Palliative Care providers in well-resourced countries often have little appreciation of the challenges faced by colleagues practicing in low-resourced areas. Before we can teach and recommend practice change, we need to understand more about the conditions in which palliative care is being implemented around the globe. Project Hamrahi is a means of sharing knowledge, experience and fellowship for both mentors and mentees.
In 2010, APLI joined with Pallium India to establish Project Hamrahi (“Hamrahi” is Hindi for ‘fellow traveller”)
Hamrahi is a collaboration to establish links between palliative care doctor/nurse teams from Australia and new teams in India. It aims to support the development of fledgling palliative care services in India. Volunteers are given the opportunity to work in a different culture and better understand the challenges faced by colleagues in those countries. It strengthens regional relationships and enriches practice in both linked countries.
Project Hamrahi received a grant from the Australia India Council in 2011 but is largely supported by donations from APLI members and friends.
How to become a mentor
APLI mentors are palliative care providers (doctors, nurses, allied health, pharmacy) with extensive experience in clinical care, teaching, leadership and team work. Mentors may have had previous experience in providing cross-cultural education in low resources countries and be able to take responsibility for their safety during travel. An openness to learn from their mentees is another key requirement. They provide a bio explaining their reason for volunteering.
Mentors commit to at least three 7 day-visits over three years, to their link site. Within one month of return, mentors submit a report to APLI and Pallium India, which is also shared with the mentee host site. The goal of visits are to establish a respectful relationship, raise the profile of palliative care, teach in both formal and informal settings, and encourage quality improvement. APLI provides a debrief on return.
APLI provides an orientation to new mentors, which includes meeting other mentors, an orientation pack with information about Hamrahi and safe travel, and support for setting up a mentoring link with an Indian palliative care service. APLI also covers the cost of return flights to India, up to $1500.
Meet the Mentors
Assoc. Prof Odette Spruijt
While training in palliative medicine in the UK, I heard Jan Stjernswald talk about the first Indian Association of Palliative Medicine conference to be held in Varanasi in 1994. I was inspired to attend the conference. That was the first of many for me, for several years, with several conferences combined with extended visits for teaching, mentoring, and just getting to know the colleagues in India. Also in the UK, I met Joseph O’Neill, another palliative medicine trainee, who set up British Aid for Hospices Abroad. This was the inspiration for Australasian Palliative Link International (APLI), which I established in 1996.
As for motivations, for me, it probably goes back to my childhood and the encouragement we always had to consider those less fortunate and to provide help where possible. Something about India in particular connects with me, something hard to define or explain. I think my first visit was so intense and the exposure to ‘the life force” there was mindblowing, and made my own culture seem so lacklustre at that time.
At times, I wonder what I can offer of any use when daily realities are so different. The warmth of friendships and the ongoing desire of many Indian colleagues for contact and support have encouraged me to continue.
Dr Anil Tandon
I am an Australian born Indian, and have travelled to India more than a dozen times to visit relatives. I have never lived nor practiced medicine in India. My Hindi is of a very basic standard only.
I have worked as Palliative Care Physician since 2001. On two occasions I have worked as a locum physician in the UK for 6 months: Wales in 2001 and Scotland in 2007.My current clinical positions are in a consultative service in a tertiary hospital and as a visiting physician to the Kimberley (which is a sparsely populated remote region in the north west of Australia with a large Aboriginal population
Living a life of comfort in a wealthy country makes it challenging to go visit family in India and see what is missing in health care (let alone other aspects of day to day life).
Adding on top of that what seems to be a lack of understanding of the importance of pain relief, difficulties in accessing analgesics etc in my home state makes me question how I can help, if at all. The incredible focus on IV fluids, high cost medicines, chemotherapy etc when death appears close (even to the untrained observer) is just the icing on the cake.
Rosalie(Shaw) has been gently encouraging me to help palliative care services in the developing world in a practical way for some time now, but mainly due to the ties of a young family in Perth, I haven’t thought seriously about going to India at a professional level until now. Now that the kids are a little bit older, maybe 2010 will be the start.
I have enjoyed nursing for 20 years, working in a variety of areas including Northern and Central Australia and 4 years in the UK. I have been working in the specialty of Palliative Care since 1997 and have had 7 years recent experience in senior nurse roles in metropolitan, regional, rural and remote areas and in all 3 forms of palliative care service delivery: consultancy, inpatient and community services, and the last 2 years as a Clinical Nurse Consultant.
I was the first Regional Coordinator of the Kimberly Palliative Care Service (KPCS) when it was reestablished under state administration in 2003 and was instrumental in the development of a strategic vision and an effective, culturally appropriate, model of care delivery, demonstrating improved accessibility to service and enhanced capacity in the 3.5 years I was in the position. While with the KPCS, I was project officer for several projects including a 2.5 year Commonwealth Caring Community Project ‘Accessing Palliative Care in the Kimberley’s Remote communities.
I have travelled extensively and independently world wide, including North and South America, but my favourite travel has been 4 months in Africa. I have always been interested in marginalized populations, and have enjoyed the privilege and to work with Australia’s Indigenous people. When attending a 2 week Palliative Care Course sponsored by Kings College in the UK a few years ago, I met many palliative care services providers from developing countries and it highlighted to me huge gaps in knowledge, access and resources. Most recently a practitioner from India spent some time learning from us, at my last work place. Their passion for their work was inspiring. My travel and work experiences has highlighted to me the great opportunities I personally have, and have planned to volunteer overseas in some capacity in the future to see if I can assist in some way.
Dr David Brumley
I am a registered specialist nurse who works predominantly with people who have been diagnosed with cancer, HIV or who are in the palliative or terminal phase. Recently, I was Nurse Unit Manager of a clinical assessment unit at Peter MacCallum Cancer Centre, a nurse-led unit focused on symptom management for cancer patients. I completed a Graduate Diploma of Advanced Nursing Practice in Cancer and Palliative Care through the University of Melbourne in 2007 and is currently undertaking my Masters in Counselling focusing on grief and bereavement.
Reflection on why I am interested in the APLI Project Hamrahi:
A sense of fairness and equality drive me in both my career and in life. Equally, time given to community service is also important to me. Project Hamrahi is, in its essense, a program that has these three values at its heart as it contributes expertise and passion to the world community. I am looking forward to providing assistance to the medical and nursing team at the Cachar Cancer Hospital in Silchar, and although I am there to educate and support for a short time I know I will also be contributing better outcomes for India in the longer term.
Dr Oliver Haisken
Dr Sok-Hui Goh
I was born in Singapore and grew up in Kuala Lumpur, Malaysia, until my teenage years. I came over to Australia to pursue my tertiary education, where I completed my Bachelor of Science in Melbourne before moving to Adelaide to study Medicine.
After my internship, I started Physician’s training, however this was interrupted by the arrival of 3 children – they were so keen to pick us! I decided to shelf my training and my husband, a surgeon, and I went to work in a mission run hospital in Niger, West Africa. Our family moved there for 3 years and returned to Adelaide at the end of 1995 for our children’s education.
In Niger, I did part-time work to help out, depending on the number of doctors available, wrote the Medical Protocol for the hospital, and did some teaching for national health care workers and expat nurses who felt called to work there. We saw the start of the HIV/AIDS spread in West Africa and were also involved in the meningitis outbreak then.
Since our return to Australia, we have gone back several times to work in Africa in short stints and our hearts are very much in the countries with poor resources.
At present, I am doing a mixture of General Medicine, Consultant at the Acute Referral Unit at the Repatriation General Hospital and Palliative Care at the Adelaide Cancer Centre. I have worked in most of the Public Palliative Care Services since I embarked on this pathway since 2000. I have also been involved in teaching medical students, mentoring physician trainees and supervising Interns who come through our Unit.
It was through Odette’s presentation at the conference that I was challenged and encouraged to offer my service and also to learn how a mentoring collaboration could be established, perhaps in Africa!
Dr Meera Agar
I currently am Director of Palliative care, Braeside Hospital, – which has 20 bed inpatient unit, two-day a week day hospital, and community service.
It is linked with the south west sydney area palliative care service which covers a huge area of south west sydney – with hugely diverse cultural backgrounds in the population we serve. My other main interests have been education – and have been lecturing with Flinders university in post graduate courses; and assisted in the curriculum development processes for palliative medicine in Australia; and clinical research – currently doing a PhD in Delirium in advanced cancer.
I have been interested in the Asia pacific for a long time – my Mother is Sri Lankan Malaysian, and I have two out of my four sisters who are adopted – one from Calcutta and one from Sri Lanka. I had always hoped my medical career would involve some work broader than Australia but had not really envisaged exactly how. I have taught with Hospis Malaysia for 4 or so years, and also have taught with the Grad Cert in health (Palliative Care), Flinders University in Singapore. It is so remarkable to see how hard these students work, and how hungry for knowledge and experience they are. Their desire to help those in their communities despite a lot working against them is heartening. The best part has been watching them find friends and mentors in the region – and being able to have a network for ongoing support.
Locally – I have had now three registrars from the Asia Pacific – this was more by accident as they had applied independently to do training in the Sydney network and were rotated to my unit – two from Sri Lanka and one from the Phillipines – all who have done 6 months of time in my unit – and have enjoyed immensely watching and supporting them blossom in to avid advocates and clinicians in palliative care. I have also seen how hard it was for them to be uprooted from their countries into a foreign health system; and still
ponder how these clinical placements can best work.
Though filled with enthusiasm – I am constantly reminded in all these endeavours how much more I have learned rather than taught – and have watched and learned a lot from Rosalie and her approach in the region – and believe I still have a lot more to learn.
I am a registered nurse very excited to be at the beginning of my career in palliative care. I am currently working in community palliative care at Melbourne City Mission in Melbourne.
From my first clinical placements as a student nurse, I knew I wanted to work in palliative care. In my first two years of nursing I worked at Peter MacCallum Hospital. I find great fulfillment caring for people at the end of their life – the very raw and real connection with patients is something I truly value. At Peter MacCallum I was also a member of the Palliative Care Champion Group which further sparked my interest in the area. I then completed a Graduate Diploma in Advanced Nursing Practice in Oncology and Palliative Care at the University of Melbourne.
I have also spent some time working in Intensive Care at The Alfred Hospital.
I have a very keen sense of adventure and am always endeavoring to experience new ways of living and appreciate the World beyond my own. Over the years I have traveled extensively in countries such as Zambia, The Democratic Republic of Congo, South Africa, Bangladesh, India, Malaysia, Nepal and China. In 2008 I lived in the Philippines teaching English to children in the slums of Manila.
I have always had a passion for connecting with others; it brings me so much happiness. Ensuring that human dignity is maintained, even just in small ways, is something that drives me and is very close to my heart. As a child I was brought-up with the mantra “To whom much is given much is expected”, and this has remained at the forefront of everything I do.
I constantly count myself fortunate to have the privilege of sharing and participating in patients’ end-of-life care.
APLI has offered the perfect opportunity to combine my love of travel and nursing with my passion for palliative care and adventure. I hope through building relationships with my colleagues in India over time we can work towards building palliative care for patients in India.
Dr Sophia Lam
I am an Advanced Trainee in Palliative Medicine, having come to Palliative medicine through the physician pathway. I have been fortunate in my medical career to have had a number of clinical and research experiences based in resource poor and/or underprivileged settings from Paediatric patients in Africa to adults with severe malaria in Bangladesh and India to Indigenous Australians in Cape York and the Torres Strait.
Such experiences coupled with my subsequent training in general and palliative medicine have inspired an ongoing interest in working with communities less developed and financially resourced than those I now work in. We have much to learn from these colleagues and patients as well as hopefully something to offer and I look forward to an ongoing partnership with the communities that Project Hamrahi gives me the opportunity to visit.
I am a Palliative Care Clinical Nurse Consultant working on the Central Coast of New South Wales with a particular interest in education and improving end of life care in all settings. I have worked in Specialist Palliative Care roles in Australia and New Zealand since 1998 across acute hospital consultancy, inpatient hospice and community services. I am currently undertaking my Masters in Palliative Care through Flinders University.
Access to appropriate symptom management and holistic end of life care for people with a life limiting illness is the hallmark of a compassionate society. In the 1990’s, I spent 7 years in Tanzania, East Africa and had the privilege of working alongside a team providing care for people suffering and dying from HIV AIDS. Experiencing the poverty and paucity of even the most basic resources, and despite these restrictions, the willingness of the people to increase their understanding and improve care was humbling. We have much to learn from these colleagues and the patients for whom they care and even a small involvement in an Hamrahi project may contribute to better outcomes for the dying.
Dr David MacKintosh
I work as a staff specialist in palliative medicine in New South Wales on the Central Coast. Having previous experience in paediatrics, clinical pharmacology and general practice I have now worked full time in palliative care for nearly 17 years and have covered all areas of care, community, inpatient – hospital and hospice – and inpatient consultative services. Explaining why I want to become involved in developing palliative care in a resource poor country is difficult without sounding either condescending or evangelical; it is simply something I want to do. I have an emotional attachment to India through my father who travelled in India in the 1940’s. As a young man from the north of Scotland he was deeply affected by his experiences there and often spoke warmly of India and the people he had met. I am also at a time in my life (close to retirement age) when it feels right to contribute something to a part of the world lacking some of the comforts I enjoy.
Dr Niamh O’Connor
I’m from county Kerry in the southwest of Ireland. I studied medicine and completed all of my medical training including specialist training in Palliative Care in Ireland. I also did a Masters in Medical Ethics and Law- my thesis theme being Justice in Advanced Cancer. Following completion of this I relocated to Australia in 2014 and worked as a Palliative Care Fellow in Barwon Health, Geelong for a year. I am now working as a Palliative Care specialist in The Royal Darwin Hospital. From here we cover all of the Top End rural and remote communities. It constantly amazes me how many similarities there are between remote communities in Australia and those I have worked with in the developing world.
My interest in working and supporting important initiatives in the developing world was sparked when I first travelled to Zimbabwe as a teenager to visit my brother who was working there. In university I was an active committee member on our fundraising project (Surgeon Noonan Project) to send funding and enthusiastic medical students to Africa. Through this project I did my medical elective in Mwanza, Tanzania and was blown away by the enthusiasm of my colleagues despite their hardships. During my training in Palliative Care I had the privilege of working in Hospice Africa Uganda in Kampala with the wondrous Dr. Anne Merriman for 6 months. Her ability to structure palliative care provision to suit its location and her drive to legalise opioids on the continent of Africa is quite incredible. Her work has and will result in comfort for millions.
I remained an active member on the Hospice Africa Ireland Committee from 2007-2014. I was delighted to learn of APLI through Dr.David Brumley and Dr. Rosalee Shaw. I think that we are privileged to live in lands of plenty. The concept of justice is very important to me in my practice. I believe that everyone should have access the care they need despite location or wealth and I feel lucky to have the opportunity to offer support and experience to those who share this goal.
I am a registered nurse with twenty-five years of cancer nursing experience in the UK and more recently in Australia. My passion for cancer nursing developed during my training and has continued throughout my career. Since completing a Diploma in Cancer Nursing at the Royal Marsden Hospitals in 1994, I have gained experience in a variety of clinical settings caring for patients with many tumour types. Spending time in oncology and haematology outpatient units, I gained various clinical skills and an appreciation for educating/training other practitioners. I firmly believe that palliative care can benefit patients and their loved ones throughout treatment. In 2012 I completed a Master of Nursing. I currently work for a cancer treatment resource website, overseeing medical oncology chemotherapy protocols and nursing content; working collaboratively with Australian cancer clinicians to ensure that the content is contemporary, evidence-based and relevant to clinical practice, therefore continuing to assist cancer patients and clinicians in a different way.
I have a passion for travel and experiencing different cultures having visited India previously. I am acutely aware of the privilege afforded me by birthplace and seek ways to give back. I am a humanitarian, passionately driven to redress inequities in health. The APLI project Hamrahi has offered an opportunity to share my knowledge and skills to empower the cancer care team towards better outcomes for those in their care. I believe it is a privilege to care for people at the end of their life and support their loved ones during this time.
I have a 15yr history working in Consultative Nursing Palliative Care positions across the acute, hospice, community and residential aged care sectors.
I describe myself as a “bedside nurse” and I work to optimise compassionate and competent palliative care especially within the aged care realm. I bring an energy and passion in the care of the dying and driven to support and collaborate with families and staff in providing excellent end of life care.
Currently working as a Clinical Nurse Consultant for the Metropolitan Palliative Care Consultancy Service (MPaCCS) in Perth, the role has developed my skills in project development and education.
Education and mentoring give me the greatest satisfaction, seeing confidence and capability grow within a service is very rewarding. Working at grassroots level, through bedside learning, and in development at head office level, I have seen services provide a higher standard of care and outcomes for all that are involved.
I have an Indian background and I have always wanted to invest my skills back where my roots lie. Meeting Dr Rajagopal 10 years ago at an Asia Pacific Hospice Network conference in Perth has given me the chance to fulfill my dream. I have visited Dr Rajagopal ‘s team at TIPS in Trivandrum, Kerala, for 10 days providing supportive education to medical and nursing teams and getting a good taste of the social, cultural, and financial challenges that are met by the team. I am keen to continue my support.
I have a nursing background and have worked in palliative care for over 25 years. Clinical experience in the community was with St Vincent’s Home Care, and Cittamani and Karuna Hospice Services. I also worked with Metro South Palliative Care’s consultation liaison teams at Princess Alexandra and Mater Hospitals.
I currently work as Director of Learning & Development for Queensland Health’s Centre for Palliative Care Research & Education (CPCRE). That role involves overseeing as well as helping develop and deliver education CPCRE provides around the state. I am responsible for PEPA Queensland, which also delivers education to health professionals, as well as providing observational placements for health professionals with specialist palliative care teams.
I have held executive positions with Palliative Care Nurses Australia, and Palliative Care Queensland, peak body for palliative care in the state, where I am currently President. While an academic at Australian Catholic University, I co-wrote and taught a Graduate Diploma in Palliative Care. With a CPCRE colleague, I wrote an online Continuing Professional Education palliative care module for Queensland University of Technology, for which I am the course coordinator. That unit runs online once a year; I am responsible for the academic aspect of the unit – maintaining the unit website, interacting with students online, and marking their assignments.
My motivation for volunteering for Project Hamrahi is that I have always felt it important to give back to others in whatever ways possible. With my experience and expertise in palliative care, and my education skills, it’s important I share that with others who may be interested. Finally, I have a lifelong commitment to social justice and equal rights, which includes helping promote access to palliative care and pain and other symptom management wherever that access is not readily available.
Hi, I’m Sandi
For the last ten years I have worked as a Palliative Care Nurse in the community of Wagga Wagga. Previously I was a community nurse and before that as a Dental Therapist in South Australia and NSW.
I have been privileged to volunteer in small villages in Nepal as a Dental Therapist with a Rotary Program. I have also spent time in the remote communities in Northern Territory delivering healthcare. More recently I have traveled to Cambodia on several occasion with a local charity based in Wagga. We have built two schools, educated the staff and provide ongoing support to the schools with mentoring and fundraising for school supplies and uniforms. This has been a very rewarding experience with one of the first students commencing university this year.
My reason for volunteering for Project Hamarahi is the privilege of being able to share experiences and information that benefits both the mentors and those receiving the mentoring. Having traveled in India and other developing countries, I have gained an understanding of the sometimes difficult conditions in which people live but also the strength derived from family structures and communities.
I am looking forward to being a mentor in Project Hamrahi as I believe everybody gains when we share knowledge.
Hi, I’m Toni and I have been working as a registered nurse in regional NSW for the past 28 years. My nursing career has taken a few twists and turns over the years, with the past ten years spent with the community palliative care team. I have also spent three years working as a Funeral Director. Part of my role has included mentoring new staff, educating medical students and demystifying death and dying within our community. I am passionate about facilitating patient and carer empowerment in end of life care and will be forever grateful to those families who have allowed me into their lives during such a sacred time.
Well, I have reached a time in my life where my children are more independent, allowing me the time to focus on projects outside my own community. A recent encounter in Indonesia inspired me to contribute more to developing communities. India has always fascinated me and a conversation with a work colleague, and APLI member Sarah, convinced me to jump on board. I look forward to learning and sharing knowledge with like-minded people to achieve the common goal of relieving suffering, creating connection and friendships.
*Information shown above is correct at the time of publishing to the website.
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Asha Kiran, Orissa
Bhagwan Mahaveer Cancer Hospital & Research Centre, Jaipur, Rajasthan
Cachar Cancer Centre, Silchar, Assam
Community Oncology Centre, Ahmedabad, Gujurat
Kolkata, West Bengal
Regional Cancer Centre, Agartala, Tripura,
Synod Hospital / Grace Hospital, Mizoram
Vizag, Andra Pradesh
Over the course of the ten year project, there have been 41 mentoring visits to 14 different palliative care services in India. There have been 28 mentors from Australia and New Zealand, including 11 doctors, 15 nurses and three other professions (pharmacist, counsellor, project officer).
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