Palliative care training in Rwanda: Working together to effect change

Julie McCarthy, Specialist Palliative Care Pharmacist Prescriber and Dr Victoria Smart, General Practitioner and Hospice Doctor at Mary Stevens Hospice, UK. In this background post to their longer article in the May/June edition of the European Journal of Palliative Care, they explain how individual health professionals and the forming of personal links are an integral part of supporting the development of global palliative care.


Julie McCarthy and Victoria Smart

Left to right: Victoria Smart and Julie McCarthy


Our narrative begins in November 2013 when Victoria, a ‘jobbing’ general practitioner and Mary Stevens hospice doctor, met Dr Christian, a palliative care champion in Rwanda, during a THET (Tropical Health & Education Trust) sponsored mentorship visit. On returning to the UK this relationship was developed through email and Skype resulting in Christian accepting an invitation to visit.

During this visit, Christian was introduced to the hospice’s multi-disciplinary team. His initial reaction to Julie, hospice specialist pharmacist, was uncharacteristically cold; he made it clear that the relationship between pharmacist and doctor in Rwanda is sometimes one of conflict and not that of the mutual support and collaboration seen here. He visibly relaxed as he chatted to Julie discussing concepts around palliative care pain management. It became clear that in Rwanda, unlike other developing countries, it was not a lack of availability that was the barrier to morphine use but a lack of experience and confidence.

Christian returned to Rwanda and Skype talks continued, Christian introduced Jean Claude, a pharmacist overseeing the manufacture and distribution of morphine oral solution within Rwanda. During these discussions, experiences and ideas were shared and an easiness of conversation evolved. It was during one such discussion that Julie and Victoria were met with the announcement that “…you must come to Rwanda and teach our pharmacists about opioids!”

It was unfamiliar territory for unassuming individuals who are certainly not part of the global palliative care education network, nor in the habit of taking international travel, except for holiday! However, by making friends and maintaining relationships, two UK health professionals were being invited to Africa to prepare and deliver opioid training. The new Rwandan friends were very persuasive, and with the support and sponsorship of THET and Mary Stevens Hospice backing, arrangements were made.

With around six weeks to prepare, evenings and weekends were spent brainstorming innovative ways to engage African colleagues. We prepared several education sessions: from the use of simple games and physical props, to quizzes and small group case discussions, and a patient recorded a video about her experience of morphine helping life with a palliative diagnosis, During the visit, we delivered two training workshops, the results of which were significant and are detailed in our article in the European Journal of Palliative Care.

We are delighted to say that ongoing evaluation within Rwanda shows the use of morphine for pain management is increasing and later this year we will return to Rwanda as part of a second THET mentoring project.

Whilst large formulated projects and teams are vital in promoting good palliative care around the world, the role of the individual health professional and the forming of personal links has to be an integral part. Many of us have skills that can contribute to this important work. We hope by sharing our experience we might encourage others, as we have shown that from chance beginnings positive change can occur.

EJPC23.3coverRead the full article in the European Journal of Palliative Care
This post relates to a longer article, Palliative care training in Rwanda – Working together to effect change, by Victoria Smart and Julie McCarthy, published in the May/June 2016 edition of the European Journal of Palliative Care (vol. 23.3).

If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.


  • THET – a global health organisation that trains and supports health workers through health partnerships, enabling people in low- and middle-income countries to access essential healthcare.



This entry was posted in EAPC-LINKED JOURNALS, EDUCATION & TRAINING, European Journal of Palliative Care and tagged , , . Bookmark the permalink.

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