Farleigh welcomes Guatemalan student
In June, we welcomed Amy Gabriela Morales Kayayan, a medical student from Guatemala, on a four-week placement, working in our Inpatient Unit.
Our Medical Director, Dr Eva Lew, explained, “Farleigh Hospice is an innovative and outward-thinking organisation that understands the importance of promoting excellent palliative and end of life care nationally and internationally. We were delighted to share our best practice with Amy and hope to offer more placements in the future.”
Amy wants to specialise in palliative medicine. She tells us about the differences between end of life and palliative care here and in Guatemala and how useful she found her time at Farleigh.
How did your work placement at Farleigh Hospice come about?
In the months before coming to Farleigh, I was completing my rotation in rural medicine in Guatemala when I met a student from Anglia Ruskin University who was doing her elective with us for a month. As we got to know each other, I mentioned that I wanted to specialise in palliative medicine and was looking for places to do my elective. She mentioned that she and a friend had been placed in Farleigh for a couple of days, and gave me Dr. Abi's contact information. After that, I emailed Dr. Abi straight away and she was kind enough to offer me a placement.
What is your clinical background?
I completed a BA in Emory University where I majored in Middle Eastern and South Asian Studies and minored in Global Health. During my time at Emory, I trained and certified to be an Advanced Emergency Medical Technician (AEMT). I worked as an AEMT with Emory's volunteer team and, after graduating, I worked in a private ambulance company in Guatemala. Originally, I was thinking about completing a Masters in Public Health, but I loved patient care and decided to start from scratch, so I started medical school in Guatemala. I am in my final year now, only missing a couple more months of clinical work.
What are the main differences between end of life and palliative care in Guatemala and here in the UK?
In Guatemala there are very few physicians who specialise in palliative medicine, and there is no network of care with district nurses, GPs, physiotherapists, social workers, or palliative care nurses. We are desperately behind the times, as the need for palliative care is immense but we do not have the resources: time, personnel, or money. Whether it be in the private or public sector, there is not enough to help all the people that need it most. Most large hospitals do not have access to palliative care teams. There are some outpatient clinics attached to public hospitals but the only home visits that occur are within private practice. This is financially prohibitive to patients who come from low income households. Most of the time, patients who are terminally ill or who have other deteriorating chronic diseases are left to their own devices; many do not have the financial, social, emotional or medical support necessary to be at home comfortably.
Why were you keen to gain more experience in a UK specialist palliative care environment like Farleigh Hospice?
Part of my career goals include specialising in the UK. Palliative care as a specialty has largely originated and pioneered in the UK, and I was keen to gain experience at an individual level with patients, but also at a community and national level to be able to understand the foundations and structure of palliative medicine. I had never been to a hospice before, and definitely benefited from learning about the organisation and team necessary to keep the lights on and patients cared for. I don't think I would have been able to learn as much about palliative care somewhere else.
How will the skills, knowledge and experience you have gained during your work placement benefit your future patients when you return to Guatemala?
During these four weeks, I have been able to learn from the team of doctors, nurses and healthcare assistants during home visits, ward rounds and direct patient care. The team is hardworking, dedicated, kind and compassionate. I have learned about palliative pharmacology, communication, planning and management. I have improved my soft skills and changed my clinical reasoning from being disease-specific to holistic and integral treatment. Hopefully, if I manage to become a palliative medicine specialist, I'll be able to work in Guatemala in hospitals, hospices and the community. I want to be able to encourage nurses to specialise in palliative care, create safe and dignified environments for patients to have access to care, and encourage others to see that palliation is not just about death, but enjoying the life we have.
What one experience during your work placement has had a lasting impact on you and why?
There were few patients that were with us throughout the whole month, and for me it was incredible to see the process of dying for the patient and their family members. To be able to accompany them throughout their stay while trying to meet their needs was very special. There were moments of joy and laughter, as well as tears and pain. During all of it, the team was there. I respect that they did not skirt away from tough moments, but wholly embraced the difficulties. I recognised that, although there are some people who may not understand ‘how we do it’, I think it is essential to know that we are not doing this alone. This is a job that involves a direct partnership with our patients and their families, forging a path together. Being able to be a part of this team has changed me for the better, and I hope to carry with me this knowledge for the rest of my career, and life.
