Right from the outset, the primary aim of Cairdeas has been to help build capacity for palliative care in countries where it is lacking by providing and assisting with training for health workers. This ranges from a day or week-long course, typically with one of our Indian partners such as Pallium India, through to the 1-year diploma and 3-year degree programmes in palliative care at Makerere University and Mulago Hospital in Kampala with Hospice Africa Uganda.

Unfortunately, many local doctors and nurses, though very keen and able to undertake specialist training in palliative care are unable to do so, for various reasons, including lack of finance.

Cairdeas helps in two ways:

• First the expertise within the team means that we can give considerable help and support, including references, to help local doctors apply for international scholarship funding; we have already done this successfully for one doctor who is currently on a scholarship funded PhD course with the University of Edinburgh.

• Second, when funds are available we can provide scholarships ourselves; so far we have awarded these to two nurses to enable them to study for the Diploma in Palliative Care at Makerere University and Mulago Hospital.

We want to continue to fund professional development in these ways, and we have set up the Cairdeas Scholarship Fund so that we can expand this aspect of our work.

To donate to our Scholarship Fund go to www.justgiving.com/
cairdeas-scholarships. If you are a UK tax payer then JustGiving will claim GiftAid on our behalf, increasing the value of your donation by 25%.

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Funding nurse training in palliative care

Lois Semanda and Gertrude Munduru are senior nurses at Mulago Hospital, and link nurses with the Makerere Palliative Care Unit, who are both taking the Diploma course in Palliative Care at Makerere University, sponsored by Cairdeas using funds from our morphine appeal. Part of our aim in Uganda is to build capacity locally and strengthen skills so that Ugandans can take the service forward in Kampala. Both Lois and Gertrude started the course in September 2011 and are studying while also working full time in the hospital. They are now about halfway through their course and our trustee Jane Williams spoke to them about their experience so far.

Gertrude says "Initially I had high hopes of learning many things that I didn’t know about caring for palliative patients and I had some worries about the course. I was worried about how I was going to get the tuition fee, how the programme would run, and how I was going to manage work and studies."

Lois agrees that she had misgivings about the financial implications of starting the course. "I hoped for full sponsorship of the course. Thank God that Cairdeas offered, may God award them abundantly!" Lois was also worried about some of the practicalities. "When I started the course I had a worry of how I will access the computer during my coursework, but thank God that I could access it at the medical school department of palliative care."

I asked both nurses what they had enjoyed the most about their time studying so far.

Speaking about the other Doctors in Mulago Hospital, Gertrude explains, "What I have enjoyed most in this study is the knowledge that I have got during the training which is wonderful that my colleagues are changed and our doctors are getting on board and yet they didn’t believe in palliative care and managements like use of morphine and administering it 4 hourly." I think Gertrude is being modest here – the nurses of the palliative care unit have been fundamental in getting changes to practice and building relationships with doctors and nurses on the wards so that patients receive better care.

Louis is encouraged by the fact that she has a better understanding of patients. "I have learnt how to handle patients with pain; at first I didn’t know that there is any other kind of pain other than physical pain."

Both Louis and Gertrude acknowledge that finding the time to study has been a difficulty for them, coupled with frustrations about internet connections and delays in submitting assignments because of computer problems outwith their control.

I asked them to share any particular experiences which had had an impact on them:

"Something I have learnt from this course is that in whatever stage of life, whether healthy or unhealthy a palliative care health worker is essential. In this I mean we care for anybody‘s need in life, be it a social problem, physical, medical, spiritual or cultural. In medical care a palliative nurse is universal. Once on the ward we had a patient who had a thyroidectomy, but developed a problem with her respiration. The ENT surgeons opted for a tracheotomy! She accepted it and it was done. This patient constantly complained of pain which we tried to control with Diclofenac and antibiotics but the pain still persisted and in the long run she resisted eating, telling the ENT staff that she felt pain on swallowing which in normal circumstances could not happen. As I was always in touch and on the ward, one of her sisters consulted me and asked me to talk to this patient. Wisely I went to her as if visiting her, then I asked her how she felt, fortunately she was open with me and narrated. She had social problems, she could not see her children, her body image with the tracheotomy was also depressing her and she just felt she could not eat anything. After counselling her and nullifying her worries, that day she started eating, and as someone who was physically able to get out of bed, she began to walk and it was the first time she smiled since she was operated." Lois Semanda

"The experience I have about the course is so tremendous that I cannot tell it all. First of all I count this course as a blessing for it has changed my life and my nursing care. I work in a cardiac institute which manages palliative cases and yet nobody seemed to know what it meant and it was all aimed at curative management, which I came to know was not the issue. Most of these patients were palliative patients and needed the right care from the time of diagnosis. But I am glad to tell you that provision of palliative care has been agreed to be the next objective of the institute to prevention of cardiac diseases. Our doctors now accept the use of morphine as a drug of choice in pain management for many conditions, and the 4-hourly timing too is agreed on. 'Palliative Care' does not mean death any more. Secondly I wish to express my heartfelt THANKS to the sponsors for having done all for me, that which I would not make at all." Gertrude Munduru