As part of our series of celebrating nurses’ contributions to palliative care, and following on from the ‘Palliative Care – Celebrating Nurses Contributions’ report that was published earlier this year in conjunction with ICPCN, WHPCA, and IAHPC, today we spotlight Ruth Wooldridge.
Ruth trained at St Thomas’ Hospital, London in the 1960s before doing midwifery training. As a more senior nurse she always felt that patients with cancer suffered with pain and other symptoms that were not controlled. During that time she spent a day at St Christopher’s Hospice in London – an experience which contributed to Ruth starting the first palliative care service in Kenya some 20 years later.
Immediately her midwifery training was completed she went to East Africa – to work as a nurse with Voluntary Service Overseas (VSO) in Western Uganda. Little did she know before she went that she would be assisting at C-sections, giving anaesthetics, training nurses and midwives, running an Out Patient dept and a pharmacy! She returned to St Thomas’s as a junior sister but it was not long before she was heading to Ethiopia to work for Oxfam twice in the very serious famines between 1973 and 1975. Her first challenge in palliative care came in Kenya, where she was living in the 1980s. She looked after a young mother of two little boys, Nancy, living in very impoverished housing and suffering from advanced cancer of the cervix. Pain relief was impossible until she was able to get a few weeks supply of morphine for Nancy who eventually died in great pain, alone, in hospital.
Nancy was her inspiration. It was immediately obvious to Ruth that there must be so many suffering from advanced cancer and receiving no palliative care – not only in Kenya but in all countries with limited health care and certainly no radiotherapy or chemotherapy then.
Together with a doctor and another nurse, she wrote a palliative care policy paper RUTH WOOLDRIDGE UNITED KINGDOM for the Ministry of Health asking for palliative care to be included within health policies and clinical care. That took another 19 years to happen but meanwhile the government gave them a small plot of land in the grounds of the Kenyatta Hospital on which to build a centre. This became Nairobi Hospice in 1990. It was only the second palliative care centre in Africa, and the hospice has nurtured and trained staff over the years throughout Kenya. To support Nairobi Hospice a charity, Hospice Care Kenya (HCK) was established, which Ruth chaired for several years. HCK now supports the development of palliative care all over Kenya.
Life is about grasping opportunities and, through moving to India with her journalist husband, Ruth met someone already involved with cancer care and this presented a new opportunity. This was the start of CanSupport – a not for profit registered society delivering free palliative care – that now has 40 teams in Delhi and beyond caring for people in their own homes and supporting the families though illness and bereavement. In India Ruth realised that the training and learning for health workers was limited. On returning to the UK she formed the UK Forum for Palliative Care Overseas based at Help the Hospices, now Hospice UK.
Ruth’s idea of a low-cost manual for home-based care in low income countries was supported and Ruth and two doctors wrote the Palliative Care Toolkit for resource limited health settings, which has an accompanying training manual and is now available in nine languages.
Visiting Rwanda in 2004 at the time of the 10th anniversary of the genocide, Ruth met health workers to find out how much they knew about palliative care. She met one particular nurse who she thought could be a champion and Ruth sent her to the first conference of the African Palliative Care Association (APCA). A training course followed for more health workers and the first home-based palliative care service started in Kigali. Ruth has encountered many challenges over the years, for example getting palliative care integrated into medical and nursing curricula, poverty, access to medicines, and persuading funders such as DFID (Department for International Development) to provide funding for palliative care in low and middle income countries. However she has found, through experience, that persistence can pay off.
Palliative care is in many ways a nurse-led service and so many times in the last 30 years Ruth has been proud to see nurses as some of its greatest advocates. For it to be a truly global service – reaching everywhere and to the poorest and most disadvantaged – each generation of nurses needs new palliative care champions.
If you would like to read more inspiring stories, you can download the free Nurses Contributions report here