The University of Iowa

UI Students Receive Pain Management, End-of-Life Training Abroad

February 8th, 2013

This article was originally posted on the UI College of Nursing website. The "Hospice, Pain and Palliative Care" course featured in this story is part of the International Development: India Winterim program.

Professor Joann (Jo) Eland and students
While many of us took time to relax and unwind over the holiday break, Professor Joann (Jo) Eland, PhD, RN, FAAN, was scrambling to finalize international travel plans while prepping to instruct a class that provides vital hospice and palliative care overseas.

On December 29, Dr. Eland and a group of 18 students (11 from the College of Nursing) embarked on multi-day journey that took them from Iowa City, to Chicago, to Abu Dhabi and ultimately to their final destination—a hospice in Trivandrum, India, a city located in the Southern tip of the country—where Eland taught a three-week course titled “Hospice, Pain and Palliative Care.”

The idea of teaching this course abroad actually came about four years ago by Dr. Rangaswamy Rajagopal, a professor in UI’s Department of Geography.

“Dr. Raj is an amazing individual. India is his native country, and he has the strong belief that lots of students from the university should travel to India,” explained Eland, who has now logged three trips to Trivandrum.

The course is co-taught and coordinated with Pallium India, a nongovernmental, nonprofit hospice organization that provides care six days a week.

“Pallium India has some of the most amazing individuals I've ever met,” noted Eland. “Six days a week, they send out three vans for home visits. The team for these remote visits is comprised of a physician, a nurse (sometimes two), and often a volunteer. Another team maintains a palliative care inpatient unit at SUT hospital as well as numerous outpatient clinics. Pallium cares for between 1,300 to 1,500 patients per month.”

Eighty-five percent of Pallium India’s services are provided to India’s poorest citizens, and all medical and nursing care, including medicine, is free to patients.

“They teach six, six-week courses a year for physicians and nurses who come from all over India to learn about how to manage hospice patients,” added Dr. Eland. “They are tireless on behalf of their patients.”

Although it may seem like the very nature of hospice training could be difficult to administer anywhere, let alone in a foreign land, Eland noted how everything about the topic is carefully presented, particularly when it is in the context of poverty.  

“The majority of patients we worked with have virtually nothing. One family of seven that we visited included a 28-year-old female who was paralyzed from the waist down after an accident. Her father is the only wage earner in the house, so they have to find a way to live on about $100 per month.”  

In addition to the 11 nursing students who took part in this invaluable learning experience, there was UI student representation from therapeutic recreation (1), health policy (grad student; 1), social work (1), pre-med (1), pharmacy (1), pre-nursing (1), and liberal arts & sciences (1).

Jennifer Nobbs, a December 2012 graduate from the College of Nursing’s RN-BSN program, worked as a CNA at Hospice of North Iowa in 1992, but didn't become a nurse until 2010. After taking Dr. Eland’s pain management class and hearing about her previous experiences with hospice/palliative care in India, she became very interested in going.

“The trip to India was amazing! It was enlightening, powerful, and made me appreciate nursing and my home life even more. I think we sometimes take so much for granted,” explained Nobbs. “I will never forget the kindness and compassion that all the Pallium staff showed the patients. There was never a ‘hurry up’ or ‘I don't like my job’ attitude that I think we see all too often back at home.”

Even though the trip took place around the holidays and involved spending weeks away from her husband and five children (ranging in age from 11 to 3), Nobbs said technology made it much easier to stay in touch.

“We would Skype 6 to 6:30 a.m., which for them was around dinnertime. I would also Skype the kids at school during the weekdays. They also followed me on my Facebook page to see pictures from the day.”

Dr. Eland also kept a blog ( to provide daily updates and photos from the trip.

BSN student Adam Connell said he would go again in a heartbeat.

“Not only was it a great experience learning about hospice and palliative care, but also how different our health care system is from those in India. They do so much with so little!

“The one part of health care I was not comfortable with was the concept of palliative and hospice care. I feel this is something that cannot be taught in the didactic setting. Having the one-on-one experience with people who are in the late stages of chronic illnesses was an invaluable learning experience and will undoubtedly benefit me throughout my lifelong career as a nurse.”

Despite the grueling nature of the return journey (totaling 32 hours of travel time, as well as adjusting to a 12-hour time difference once the group was back in the Midwest), everyone who made the trip  felt it was well worth it.

“It's a wild ride; this kind of travel is not for the faint of heart,” laughed Eland. “But it's truly an amazing experience, and I look forward to teaching more of our incredible students while continuing to collaborate with the dedicated staff at Pallium for years to come.”