This month our Featured Article comes from Dr. Mhoira Leng, Head of Palliative Care in Makerere University, Uganda, and Medical Director of Cairdeas International Palliative Care Trust, Scotland. Dr. Leng is also a member of the IAHPC Board of Directors.
As international momentum for palliative care builds with significant progress it throws into stark relief the most vulnerable populations. The world is experiencing huge movements of people seeking security, freedom and fairer opportunities for their families. As a global palliative care community we need to find a way to respond. A new informal network, Palliative Care in Complex Humanitarian Emergencies (PALCHE), is seeking to find ways to respond and engage. Many of these emergencies lead to years of chronic suffering outlasting the media coverage and donor interest. When the burden of facing chronic life-limiting illness is compounded by chronic conflict, political and societal insecurity, lack of freedom to travel, limited opportunities for the young, and uncertainty regarding the basics necessities of life, should palliative care be seen as a necessity or a luxury?
On a recent visit to Gaza with the University of Edinburgh and Cairdeas Trust, I was humbled by the warmth of the hospitality and the resilience of the Palestinian people yet also struck by the chronic, unending nature of the challenges facing the 1.5 million population (1.1 million classed as refugees). For some, the overwhelming insecurity and injustices of life made it difficult to engage in discussions about chronic disease and palliative care, but for others there was a deep understanding that restoring dignity through holistic care and pain control is an essential part of sharing in our common humanity. A senior surgical colleague working in Al Shifa hospital and well known for his emergency work during the many violent conflicts said, "Our people are in pain; we have no choice but to act." Gaza has many committed colleagues seeking to develop partnerships and creative solutions to meet palliative care needs in an integrated way. One of the longest-standing refugee support networks, UNRWA (United Nations Relief and Works Agency), has adopted a family health approach to address the complex link between health, hopelessness, chronic stress and struggles with social cohesion. They are discussing how to integrate palliative care in Gaza and the wider Palestinian diaspora.
Another country affected by chronic insecurity is Sudan where, despite economic and political challenges, a developing palliative care movement reflects the hospitality of this multiethnic, culturally rich desert country. Working with colleagues in the cancer centre in Khartoum and other hospitals I have seen creative ways being utilized to raise awareness, deliver training, develop networks for care and mobilize communities to include those affected by chronic conflict, poverty and life-limiting illness. Again, a resilient, innovative people seeking to address the palliative care needs in the face of many challenges. Travelling through the desert heat I was struck by one particular evidence of Sudanese hospitality: earthenware vessels, provided by residents, are regularly filled with fresh water for passersby so that even strangers are able to quench their thirst. From the streets of the capital city to the back roads in the desert, there is a recognition that we must care for one another, that the needs of each one affects us all.
How we enable the voice of those most vulnerable to be heard, how we support care for the vulnerable, for the sick, for those at the end of life, reflects the deepest values of our societies and never more so than in the face of such overwhelming need.
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