When East meets West via India

David Oliviere, born in Kolkata, reflects on India as he prepares to lead a study tour to India from February 26th to March 12th, 2023

What can one say about India?

A land of extremes. It has already been said that whatever you say about India, the opposite is also true!

The world’s biggest democracy: we hear of the economic uptake but the poorer seem poorer by contrast and the huge slums still exist big time. Yet culture, tradition and smiles exist on every corner!

So, what of some of the many challenges for palliative care in India?

Poverty, a gradually ageing population, limited prevention, a culture of exploiting the potential for profit by offering futile medical treatments, still limited access to morphine (although huge strides have been made), families who police information about the diagnosis and prognosis, massive taboos and stigma around cancer and other conditions and the colossal ongoing need for education in end of life care for doctors and other healthcare workers.

Still the resources of families, local communities, volunteers and spiritual support, virtual resources, leadership, innovative services are among the social capital and strengths of palliative care in India; CanSupport being one example among many.

CanSupport

‘Zita’ was the first CanSupport patient I visited some years ago when one of the teams took me out on home visits. Zita, 35 years old, married with two young children and living in a semi-slum district. Her cancer of the stomach and extensive secondaries left her in severe pain. This woman demonstrated the ‘total pain’ picture we talk about in palliative care: physical pain, very thin and weak; emotional pain (her 12 year-old daughter died two years before, falling out of a rickshaw and Zita won’t talk about her); social pain (her two children were being looked after in Bihar by her family); financial pain (her husband was trying to run a tiny shop selling 6 items, whilst still caring for her in the one room behind the shop counter). The doctor, nurse and counsellor pulled out all the stops to relieve the suffering of this patient and family. As the morphine and other medication was administered, you could see her pain being relieved and Zita becoming more relaxed. She was ‘holding on’ to once again see her children arriving home tomorrow.

Thus started a fruitful relationship with CanSupport. I had been impressed by Harmala Gupta who took the initiative to set up CanSupport in North India. She had been to study briefly at St Christopher’s Hospice, London, UK where I worked as Director of Education and Training. I was impressed by her insights, her conviction and drive to get better help for those with cancer and other illnesses in New Delhi 25 years ago, her critical eye and friendship of the heart. This has led to a remarkable venture now serving across five States in India and nearly 20000 patients and their families in a year.

I am always impressed by CanSupport staff’s high standards of care, the skills of the multi-disciplinary clinical teams, of the many poignant and tricky situations they enter in treating patients and family caregivers and their ability to be ‘a voice for the voiceless’ in the poorest of situations. And their ability to help set up other services in India.

Training

Over the years I have had the honour of being invited to run intensive two-week clinical training programmes with the doctors, nurses and counsellors, with the aim of ‘training the trainers’. Topics focus on the psychological, social and spiritual areas of care: difficult conversations, effective communication, supporting family as well as professional caregivers, spiritual struggles, dealing with issues of intimacy and sexuality, responding to loss, grief and bereavement, multi-disciplinary teamwork and unlocking resilience in patients, families, organisations and communities.

Staff have worked tirelessly on improving their skills; practising sensitive conversations about areas much of society finds taboo; sharing their experiences including the pain of helping patients and their families towards the end of their lives. It is exciting seeing many staff become skilled trainers themselves.

Thank you CanSupport for what you do and for your hospitality. The workforce of clinical and non-clinical staff work hard with an important goal of continuing to spread appropriate services in other regions. To offer all this in a huge urban setting is an achievement. In addition to offering the care to patients at home, the Helpline, education service, consultancy, day care, resource facilitation, family rehabilitation and out-patient services make CanSupport a leading example in India of how palliative care can be successful in this challenging setting. They have recently introduced a mobile palliative care clinic.

A lasting memory as I returned to London, is CanSupport’s Remembrance Days: some 400 caregivers coming together to remember loved ones deceased over the previous year – beautiful poignant moments of times shared and family memories created so that out of sadness and suffering can come closeness, joy and celebration of good care, relationships and love.

David Oliviere

David Oliviere, born in Kolkata, leads JBT Palliative Care Study Tour to India 26 February – 12 March 2023. The tour offers a varied cultural programme balanced with a wide-ranging professional itinerary including visits to the All India Institute of Medical Science (AIIMS, Delhi) Palliative Care Dept., CanSupport to examine their work in providing practical, emotional and spiritual support to patients, Chakrapati Ayurvedic Centre, a Specialist Palliative Nursing Seminar and talks and meetings with palliative care practitioners in both rural and urban India.

Travel from Delhi, a city where Mughal and colonial history rub shoulders alongside a vibrant contemporary culture. Continue to the pink city of Jaipur, onto Agra, dominated by the majestic Taj Mahal, to colonial Lucknow and the great spiritual centre of Varanasi, where life and death meet. The tour finishes in the Bengali capital of Kolkata, rich in literature and culture and the first capital of the British Raj.

More details can be found here or by contacting Jon Baines Tours on +44 (0) 207 223 9485 or info@jonbainestours.co.uk

Jon Baines Tours have been creating professional study tours, cultural tours and tailor made tours from their offices in London and Melbourne for over ten years. Each tour offers privileged and specialist access to a country. www.jonbainestours.com

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