Throughout the year, IAHPC board members contribute a range of opinion pieces and other thought-provoking articles to the IAHPC Newsletter. This month, it is the turn of our board member Dr. Mhoira Leng.
Mhoira is a specialist palliative care physician currently holding two roles as Head of Palliative Care in Makerere University, Uganda, and Medical Director of Cairdeas International Palliative Care Trust, Scotland. Mhoira has a particular interest in international palliative care and works alongside partners in the developing world to build capacity, offer mentorship, support curriculum development and models of health systems integration.
It is one of my great privileges to be involved in palliative care education in many parts of the world. We are all aware of the need for palliative care and the crucial role that health and social care practitioners play in meeting this need – and the gap in so many curriculums and training programs. The World Health Assembly Resolution encourages training and curriculum integration at all levels and for all cadres and the World Health Organization emphasizes universal health coverage. So is the answer more training courses? Will that change practice and behaviors?
The global educational emphasis is increasingly on values-based or transformative education which focuses on exploring, discovering and challenging our core values which in turn drive behavior. Palliative care gives us an almost unique opportunity to engage with these deeper issues. Beliefs, attitudes and values underpin our practices, and dealing with the challenges of life and death, quality and mortality, family and ethics, hope, meaning and truth offers an opportunity to see this transformative change. How do we engage in values-based education? We ensure that experiential learning and clinical modeling are essential components; we train the trainers and senior colleagues; we offer centers of excellence for quality and evidence-based practice; we integrate our training within health systems changes and we support curriculum development.
Hear the words of one of our postgraduates in internal medicine in Makerere University where we have integrated palliative care training:
“The palliative care training has made a huge impact; I now see the patient as a person and not a disease, I don't avoid difficult conversations, I don't order unnecessary investigations, I see them as part of a family, I do holistic care. It was not like that before.”
Listen to one of our medical students in Makerere:
“I am not the same person as I was on Monday. This palliative care week has changed me completely.”
In Chile, I was so encouraged to see the Tuning Project report, which will underpin the competencies for all medical graduates in Latin America, state goals: ‘the promotion, prevention, attention, rehabilitation and palliative care of individuals, families and communities in all their cultural diversity . . . work well in teams, participating effectively in the healthcare systems . . . by means of communication with the patient, their family, the healthcare team and in society, seeking quality of care.’
I have just returned from teaching the first palliative care course in the Islamic University of Gaza (pictured). Hear some of the feedback:
“We learned never to say there is nothing we can do.”
“We learned how to listen to our patients... and I feel so much better.”
And the words of Jessica, living with cancer in Chile:
“What do people need from their doctors... to be valued, listened to, cared for, loved.”
All of us teaching palliative care have seen this transformation.
Our colleagues in health and social care do not always need us to persuade them to include palliative care – they need us to give them the tools and model evidence-based transformative practice. At the request of the University of Rwanda’s Vice-Chancellor, we developed a Palliative Care Curriculum Toolkit with the Global Health Academy at the University of Edinburgh to support this type of integration – agreeing competencies and modeling values-based change.
We can change the next generation of healthcare workers and, in the process, we ourselves can be challenged and renewed – and make a difference in our world.
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