Teaching palliative care in Lesotho: reflections – Simon Pennell

Life has taught me, that when opportunities arise, always take them when you can.

So after George (Smerdon) made contact with me to discuss a teaching opportunity in Lesotho, about to be provided by PCW, it did not take me long to agree to be part of the Team going there to teach. I’m so pleased I went.

PCW provided their first Palliative Care teaching in Lesotho in November 2024 and had been invited back with support from Starlight Oasis Hospice of Hope Charity (SOHH) and, we believed, the Lesotho Ministry of Health. The plan was to start our time there meeting up with the November cohort and review/reflect on their programme and any progress made since. Then we would provide two modules of 5 days teaching, based on the Palliative Care Toolkit, to new groups of health and social care professionals.

I joined the experienced team of Ruth Wooldridge and Gillian Chowns who very kindly and skilfully guided me on the teaching programme.

Many hours of careful lesson planning plus zoom meetings with SOHH personnel preceded our arrival together in Lesotho. Here we were picked up by ever-reliable Gabriel who was to become our friend and taxi service whilst in Lesotho.

On the first day of work, I joined the reunion of the November 2024 cohort for whom PCW had provided teaching. There was good support for this review day and participants were clear that they had all learned a great deal that they were now putting into action – there were many positive discussions about how they hoped to develop their work in providing palliative care in different settings. All remained enthusiastic; they shared sometimes over ambitious plans but with a motivation to make them succeed. Time will tell. On this day I developed a better understanding for the teaching to come.

The first weekend was my introduction to using both the Palliative Care Toolkit and the Trainers Manual as we sat and planned for the following week’s teaching. What a privilege to have Ruth and Gillian to guide me. It takes a while to see how the plans pull together and how contributions are organised – I immediately felt the flexibility that the Toolkit provides in teaching, as it was much less prescriptive than I expected and can easily be adapted to the differences we saw in the personalities within the groups.

Arrangements for the teaching were not straightforward but through enormous hard work and effort Tebello and Paul Myres (from Starlight Oasis) made sure we had two good sized groups, accommodation and catering for the two courses.

They did their best to work with the Ministry of Health and provide IT for the teaching – both were challenges that we had little control over but did not ultimately affect the running of the courses and we were able to manage most of the difficulties.

Each of the five-day courses were held in different locations, each with challenges – what helped was more the enthusiasm and excellent attendance of the students who came from very different clinical environments. We were joined by Nurses, Doctors, Social Workers, Chaplains, Pharmacists, a Physiotherapist and academic teaching staff. This brought a beautiful working atmosphere to each group.

I loved observing the traditions that are part of being in Lesotho; the importance of having the Course opened and closed by the Ministry of Health with certificates provided on the final day. Each morning was a real joy to witness prayers and the most beautiful singing to start the day.

On each day we had an organised programme based on the Toolkit for the teaching to be provided that we had discussed and planned for. Each of us were able to fully contribute in teaching, facilitating, observing/listening, recording and of course ‘role-play’.

The teaching was very different from what all attendees might have expected – they would have been very comfortable sitting in rows behind desks looking at Power-Point presentations. I think the variety of interactive and self-directed learning approach based on the Toolkit did win them over. This way of learning, particularly working in groups was very productive. Sometimes it would be in their own hospital group or in groups of their own discipline, sometimes in mixed groups. We used this to fit with the planned teaching. I think it was a surprise to most of them how much work they did on their own. Allowing this made the work so much more relevant to their own practice and where they were working (and fun, too). The Toolkit then remains an ongoing resource back in their own working environments.

We worked long days; in the evenings we then spent time reflecting on the day’s teaching and fine-tuning the next day's teaching and then preparing it. Luckily, we had the ideal accommodation at the Kick4Life facility. Rooms were very comfortable, with excellent food and space for our discussions. All was provided by wonderful staff who could not have been more kind and helpful, always with the huge Lesotho Smile.

We had a refreshing break near the mountains in the middle weekend which re-charged us all for the second week. We followed the same programme for week two with adjustments to suit the needs of the group.

At times IT was a real issue. At home we get used to the reliability of Wi-Fi etc – in Lesotho you sometimes just have to do your best to overcome some of the technical problems – the groups were very tolerant of this, and I still think we provided teaching from which they all benefited.

Each week finished with locality groups putting together proposals and plans for their next steps in taking back Palliative Care learning into the workplace and how they may see it develop there.

Each group was able to demonstrate enthusiastic plans they hoped to deliver. We know already that some of this has led to real action. The participants' evaluation of the programmes was very good, and we were particularly pleased to see them report growing confidence about Palliative Care after the teaching.  We are now all excited to see how this develops into the future, for Palliative Care in Lesotho.

This was a wonderful experience, and one that PCW should feel very proud to have facilitated. Let’s hope we can return to see many outcomes develop after the teaching.