Visit to Bangladesh teaches Maaike so much

I was there primarily as part of a project we’re doing through The Worldwide Hospice Palliative Care Alliance to support Bangabandhu Sheikh Mujib Medical University (BSMMU) and AYAT Education with developing and strengthening their palliative care education. With our Learning Technologist Matthew Tregellas, we’d run a virtual Teach with CARE course with BSMMU and AYAT Education in the autumn to better understand their needs.

But the trip was really an awe-inspiring opportunity to discover what palliative care education and practice really looks like in Bangladesh, in hospital and out in the community, as well as a chance to hear from the incredible people providing that care, to truly understand their strengths, challenges and needs.

My feet barely touched the ground throughout the whole time I was there.

Within an hour of leaving the airport I was teaching and that set the tone for a whirlwind of workshops, teaching, visits to wards, trips out to see care being given in people’s homes, meetings with palliative care professors and leaders.

That’s not to mention the teaching that was at the heart of the trip, including a number of day-long sessions to help colleagues as they redesign their palliative care curricula for doctors, nurses, community health care workers and volunteers.

What was clear at the end of these days when we looked at redesigning learning objectives and how we can introduce learning technology to work in their setting, is that they felt empowered and enabled to be brave enough to think strategically and to do things differently.

I understand now more than ever how important it is that Teach with CARE ensures the teaching is context specific and that means adapting what we offer here.

I went with the stated aim of supporting doctors and nurses with shaping and redesigning their palliative care curricula. I quickly came to realise that most of the learning was mine to do, being generous enough of spirit to realise that while St Christopher’s has more than 50 years of experience to share, we don’t have all the answers and even if we did they wouldn’t necessarily be applicable in places like Dhaka. Instead my focus quickly shifted to capacity building, leadership and empowerment.

One session in particular, with some nurses, including Lailatul Ferdous, one of our 30 Pioneering Nurses, made me understand that it’s not knowledge, clinical skills or even really resources that are lacking in Bangladesh (although there clearly is a lack of resources).

What the nurses, needed from me, and I don’t think they realised it either, was to be empowered.

Firstly, to be told that they are amazing at what they do and secondly, to give them the confidence to take more of a lead in a system where the doctor decides. We discussed building capacity around Lailatul so that she can start to work at more of a strategic level.

Speaking of strategic level – I was really excited to hear about plans for an Institute for Palliative Care. Professor Nezam, who first developed and introduced palliative care in the country, is mapping out this exciting new venture.

In some ways, it will mirror our model at St Christopher’s CARE, being a place, where’re citizens can come and engage with death, dying and palliative care, while education will be one of the primary components. It’s early days, and architects are just starting to draw up plans, but it is a mark of the huge progress Dr Nezam and his team have made.

I had a similar experience with some of the community health workers. I asked them why they do they what they do, what gets them up in the morning and what motivates them to keep going.

I think they were surprised that I was asking them questions and had presumed that they would be deferring to me. Once they understood that I genuinely wanted to better comprehend where they’re coming from, I couldn’t stop them. It was transformational for them as it gave them a voice, for the doctors and project managers as they were hearing from their colleagues for the first time really, and lastly for me as I truly learned how a community looks after itself with precious few of the resources and targets we have here!

If only we appreciated what we have and made better use of the resources. They are so resourceful and pay so much attention to the human and social aspects of palliative care.

Without understanding their circumstances and how things work in Bangladesh, and indeed other places like it, we can’t really help them to build services and education courses applicable to their needs.

This was exemplified by my visit to Korail, an informal settlement, where I met a woman who it’s believed is 120 years old. She lives on a plank of wood in a corrugated iron shack with her daughter and her family. The lady is blind but has no known life-limiting conditions. Her family have nothing, but they, with the support of the community health workers and volunteers, are giving her fantastic care.

It will take me some time still to process everything I learned in Bangladesh, but I know for sure that it will inspire me and empower me too to ensure St Christopher’s CARE continues to build capacity through education, true to our mission to enable as many people as possible to access palliative care.

I’m so pleased it looks like I’ll be returning…

Maaike Vandeweghe, Course Director and Senior Educationalist at St Christopher’s CARE