Report on Palliative Care Course, Lesotho September to October 2025 – Dr Gillian Chowns

Purpose of Visit

This teaching trip was in response to an invitation from Ms Tebello Lepheane, founder of Starlight Oasis Hospice of Hope, to deliver a fourth one week course to a cohort of practitioners in palliative care.

Teaching Team

Dr Gillian Chowns (social worker)

Dr Simon Pennell (physician)

Joan Marston (Mon-Wed – nurse)

Ms Tebello Lepheane (Observer)

Stakeholders

Ms Tebello Lepheane (Founder, SOHH)

Dr Paul Myres, (Chair of Trustees, SOHH)

Context and Background

Ms Tebello Lepheane is a Masoto who has lived and worked in England for over 20 years. She has pursued her vision for palliative care services and a hospice in Lesotho with considerable determination, and with the support of Dr Myres and the Board of SOHH has developed strong links with the Lesotho Ministry of Health and with the Queen of Lesotho, Mme Masenate Mohato Seeiso.

Having successfully delivered a first course in November 2024, and two back-to-back one week courses in February of this year, PCW was asked to deliver a fourth one week course for the remaining hospitals not yet involved.

The cohort for this week came from nine government and Christian hospitals – Mohlomi, Maseru, Mafeteng and Motebang hospitals, Mokhotlong, Mashabeng, Quthing, Paray and Seboche hospitals, plus two Ministry of Health personnel.

Logistics

The course was delivered from 29th September to 3rd October inclusive. Gillian and Stephen Chowns flew in from Botswana, via Johannesburg, where they had been representing PCW at the 20th APCA conference, on Saturday 27th; Simon Pennell joined them on 28th and Joan Marston arrived overland from Bloemfontein on Monday 29th.

The team was accommodated at Hokahanya Inn, run by the charity Kick4Life, until Wednesday 8th October.

Finance

Simon Pennell’s return flight Heathrow -Maseru was met by Starlight Oasis Hospice of Hope, as was his accommodation. Gillian Chowns’s flight form Gaborone was met by SOHH: her flight to Gaborone for the APCA conference and from Maseru to Heathrow was met by PCW. Stephen Chowns’ flight to Gaborone and back from Maseru was met by PCW, but he paid for his flight to Lesotho privately. PCW had planned to meet his subsistence costs in Maseru but SOHH declined to charge for these, recognising his contribution to the course. PCW did not make any charge for facilitators’ fees; this was a pro bono offering.

Sunday 28th September

Gillian, Stephen, Simon and Tebello met at Kick4Life, organised folders and reviewed plans for the week’s teaching at Maseru District Hospital.

We were therefore very taken aback to learn late in the evening that the venue had been changed – because MDH had been double-booked – and we would now be teaching at Queen Mamohato Hospital several miles away in a room that we had never seen and of whose facilities (A/V, space, flexibility) we were completely unaware.

One week course Monday 29th – Friday 3rd October (see timetable attached)

Monday 29th September

We arrived by 8.15 and were eventually shown to a room with A/V and chairs and quickly rearranged the seating to as much of a horseshoe shape as possible. At 8.30 am we had four attendees, 14 at 9am and 21 at 9.30am, an hour after the start time. Registration, distribution of Confidence Rating sheets and provision of folders containing the Toolkit, timetable, paper and pen were concluded by 9.30am, ready for the first (truncated) introductory session. This was opened with prayer and a hymn readily sung by the group. Opening remarks from Tebello and our team then followed, and then a series of activities helped us all to get to know each other just a little. The first teaching session (What is Palliative Care, and You Can do Palliative Care in your setting) was led by Tebello.  Tebello was not able to stay for the afternoon programme as she had to be at a site meeting. Joan Marston arrived during lunchtime, which was delivered late and which then altered the afternoon timings. The first afternoon session (You can improve your communication skills) and the last session (You can assess pain and other symptoms) were slightly truncated to enable us to finish on time and the day concluded with our usual practice of holding a 15 minute ‘Roundup’ which enables us to gather some feedback on the day in a non-threatening and often light-hearted manner. We were much encouraged by one participant’s comment that it felt as if they had been together for almost a week already, as they felt relaxed and positive.

On returning to our accommodation, we three and Joan met for an hour’s debriefing and reflection. This is our usual daily practice and while we are often tired after the day’s teaching, we consider this an essential and very useful aspect of our courses.

Tuesday 30th September

The following topics were covered – Control of Pain, Breaking Bad News, Symptoms 1 and Assess, Treat, Care and Prescribe. The content was somewhat weighted towards the medical rather than the psychosocial, in order to maximise use of Joan’s expertise; the students were engaged and responsive. Because Stephen had downloaded the videos in advance we had no problem during the week in showing these.

Wednesday 1st October

The opening session (Palliative care in children) was expertly and compassionately delivered by Joan, and the students much appreciated her input. It was followed by a Children and Families session and, in the afternoon another important session, You can use morphine, delivered jointly by Simon, and Dr Hassan from the Senkatana Oncology clinic, ensuring that the information was relevant and appropriate to Lesotho.

The day ended with Spirituality. The teaching team stayed on to hold their Reflection session in the room: Tebello was using the week to observe the whole teaching process and offer us her insights and feedback.

Thursday 2nd October

Tebello was at another site meeting in the morning, when the topics were End of Life Care and Bereavement (in which the facilitators were fascinated to learn about Lesotho customs around burial and mourning rites). She returned in the lunch break and negotiated with the QMMH staff  about the planned ward visits to enable the students to practise holistic history taking. A list of patients was eventually agreed, with   Simon, Tebello and myself each supervising eight students. As eight was too large a group for bedside visits, we further divided them in two, as a consequence of which, each group of four were only able to practise with one patient. Nevertheless the exercise clearly made an impact on them. As the session was relatively short, we were able to debrief as a whole group back in our teaching room. This was time well spent, for some of the situations had been quite distressing and it was important to hear the students’ concerns and validate their reactions.

Friday 3rd October

The first session incorporated Looking After Yourself as well as Advocacy and Team-building; thereafter the bulk of the morning was spent on the crucial topic of Implementation.

Once again, we were gratified to note the energy and enthusiasm of the students, who clearly were motivated to drive palliative care forward in their settings. We were much encouraged by the proposals that each group presented, even if (like those on the November and February courses) their timelines were perhaps rather optimistic!

At the closing session after lunch the participants completed post-course confidence rating sheets and an end of course assessment test. After time for a formal evaluation, the course concluded with presentation of certificates and speeches from Tebello and our teaching team.

On behalf of PCW, Stephen spent much of the course filming the activities and presentations: the intention is to make a film about PCW’s teaching approach.

Weekend R and R

The team left for Semonkong Lodge later on Friday afternoon, returning on Saturday evening. On the Sunday we travelled to Malimo Nthuse Lodge for an overnight stay, largely spent relaxing in front of welcoming log fires while an amazing thunderstorm carpeted the whole area with a blanket of hailstones!

We returned on the Monday (a public holiday for Independence Day) via a visit to, and tour of, the impressive new buildings of the Hospice, and then to Tebello’s home where she kindly entertained us to an excellent meal.

Tuesday 7th October: Review Day for previous course participants.

This had been originally planned as three separate sessions for each of the November and February cohorts. It went through several iterations as a consequence of disappointing responses and was eventually scheduled as one half-day with 11 participants confirming attendance. However, only six individuals attended. While we believe that they found the session useful and encouraging, it would be dishonest not to acknowledge how disappointing this was. For the PCW team, it meant that of the five days spent since the course closed, we had only worked one half day. The confusion over whether or not the Monday would be declared a public holiday was frustrating, and delightful though it was to have had the opportunity to explore more of Lesotho, this was perhaps not the best use of our time or the project’s money, since SOHH were meeting the cost of five days accommodation. Of course, the team met the costs of both the Semonkong and Malumi Lodges.

Wednesday 8th October

Simon had left the previous afternoon, but our flight was not until the Wednesday afternoon, so we were pleased that Tebello was able to arrange a visit to Senkatana Oncology clinic in the morning. Dr Hassan obligingly showed all-round the department, introducing us to all his staff. It was clearly a very busy clinic and we were grateful for the time he gave us.

Reflections

This was another rewarding and worthwhile course, despite some serious challenges.

As before, the students’ standard of English, and therefore fluency and readiness to engage, was impressive.

Timekeeping was more difficult, with heavy traffic in Maseru contributing to delayed start times.

Mobile phones remain an issue. It was disappointing to note how frequently some students exited the room with mobile in hand, presumably because their workplace was contacting them about an (urgent?) issue. In our view it is a form of abuse for organisations to contact employees when they are on a course, unless the matter is extremely urgent. Frequent mobile messages interfere with students’ ability to concentrate on their learning, engage with facilitators and fellow students and contribute effectively to the group. It was of course impossible to know how essential or otherwise these calls were – or whether indeed they were in fact an opportunity for a toilet break! This is a culture that PCW cannot easily challenge, but it is counter-productive for organisations to invest in training for employees and then undermine it in this way.

As with earlier courses, it was clear that our teaching style, based on short presentations with few slides, leading into facilitated group work, use of role-play, interaction between facilitators, interactive games, quizzes and exercises, was an unfamiliar but much appreciated approach and the atmosphere throughout was warm, positive, collaborative and good-humoured. There were some extremely thoughtful contributions from the floor.

Reflections

Role play and drama continue to be the most popular teaching methods.

We struggled to grasp the more complicated names of the students and had to work hard to resist the temptation of always turning to the few students whose anglicised names were easy to grasp.

The reasons for the very poor turnout at the review meeting need consideration; it is crucially important not to lose momentum.

Though we rarely needed to call on him it was helpful to know that there was an A/V technician available.

While course participants were almost exclusively from the health, as opposed to social care, professions, they readily grasped the concept of holistic care and endorsed its importance.

Future plans

Acknowledgements

Gillian, Stephen and Simon would once again like to pay tribute to the continuing commitment, passion and persistence of both Tebello and Paul in enabling this course to finally to take place.

We are very grateful to Paul for making the arrangements for our accommodation and equally grateful to Tebello for her constant liaison with all involved in order to achieve a successful course. Gratitude also goes to Joan Marston, who stepped in as the nurse in our team.

While not an active member of the teaching team, Stephen was invaluable in many ways, operating the A/V, recording much of each session on film, leading a slot on team-building and generally contributing to the smooth running of the course.

There is no doubt that it was quite tiring. Nevertheless, we were heartened by the reactions of the students, the positive tone of the evaluations and the commitment evident in the Implementation Plans; once again it has been a privilege to contribute to the growth of palliative care in Lesotho.

Dr Gillian Chowns, Project Leader