Lucy Selman, 2007

1

WINSTON CHURCHILL TRUST FELLOWSHIP 2006

YOGA AND MEDITATION IN PALLIATIVE CARE Introduction to the Project

From January – July 2005 I was a field worker in India for the International Observatory on End of Life Care (Lancaster University). During this time I travelled independently all over India, visiting over 50 palliative care centres and conducting interviews with professional staff, volunteers, patients and family members. During this time I noticed that many centres provided yoga and meditation sessions for patients, as a holistic health intervention. At that time, yoga had been an interest of mine for about 4 years, and before starting work for the IOELC I completed a Sivananda yoga teacher-training course in Kerala. On my return to the UK in July 2005 I decided to apply to the Churchill Trust for a fellowship to return to India and learn more about the use of yoga and meditation in end of life care. The project I undertook for my fellowship had two components: practical learning and research. Practical learning: I undertook a 6-week yoga teacher-training course with AG Mohan in Chennai, specialising in yoga therapy, and a 2-week course in Thai massage (a form of assisted yoga) in Mysore. Research: I visited CanSupport in New Delhi to interview the yoga teachers and class participants, and the SYASA yoga research centre in Bangalore. I have also made links with contacts in India and the UK. Through an article I wrote for the Trinity Hospice Volunteers‟ magazine when I first received my fellowship I made contact with a yoga teacher (Julia Williams) at Trinity Hospice. July-October 2007 I will be conducting interviews in London with her and the class participants at Trinity. This data I will then compare and contrast with the interview data from the New Delhi service. The skills I learnt and the data I collected during the fellowship will inform my future academic and therapeutic work. I am now planning on presenting the data as a pilot study and background work for a PhD. Conducting the fellowship was an incredible experience, and my sincere thanks go to the Trust for enabling me to carry out this project. Aims

The primary aim of this project was to explore current practice and perceived effects of yoga and meditation in patients attending palliative care.

Lucy Selman, 2007

2

The objectives were: 1. To explore the views and experiences of palliative care patients and

informal carers in New Delhi, India, who practice yoga; 2. To explore and compare the views of the yoga teachers attached to the

collaborating service who work with palliative care patients and carers; 3. To learn which yogic techniques are of benefit in this patient group, and

how to apply these; 4. To identify key research projects and research challenges from India and

internationally in the subject of yoga in palliative care. Scientific Background

There is very little literature on the subject of yoga in healthcare in the Western world, and practically none specifically in the field of palliative care. A search of the Medline database (1966 – October 2006), for example, results in just 2 matches for the subheadings „palliative care‟ and „yoga‟: a description of a „wellness program‟ in Cleveland, Ohio (Abdallah-Baran (2003)), and a review of yogic techniques in the management of pain published in 1991 (Nespor (1991)). More has been written regarding the use of yoga in cancer, and the International Association of Yoga Therapists has compiled a 44-page bibliography on the subject (available at www.iayt.org). However, many of these are discussion papers or reviews, and as is the case for other complementary therapies, the number of clinical trials and research papers is low. A recent systematic review of the efficacy of meditative techniques (including yoga) as treatments of medical illness identified 82 studies, 20 of which were randomized controlled trials of sufficient quality to be included in the study (Arias A, Steinberg K, Banga A, Trestman R (2006)). The results supported the safety and potential efficacy of meditative practices for treating certain illnesses, particularly mood and anxiety disorders, but identified a lack of clear and reproducible evidence. A large body of research into yoga has been conducted in India, but these studies were not rigorously conducted (McCall (2003)). Currently, however, scientific studies are being conducted in India, and one of the objectives of this project was to identify methodologically sound research projects that may be currently unknown in the rest of the world. Despite a lack of scientific evidence for the effectiveness of yoga as complementary therapy, a small but growing body of research suggests that yogic techniques such as meditation, „mindful movement‟ and awareness of the breath can have beneficial effects on patients with advanced disease (Bower, Woolery, Sternlieb, Garet (2005)). Ernst, who has written extensively on the subject of complementary therapies and medicines in the UK, argues that good research in this area is lacking, and with large numbers of patients using such therapies our current knowledge gaps urgently need to be filled (Ernst (2003),

Lucy Selman, 2007

3

(2001)). This small, comparative and exploratory study hoped to illuminate some of the complexities at issue in order to pave the way for a more extensive research project in the future. References: Abdallah-Baran R (2003) Nurturing spirit through complementary cancer care. Clinical journal of oncology nursing [1092-1095] vol: 7 iss: 4 pg: 468 Arias A, Steinberg K, Banga A, Trestman R (2006) Systematic review of the efficacy of meditation techniques as treatments for medical illness. The Journal of Alternative and Complementary Medicine [817-832] vol: 12 no: 8 Bower J, Woolery A, Sternlieb B, Garet D (2005) Yoga for cancer patients and survivors. Cancer Control [165-171] vol: 12 no: 3 Ernst E (2003) The current position of complementary/alternative medicine in cancer. European Journal of Cancer [2273-2277] vol: 39 Ernst E (2001) Complementary Therapies in Palliative Cancer Care. American Cancer Society [2181-2185] vol: 91 no: 11 McCall TB (2003) Western science vs. Eastern wisdom. Yoga Journal, downloaded from http://www.yogajournal.com/health/844.cfm Nespor K (1991) Pain management and yoga. International journal of psychosomatics [0884-8297] vol: 38 iss: 1-4 pg: 76 Itinerary

28 October 2006 Depart, flight London Heathrow-Bangalore. 29 October 2006 Flight Bangalore-Chennai 30 October – 8th December 2006 Svastha Yoga courses (in yoga and yoga therapy) with AG Mohan and family, Chennai, Tamil Nadu. AG Mohan is a long-term student of the later Sri T Krishnamacharya and author of the books Yoga for body, breath and mind and Yoga therapy. 11-14 December 2006 11 December train Chennai-Bangalore. Visits to the SVYASA institute and Prasanti Kutiram Campus, and interviews with Vice-Chairman Prof. Nagendra and Research Scientist Dr. Raghavendra Rao, Bangalore, Karnataka. The Swami Vivekananda Yoga Anusandhana Samsthana is one of the oldest and largest yoga research institutes in the world. 14 December 2006 Flight Bangalore-New Delhi

Lucy Selman, 2007

4

15-22 December 2006 CanSupport cancer support service. Interviews with 3 cancer patients and 8 family caregivers who practice yoga through the service, New Delhi. CanSupport is an NGO with the mission of enabling people with advanced cancer and their families to make informed choices and decisions and to receive appropriate physical, emotional, social and spiritual support. 22 December 2006 Flight New Delhi-Calicut 22-24 December 2006 Visit to Institute of Palliative Medicine, Calicut, Kerala (WHO model site for palliative care in the developing world). 24 December 2006 – 1 January 2007 Holiday with mother, Kerala and Karnataka. 1 January 2007 Bus Koorg region-Mysore. 2-19 January 2007 Thai massage training, Mysore, Karnataka, with teachers of the Sunshine Network, an international, accredited network of Thai massage teachers. 22 January 2007 Train Mysore-Bangalore. 23 January 2007 Return, flight Bangalore-London Heathrow. Lessons learned

The Courses I finished the Svastha yoga course with 3 large exercise books full of notes taken during the classes. Three months after returning from India I am still digesting what I learnt, and learning more all the time, through my own yoga practice and through designing yoga sequences for other people. I plan to start teaching in hospices (staff, carers and patients) this summer, once I have more experience of designing Svastha yoga practices for specific conditions. The Thai massage course was also excellent, and I have been practicing since I returned on friends and family, who are continually appreciative. I understand since doing the 2 courses in Mysore how deeply Thai massage works, and the potential benefit to those with chronic or life-limiting illnesses. As with yoga teaching, I plan to start working in hospices once I have built up more experience.

Lucy Selman, 2007

5

The Research The research project I undertook, interviewing research scientists, yoga teachers and cancer patients and their family carers who practice yoga, has opened many avenues for further investigation. From the researchers I learnt what it means to conduct scientific research on a holistic practice like yoga, specifically the many methodological issues this raises and how to overcome them. The teachers talked about the principles they teach by and the practices and techniques which seem most beneficial for cancer patients and carers. Most of all, the patients and carers I interviewed taught me what it means to live with cancer in Delhi, and how yoga, whether in small or larger ways, may help with day-to-day experience. The patients and carers I spoke to were all very poor, and most were living far away from their villages and families in impoverished conditions. Nevertheless, many spoke about the sense of peace they were able to achieve through yoga and meditation, which was inspiring and moving to hear. There was also great variation in what was being practiced under the banner of „yoga‟, from a series of physical exercises separate from spiritual beliefs, to breathing techniques learnt from a television „guru‟, or meditation with the aim of connecting more deeply to the Divine. From a scientific point of view, this is relevant owing to the perceived need to „standardise‟ complementary therapies such as yoga before carrying out formal evaluation of their effectiveness. Other important research considerations raised include accessing the subjective experience of a holistic therapy in an objective way, and the use of interpreters for in-depth interviewing. My interest in these issues has led me to pursue funding for a PhD looking at the use of yoga and meditation in end of life care in multicultural settings. Overall In general, the Fellowship taught me the importance of having a vision and seeing it through. Receiving the Fellowship enabled me to spend time focussing on a fascinating subject which I would not otherwise have been able to look into. Travelling abroad gave me the opportunity to put my life into proper perspective, get to know myself better and make new friends from all walks of life.

Lucy Selman, 2007

6

Appendices – Dissemination: Articles and Abstract 1. Article for Yoga and Health Magazine (published April 2007)

Yoga in Palliative Care

A Winston Churchill Fellowship in India „What provision do you make for the spiritual care of patients?‟ I asked the nurse, Amrita. „Well, just outside the hospital there‟s a place where patients can go for yoga, and every morning a teacher comes to us, to do a guided meditation with the patients.‟ I was more than interested: something clicked, and I knew this was a subject I would look into more deeply. It was February 2005 and I was in India conducting research into palliative care, care for people with advanced, life-limiting conditions, provided by hospices and palliative care teams at hospitals or in the community. The research was for Lancaster University‟s International Observatory on End of Life Care, and took me all over the country interviewing staff about the services they worked for and the care they provided. Yoga had been a strong interest of mine for several years, and before starting the fieldwork I had done a month-long Sivananda teacher training course in Kerala. Fresh from the ashram, I was full of questions about yoga, my practice, and what it was all for – including how I could integrate what I had learnt and experienced into my daily life back in London. When I became aware of how in Indian palliative care settings yoga sessions are sometimes provided to support those at the end of life, I saw how two major interests could be combined. The link between yoga and palliative care made sense to me in a profound way, as palliative care is the only medical specialty within conventional medicine that has, since its very inception by Dame Cicely Saunders in the 1960s, been defined holistically. The World Health Organisation defines it as:

„An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.‟

With this focus on the physical, psychological and spiritual well being of patient and family, palliative care is, I think, uniquely suited to the integration of holistic complementary therapies in mainstream clinical practice.

Lucy Selman, 2007

7

I became aware of the Winston Churchill Trust in 2004, although I did not apply for a fellowship until I came back from India in June 2005, thoroughly in love with the country and hatching a plan to return. The Trust is a grant-giving body set up in memory of Churchill to fund overseas projects by British citizens, and in the 2007 round awarded ₤500, 000 to fund projects by people from all walks of life. In the way that these things turn out, care of the dying was a category for applications in 2005. The application process was in 3 stages: an initial on-line application form; a more comprehensive project outline; and an interview with a panel of esteemed professionals hand-picked for the care of the dying category. The interview took place in an imposing building in Kensington complete with high ceilings and plush carpets. Air Vice-Marshal Nigel Sudborough, Director General, led me to the interview room with a few friendly words to break the formality of the occasion. During the interview, one of the questions the panel asked me was „How will seriously ill people be able to do yoga?‟ It is a question that keeps coming up when I talk to people about my work, prompted by the Western perception of yoga as exercise for the youthful, flexible and fit. It points to a rift in modern conceptions of yoga: on the one hand, images of models in advanced „poses‟ that appear in the media; on the other, yoga‟s heritage as a system of health and spiritual practice at least 2000 years old. In the UK I have found that when you tell people you are a yoga teacher or practitioner they often say „Oh, I could never do yoga, I‟m really stiff.‟ In India, though, people are more likely to respond with an ailment they would like help with: „I have arthritis in my knee, which asana would be good for that?‟ Two weeks after the interview the Trust wrote to say I had been awarded a grant to go back to India and study the use of yoga in end of life care. That‟s when the real work started: planning my itinerary and the best use of available time; establishing and emailing contacts in the UK and in India for advice and information; arranging flights, a visa and vaccinations; applying for ethical approval for the interviews I wanted to conduct; and at the same time working in a busy, stimulating department at King‟s College London. I joined the Department of Palliative Care, Rehabilitation and Policy in July 2005, and was really enjoying my job, as well as learning a lot which would stand me in good stead on my fellowship. I‟m lucky enough to have a manager and a Head of Department who are very supportive, and I was kindly granted a month‟s study leave to go to India, while the remaining time I took as annual leave. The itinerary I settled upon lasted 11 weeks and was partly practical learning and partly research. I began in Chennai with a 6-week course in yoga, yoga therapy and Ayurveda with A.G. Mohan, his wife Indra and son Ganesh. I had met the three teachers in London in August 2005, when I attended a weekend course on Svastha yoga and was impressed by their knowledge, humility and presence.1 A.G. Mohan studied closely with Sri Krishnamacharya for 18 years, but has opted

1 „Svastha‟ in Sanskrit refers to the state of complete health and balance.

Lucy Selman, 2007

8

to remain out of the international yoga teaching limelight that shines on some of Krishnamacharya‟s other students (Pattabhi Jois, BKS Iyengar, Desikachar). Mohan, Indra and Ganesh truly do seem to live the practice they teach, and between them represent a most profound body of knowledge and experience.

AG Mohan (L) and son Ganesh Mohan

The course in Chennai didn‟t disappoint. The philosophy and psychology of Patanjali‟s Yoga Sutras were taught in a thorough and scholarly way, always encouraging questioning and stressing the importance of clarity on your own path. From the perspective of palliative care, the teachings on Abhinivesa were of particular interest. Translated as „fear of death‟, Abhinivesa is described in the Sutras (II.3.) as one of the klesas (causes of suffering) that arise out of the field of Avidhya (incorrect knowledge or misperception). Abhinivesa can be understood as a deep-rooted sense of self-preservation, present in all living things; in human beings, it is the feeling that the physical and psychological „I‟ must not cease to exist. It is the epitome of perceiving the impermanent as permanent, for of course the self in this sense will die and be absorbed back into world. Yoga teaches, though, that meditation increases one‟s sense of oneself as the observer, and that through sustained practice of pranayama the feeling “I am not the body” arises, which is the beginning of the absence of the fear of death. Another discussion point, often overlooked or misunderstood in the West, was that the psychology and philosophy of yoga are atheistic at root. In the context of modern palliative care this is an important fact, as the feasibility of yoga as an intervention depends on how acceptable and appropriate it is in culturally diverse communities. The practices described in the Yoga Sutras can be combined with different religious or spiritual beliefs, including atheism. For example, while Isvara, one‟s personal conception of the Divine, is said to exist inside you, it is not a religious precept – as Mohan would say, no flag has to be held! The concept of Isvara is, rather, based on psychology, and can be conceived as a particular state of mind or quality of peace. The universality of yoga comes from the universality of the psychology it describes: states of mind are shared between

Lucy Selman, 2007

9

all human beings, regardless of cultural context or historical period. Therefore the practices needed to overcome negative samskaras or thought patterns and achieve peace are also universal, needing no allegiance to a particular religion.

Indra Mohan

Alongside these vital philosophical teachings were discussions of Ayurveda and practical sessions designing asana and pranayama sequences based on the practitioner‟s unique characteristics and circumstance. In a logical, systematic way the Mohans put forward the approach they have developed on the firm foundations of Krishnamacharya‟s teachings. The final two weeks of the course looked at specific conditions that can be helped by the correct daily asana practice, including asthma, scoliosis, knee problems and back pain. Throughout the course, theoretical and practical lessons were balanced by personal practice and refection, with the Mohans available for individual consultations. The next stage of the fellowship took me to the SVYASA (Swami Vivekananda Yoga Anusandhana Samsthana) headquarters and its campus, Prasanti Kutiram, near Bangalore. The aim of SVYASA, as stated in one of its brochures, is to „combine the best of the West (modern scientific research) with the best of the East (yoga and spiritual lore).‟ During my visit I had informative meetings with Vice-Chancellor Prof H.R. Nagendra and Research Scientist Dr Ragavendra Rao. Rao recently finished a PhD. looking at the effects of yoga on breast cancer patients, and was a great source of advice on the scientific challenges of investigating such a complex thing as yoga.

Lucy Selman, 2007

10

Sign at the Prasanti Kutiram Campus, SVYASA

From Bangalore I moved on to New Delhi, where I conducted interviews with three cancer patients and eight family carers attending yoga classes through the charity CanSupport. I also interviewed the two inspirational yoga teachers there about their experiences and advice for other teachers wanting to work in the area. Owing to my inability to speak Hindi, CanSupport volunteers kindly interpreted during the patient and carer interviews. I talked to participants about disease history, their view of yoga, the history of their yoga practice, perceived benefits (physical, psychological or spiritual), and perceived difficulties. The interviews were insightful, moving and a privilege to conduct. One patient (pictured) told me,

„Yoga has brought a golden future for me. I don‟t know how long I have to live, but whatever days and months and years that I have, however sick and disabled I might be, I am going to do whatever kind of yoga I can until the day I die. That‟s what it means to me.‟

Lucy Selman, 2007

11

CanSupport patient

The final phase of my fellowship was three weeks of Thai massage training, covering a basic full-body massage and advanced exercises in the side position. Although saying you studied Thai massage in India gets you some strange looks, this form of bodywork actually originates from India, having moved into Thailand along with Buddhism in the 2nd or 3rd century BC. Thai massage is a form of therapeutic healing that shares the same roots as yoga, and incorporates exercises directly correlated to asana (hence the alternative name „Thai yoga massage‟). It is based on working the Sen lines, a network of energy lines and acupressure points believed to have therapeutic application for a host of emotional and physical disorders. For this reason it is a natural complement to yoga therapy, particularly when working with very sick patients. Although I had studied Thai massage in Thailand previously, I felt a refresher course was in order. The excellent teachers I studied with in Mysore, Lara Pearson and Laurino Bertelli, are members of the Sunshine Network of Thai massage founded by Ashokananda.2 The courses are intensive and thorough, incorporating the spiritual element central to Thai massage through Vipassana meditation techniques and the development of Metta („loving kindness‟). Looking back, I feel blessed to have been able to carry out this project. As well as being a time of personal and professional growth, it has filled me with new questions and ideas to explore in this exciting area. For example, what are the mechanisms by which yoga benefits people at the end of life? How do people‟s experiences of yoga in a Western context compare to people‟s experiences in India – and how do both relate to the psychology of the Yoga Sutras? Finally,

2 Ashokananda was a German Buddhist who was one of the first Westerners to undertake in-

depth training with Thai masters. He died in June 2005.005

Lucy Selman, 2007

12

how does one go about studying people‟s experiences of yoga in a way that is both true to spiritual tradition and scientifically sound? These are, I think, questions worth exploring. Contact

Please contact Lucy Selman at lucy.selman@kcl.ac.uk. Lucy is hoping to start a PhD. in 2008 looking at the subject of yoga in palliative care. Links

The Winston Churchill Trust http://www.wcmt.org.uk/ King‟s College London Dept of Palliative Care, Policy and Rehabilitation http://www.kcl.ac.uk/schools/medicine/depts/palliative/ Svastha Yoga with the Mohans http://www.svastha.com/ SVYASA http://www.svyasa.org/ CanSupport http://www.cansupport.org/ The Sunshine Network http://thaiyogamassage.infothai.com/ Acknowledgements I wish to thank the Winston Churchill Trust for making my trip to India possible; Sri Krishnamacharya and the Mohans for their excellent teaching and example; Jane Burt for allowing me to use her photos of the Mohans; CanSupport and SVYASA for their hospitality and assistance; Lara and Laurino for their comprehensive Thai massage training; Dr Richard Harding and Prof Irene J Higginson for their support of this project; and the wonderful people I met along the way, particularly the patients and carers at CanSupport.

Me back in London!

Lucy Selman, 2007

13

2. Article for Hospice Bulletin

(Editor and contributor, in press, to be published Summer 2007)

Winston Churchill Memorial Trust Fellowships The Winston Churchill Trust is a grant-giving body set up in Churchill‟s memory to fund overseas projects by British citizens. In 2006 Care of the Dying was an application category; here, eight Fellows talk about their experiences. Listening and learning together: Palliative care in Africa “Suddenly, I realised there was something I could do; learning about palliative care excited me, because it showed me how I could make a difference to people who were dying.” This was a typical comment from a palliative care professional I met during my nine-week odyssey through East and Southern Africa. The twin foci of my investigations were the impact of palliative care education on the practice of those caring for the seriously ill, and the support given to children of dying parents. Despite their differences, I found common themes in the six countries I visited: an enormous thirst for palliative care education at every level, and enormous challenges, including the need for better support for the children of dying parents. Meeting their needs for support, information and honesty, both as young carers and simply as children, is as much an essential part of good palliative care provision in Africa as it should be in the UK. Gillian Chowns Specialist Palliative Care Social Worker, Senior Lecturer in Palliative Care, Oxford Brookes University

Email: gpatgc@aol.com

Storytelling in the care of the dying and the bereaved I work as a therapeutic storyteller in a children‟s hospital, and as a Cruse Bereavement counsellor. During my two-month fellowship I visited storytellers in the US and Canada who work with the dying and the bereaved. In the UK we have all but lost our traditional stories of dying – but they still exist, and we can learn to use them from other cultures. Two Native Americans explained that by telling stories handed down over time, they allow people to find new meanings, and see that previous generations wrestled with the same questions about death and dying. I met with storytellers who work with children with terminal illnesses, creating stories and films. I met storytellers who work at bereavement camps, where people share their grief and hear traditional stories that help them find a common understanding. Stories are a powerful medium to express and share ideas, and the inspirational people I met in North America confirmed this.

Janet Dowling

Lucy Selman, 2007

14

Theraputic Storyteller Email: JanetTells@gmail.com Website: www.JanetTellsStories.co.uk Music Therapy

As a nurse, community musician and healing arts practitioner, the opportunity to experience music in palliative care in the USA was enriching. „Music thanatology‟, (from the Greek „thanatos‟, death), uses music to comfort the dying, ease emotional pain and physiological symptoms. Music can facilitate transition and have a profound, harmonious effect on all present – patients, loved-ones and staff. I visited centres of excellence, learning and sharing my own work with voice, guitar and Tibetan singing bowl. At the San Diego Hospice I joined harp therapists. In San Francisco I worked with the Zen Hospice Project, the Art for Recovery program and the Threshold Choir, which honours the ancient use of voice as a vehicle for bedside compassion. One patient reported „being held in a cradle of sound‟. My fellowship inspired me to initiate and promote further music projects in hospices, and I hope to see more musicians in the care giving team. Lou Beckerman RN, RM, MNFSH Email: info@loubeckerman.com Website: www.loubeckerman.com Hospice at Home Care in India During my fellowship in India I saw many similarities and many differences in Hospice at Home care, both between the UK and India, and between the organisations I visited. At CanSupport in New Delhi I spent time with the Home Care teams and working in Day Care – an important resource when many patients have come to the city from rural areas, often in hope of a cure. I flew south to the Institute of Palliative Medicine in Calicut, and then on to Karunashraya Hospice in Bangalore, where I felt most at home. My final week was spent in Chennai at the Dean Foundation, where my eyes were opened to the needs, expectations and cultural differences of Indian patients and families. In India I discovered that people continents apart, regardless of education or finances, share many of the same fears and anxieties over end of life care. I met hard working and dedicated individuals who provide good palliative care with limited resources, and I feel privileged to have worked alongside them. Louise Dresch, Hospice @ Home Nurse Manager at Thames Hospicecare, Windsor Email: louise.dresch@thameshospicecare.org.uk

Lucy Selman, 2007

15

Bringing academic leadership to palliative care in Yorkshire

For my fellowship I spent seven weeks in Houston, US, at the University of Texas MD Anderson Cancer Centre, and a week in Canada at the Universities of Calgary and Alberta, Edmonton. As well as gaining insight into clinical practice, my main aim was to learn how research could be successfully integrated into clinical services. I dedicated myself to 3 principal studies and spent time working up research protocols for each study – two of which are now up and running. Thought-provoking discussion with faculty members and frequent meetings with the head of department, Professor Bruera, were a great inspiration. The teaching I undertook, for example on neuropathic pain, stimulated my thoughts not just on teaching methods and delivery, but perhaps more importantly, on the role of the doctor in this specialty. This was enormously useful in shaping my views about delivering a service back in Leeds and Yorkshire. Dr. Mike Bennett, St Gemma‟s Hospice, Leeds Email: m.bennett@st-gemma.co.uk Acupuncture

I run a busy Oriental Medicine clinic near Croydon, and practice acupuncture in central London. My fellowship provided an opportunity to fulfil a dream - to visit Japan and train with a specific acupuncturist. A large proportion of those treated by the clinic were using acupuncture to reduce the detrimental effects of cancer treatment on the body and quality of life. Thanks to acupuncture, patients live longer, more conscious lives, benefiting them, their friends and family. It provides the opportunity for people to die with dignity, fully conscious and at home with loved ones. People often come for treatment suffering a lot of discomfort and fatigue. During treatment a sparkle returns to their eyes, colour returns to their face and they walk away with a renewed bounce in their step. Snow Ruixue Wang Website: www.centredhealth.com Lymphoedema Services On my four-week fellowship I visited Ontario and Quebec, Canada, to research service provision for patients with lymphoedema. Lymphoedema services vary substantially within and between the two provinces, since in Canada Provincial (state) government is responsible for the management of healthcare. Rich provinces, such as Alberta, can offer patients healthcare treatment options that less wealthy provinces cannot. Most services in Canada are for patients with cancer-related lymphoedema. Arguably, this means that distinguishing palliative from non-palliative lymphoedema care is less significant than in the UK, where many lymphoedema

Lucy Selman, 2007

16

patients do not have cancer. Throughout my trip I found that policy makers and service providers from both countries could potentially learn from each other. I also had interesting discussions regarding when care becomes palliative. In Canada, providers believed that treatment of lymphoedema as a chronic condition is almost always palliative. Monica Burchell Email: monicabisset@hotmail.com Yoga in Palliative Care This winter I went to India for 3 months to learn about the therapeutic use of yoga in advanced progressive disease. I work as a palliative care researcher at King‟s College London, and have trained as a yoga teacher, so my fellowship brought together two major interests. In terms of practical learning, I studied yoga therapy for 6 weeks in Chennai with AG Mohan, and trained in Thai yoga massage in Mysore. On the research side, I visited a yoga research institute in Bangalore, and interviewed cancer patients and care givers at CanSupport, New Delhi, where one man told me, „Yoga has brought a golden future for me. I don‟t know how long I have to live, but whatever days and months and years that I have, however sick and disabled I might be, I am going to do whatever kind of yoga I can until the day I die.‟ It was an unforgettable, stimulating trip. I warmly recommend that you take the plunge and apply to the Trust if you are considering it! Lucy Selman Email: lucy.selman@kcl.ac.uk Categories for the Trust‟s 2008 round and a timetable for applications are now available on the website http://www.wcmt.org.uk/

3. Abstract submitted to Help the Hospices Conference, October 2007 (decision awaited) Yoga and meditation in palliative care – A research project in India Author: Lucy Selman Background There is very little literature on the subject of yoga in healthcare in the Western world, and practically none in palliative care. More has been written regarding the use of yoga in cancer, but the number of clinical trials and research papers is low. However, a small but growing body of research suggests that yogic techniques such as meditation, „mindful movement‟ and awareness of the breath have beneficial effects on patients with advanced disease.

Lucy Selman, 2007

17

Aim To explore current practice and perceived effects of yoga and meditation in advanced cancer patients and their carers. Methods Semi-structured qualitative interviews with patients and family carers attending yoga classes through the CanSupport service in New Delhi, India. Interviews were conducted by LS with CanSupport volunteers as trained interpreters. English portions of the interviews were transcribed verbatim and complied into case studies for comparison and analysis of emergent themes. Results Patients (n=3) and carers (n=8) were interviewed about their experiences of practicing yoga, with a wide range of techniques described: meditation, physical exercises (asanas) and breathwork (pranayama). Participants reported a wide range of benefits, including increased feelings of peace, mental focus and positivity. Patients reported using yoga to cope with physical symptoms such as breathlessness and sleeplessness. The issue of unethical representation in the Indian media of yoga as a potential cure for cancer was raised. Conclusions The practice of yoga and meditation may enhance the coping strategies of patients with advanced progressive disease and their carers. More research is needed into the acceptability, feasibility and effectiveness of yoga-based interventions, with a view to developing and evaluating appropriate holistic interventions in palliative care.