Whisper it quietly, but the future development of palliative care globally might have just taken a huge step forward. For five days during the first week in February, 136 delegates from 43 mostly low- and medium-income countries logged on to participate in the Palliative Care Fellowship – the third time we’ve co-hosted this course, but the first time online.
The Fellowship is run as a partnership between St Christopher’s, the Institute of Palliative Medicine, and Sanjeevan Palliative Care Project, both in India, as well as Bangabandhu Sheikh Mujib Medical University, Bangladesh. It came about through professional relationships built up over a number of years and the shared belief in the power of learning as part of a connected and sustained community as well as the need to identify and promote models that serve communities globally.
As Heather Richardson, St Christopher’s Joint Chief Executive explains, the Fellowship is designed to empower delegates to build sustainable and successful palliative care programmes in their countries.
“Our ambition for the Fellowship is to identify and support new leaders; those people who, despite huge challenges, are transforming end of life care in their countries. We believe they will be successful because they are arguably starting in the right place, where community involvement is paramount, and power is shared with citizens. We spend some time looking at clinical issues but most of the course is about bigger picture strategy and resource allocation, about how to deliver and grow services in low and middle income countries.”
And on the evidence of the level and strength of participation during the first week of the course, it looks like that goal is well on the way to being achieved.
Delegates from countries as diverse as Iran, Chile, The Maldives and Bhutan were just some of those who experienced the six hours of interactive learning each day, Monday to Friday. Zoom’s ability to shrink the world also brought home the reality of world events, when on the first day of the course delegates from Myanmar disappeared offline briefly when the internet was switched off as the country’s army seized power in a military coup.
The two previous Fellowship courses have been hosted at the Institute of Palliative Medicine in Kerala, which has, under Dr Suresh Kumar’s leadership, championed the community approach to palliative care.
The limitations imposed by COVID-19 have brought some gains. Delegate numbers have trebled from the 40 who travelled to India in previous years. And being online, it’s been possible to accommodate different time zones, with the course running for seven hours in the afternoon and evening in the eastern hemisphere and then seven hours in the mornings for those in the west.
Dr Libby Sallnow, Senior Clinical Academic at St Christopher’s and Palliative Care Consultant at Central and North West London NHS Trust says: “There are real benefits of being online. It has undoubtedly helped to democratise the Fellowship and increase the numbers, although by pricing it at $100 we’ve always aimed to ensure it is accessible to all.”
“Participation has been wider and given a voice to people who might not get to contribute in a traditional conference, although it does mean it can’t be quite so immersive.”
People joining from their clinic or kitchen table have been able to tackle genuine problems, come up with solutions and then receive real time feedback from palliative care leaders around the world.
The hope is that, pandemic permitting, a cohort will be able to travel to meet face to face in India in September to experience the community work in Kerala. That will help complement the intense learning programme delegates have experienced during the week’s course, which will be built on further with a day a month of online learning from March 2021 to July 2021.
In addition, the delegates are expected to spend an additional 80 hours over six months on the Fellowship – including five further days of intensive learning in the virtual classroom, assessed group work, an exam and five assignments.
During the week, a first-class set of speakers covered topics as varied as: Death, Dying and Spirituality, Fundraising, Palliative Care as Primary Care, Community Engagement and Volunteers and Integration of Palliative Care into Mainstream Health Care, all in interactive practical sessions. Delegates were given numerous opportunities to break out into groups, recount their experiences, discuss scenarios, and share ideas.
It’s that shared learning that lies at the heart of the Fellowship, both within the confines of the course itself and beyond.
Libby adds: “We all understand that palliative care is context dependent and there is huge strength in learning from people’s experience and working together to find solutions.
“By sharing expertise from a diverse group we can create a strong and dynamic set of leaders globally. Some of the delegates are finding ‘colleagues’ in their own countries that they never even knew existed. That gives them someone to speak to, someone to share with and a sense of a network to draw on. The course is helping to build a critical mass and helping people in different countries to advocate palliative care and influence policy in their regions.”
Outside of the week, The Fellowship is growing its reach and connectivity year on year, using modern communications platforms. Each year group of the Fellowship has its own WhatsApp group, and these are divided into smaller groups each with mentors and a mix of disciplines and countries. These are very active and see problems and solutions shared on a regular basis.
Travelling to visit Fellowship members in Bhutan and the Philippines, for example, Dr Suresh Kumar, of the Institute of Palliative Medicine (IPM) in Kerala, has also helped to embed major changes being implemented and support progress. And for the 200+ unsuccessful applicants to the Fellowship this year there are plans for a set of workshops, designed to meet people at different levels of knowledge, thereby extending its reach even further.
Suresh says that reach will only grow with the support of the World Health Organisation. He adds: “Institute of Palliative Medicine is a WHO Collaborating Centre and WHO is happy to see that the course helps them take their global agenda in palliative care forward. WHO has been circulating the information about the course and encouraging potential champions from member countries to join.”
One delegate keen to put the week’s learning into practice is Catherine Ooi, General Manager of Kasih Hospice Foundation in Malaysia, who said:
“The programme has introduced me to so much new ground that I am busy recalibrating and, in some cases, unlearning old belief systems. I think I will emerge from the programme more certain of my values and my direction. And with a new, far better map to help me navigate.”
While Archana Ganesh, a Research Assistant working for Australasian Palliative Link International in Bengaluru in India, said:
“I value the richness and the international flavour that the Fellowship provides on a single platform encapsulating ideas from all over the world. There is such an enormous networking and cross fertilization of ideas and concepts which one would have never had access to otherwise.”
The Fellowship promises to go from strength to strength as it draws on the expertise and learning of participants from previous years as mentors and teachers, and encourages current participants to share their knowledge too.
It is the belief of Suresh, Libby and Heather, the course directors, that its participants are the leaders of the future and that investment in their development is key to much needed global changes related to end of life. The level of inequities related to access to palliative drugs, expertise and services in some parts of the world is absolutely unacceptable and this fellowship is one way to start to redress them.