patient visits

I want to invite you to come with me on a couple of visits to the homes of patients. Perhaps you can try and imagine some of the sights and smells and sounds as we travel together. It is hot - more than 42 degrees today but our vehicle has AC. It was donated by the Friends of Vellore, UK. A family have called to say they are worried about their mother who is known to the team. She is very ill and in pain and they asked for help. It can be hard to know how to care for relatives at home without support. There are few comforts at the best of times and still so much fear about diseases such as cancer. Our patient was a lady in her 60's. She was clearly feeling miserable when we arrived - lying on a hard concrete floor, flies buzzing relentlessly and obviously in pain and distress. Our hearts went out to her and her family. Within a short time we were able to help her family wash her and bind her weeping sores. Advice and medication were given. Her son then helped fill a waterbed we had brought - an inexpensive but effective way to relieve pressure sores and give comfort. It was quite a challenge to find the right size of pipe and water funnel!! Meanwhile, the grandaughter had overcome her shyness of the foreign doctor and we were making friends. Soon many of the neighbours in the village had also joined. We left some time later tired and very thirsty but knowing we had been able to help. A drink of tender coconut juice on the way home was wonderful.

Let me take you down to Trivandrum now. I met this gentleman during a visit to the Pain and Palliative Care clinic jointly run by SUT Hospital and Pallium India. I was joining Prof Rajagopal and his team to help with some training programmes. this man lives in a small town 2 hours from Trivandrum. For the past week he has made a daily journey to the palliative care clinic. He has cancer of his mouth with a nasty open wound. Despite good care from his family he began to have worsening pain and swelling. The team have been treating him with analgesics, steroids and antibiotics but also spending time every day removing maggots - totalling more than 100 maggots. This is a distressing yet common complication of these wounds in a tropical climate. He is thankfully much more comfortable now and will be visited by the team at home. He spoke of his pain and his struggle with feeling 'unclean'. Like many patients, his pain is far more than just the physical.

It was great to meet Donald McNeil and Ruth Fremson from the New York Times who are researching the issue of morphine availability. It will be a fascinating story so look out for it.

hot, hot, hot

I realise that the UK had just had the warmest spell 'since records began' but I would love to open a quick window to Vellore and let you feel the heat. With the thermometer hovering around 38-40 degrees C, it is dry and dusty with any breeze circulating the air like a blast furnace. Rain is a welcome relief and washes the trees and shrubs till they sparkle and glow. A few days back we were treated to a spectacular thunder and lightening show and ran through the rain to get a better view. My partners in the madness were Dinesh (from New York) and Graham (chaplain from Adelaide) Here they are making puris one night for our supper!! It has been so lovely to share my time here with many some very special people - thanks to them all. Many have left recently - partly to avoid the worst of the summer heat; and we say our fond farewells. Here is Nita leaving - also a chaplain from Adelaide. The car is an Indian classic and is driven by our friend and driver, Suren. Many Indian friends are planning an escape to the hills too as the children are on their summer break.

One of the excellent projects we are involved with is a Distance Learning Module for Family Practitioners that has it's inspiration and leadership from Dr Vinod Shah. Some of you will recognise him from the days when he was the Director of the Emmanuel Hospital Association. This programme runs over 2 years and has 200 family doctors registered . A great achievement - and much of it due to the innovative and professional way the course is run by Dr Shah and his team. We are writing palliative care modules for year 2 of the course and I joined a writing workshop in Pondicherry. It is a great way to get a group of 'experts' together and some hard graft done - while also enjoying a few days away from the business of CMC. It was fun to explore the streets of this old French area - of course very much Indian now. We did manage some 'Gallic inspired' food and I have some cheese - a real find in India. This course has an important role - as so many Indian in rural areas rely very much on their local doctors. Referrals to hospital may be simply too expensive for many. The standard of practice and training of family doctors can be very variable. The course is also linked with many rural mission hospitals and will have the 'contact sessions' delivered in several locations. Having palliative care as part of the training will help take the philosophy and some knowledge and skill to new areas. Let us hope that in turn, many people and their families who are in need will find benefit and support. Remember, only 3% of the people in this vast and amazing country have access to pain relief at present.

I am off to visit Kerala for some training programmes now so will tell you more in my next post.

ps Dr Danjuma - lovely to hear from you. Let me have your email and I will write.