Guest advocacy column

2020; Volume 21, No 9, September

These are excerpts from a webinar held in August titled, “Palliative Care – The Solutions We Never Knew We Had — as an effective response to COVID-19 and health-system strengthening,” organized by The Public Health Foundation of India and Pallium India.

A Pandemic-Induced Journey into Palliative Care

Harsh Vardhan Sahni

By Harsh Vardhan Sahni
Consultant, Pallium India

Jumping from working on public health with management consultants to a grassroots NGO, Pallium India, I always struggled with how palliative care defied a quick and comprehensive definition. The more I learned, the more I realized that as a branch of medicine it adapts itself to the patient and environment...different forms of care for different kinds of needs.

The more I saw it unfold, I realized that palliative care is fundamentally the compassionate practice of medicine.

It took a pandemic...

The World Health Organization counts palliative care as one of the five essential components of comprehensive health care. However, it took a global pandemic for a lot of us to see how essential it is. Nobody trained doctors to face so much suffering and mortality, nobody planned to get so sick so suddenly, and, above all, nobody told loved ones how to get closure as they witnessed suffering and death from an enforced distance, encased in face shields.

Trained or not, providers the world over now have to practice palliative care: have difficult conversations; use symptom relief measures for intense breathlessness, agitation, and delirium; and learn to take care of themselves and their families when yet another patient passes away.

Had medical education, training, and practice prioritized palliative care, the physical, emotional, social, and spiritual weight of this pandemic would perhaps have been easier for patients, providers, and communities to cope with.

Everyone has a role
in reducing suffering

Every person has a role they can play to reduce suffering.

At an individual level, doctors can learn skills and tools:

Organizations like Pallium India offer short courses on such topics free of charge.

At a community level, we can educate ourselves about palliative care provisions — options available if someone falls very sick or nears end of life. This knowledge can translate into creating links to services when the need arises.

At a systemic level, compassion can be induced in ways big and small.

Pulling together strengthens all

The theory is well laid out: initiatives to implement and practice coupled with awareness and demand from communities will strengthen our health system. My limited experience working on scale and sustainability of public health endeavors has taught me that individual efforts matter.

Any one doctor can be a beacon for others when they incorporate palliative care in their practice, whole communities can learn from a single family that has benefitted from palliative care, and whole governments can learn from best practices at the sub district level. When all components synergize, we will have a stronger health system.

Lastly, the greatest service tiny acts of compassion will do is to build trust and understanding between not just doctors and patients, but also between the health system and communities. When we work with rather than against each other, we will build a more resilient health system.

Harsh Vardhan Sahni wishes to acknowledge input from Dr. M.R. Rajagopal, Chair of Pallium India, and Smriti Rana, Director of Programs, Pallium India.

For more information on Pallium India, see our Global Directory of Palliative Care Institutions and Organizations.

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