Recently, we asked IAHPC Board Members to address one topic. Here is Dr. Sushma Bhatnagar’s response to the topic ‘What I learned this past year that helped transform me professionally.’
Access to palliative care is the right of every patient, and its provision is the moral responsibility of every doctor. A national policy by India to provide such care has been proposed. Nevertheless, despite people working in all directions to increase and improve palliative care, there remains a huge difference between demand and supply. The problem lies in three areas: different and limited availability of resources, poor infrastructure, and a poor doctor-to-patient ratio. This forms a vicious cycle of deprivation and suffering. Establishment of palliative care in such a scenario is a gargantuan task where access to essential and basic lifesaving treatment is difficult.
Who, then, is bothered about the comfort of the patient when death approaches? Who can fill this void?
Working in a premier medical Institute of India, teaching and practicing palliative care, made me realize that the country’s young doctors and nurses can bridge this gap. If we target the young health care workforce, educating and training them about principles of palliative care, it will cause a ripple effect throughout the continuum of care.
‘My medical practice was incomplete before joining IRCH, AIIMS [Institute Rotary Cancer Hospital, All India Institute of Medical Sciences],‘ said one doctor who was leaving the Institute after three years of residency. ‘After coming here, I realized for the first time how practicing with humanity, giving even a fraction of my dedicated time to a patient and listening to them, makes a huge difference in the patient’s life.’
My happiness knew no bounds when I heard from one of my junior residents that, ‘My patient needs an honest opinion and realistic hope, and this can give 100% care and satisfaction.’
The resident added, ‘I worked hard for three years at IRCH, AIIMS and learned something that I would like to continue for rest of my life. My corporate hospital was not ready to start palliative care. I struggled and worked hard [to bring palliative care into the hospital] and now I feel more than satisfied when I see that this, the biggest corporate hospital in India, has started a dedicated palliative care wing.’
Most of the residents who join the department are qualified anesthesiologists, and they leave after three years of experience and training in palliative care and oncoanesthesia. But most of them continue to practice only palliative care after they leave.
What is it that convinces them to leave their lucrative and established branch of medicine, and inspires them to practice palliative care, which is still in the inception phase in India? It is only determined youth who can overcome such a challenge.
Another resident who successfully initiated a palliative care department in his medical Institute said, ‘Initially, the administration thought, “What is the benefit of starting a palliative care wing?” I had joined recently and struggled to integrate palliative care principles in the continuum of care. It took me five years to prove myself to them, but now everyone in the hospital recognizes that this “extra” care had been needed for a long time.’
These anecdotes give me reassuring positive energy and the strength to work harder; they persuade me to say that the situation is not so grim in this country. There is a need to teach humanity in undergraduate and postgraduate teaching curricula. Palliative care should be taught from the beginning. And the young generation of India is ready to work hard; we, as their mentors, must help to guide them along the correct path.
National policies are in place, drug policies have been reformed, and the Medical Council of India has recognized palliative medicine as a dedicated specialty. Many courses have been rolled out for training physicians in palliative care: postgraduate courses, fellowships, short-term certificate courses, and more. There are courses not just for medical professionals, but for all those who are part of the chain involved in provision of palliative care, including nurses, paramedical support, and even volunteers and social workers! This shows the effort being made to incorporate the community — the target population.
Accordingly, India is working rigorously on strengthening the three pillars of palliative medicine throughout its vast geographical area and diverse cultural milieu: government policies, education and awareness, and access to essential drugs.
India, being a developing nation with its own diverse set of problems, can empathize with other such countries where people are deprived of palliative care due to limited resources. At the same time, we can set benchmarks for the way we have overcome barriers, and continue to do so.
Innovative ways of using local resources eases access to treatments and reduces their cost. Thus, in India, palliative medicine is swiftly gaining the dignity it deserves and should, in near future, be accessible to one and all. This will require perseverance and a goal-directed malleable approach, and continued efforts of the medical fraternity. There is a need to actively encourage people who are working hard, even if they are few. Education, training, satisfaction, and inspiration will form a productive cycle, which will override all barriers and drive us to progress.
Therefore I can say, ‘The situation is not so grim. There is hope.’