Tuesday, May 16, 2006

home care

I want to give you a glimpse into palliative home care. You have heard from Jan and Graham about their experiences and it is always a privilge for me to join a home care visit. In Calicut, a team consisting of trained volunteers, nurse, doctor and driver go out every day. Patients are reviwed, urgent visits arranged, proceedures carried out such as IV infusions, dressings, tapping of fluids in the chest or abdomen, medication supplied, social support given and emotional and spiritual support offered. The driver's role is the most intriguing as he at starts by negotiating the rural roads like a pro, reversing up impossible lanes before changing roles and assisting in dispensing medication and is then asked to help with preceedures. The combination of local knowledge (coming from the volunteers, who often live in the area) and the health care skills is inspirational. Here is one of the volunteers being introduced to me - he is a huge support to so many families. Coping with the journey, hot and humid climate, responding to unexpected needs, supporting relatives and patients is a draining yet rewarding task for the teams. What a privilege it is to be invited into someone's home often at a very difficult and vulnerable time. The photo here shows an elderly lady who was sharing some difficult feelings. Can you see how the team is around her offering her unspoken support, listening and concern? A real picture of palliative care in action. Some families are known over many weeks and months allowing real relationship building and trust. Othere are referred very late - though the network of local volunteers is helping prevent this. The teams offer an opportunity for training and mentoring as well as care for patients and their families. Areas of particular need have been identified such as psychiatric and psychological support, rehabilitation for spinal injuries; and these areas targeted for training and service development. A dynamic and responsive service - and an inspiration.

Thursday, May 11, 2006

visiting impressions from Jan and Graham

"Gods Own Country"

Just back from India we wanted to say a few words about our time with Mhoira in Kerala....

This trip was only for two weeks but in that short time we were challenged,inspired,suprised and blessed in ways we had not expected by this wonderful place and people. Kerala is a beautiful place,as are its people.Mhoira's descriptions can give you a real flavour,but going out to see for yourself you experience the sights sound and smells will challenge any preconceptions about India and in our case has left us humbled and much richer for our time there.

Mhoira organised much of our trip for which we are grateful and highlights of Kerala included a boat trip on the beautiful waterways which criss cross Kerala(called the Backwaters), travelling in old white "Ambassador" cars and crazy auto-riskshaws(the only way to travel!) a stay in a coffee and vanilla plantation in the hills of Wynaad complete with a bush safari and elephants,and lovely meals out with Mhoira's friends sampling the yummy South Indian food,and the warmth and ready smiles of the locals .We could go on!!...but the real highlight was seeing some of the work Mhoira is involved in and meeting some of the great people she works with.

In Calicut,like Kenny, we had a chance to see first hand how the original vision of pioneer Prof Rajagopal, and his team has continued and grown into an impressive and unique model of community involvement in assessing,treating and supporting people in need of Palliative Care.Graham and I come from a shared professional background of psychiatric nursing,engineering,statutory and voluntary social work and were overwhelmed by the sheer numbers,as well as skills and commitment of local volunteers who are an integral part of the project,and in some areas take a lead role.They come from a variety of backgrounds including, on our trip, a local primary school teacher and retired engineer.This level of community involvement is unique in my experience,and our time out with Mhoira and one of the home care teams,visiting patients in the rural areas around Calicut,was both moving and humbling.
If only we had this kind of commitment in our communities back home! We were also impressed by the commitment to training,and I was delighted to meet one of the psychiatrists involved in teaching volunteers psychological skills,particularly as he has worked in the same psychiatric service as me in Edinburgh!

The opportunities for training,as Mhoira has described already, are there,and having seen the commitment and enthusiam for it, as well as the potential to change whole communities we have come back challenged about our own work,and inspired by what Mhoira and others have and could achieve. Do go see if you can...and meantime get behind the work of Cairdeas. These are real people,like Praveen, who need support for training and equipping so that they can make a difference. Oh and if you do out....those homecare drivers will take you on a journey you won't forget!

Jan and Graham Beckett (Mhoira's sister and brother-in -law)

Monday, May 08, 2006


You may have noticed how often I mentioned Calicut in my posts and newsletter. Let me tell you a little of the history of this pioneering service in Northern Kerala. In 1993 Prof Rajagopal, Dr Suresh Kumar and a small team formed the Pain and Palliative Care Society (PPCS) and began to develop a palliative care service based in the government medical college. A busy OP, with the words 'listen' pinned to the walls, was the focus with home care teams and link centre clinics. Negotiations with government made morphine available and a unique model of empowering faimiles and training volunteers developed. This was recognised with WHO demonstration project status as a model of palliative care for developing countries. Over the ensuing time this service has continued to evolve. In 2002 a movement known as NNPC (Neighbourhood Networks in Palliative Care) mobilised whole communities where the service was owned and run by the volunteers with input from health care workers. Perhaps I will tell you of this in a separate BLOG post. In 2003 a centre for education, training and in-patient care was opened - the Institute of Palliative Medicine. Much of the training is for volunteers with staggering numbers completeing basic and advanced training. This includes an innovative project to train trainers in offering psychological interventions as part of their therapeutic care. The nurse with a young patient on the left is Mina - one of the original team . Her smile and skilled care speak volumes. Praveen is a volunteer who has worked for 13 years in the PPCS and is involved in many of the training programmes. Here he is teaching communication skills. I have been involved in Calicut since my first visit to India in 1999, and it is always like coming home. This trip I have contributed to the BCCPM - a 6 week training programme for doctors (see picture)and the Fellowship programme for distance learning. The slogan for the PPCS sums it up - 'People for People in Pain' It is a place of ideas, energy, skill, inspiration and compassion. I am delighted to say that Cairdeas will continue to have a working partnership here and I will continue as visiting faculty to the Institute.