - not least the most famous monument to love, the Taj Mahal.
Talking of culture; in the famous city of poetry, Lucknow, I had a poem written and recited to me by one of my students - in Hindi!

Friday, June 04, 2010

Hope and courage

Many thanks for all the messages of encouragement about our Degree students. They are sitting exams at the end of their first semester and mostly doing well. We have now selected 20 more for the August intake with 8 countries represented; very exciting. I had the privilege of meeting up with 3 of our Malawi students on a recent visit. Let me introduce you to Davie Mpate. He is a clinical officer at Mulange Mission Hospital which nestled at the foot of the Mulange Massif. Davie became interested in palliative care through his work with HIV/AIDS and is brimming with enthusiasm. Here he is with the new vehicle for
home visits that has been bought by Hospice Africa UK. The small palliative care team see patients from a 40km radius of the hospital which also offers health care to very poor and rural villages. Presently there is no resident doctor at the hospital and it is clinical officers like Davie and nursing staff who do the majority of clinical work in many such centres. Davie is passionate about palliative care and supporting those in need and excited about the training opportunities offered by the Degree programme. It was so encouraging to meet him as well as 2 others students; Chris at Ndi Moyo in Salima and Fred at the paediatric wards in Queen's Hospital in Blantyre. Mentorship visits like this can be an important source of encouragement and support for students as well as
giving us a real feel for the challenges and achievements of our students and I hope to be able to make such visits annually supported by Cairdeas. These students will be the leaders for palliative care and give us great hope for the future. I also had the chance spend a few days climbing Mulange (you can see why it is called the 'island in the sky') and then relaxing by lake Malawi with my friend Geoff.  What an amazing privilege to be able to explore such beautiful places.

Back in Mulago we have been busy with the undergraduate and postgraduate exams with a communications exam included for the first time. Our clinical team is busy with increasing numbers of referrals. Let me introduce you to a young woman we met recently on the wards.Angela has a bone disease that means she is liable
to fractures and recently broke her hip which cannot be mended surgically. She is in constant pain and her family were praying they would find some help. When our nurse Regina came the next day and was able to give support and prescribe oral morphine Angela slept for the first time in weeks. What a difference yet morphine is not available to so many millions and even in Uganda we are struggling with a regular supply  and in serious risk of running short this month. Angela could not thanks us enough and despite her continuing pain and
disability she has such a grace and peace. Her mother cried as she shared about their fears and Angela's courage and again thanked the 'angels who helped in their hour of need' . Here is Angela sharing some verses from Psalm 41v1-3 which talk of the blessings for those who help the sick and the protection and healing that comes from God. We left her room encouraged and humbled.
Thanks as ever for your support. I am back to India soon to follow up on previous visits and of course see great friends and colleagues, eat spicy food and gaze at the mountains of Mizoram once more.

Wednesday, March 31, 2010

Building for the future


Is there anything more rewarding than mentoring and supporting committed, enthusiastic, compassionate colleagues and seeing them grow and develop? It is perhaps the greatest gift we offer in Cairdeas and one of my personal privileges. The new BSc in palliative care has been long been a dream, had a tricky and demanding gestation. But finally we have our 'Degree for Africa' and the prospect of training many many future leaders for palliative care in Africa. Here is a truly inspiring group of palliative care colleagues. Some are part of the team from Hospice Africa Uganda and Makerere University who have developed and now teach this new Degree programme. The rest are some of our first group of 21 students who started year 1 in February. They come from Uganda, Kenya, Namibia, Malawi, Swaziland and Tanzania. We have mothers, poets, government workers, mission hospital staff; they speak different languages and come from different cultures;  yet all have such a commitment to learn and to make a difference for the many many who are in need in their countries. They have completed an intense 4 weeks of face to face teaching and now have gone back to their own countries to work at a distance completing assignments and exams and then clinical placements. Those leaving after Year 1 with a pass will be awarded a Diploma and others will stay on till Years 2&3 to complete their BSc. We have a further 13 coming straight into Year 2 in August who already hold a relevant Diploma. What an exciting opportunity for all of us! Here are the 5 students from Malawi where palliative care developments go from strength to strength. Do you like our team tee-shirts? I think wee Hannah is a bit too young for now. Why do we need this Degree? The majority of those in need in sub-Saharan Africa who face life limiting illness with pain, distress, loneliness and financial desperation do not have access to help. Most will not be able to have even basic pain relief with oral morphine. Families will struggle without support. These students and all those they in turn will teach and train will help to make a difference; please pray for them.
One last visit for this post. I have not only the privilege of seeing students train but also to be able to support and offer expertise to more senior colleagues. A fascinating conference recently in Riyadh, Saudi Arabia brought together many from across the Arab world as well as international experts form the WHO, USA, UK, Europe and yours truly! This Initiative to Improve Cancer Care in the Arab World (IICCAW) had the ambitious aim of eliciting the current stare of services and planning and brining together a strategic planing process for the next 10 years. We worked hard and there were impressive results - now to put it into action. I was especially pleased to meet palliative care colleagues from Saudi Arabia, Jordan, Sudan, UAE, Qatar, and interested others from a wider field. Riyadh is a very different place; full of the usual warm open Arabic hospitality yet also seems a world apart. It is respectful for women to be covered in public so I had my first experience of wearing an abayah. Who would have thought!

Sunday, February 21, 2010

A beautiful world

How did your new decade begin? I was privileged to be exploring the south west of this beautiful country then down into Rwanda. Beautiful Lakes Bunyonyi and Lake Kivu, paddling in a dugout to church, climbing cloud covered Mount Muhavuru volcano to almost 4000m, exploring Ishaha national park with tree climbing lions, hippos, buffalo.....Living and working here in Uganda is a real privilege. My thanks to my friends and colleagues who share this journey with me and who inspire and encourage and who share the laughter, the tears and the joy.
Back from my holiday it was down to work to prepare for the launch of the Degree programme at Makerere and Hospice Africa Uganda then off to India for a whistle stop trip. Delhi was cold for a lass from Africa! I was delighted that Ruth Wooldridge, an experienced palliative care nurse who has helped develop palliative care services in many countries including Delhi and Nairobi (as well as a friend), joined me for a mentoring visit in partnership with Pallium India. After a great day at the Cansupport foundation training course in Delhi we traveled to Lucknow in Uttar Pradesh.

We joined the team at Canceraids society and at Sanjay Gandhi Postgraduate Institute to review the progress since my last visit 6 months ago. The clinic was steadily growing with good relationships across the hospital and with current training of a nurse there will be better support for Dr's Shakeel and Sanjay. We were delighted to meet another nurse who has experience in palliative care and who immediately volunteered her help. Canceraids society has finished the building of a day care centre and now planning the service. We also saw real progress in encouraging others to develop palliative care and visited the medical colleges in Lucknow and Kanpur. There is such huge need in this state; 160 million people, a handful of places where oral morphine is available, rural agricultural economy with the majority living below the poverty line and so few palliative care developments as yet. We are planning to continue our mentorship and training support. In Kanpur I saw my first glimpse of the holy river Ganges - here a silted, sluggish brown shadow due to industrial pollution. Lucknow is an ancient and beautiful city and we sampled the architecture old and new and the food delights. If you visit make sure you taste malai mukkan and the chhappan bhog sweet shop!

Off to the warm south and a brief visit to my friends at CMC Vellore. I stayed at Sneha Deepam in the hospice and education centre and reminisced about being the first faculty to stay here. The gardens are now grown and beautiful and the service to many of the poorest continues to grow.
It is especially exciting to see young colleagues and former students grow and flourish. Bangalore is seeing growth and development in palliative care and the new head of department at St John's College is Dr Shoba Nair. With sincere and interested support from the management in this prestigious institution this enthusiastic department are developing training for HIV and palliative care as well as providing a clinical service. I took part in a writing workshop with Dr Chitra Venkiteswaren and others and gave an invited lecture. Then there was wonderful times of sharing with colleagues and friends across Bangalore, seeing 2 other former students, Dr Praveena and Dr Ravi Livingstone, now leading services in other hospitals and enjoying wonderful Kerala hospitality with Shoba's family.
On to the VXVII IAPC conference in Tiruchirapalli, a south Indian city full of ancient temples and Tamil history. With the overall theme of 'Twilight years' we looked at the particular problems of the elderly as well as sharing what has been happening across India. As ever I was overwhelmed by the warmth of the welcome, the wonderful food, outrageous compliments when wearing a sari and the inspirational commitment of my Indian colleagues. It has been a joy to see the growth and developments over the past decade and a privilege for myself and Cairdeas to be able to continue to support for this new decade. India has still so much need for many many of its people who live and die in preventable suffering and pain.
Come to India sometime with me and be inspired, challenged, intoxicated - I promise you first visit will not be your last.
Back now to Uganda for th start of the Degree programme - and that will need to wait till my next post.

Tuesday, December 15, 2009

Christmas in Africa 2009

Listening to my neighbours singing carols round my door last night made me nostalgic for frosty evenings, Christmas trees straight from the forest, sparkling lights in the early darkness, the eerie stillness of snow falling and time to celebrate with friends and family the wonderful joy and hope of Christmas. Maybe I am overlooking the busyness, shopping frenzy and choked roads though the latter is very much a reality here in Kampala. Uganda loves Christmas and there have been slightly strange Santas and endless carols in the supermarket for some weeks now. Hospice Africa Uganda hosted a wonderful Christmas party for patients attended by many friends including the Irish ambassador shown here with Dr Anne. The children had a crazy time on the bouncy castle which kept threatening to deflate - something to do with the hoards of kids all jumping at once. You may remember the story I told of a young woman from Congo called Josephine who features in my last BLOG post. Here she is enjoying the celebrations with her family and she sends her love to all the Cairdeas family.
These past few weeks have been busy with visits to Tanzania and Sudan for cancer conferences. There is more and more interest in developing comprehensive cancer control programmes and integrating palliative care. Governments are becoming involved as they realise that non-communicable diseases such as cancer will become major threats to health in the African region over the next few decades. Francophone and North Africa have new initiatives to develop palliative care and it was inspiring to spend some time in Kampala with colleagues from Senegal, Egypt, Morocco and Sudan. It can be a tremendous encouragement and support to meet like minded colleagues who can advise and support and it is a huge privilege to help in this way. This photo shows the small palliative care delegation at the Sudan conference; Dr Nahla from Sudan, Esther a UK nurse working in Sudan, Dr Omar Shamieh from Jordan and working in Saudi Arabia and yours truly.

Back in Kampala we are hard pressed to finish the planning for the degree in palliative care but it has been great to have some volunteers and visitors to our team. Dr Jo over from the UK for a year, Willemien from the Netherlands, Dr Elaine from Ireland and others from the USA and beyond. They bring energy, skills,love enthusiasm, ideas and fun. Thanks to all.
So what are some refections at this festive time. There are the panoramic pictures in my mind of Khartoum at sunrise overlooking the confluence of the White and Blue Niles, the beauty and tranquility of the Indian ocean and joining with over 700 delegates in Tanzania to fight cancer. Then there are the intensely private moments we are privileged to witness and share; 16 year old Viola pictured here, very ill and telling us how much she loves her jaja(grandmother); singing a favourite hymn on the ward with Jackie, a young mother, sharing a cuddle with Ben who is 5 and enjoying the party; listening to Joyce's father tell us how much he will miss her; making sure Annet will get her pain controlled and get home for Christmas; seeing Josephine's beautiful smile despite her uncertain future.

We celebrate the Prince of Peace coming into a hurting and needy world with a message of love and hope for all peoples. Thankyou so much for all your love and support and wishing you a wonderful Christmas.
www.cairdeas.org.uk for more information and to sign up for regular updates.

Saturday, September 19, 2009

Discovering your voice

'God is merciful and will help us.'
Let me tell you Josephine's story. Living in Goma, eastern Democratic Republic of Congo(DRC, her life has been surrounded and affected by the terrible conflict that has torn apart that whole region. She and her husband Celeste made the difficult decision to flee becoming refugees only when their oldest two children and severalfamily members were killed in an outbreak of violence. Arriving destitute in Uganda they lived in a refugee camp close to the DRC border till they were able to get jobs and begin to rebuild their lives. Josephine was working as a teacher and they all learned the local language. Their family knew peace for the first time only for Josephine to become ill with cancer. They took her to several hospitals until they reached Mulago cancer centre - in severe pain, distrssed and desperate. Celeste and the two children slept under her bed as they waited for news of treatment and for support from the UN High Commisssion for Refugees (UNHCR.
What could we do to support Josephine and her family? What helps them to cope with this new tragedy? Her pain is now controlled and treatment for her cancer started.We have found translators so we can listen to her worries and concerns. UNHCR have found accommodation for the family in Kampala though the fees are still to be paid to allow her chldren to go back to schhool. She talks of her worry for them then says with calm assurance and grace 'God is merciful and he will help us'
This year's World Hospce Day is about 'Discovering your voice' - telling the storeis of those who are suffering and listening to what they are saying. A recent presentation reportered in the African Palliative Care Association newsletter http://www.apca.co.ug/talked of an African palliative care patients 'bucket list'. What would and do people ask for from those who will listen?
1. freedom from pain and symptoms
2. enough decent-quality food
3. family and community support
4. secure future for their children
5. adequate resources to address their illness
6. scale-up so that such care would be available to everyone suffering in a similar way in Africa.
Dr Faith Mwangi Powell

Let us listen to Josephine and to many others. Also let us be humbled and inspired by the courage and faith we are pivileged to see so often in patients and families. Thank you for your support for our team in Mulago and for so many others who are seeking to work to make a real difference. It has been so encouraging to meet with many of you these past 2 weeks and share in the work of Cairdeas.
One final comment from Josephine; 'Will people in your country be interested in my story?

Sunday, August 09, 2009

mountains and spices

Greetings from India. As I write this I am preparing to leave the 40 degree heat of summer in Delhi for the relative cool of Kampala. It has been an amazing month and many thanks to all who have been supporting and working with me this visit.
First stop was the beautiful, remote and mountainous state of Mizoram.(Far North East of India between Bangladesh and Burma) Following ascoping visit a year ago I was back with a team of expert faculty (Dr Grahame Tosh from Southend, Dr Chitra Venkateswaran from Kochi and Dr Shoba Nair from Bangalore)at the invitation of Dr Jeremy Pautu from the Civil Hospital, Aisawl. They have started the first palliative care clinic in Mizoram and our visit was aimed to raise the profile of palliative care, support the development of strategic planning for palliative care and run a state wide training using the Palliative Care Toolkit. 2 weeks flew by with every day another amazing vista to feed our souls. We were able to meet with colleagues from hospitals, community groups, churches, an eminent theological college and government. The state health minister not only met with us but also inaugurated our training course. It was very encouraging to see how many took the concept of palliative care to heart and wanted to 'discover their voice' and the voice of those in need with no access to help. Comments from the 24 delegates included 'this was the best course I have attended' and 'this will help my practise from tomorrow'. They committed to taking their learning and experience into their workplaces and there were 2 hospitals committed to developing palliative care service in addition to the existing civil hospital clinic. Please remember these colleagues and friends as they grow and develop. We have prepared a draft strategic 5 year plan and there is much to think about and accomplish. We were also so touched by the strength of community and caring for others. There is a Mizo phrase 'tlawmangaihna' which translates as service to others and is a philosophy for Mizos every where. It is humbling to see so many signs of this sacrificial caring.

Back to Delhi and an overnight train to the far south of Uttar Pradesh. This state is home to 3% of the worlds population(180 million)60% of whom live below the poverty line. I was visiting a small rural hopsital in Lalitpur at the invitation of Dr Anne Tyle of EHA. Emmuanual Hospital Association is a non-governmental Christian network of 20 hospitals and 30 community projects accross the north of India and with a vision to reach the poorest in rural areas. They have recently committed to developing palliative care programmes and Lalitpur is planned for one of the first services. It was great to meet the dedicated team here and offer some encouragement and advice. I very much hope Cairdeas will be able to work in partnership to support this initiative.

Lucknow, the capital of Uttar Pradesh was my next visit; this time representing Pallium India as well as Cairdeas. There are very few palliative care services in UP but over the past couple of years there is a new energy and will to see a change. I visited one of India's foremost postgraduate institutes, the Sanjay Gandhi Postgraduate Institute, which has a palliative care programme running for only 2 months. Many colleagues showed an interest here and in the King George Medical College. In between I visited a dynamic Indian NGO, Cancer Aid Society which is leading the drive for oral morphine availability and met a senior official in the excise department. Lucknow is a beautiful and ancient city and hopefully will also become a training centre and focus for palliative care. The people of UP so need and deserve this help and support.

Seeing India throught the eyes of my niece Sophie and her friend Hazel was a real privilege. They are volunteering at ASHA; an amazing community empowerment project in the slums of Delhi. In between work we managed to travel on trains, cars, elephants and planes and to visit the pink city of Jaipur, the breathtaking Taj Mahal, the misty Himalayas and explore sweltering Delhi. My trip culminated in sharing with the girls and all at ASHA the celebration of 176 students from the slums gaining places at Delhi University and other institutions. An amazing achievement which speaks of the resilience and hard work of the students, the long term support from ASHA and the tremendous potential of India's human resources. The home minister of India and many other international guests celebrated the event. We wish all the students every blessing from Cairdeas.