Report
Unfortunately my trip got off to a bad start. There was fog in Delhi. The flight from Frankfurt was delayed 8 hours. This meant I missed my connections. I had to overnight in Chennai. I learned this lesson: don’t travel via Delhi during January as there will often be fog!
Since I had arrived in Calicut (Kozikode) a day late, I missed inauguration ceremonies for the new Institute of Palliative Medicine on January 21st. The government of Kerala had donated the land for this new unit, built entirely with private donations. The Institute includes an inpatient unit, teaching facility, and accommodations for visiting professors. It should be ready to admit patients within the next few weeks.
The first Pain and Palliative Care Clinic in Kerala was opened in Calicut in 1993. Now, ten years later there are 33 linked satellite centres that share the same philosophy. Patients are seen and treated irrespective of resources. If they can’t afford the medicines these are provided freely, as there is no National Health Service in India.
Kerala state is one of the jewels of India. It is situated below Goa on the West Coast of India. Literacy rates are the highest in India, over 90%. A sense of equality pervades all of society. Volunteerism is the cornerstone of Palliative Care here. Many medical students are volunteers.
January 22nd to 26th: I participated in teaching a refresher course for physicians who had already completed the basic course. Other faculty members were Dr Robert Twycross from Oxford, Dr Mhoira Leng from Aberdeen, Scotland. Ms Val Hunkin and Dr David Clark, as well as Dr Manoj Kumar, a psychiatrist originally from Kerala but now practicing in the U.K. Physicians from all over India attended these sessions. Feedback from the participants was very positive.
I presented on Palliative Care Sedation and Problem Oriented Case Discussions and Symptom Control in Children. Other sessions included: What’s New in Therapeutics, Procedure Related Pain, Sweating in Palliative Care, Cachexia/ Anorexia, Family Dynamics, Psychosocial Issues in Palliative care.
I then travelled to Cochin where I visited a 50-bed hospice that was run by nuns. I taught a workshop on Communication Issues for Nurses in the afternoon. I illustrated the talk with a case presentation from the floor with a patient asking: "Will I be cured? Why has God punished me?" I had been warned that the nursing students would not ask questions. After a tentative beginning, it was a very interactive session that was hard to bring to a close.
On the 30th January I left from Calicut with the group and traveled 26 hours by train to Hyderabad. There I attended the 10th International Conference of the Indian Association of Palliative Care. I gave a Plenary on Information Needs of Palliative care Patients and their Families as well as a session on Sedation at the End of Life.
I was also the judge for a Free Standing Papers Session on February 2nd. Prizes were awarded to a paper on "Stress Management and Support for Palliative Care Staff" by Dr M.Joshi from the Cipla Palliative Care Centre in Pune. A prize was also awarded to Dr Praveen G.Pai who gave a provocative paper on suicide in the elderly illustrating the "Need for Palliative Care in the Elderly". Still another prize was awarded to Ms Kumari Thankam, Nursing Staff from the division of Palliative Care in Trivandrum on "Rainbow of Caring".
Hyderabad is an exciting city and is exploding with the development of Information Technology. It is arguably the cleanest city in India. New glass and concrete buildings are springing up all over the place. Although I didn’t have much time for site seeing, I was able to take in a Light and Sound Show at the Golkonda Fort.
It is always exciting and challenging to visit India. It forces me to personally reflect on my life and my remaining goals. I believe that I always gain more than I give. The gentle people of the South, their culture and food are always a delight. The memories will stay with me always.
I would like to thank IAHPC for the opportunity to undertake this Fellowship. There was much interest in the organization. I ran out of leaflets and I hope this means we will have many new Indian members in the near future.
