On a Monday morning last September, sixteen health and social care professionals arrived at St Christopher’s Education Centre from all over the world for one of our annual international events, Multi-Professional (MP) Week. Countries represented included the UK with a nurse from the NHS, Ethiopia, Brazil, Spain, Bermuda, Singapore, Bangladesh, Thailand, Sri Lanka, South Korea and Australia. Only five of the delegates spoke English as their first language. The remainder spoke English to varying levels of proficiency but determination and passion for the subject conquered any hint of reticence to participate.
The multi-professional tutor team witnessed the most extraordinary cross-cultural classroom discussions. Questions posed were breathtakingly refreshing and bold. Narratives used to articulate cultural reality were moving and insightful. Many of the challenges faced by those wanting to ensure better experiences of dying, such as reluctance to have open conversations, seemed universal, regardless of resource.
This programme, for professionals new to palliative care or considering beginning a palliative care service in their country, has been running now for over thirty five years and many successful projects can trace aspects of their development back to St Christopher’s MP Week. Dr Christian Ntizimira, a Rwandan physician and palliative care activist, for example, attended in 2014. In my first year as Director of Education and Training, I remember clearly how movingly Christian spoke of the “dark history” in 1994 when the genocide against the Tutsi took one million people in 100 days. He described how, in his opinion, humanity itself was also lost. He then drew parallels with the loss of dignity often experienced by people with life-limiting illnesses. It was his belief that the concept and values of palliative care could not only contribute to bringing back the sense of wholeness to patients and their families, but could bring healing to whole communities when integrated into health care more generally. He reiterated this view in an article in ehospice.
Mihaela Dumitrache came on MP Week in 2009. A nurse from Romania, Mihaela had been disillusioned with the post-communist Romanian health service and nursing. However, she was introduced to palliative care in 2005 when a UK charity working with children with special needs needed someone to lead a new community paediatric nursing team in Bacau, North-East Romania. MP Week inspired Mihaela, gave her a sense of being part of a worldwide movement but also gave her confidence to become a lead within her country on the implementation of a new, more person-centred model of care for children and young adults with life-limiting disease. She is now not only Executive Director of the palliative care service, Casa Albert, in North-East Romania, but a member of the board of the National Association. She has secured funding from a multi-national corporation and land from the local government, and supervised the building of a fourteen-bedded inpatient unit that opened last May.
Since 2000, many like Christian and Mihaela have received a full bursary to attend MP Week, funded by the Wives Fellowship, a UK-based women’s organisation set up during the First World War. Four to six bursaries have been awarded each year. It has, however, become clear that the demand for a programme for professionals new to palliative care is dropping whilst there is an increased need for support for those who, in the light of new global challenges, need to evaluate and rethink how palliative care services should be developed. St Christopher’s Academy caters for this audience, again offering a small number of fully funded places.
Learning on these inter-disciplinary, international programmes cannot simply be translated into a programme of e-learning. It relies on taking learners on a journey, calling upon their imagination as they move from the origins of the vision, that initial epiphany of Cicely Saunders as she observed the suffering of the dying cancer patient; through the years of refinement of palliative care principles by the early pioneers to the present reality of a very different world where people live longer and with multiple conditions and complex needs.
Students and tutors alike listen to patients, carers and one another to share their experiences. They explore tentative solutions to the issues, both the universal and the culturally specific. A community of learning which is dynamic and professionally enriching emerges, full of leadership potential. In the past, students would return to their countries inspired by the example set by the courage of Cicely and others. Today, technology can enable students to stay connected, to continue to be inspired by the courage and determination of their peers and their contemporaries scattered around the globe, and they can together collect data, measure outcomes and share knowledge.
The last words should go to our students. One nurse, very new to palliative care, from a small Caribbean island recently ravaged by hurricane Irma, wrote on her return, “I learnt so much and many situations that are/were occurring with my patients are now better to understand.”
On their final morning in the UK, when asked what will be the most significant thing theywill take back to their countries, one of the bursary students, a doctor from Sri Lanka, answered (whilst the others nodded in agreement), “To see the respect you all have for one another. There is no hierarchy in your teams. You focus only on what is best for your patients.” She went on, “I must model this and show others that holistic care is what is needed, which means all disciplinary contributions must be equally valued.” Music to my ears!