12 July, 2012

Remembering what is important: A gentle approach to medicine.

I found it interesting that a good majority of people did not understand what palliative care was. I myself was at a loss for words when asked what I was going to be learning about in India. What I came to know was that palliative care practices medicine in such a way that aims to treat the patient as a whole, taking into consideration the physical, mental, emotional and spiritual components of the person's battle with illness. And interestingly, with the patient also comes the family, a so-called extended unit, who as caretakers should be looked after as well. Families in India have an extremely strong sense of togetherness and so often one person is not recognized as an individual, but as part of a whole. With all this in mind, palliative care strives to help people suffering from life limiting or life threatening illnesses through effective pain relief and end of life care tailored to make the patient feel comforted and dignified.

I felt such a sense of relief to be amongst people who understood that medicine should be practiced in this way: a wholesome humanistic approach. It was an honor to observe doctors and nurses of Pallium India (http://www.palliumindia.org) bringing their expertise and care into the homes of patients. They would often sit near to the patient, exchanging words in an attentive and soft-spoken manner and allowing the patient and family members to openly express their concerns, fears and hopes. Without question, many of the situations I witnessed were emotionally heavy, and I could feel the weight especially in particular moments. Moments when I could see photos hanging on the walls of the patient in there former healthy self; when observing spouses, children and parents in their new unaccustomed role as caretaker; and when it was expressed that many families were crippled by treatment costs, accumulating an unrealistic amount of debt and forcing family members to act out of desperation. Most homes were full of family and friends wanting to help, but others were empty. The patient potentially abandoned by family who were too fearful or selfish to care for them, wanting only to run.

Unfortunately, these problems are all too common and are only a drop in the ocean as to what families in India face when illness comes knocking. Resources are poor to begin with, but to further the impact the national government has yet to devise an insurance system or a plan for socialized medicine. Often people are forced to pay out of pocket, feeling neglected and helpless. And even though India is said to be the pharmacy of the developing world, a good majority of medicines produced are exported, and the government has imposed unreasonably strict regulations for obtaining morphine and the legal right to administer it.

This entire clinical experience was very black and white for me, alternating between two extremes. Where I saw misfortune and sorrow, I also saw smiling faces and simple ways. By extending medical care into the community, usually at no cost, Pallium India has become a monumental source of relief for many families. Even still there is something to be said about the people. It was rare for me to see homes filled with material riches because most families endured daily struggles to survive. But I could see that even they were smiling and that these homes were full of love and support. These were people with an obvious appreciation for the simple, yet more valuable, things in life.

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