By Alison Ramsey
An interview with Dr. M.A. Balasubramanya, one of the founders of the Swami Vivekananda Youth Movement. SVYM recently joined IAHPC “to get a wider perspective of the whole concept of palliative care. It’s definitely useful: I get to know a lot about it, and emerging trends.”
Not all paths to providing palliative care are direct.
Palliative care wasn’t even a remote blip on their radar when a group of idealistic young medical students in India — inspired by the teachings of Swami Vivekananda — launched a movement to bring ‘rational, effective’ medical care to those most in need, in a respectful way that prioritized patients’ dignity.
The Swami Vivekananda Youth Movement, which began in 1984, first targeted poor patients admitted in the students’ medical school and at weekend clinics held in the rural neighbourhood. Then, in 1987, SVYM started working with Indigenous tribal communities in the students’ home region of Karnataka state. Decades of effort, guided by its ever-expanding domains of care, have resulted in a movement that flourished beyond belief.
Their initial project was a clinic, soon joined by an informal school and 10-bed hospital. At that point, “We realized that health and education were only effective if we people had a meal on their plates,” said Dr. M.A. Balasubramanya, SVYM secretary and part of the original group of students. “We saw that medical care was insufficient, incomplete, without the full dimensions of health — physical, mental, social, economic, spiritual — and health determinants, like housing, water, sanitation, and nutrition. We realized that for these to take shape, we needed to educate communities both informally and formally.”
The growing group was also aware of discrimination within the health care community; it reacted by creating the multidisciplinary Vivekananda Memorial Hospital and Viveka Tribal Centre for Learning in the 1990s, where “the poorest of the poor had access. This new generation of students appreciated our integrated approach.”
As the year 2000 approached, SVYM saw clearly that treating those living with HIV not only lengthened patients’ lives, it strengthened their social bonds. “This is when we started thinking more about palliative care,” said Dr. Balasubramanya. “We had become more of a country with chronic diseases — diabetes, hypertension, renal disease, neurological diseases... It opened our eyes to palliative care. It was important for us to bring in a system where all of the care components we had identified became part of the public health system. It was important to work with the government to sensitize the medical community from the ground level, to understand the emerging trends of health and the need for holistic intervention.”
But the communities themselves had little understanding or provision of palliative care. So SVYM decided to work with the government on a “family-centric” model. It solicited donations from local industries and community groups to equip a joint SVYM/government project: the Palliative Care Center in Mysuru.
A second palliative care center has since opened, and planning is underway for a third. “Many people we treat, especially cancer patients, have gone back to work,” said Dr. Balasubramanya. “You’re not completely cured, but you are still able to be economically productive.”
A key achievement came in 2016 when, largely influenced by SVYM, Karnataka became India’s third state to enact palliative care policy.
“Palliative care can be the trigger to build kinship in communities,” said Dr. Balasubramanya, noting that nuclear families have become more prevalent in India. “It appeals to a larger context. Everyone feels isolated, a stranger within their own community; what is better than health care for showing concern for a fellow human being?”