Isobel Butorac, an MSc student at King’s College London, recently interned for two months at the King Hussein Cancer Center in Amman. Read more about her time there below.

In lieu of graduating from a Global Health and Social Medicine masters, I was keen to put of all of that theoretical contemplation and toilsome essay writing to practice. Toward the end of the year I approached one of my lecturers, Dr Hanna Kienzler, who is highly involved in mental health research in conflict areas and KCL’s R4HC-MENA programme. R4HC’s goal is to build research and policy capacity in conflicted affected areas with a focus on mental health and non-communicable diseases. One of the partners of the programme is the King Hussein Cancer Center (KHCC) in Amman, Jordan. My lecturer kindly put me in touch with Dr Omar Shamieh, a leading specialist in palliative care and the Director of the Center for Palliative and Cancer Care in Conflict. Having a background in psychology and previously working in a tertiary cancer center in Australia, it seemed likely to be a good fit.

After multiple vaccinations, a surprisingly straight-forward visa process and agreeing with Dr Shamieh that the more time I was able to spend at KHCC the more instrumental the internship, I was on my way to a 2-month internship in Jordan!

The KHCC hospital prides itself as a center of excellence and during the first week I was warmly welcomed by so many of its staff, all of whom were deeply proud to be working in such an admirable institution. Dr Shamieh and his team allowed me to sit in on some very sensitive psychology consultations, enthusiastic group therapy sessions and sombre palliative care visits. All of this was to get a feel for what KHCC was about, what it was doing well and how it could be improved from a palliative care and psychosocial perspective. This first week was incredibly interesting, particularly coming fresh from a Bioethics masters programme, as I witnessed the intersection of Islam and cancer and palliative care collide in a way that was vastly different from how I’d seen cancer and palliative care operate in Australia. It challenged me to reassess my understanding of autonomy and its differing cultural interpretations, forcing me to be aware of my instinctual paternalistic views and in turn attempting to avoid placing my preconceived western values on clinical situations.

At our first official meeting Dr Shamieh wanted to ensure that I made the most of my time at KHCC, and so we agreed upon a number of internship duties. These included updating the psychosocial oncology guidelines, drafting a patient distress thermometer as per the National Comprehensive Cancer Network guidelines, and drafting a funding proposal for a brand new, first of its kind hospice center. Each of these duties were enjoyable challenges in themselves, with each requiring new skills that I think will prove incredibly useful down the line. However, it was the new hospice proposal that was top priority for Dr Shamieh and his research team. Having never written a grant application of that scale before, it required a week or so to get my head around it, including researching the demographics of Jordan, its healthcare system, and why there weren’t already hospice facilities available in the region.

The following 7 weeks flew by, with staff members continuing to be exceedingly welcoming, making sure I understood the flow of conversation (I couldn’t speak a word of Arabic!) and explaining any cultural particularities that they thought may not make sense to me. This first-hand background information would prove very useful when pitching ‘the case’ for the new hospice. I learnt that opioid usage for cancer patients was abnormally low in Jordan, due to cultural opinions about pain relief, and that the influx of refugees from neighbouring countries was placing a huge burden on an already strained healthcare system.

Coming in at just a few hundred words short of the length of my Master’s dissertation, we have just about finished the hospice grant proposal and are now in the final stages of editing with the hope to pitch the proposal to external funders in the new year. Working with such a generous and passionate team was a humbling opportunity, and to be given the responsibility of researching and composing a document that could potentially bring KHCC a brand new palliative care center was a truly great experience and an honour to make a contribution to a passionate healthcare team.

Isobel Butorac
MSc Bioethics and Society