IAHPC Traveling Fellow’s Report

Report on training activities at the Radiation and Isotope Centre, Khartoum (RICK) Sudan December 2nd – 10th
Esther Walker, RN

Introduction

Whilst living in Khartoum, Sudan 2008 – 2011, I worked as a volunteer nurse assisting RICK to develop a palliative care service for its population of oncology patients, the majority of whom present with advanced cancer. During this period I worked alongside my Sudanese colleagues, in particular Dr Nahla Gafer, teaching, supporting and advocating for palliative care services.
Upon leaving Sudan in April 2011, a busy palliative care out-patients clinic had been established and a nine bed palliative care unit had recently opened. The embryonic palliative care team was also beginning to provide a weekly homecare service.
I was invited to return to Khartoum in December 2011, to participate in a one week training course for the palliative care team and other interested healthcare professionals from RICK and SOBA University Hospital.

I am very grateful to the IAHPC for the Traveling Fellowship that enabled me to return to Khartoum.

Programme

The purpose of this training was to ensure that all current palliative care team members had received education and training in the fundamental aspects of palliative care and to look at issues that had arisen from their clinical work. The current palliative care team is small, many members working as volunteers, some had joined the team recently and others had benefitted from previous education. This was the first opportunity to bring all the team together for joint training. We had a multi-disciplinary group of seventeen participants; including doctors, nurses, psychologist, pharmacists and even a dentist.

I was joined by nursing colleagues from Hospice Africa Uganda, Catherine Nawangi and Rachel Dipio, and together we provided a programme of teaching and training over five days. Rachel and Catherine were able to travel onto Sudan’s other oncology centre at Medani to repeat this training course.

The week commenced with a pre-test exam which was repeated at the end of the week, with all participants successfully demonstrating their learning.

Topics covered during the week included:
Models of palliative care
Ethos of palliative care
Ethical issues in palliative care
Pain assessment and management
Communication skills and breaking bad news
Social and psychological problems
Symptom management
Palliative care emergencies

The participants also worked on the general oncology wards, assessing patients using a palliative care assessment document; this was then reviewed and presented to the whole group.

Participants were each given a topic to research and then gave a fifteen minute presentation at the end of the week. For some of the participants this was the first time they had ever presented, especially for the nurses presenting to doctors and other members of the multi-disciplinary team.

Methods of teaching during the week included lectures, group work, role play, discussions and presentations. Each session was evaluated by the participants and feedback was on the whole very positive.

The week culminated in a meeting of the Sudanese Palliative Care Taskforce Group. We began the meeting by reviewing the development of palliative care in Sudan, current obstacles and challenges. The group then looked at issues related to training, drug provision, in particular the on-going work to secure the importation of morphine powder into Sudan, service provision and the recurrent problems of securing funding for staff positions, plans for advocacy and service development in 2012.

Outcomes of the week:

• A palliative care team that is better equipped to meet the needs of their patients and families
• The team working in a more cohesive way, appreciating the benefits of multi-disciplinary work
• An opportunity to reflect and revise the daily activities in the ward and clinic
• A newly opened ‘training room’ was used for the first time, demonstrating how the room could be used for both training, educational work and meetings with staff and patients/families.
• An embryonic service emerged that feels supported and encouraged by international participation
• A renewed enthusiasm for their work was observed in the team
• There was a taskforce team meeting to set goals for 2012

Esther Walker, RN
Palliative Care and Community Advanced Nurse Practitioner
Staff Nurse, St Michael’s Hospice,
Hereford, U