David Oliviere is a social worker, counselor, educationalist and formerly Director of Education at St. Christopher’s Hospice in London, UK. Here, David explains how an IAHPC Fellowship enabled him to deliver an intensive training program for CanSupport, a palliative home care team in New Delhi, India.
‘The monkeys are back to welcome me,’ I thought, as I approached my hostel in the centre of New Delhi ready to hold two intensive training modules over three weeks in near 40 degrees, double the temperature as I left London. I never cease to be amused by the antics of the monkeys on the streets and adorning some buildings.
After months of teaching preparation for delivering training six hours per day singlehanded, I returned to CanSupport with joy, mixed with some questions and jumbled thoughts: ‘Was I just indulging myself as a palliative care colonialist, joining the trail of other westerners in offering a bit of do-gooding?’; ‘Would I just be imposing UK cultural templates and models in a land where no one model can say it all?’ ‘Was I just indulging myself in a cushy retirement job?’ Or ‘Would those dinner party acquaintances be polishing my palliative care halo even more shiny following that inevitable question, “what do you do for a job?”’
What can one say about India? A land of extremes. The world’s biggest democracy; we hear of the economic uptake but the poor seem poorer by contrast and the huge slums where CanSupport see a number of patients still exist big time. Delhi, 18.2 million population and expected to rise by 40% by 2020 in the Delhi metropolitan district.
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 diagnosis and prognosis for the patient, massive taboos and stigma around cancer and other conditions, the overwhelming concentration of palliative care teams in Kerala in the South, and the colossal need for education in basic good manners and end-of-life care for many doctors and other healthcare workers. Yet, the resources of families, local communities and spiritual support are among the social capital and strengths.
“There has been a lot of progress in India, but the fact
remains that despite the passing of almost a quarter
of a century of palliative care activity in the country,
even today palliative care reaches only almost 1% of
the people of India.” (Rajagopal, September 2015).
As Dame Cicely Saunders frequently told me – “there’s a lot more work to be done.”
Founded by a patient and activist for improved cancer and end-of-life services, Harmala Gupta, and English nurse, Ruth Wooldridge, almost 20 years ago, CanSupport is one of the leading palliative care services in India and the most established in New Delhi. Some 1,600 patients at a time are cared for by 23 multidisciplinary home care teams of doctor, nurse and counselor, and outpatient clinics and volunteer-led day care provision. In 2014-15, a total of 11,500 were helped. Research and education are integral.
A day observing with one of the homecare teams is always a brilliant learning experience.
Sunita, aged 32, with breast cancer, living in her parents’ home. Her husband and five-year-old daughter lived with his parents and Sunita was desperate to see more of her child. It was difficult to imagine that the wedding picture that hung on the wall showed the same woman in front of me, cachetic, slow and fatigued, almost bald and covered in warts from another condition. Sunita’s great strength was her religious faith, which sustained her and gave her inner peace.
Increasingly commissioned to undertake needs assessments, capacity build, educate and train teams in various parts of India, CanSupport urgently needs to train senior staff in teaching skills and competence. Therefore, the plan was to offer intensive training to build practice skills and confidence for participants to cascade the training to others.
Module 1: Advanced Psycho-social-spiritual Palliative Care for Counselors
Learning outcomes
Curriculum
Module 2: Teaching and Presentation Skills for Senior Counselors/leaders
Learning outcomes
Curriculum
The modules were extremely well received and highly evaluated and learning outcomes achieved.
With grateful thanks to the IAHPC for the Traveling Fellowship, without which this work would not have been possible.
Rajagopal, MR (2015) Cancer Control Information. The current status of palliative care in India. Palliative India Newsletter, September.
CanSupport (2015) Annual Report 2014 – 2015.
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