Aims
To improve access to palliative care in the developing world

Methods
Facilitating and coordinating links between nascent palliative care services in India and palliative care medical and nursing providers in Australia, through the collaboration of Pallium India and Australasian Palliative Link International (APLI). Project Hamrahi has endeavoured to engage a group of western professionals in giving sustained support to individual initiatives in India, where palliative care is available to a tiny minority of the population.

Results
Since its inception in 2010, over 14 Hamrahi visits, involving 16 doctors and nurses working in Australia, to 8 Indian sites, have taken place. The model of doctor-nurse teams committing to 3 visits of at least 1 week, over 3 years, has proved to be successful in sustaining both the visiting teams and building capacity in the Indian services. Change has been slow but evident. In Agartala cancer centre in Tripura for example, there has been strong organisational change with improved facilities, standards of hygiene, and aspirations to develop state-wide palliative care coverage. In Jamshedpur, at Meherbai Tata Memorial Hospital, individual doctors have developed increased capacity to institute and prescribe opioids for severe cancer-related pain, despite the intense resistance to opioids which remains widespread in India.
Key to success is the support of senior leadership within the hospital, and the absence of such support was evident in the 2 of the Hamrahi sites which have not been sustained. Fears of prescribing opioids, internal politics, lack of financial gain, lack of community care and burnout in the face of overwhelming need and suffering, all impact on the development of palliative care in India. For the volunteer, debrief and linking to other volunteers has proven to be important especially following the first Hamrahi visit.
Conclusions
Hamrahi provides a model for sustained, collaborative, mutual learning, across cultural, resource and other barriers