Project Hamrahi – the value and lessons of mentoring programs
A blog post written by Associate Professor Odette Spruijt, Australasian Palliative Link International
“We have more in common than we have differences” Mentor Q29_6
Project Hamrahi began in 2010, a collaboration between Australasian Palliative Link International (APLI) and Pallium India. Over the years 2010 – 2020, 50 mentoring visits took place, involving 32 mentors from Australia and New Zealand (14 doctors, 15 nurses, a pharmacist, counsellor and a project officer) and 20 different Indian palliative care services. The number of visits per site ranged from 1-7 visits. From February 2020, in-person visits were prevented by the travel restrictions instituted in relation to the COVID-19 pandemic.
The project evolved over time. The initial model was for a doctor-nurse team from Australasia to conduct annual week-long visits for at least three years, during which they would participate in bedside teaching and community visits, formal lectures, service review and planning, and promote palliative care. Over time, the project expanded to respond to a more varied range of local needs, such as conducting opioid availability workshops, contributing as faculty in a 10-day state-wide foundation course in Tripura, and a 6-week palliative care foundation course in Rajasthan, and providing teaching at hospitals across Patna who were beginning their palliative care services. From 2014, the regional Pallium India Project Officer (PO) for that area, accompanied the Australian team whenever possible, which strengthened the cross-cultural understanding and continuity of education and advocacy between annual visits.
In 2020, APLI led a mixed-methods evaluation of Project Hamrahi, through an online survey of participants (total of 83 clinicians: a response rate of mentors 61%; mentees 45%; POs 100%) and eight, in-depth semi-structured, phone interviews with a sample of the Indian mentees chosen to reflect the diversity of Indian sites, practitioners and experience with Hamrahi. In addition, the mentors’ visit reports were included in the thematic analysis.
Four key themes emerged from the deductive analysis.
- Facilitated ongoing and mutual education: Both mentors and mentees gained knowledge, skills, and new attitudes from this relational learning experience.
“Definitely a two-way learning process – we learn as much from them as they from us.” MentorQ29_1
“Because of their project…our nurse's confidence level have increased...yeah...I have seen changes, I want to tell that makes a lot of difference...like before they came, I also did not have so much confidence...and now including me also, we have lots of confidence...like doing so many visits with them...going with them...and working with them...They have given us lot of development.” PH_N-001
“Observing how hospitals can do very useful palliative care with little money.” MentorQ29_26
- Provided opportunities for advocacy and the promotion of palliative care in India: There was a positive impact on mentees’ advocacy efforts to raise awareness among other healthcare staff, hospital administrators, local government officials, as well as patients and families.
“It made a huge impact on social systems, people started to think more about palliative care. The visits opened the eyes of administration and health care professionals...and more enthusiasm poured into our palliative care services.” MenteeQ23_21
- Created a space, through the formation of lasting relationships, for deeper engagement and sharing of challenges and expertise: When mentor and mentee teams were stable, trusting relationships could be built up over time.
“The visit of APLI members at our hospital had definitely made a positive impact. Each visit was unique and it opened avenues for mutual academic learning, fostering relations, capacity building, and collaborative research across cultural resources and other barriers.” Mentee Q13_17
“Nurses change completely during visits…so relationship building was hard.” MentorQ25_7
“The biggest problem was language…even I cannot follow their pronunciation...but fortunately Pallium India had arranged Project Officer...to be there along with these nurses." PH_D_002
- Could be improved with better processes of engagement, planning, and monitoring of outcomes in the future: feedback included requests for more intensive contact, not limited to annual visits.
“Sharing (reports) between groups would be useful – what has been useful, not useful, difficulties, problem-solving. Although every site will be very different, I think there would be some good learnings.” MentorQ43_17
“I think there needs to be clarity on what exactly the deliverables are in this project.” MenteeQ23_18
From this evaluation, APLI and Pallium plan to continue to build Hamrahi, and respond to the current COVID-19 restrictions by exploring a virtual mentoring model to sustain these existing and valued educational and supportive relationships.
Useful links:
The Status of Palliative care in the Asia-Pacific Region
Epilogue: Reflections from International Mentors of the Quality Improvement Training Programme in India
Associate Professor Odette Spruijt, Australasian Palliative Link International
This work will be presented at the Oceanic Palliative Care Conference 2021.