On a mission

When a group of public-spirited individuals met in Edinburgh’s New Town in 1841, they could have had no idea of the far-reaching effects they would have.

They founded what was to become the Edinburgh Medical Mission Society (now known as EMMS International) credited with being the first medical missionary society, and believed to be Scotland’s longest-serving healthcare charity.

Today, after more than 180 years of continuous service, the charity remains dedicated not only to improving healthcare in some of the world’s hardest to reach populations, but also to supporting women in these communities to gain healthcare qualifications, improving their prospects, reducing gender inequalities – and making a real difference to patients on the ground.

The charity, which for more than a century has been supporting women to have careers in medicine, including some of the earliest women to qualify as doctors, began closer to home, with a dispensary in Edinburgh’s Cowgate, explains EMMS International CEO Cathy Ratcliff.

‘For many years, EMMS operated as a society that would send missionaries, but also train doctors by sponsoring people through medical education. The dispensary in Cowgate had the dual role of helping people of extremely low income during the industrial revolution, and of training doctors – including women – who went overseas to do missionary work.’

Today the charity has moved away from its original ‘mission’ purpose and has programmes supporting healthcare projects among the most vulnerable and marginalised populations across the globe. It does this by working in partnership with organisations in the countries where it works, which currently includes India, Malawi, Nepal, and Rwanda.

Improving access to palliative care is a particular priority, and the charity helps support local doctors and other healthcare workers by providing training and support with building capacity, for example, by creating links with governments.

Helen Morrison, who until recently worked as a consultant in palliative care in Glasgow, is vice chair of EMMS International. Although palliative care was already a focus of EMMS when she joined the organisation, she is keen for it to remain a priority.

‘As someone who worked in the field, palliative care is very important, and it’s something that’s still developing, even in the Western world. But in much of the world it’s in its infancy.

‘EMMS has been working in Malawi in particular for a long time in palliative care – to the extent that it’s now scoring very highly for it,’ she says. ‘But in countries like Nepal and African nations where we’re starting to work, the poorest people who have life-limiting conditions have access to barely any drugs – you can’t get morphine for patients.’

Palliative care isn’t just about dying well, she adds. ‘We’re also trying to help people with living, and that might be a period of days, weeks, months or even years. It’s about helping people with the chronic pain from conditions and all the social and psychological and emotional aspects that come with that.’

As well as its international work, EMMS also remains loyal to its Edinburgh origins. The dispensary in Cowgate is long gone (although it was to inspire other home medical missions, including in Glasgow, Liverpool and London, according to its archive which is held by the Royal College of Surgeons of Edinburgh).

The current project supports families living with dementia with a community lunch programme. ‘It’s for low-income families because we only work with the most vulnerable,’ explains Dr Ratcliff.

In addition to palliative care, the charity’s priorities include putting solar power into hospitals – something increasingly crucial owing to the climate crisis, and also because of the cost of fuel.

But improving the prospects of women in healthcare careers remains a focus; its Healthcare Career Pathway aims to build and sustain a dedicated and highly educated healthcare workforce, improving the life chances of women, particularly in rural areas, and also building capacity.

‘There is so much migration of healthcare workers around the world, and this has huge implications for the countries where we work as they lose some of their health workforce,’ says Dr Ratcliff. ‘We hope we’re doing our bit by helping these young women, but also helping the national workforce.’ 

Only 1.7 per cent of families in need of palliative care have access to it in Nepal, and the situation is worst in rural areas.

EMMS International has been working with doctors to expand rural palliative care in western Nepal, training staff and volunteers and bringing care closer to home.  

Amrita Shrestha is head of the Palliative Care and Chronic Disease Unit at Green Pastures Hospital in Pokhara, Nepal. As a consultant paediatrician, she first became involved in palliative care in 2018 when she began running a clinic for children with cerebral palsy.

Since then, supported by EMMS International, she has completed the National Fellowship of Palliative Medicine from the Institute of Palliative Medicine in India, and now heads up an integrated palliative care service for adults and children.

For her, palliative care is about meeting the needs of patients and their families in a holistic and personalised way.

‘The children who were coming to the clinic didn’t only have cerebral palsy – they had other disorders or multiple complexities,’  she explains. ‘I realised these children and their families really needed palliative care.’

As part of her work, she is involved in training healthcare staff and community volunteers to identify if a patient needs palliative care and to provide support or refer on if necessary. The specialist centre also treats patients from other rural hospitals, and they work with government to press the need for palliative care services.

And the need is there, she says. ‘Of the children who come to my clinic, more than 75 per cent need palliative care. We do assess them clinically, but also look at whether they need psychosocial support.

‘When I started the clinic, I realised that the needs of the families were all different – for example, sometimes the parents were overwhelmed with the child’s condition. I realised that what was needed was a palliative care approach.

‘What we’re doing in Nepal is integrating palliative care, not just in cancer, but in chronic disease or developmental disorders. I think it’s quite unique in itself.’

EMMS International’s Global Women in Healthcare Awards, held in association with the RCPE (Royal College of Physicians of Edinburgh), aim to celebrate the global impact of women working in healthcare, and mark International Women’s Day.

There are four categories, including the Dr Elsie Inglis Award for championing sex equality in the medical profession. The others are for a ‘rising star’, outstanding leadership, and health technology.

The closing date is 1 February and the winners will be announced at the Elsie Inglis Charity Ball at the RCPE on 9 March.