Can I help ?

 


This was originally posted in a saree group a few weeks back.


One of the unique  privileges of being a physician is to be there for a patient at vulnerable periods of his or her life. As a young physician the gravity of this responsibility was not as deeply recognized by me as it is now. Having seen several patients in my panel go from active,healthy adults to ailing senior citizens over the span of last 25 years I am equipped now with a wider, slightly better perspective of health and living. On one hand I continue to meet newer, younger patients (18 years and older) and on the other end, I often lose my senior patients( 65 and up) to the ultimate conqueror, death! 

The messages for the two ends of the spectrum are very different from each other. Almost like day and night.

For the younger patients it is all about investing into the future for good health. 
Eat healthy, exercise regularly, drink plenty of water, stick to a regular sleep wake schedule, learn to manage stress, learn to balance your time between family, work and yourself, don’t smoke, don’t use illicit drugs, avoid excess alcohol, get your immunizations on time, do the recommended screening tests on time. 
These are general guiding posts to a better life. The entire concept falls under the category of Preventive Medicine. Multiple studies have shown that every dollar spent on prevention saves several times more in treating illness. Not to forget that it allows a better quality of life.

Fast forward another 40-50 years. A 30 year old man or woman is now 70-80. Problems are often arising at this stage. Some small, some big. The doctors try their best to put out fires as they arise. Sometimes they are successful, sometimes not. It is when fires are burning relentlessly and nothing can put them out is when the doctors have to start a difficult conversation. A conversation about accepting the end of life. Some patients (and relatives)are realistic about life expectancy, though most are not. 

Ironically preventive care and end of life care have something in common. They are both connected with quality of life and costs !! If done properly, they both improve quality of life and reduce healthcare costs. While these factors are easy to convey to a young patient, these topics become very touchy with dying patients. If anyone can effectively communicate with a patient and his immediate family that time is running out, it is their trusted physician. It could be their primary physician, or sometimes a specialist.  Essentially it is the bond of many years that allows this difficult conversation to become palatable. 

Doctors treat sick patients. Most people only think of this when they think of doctors.

In reality, the role of the doctors to treat illness is just the tip of an iceberg! Underneath the surface the work that awaits is preparing the patient at the start of the journey for a better life and at the far end of the journey for a better death! 

Yes, death can be made better!! Not many people are aware of that ! Death is inevitable, suffering is negotiable. Yet most people are unaware about their options. The options for facing death with the least amount of suffering is what Hospice and Palliative Care is all about !

Whether it is a western country like the USA or an eastern culture like in India, majority people are not ready to discuss end of life. However, when the discussion begins in western countries , the doctors are in a much better position to offer options. Despite initial denials and reluctance, when the role of palliative care or hospice is explained and the benefits of these services are understood, patients are willing to embrace them. A well organized and established team of trained personnel from the Hospice center then takes over the care of these individuals attending to the needs such as pain control, respiratory distress, difficulties with ambulation, bowel control issues, anxiety, agitation as well as support for the family members through the difficult period. Basically comfort care or everything short of unnecessary prolonging of life and suffering.

In the last 4-5 years the illness and deaths of a few of my own family members in India, the latest being that of my dear father exactly 2 years back, made me painfully aware that palliative and hospice services that my patients here can avail of are as good as absent in India! That makes the doctor’s job much harder to break the news to a patient that he or she is at the end of the road and there is nothing to offer! More often than not, under these circumstances, the patient ends up being taken to the hospital multiple times by panicking relatives instead of having a peaceful death at home surrounded by loved ones and cared for by a hospice team. For all this the family is paying through their nose. There is no quality of life remaining for the patient or the family! And after all this suffering, the end point is death! That can’t be avoided.

Sadly, for the larger population in India, not just Palliative and Hospice services but even Preventive Care is not the norm. Many people are not aware of preventive services. Many women don’t know what a Pap smear or mammogram is, leave alone that they should get it done.

Having seen both sides of the world, I have come to strongly believe that it is time for individuals to join hands and start raising awareness in India for both preventive and palliative services. One cannot make sense of illness without connecting the beginning and the end. Education about the beginning as well as the end is essential to connect the dots, avoid unnecessary financial hardships and physical and emotional suffering. 

Alongside the education we will need to create the infrastructure for these services to be available and easily accessible.

My recent trip to India was not just about seeing rhinos, tigers, birds, meeting friends, visiting artisans and serenading in sarees at various locations! Underlying all these, constantly within was the pain of seeing my father die. It is this pain that drove me to start a dialogue with doctors in India about Preventive and Palliative Services and understand the barriers that come in the way of implementing these for our people. 

It’s a long road but I definitely saw some bright spots. In Khopoli, my hometown, for example, Tata Memorial Center has started its work for preventive services beginning earlier this year. I was truly impressed with how much thought and design structure has gone into their project there targeting populations at the local municipal hospital, industrial workers, housewives during social celebrations like navratri, school children and even the tribals in surrounding areas. They are actively outreaching these people to quit smoking or using tobacco products, getting screened for cervical and breast cancers, promoting immunizations etc. And all this is free of cost. 

In Pune my meeting with Dr Kelkar at Deenanath Mangeshkar hospital also proved valuable to let me understand what they are doing presently for these causes and how we can work together to improve on these. 

No matter what part of earth we live in, we are entitled to live a healthy life and die with dignity. And for that we must help ourselves, individually and collectively. I invite each of you to join in this dialogue. Meet with your personal doctor. Ask questions about what you can do to improve your health? What cancer screenings are you currently eligible for? Recruit your dear ones to get their screenings too. Even your house helps. Enquire about any available Palliative services near you if a family member or friend is terminally ill. One person’s awareness can light the lamp for many others. Let’s start somewhere…….

I entertained( readers) with my fun travel stories for the past month and kept this serious topic for the last. That’s because this topic is dearest to my heart, a lasting one that can make a difference to many. Forgive me for the long post but I wanted it to make sense when you read. I hope it did. You will be hearing from me in the future about the work in Khopoli and Pune. 

Per rules, this post needed a photo in a saree! Photographer on vacation. Now what?  Barriers need to be overcome by hook or by crook! First I tried a selfie before going grocery shopping. But that didn’t show the full saree.
 At the grocery store my mind worked non stop whether to ask a fellow shopper or a store employee to oblige with a picture. But I couldn’t muster courage. Everyone was busy shopping for tomorrow’s Thanksgiving holiday. I came home with the groceries and there I saw my saviors were sent by God. My loyal gardener and his wife were working in the yard. The lady was very happy to take my picture, even giving me tips about where the light was good at that time of the day. 

This coarse Kala( black) cotton striped beauty bears all the hallmarks of a classic Bhujodi weave. Brick red, beige, maroon with indigo and a hint of green, all natural dyed, stripes of varying widths alternate with each other across the body of the saree as well as on the borders and pallu. Paired with a khadi blouse with jamdani buttis.

Sharing  some pictures taken at dawn on the familiar street and in front of the home. Alas! I could only take the pictures, not be in the pictures! 3rd day in the home, all by myself! And oh, for the very first time in my life, I did the laundry in the machine all by myself and quite successfully! I don’t think I felt as proud when I cooked my first full meal! Who says you cant teach an old dog new tricks ? 😃






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