“What can you tell me about Palliative care overseas?” It was the summer of 2015 and I was on the phone with Dr. Aletta Bell, who served her whole medical career overseas. “Well, let me tell you!” she responded. I was starting a second course in palliative nursing training, and I had started asking the Lord, “Why am I taking this course in palliative care? What is Your purpose for me taking this course?” Dr. Bell told me about the 5 home-based palliative care projects which EHA was already running at that point, and at the end of the call, she voiced just what I had been thinking: “Patti, I think you need to go see it!” I went on a vision trip with her in 2016 and while I was at Prem Sewa Hospital, on the last day of my visit there, 4 different patients asked me “when are you coming back?” That was just the beginning of several signs from the Lord that He wanted me to volunteer with the home-based palliative care projects. (One sign was a license plate on a car in London that drove in front of me one day: it read “Namaste”!)
Palliative Care overseas is very different from palliative care here in Canada in many ways. But in other ways, it is all the same. The greatest difference, of course, is the disparity in resources. Morphine is tightly controlled, and hard to come by. Most patients receive their diagnosis & “treatment” when it is far too late. On the other hand, every palliative patient and his or her family, all share the same struggles as end-of-life approaches, and the human soul has the same need around the world for comfort and peace.
There is a great need for Palliative Care, especially in north India. It is very difficult to obtain accurate statistics about the actual number of cancer patients. Many cancer patients never receive appropriate treatment, and they die from cancer which could have been treated. Sometimes this is the result of using folk treatments, like cow urine, crushed camel bones, or rat oil. In the north where I was working, the vast majority of patients we saw had oral cancer, due to the use of paan and gutka, tobacco-like products which are carcinogenic.
I was part of a Team, which included a Doctor, a Community Health worker, a Social Worker, one support staff (who was also our driver), and a nurse. We went out to the villages in the rural areas 5 days/week and on Saturday we held an out-patient clinic in our office. We also had 2 in-patient beds which were used for admission when needed. We were often involved in counseling the patients and their families, as many did not understand the prognosis which they had been told at the larger Cancer hospital.
I want to share with you the story of Ammani.* Ammani was a lady in her late 40’s. In the summer of 2018, she was diagnosed with brain cancer. She lived in the town where our hospital was situated. Her husband owned a shop, and he sold his car and the business to try to get enough funds to pay for Ammani’s cancer treatment. She had surgery, however it wasn’t successful and resulted in complications. We met Ammani and her husband, her 2 sons and her daughter, in November of 2018. We tried to “break the bad news” in a gentle way, that Ammani would never recover from her debilitating illness. She already was paralyzed and bed-ridden when we met her. Her symptoms were becoming worse, and she was eating less and hardly talking or responding to her family. We counseled her family that we could provide some medications to manage her symptoms, but that it would not provide a cure. We started her back on steroids, and Ammani brightened up and was more talkative and eating more! Her husband was really grateful that her quality of life could be improved.
We were also so thrilled that we could loan out a wheelchair to them, which had generously been donated by another family who had lost their loved one to cancer. The wheelchair meant that Ammani’s family could wheel her outside into the sunshine and she could enjoy the weather and a change of scenery! As the primary nurse on the Team, I carried the Team mobile phone, and many times her husband called after hours, feeling nervous about what to do, and it was a real privilege to provide advice and re-assurance to him, as he felt the burden to care for his wife whom he loved so much. We were also able to provide them Morphine to manage her pain. When our supply ran out and we could not obtain more, we helped them to get a new supply from the cancer hospital 4 hours away that had done her surgery. Ammani passed away in April 2020 after I left India. She is one of many patients since the project began in 2013 that received comfort care and patient/family-centred support to help during their last days, not just physically, but also emotionally and spiritually.
*Name has been changed
Patti Halliday is a Registered Nurse, living in London, ON. She served with Emmanuel Hospital Association in India with the Palliative Care Team at Prem Sewa Hospital, from February 2018 to March 2020.