Alison Landon I worked as a doctor in Hospice Casa Sperantei, Brasov for seven and a half years and since 2016, I have been a member of Hospices of Hope’s board of trustees. Overseas placement Since early student days, I had always hoped to do some voluntary work overseas. When the opportunity arose in my career path to look for a placement I researched widely and happened to read about Hospice Casa Sperantei. Having been to Romania several times previously with a small charity delivering aid, the idea of practising palliative care in a country which had already touched my heart was particularly attractive. I contacted the UK office of Hospices of Hope and was interviewed by the director, Graham Perolls and Dr Mary Baines. I explained my motivation and expectations and we agreed on a two-week introductory visit to Romania, as an opportunity for the team and myself to see if we were compatible and whether a placement was likely to work. Years later This was an excellent opportunity to see the project and to meet some of the staff and after this visit, I was fairly convinced about returning and the team was also very keen. We agreed on a six to twelve month placement, depending on how things went and how I coped, with my main role being to support and develop the inpatient team. Little did I know that I would still be there almost 8 years later……… Cultural differences On arrival in Romania in June 2002, I experienced a major culture shock. The general pace of life was noticeably slower, simple tasks such as posting a letter were made into complicated routines, and red tape seemed to appear at every possible opportunity. Punctuality was not an issue for most people. I soon realised that if I was to settle in and be of use to the clinical team I would have to adapt to their way of doing things. I chose to observe closely and offer suggestions as to how situations may be managed, rather than impose UK practices. A new inpatient team It was very fortuitous that my arrival coincided with the opening of the inpatient unit. The team that I was part of was composed almost entirely of new staff who had had basic introductory training in palliative care but very little, if any, practical experience. Together we formed a team, learning together and developing the inpatient service. Language barrier The greatest challenge I faced was the language barrier. The solution to learning Romanian quickly turned out to be extensive patient contact and extremely willing colleagues who kindly interpreted for me. I was pleasantly surprised after six months to be able to have quite difficult end of life conversations in Romanian. Other challenges Other challenges I confronted included: adapting to the lack of resources, with limited medication and materials available; facing extreme poverty with very low income families living in precarious conditions; observing many cases of late presentation of disease with giant fungating tumours; adjusting to the preset attitudes of the traditional hierarchical medical team; and teaching family members to offer nursing care including changing dressings, administering injections and changing syringe drivers. The health care system The health care system in Romania is in constant flux. Primary care is less than optimal, with little or no district nursing services, limited access to patient information and communication between services and professionals is ineffective. Evidence-based medicine is a new and not widely accepted or applied concept. The prescription system causes much angst and distress for patients and their families, as does the poor availability of dressings and other disposables. Rewards The opportunities and rewards of working with the Romanian team undoubtedly outweighed the challenges and frustrations. Not only was I able to offer medical cover for the inpatient unit, I was also involved in administrative and managerial tasks including developing policies and procedures, developing the patient record system and teambuilding. Teaching I had an extensive teaching commitment, with groups and individuals from around the country and international participants, both theoretical sessions and practical hands-on training. Developing palliative care in other countries I was involved in projects developing palliative care in neighbouring countries and travelled to the Ukraine, Moldova, Serbia, and Kazakhstan as well as extensively within Romania for training programmes. HIV project I coordinated a three-year project to develop palliative care for people living with HIV in three centres in Romania, which included not only clinical activities but also arranging courses and seminars for professionals and teaching programmes in schools. Summer camps and fundraising I took part in the children’s summer camp and many of the fundraising activities both locally and nationally. Amazing people Most of all, the people I met both in and out of work, the amazing patients and their families, my colleagues and friends made it probably the most rewarding period of my life to date. Although it was a lonely experience to start with, I was made to feel so welcome that I soon became a member of the hospice family and an honorary Romanian. I met so many inspiring individuals who will stay with me forever. Huge privilege It was a huge privilege to be a member of such an enthusiastic team, pioneering palliative care in Romania and to have had the opportunity to provide high quality care to our patients and their families who are in such desperate need, to relieve their suffering and improve their quality of life. I am forever grateful to Hospice of Hope and the entire Casa Sperantei team for making this possible.