“You must be an initiator and never be afraid because if you don’t start anything you wont ever do anything.” Four thousand miles apart, and pior to the establishment of the launch of the Global Palliative Nursing Network (GPNN), living very separate, parallel lives, Yangden Paki and Halima Ibrahim share many of the key qualities required to enable them as nurses to introduce, establish and grow palliative care provision in their respective countries – Bhutan and Sudan.
Both Yangden and Halima have not only been instrumental in setting up and growing palliative care services, but also in doing so have built confidence in themselves and their nursing colleagues and raised the profile and status of nurses.
Now, this pair of trailblazing nurses are among the more than 700 nurses from over 50 countries joined together in the GPNN with the collective goal to empower nurses the world over to harness the power of nursing to grow palliative care.
For Yangden, the journey has been quick. After two decades working to improve maternity care she was approached about starting the country’s first ever palliative care service in 2018.
“I knew very little about palliative care and I was sceptical, but other people convinced me that I should do it and so I embraced the opportunity,” she says.
One very understandable reason for her concern, was that Yangden was still grieving the recent death of her husband. Now, seven years on, Yangden believes that personal experience was instrumental in the success she has achieved.
“The single most important quality you need to lead as a nurse is courage. Because of my personal experience people thought I would be resilient and a good agent for change. You certainly do need to be able to bounce back from the challenges you encounter and be open to embracing change.”
Dr Yangden Paki
The facts speak for themselves. From a standing start, Yangden, with support from her management at the national referral hospital, has built a team of five nurses, a palliative care physician, a nurse anaesthetist with prescribing rights and a physiotherapist.
She’s built working partnerships with Bhutan Cancer Society and with the Central Monastic Body.
Additionally, she’s part of a team entrusted by the Ministry of health to create a training programme which has been rolled out to 10 of the country’s 20 health districts. In six years, Yangden and her colleagues have provided palliative care for 875 people, most of them with cancer, but an increasing number have other conditions, including COPD, strokes and kidney disease. The support of the Royal Family of Bhutan has been a significant factor too.
Looking ahead, Yangden says the ambitious five-year plan with the Ministry of Health is to provide training in the remaining 10 districts. And, perhaps most excitingly, Yangden is involved in the planning for a hospice is expected to be built by the end of 2026.
Halima’s achievements are equally impressive. Experience gained at the National Cancer Institute, caring for cancer patients with serious wounds had a serious impact on her.
“I felt the pain these people were suffering, and I wouldn’t accept that it was ‘normal’ as a senior nurse said to me,” she remembers.
Off her own back, Halima started an online course with Stanford University and started applying her learning, doing holistic assessments and taking a new approach to wound care.
The other nurses and doctors started to see the evidence and they began referring patients to me,” Halima added. “All this was alongside my day job on the chemotherapy unit.”
Halima Ibrahim Ali
Her approach to a new palliative care unit initially fell on deaf ears. Demonstrating real tenacity, Halima continued training nursing colleagues and when all staff attended a workshop she organised, the hospital hierarchy started listening and, in 2016, she became the coordinator of a palliative care unit which is supported by the National Cancer Institute. Like Yangden’s programme, it provides patient care, follow-up calls, training and education and has established ties with family doctors. All of this, while a civil war has been raging in Sudan.
How does Halima explain her success in harnessing her power to grow palliative care?
“The first thing you need is to be a good observer, to respond to what is going on around you. Then you have to be patient, because in Sudan nurses have no voice which also means you need courage because no one does anything for you.
“You must also be an initiator and never be afraid because if you don’t start anything you wont ever do anything.”
Halima sees her role extending beyond the workplace too and while some people talk about encouraging more people to talk about death and dying, she actually does it – wherever she is, including on bus journeys.
Both Halima and Yangden share the belief that nurses that want to make a real difference must commit to being lifelong learners.
Now, with evidence of positive outcomes they are both receiving more recognition for their services.
“I think my voice is heard more now since people have seen the results of our work in the service,” says Yangden.
“People often describe me as action oriented. I may not speak much but am committed to demonstrate results.”
While Halima says: “Now, our dean, doctors, nurses and patients listen to me and some nurses now feel like they have a voice. They have been given the chance to talk and to study more and some are doing research into palliative care. We are opening the eyes and ears of the physicians.”
In 2024, Halima oversaw the opening of The Comboni Hospice Nursing Clinic in Port Sudan, provides patient care (currently for 63 people), training of 263 health professionals and 200 volunteers in palliative care as well as training for nurses and volunteers in spiritual care as well as 200 home visits.
Both Halima and Yangden’s eyes and ears have been opened to the experience of each other and hundreds of other fellow palliative care nurses in the GPNN.
“It’s given us a platform, opened my eyes and widened my horizons,” says Yangden. “I feel like I have benefitted professionally and personally. We are all nurses with similar dream, facing similar challenges. The network provides a sense of belonging and is a safe space where you can express yourself honestly. I now have global friends and see the work they do despite the challenges they face which inspired me to move forwards.”
Halima feels equally connected with her colleagues across the world.
“It’s a way of communicating with nurses globally. Before, I felt alone but now I know I am not isolated and we share the same problems can learn from each other and help each other.”
“[The GPNN is] a way of communicating with nurses globally.
“Before, I felt alone but now I know I am not isolated and we can learn from each other and help each other.”
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This article was first published on the St Christopher’s website and is republished here with permission.
It is really tremendous Halimsa and Yanden for inspiration and motivational. With passion we can build palliative care, even in very remote places.