mizoram

Nestling amidst cloud covered mountains with roads clinging impossibly to the cliff sides, warm generous people with strong community, cultural traditions and Christian faith is the hill state of Mizoram. Despite 2 international borders and 3 state borders it's geography and history have kept a sense of identity and relative isolation. Food, ethnicity, dress, language, lifestyle, faith - all very different from the 'plains Indians'. Here the patients do not have the latest 20-20 cricket heroes on their wall but a photo of Manchester United!
It was a privilege to make a short visit as part of an on-going project with the Civil Hospital and Regional Cancer Centre in Mizoram and Pallium India. A Pain Relief and Palliative Care clinic (PRPC) began in the Civil Hospital, Aisawl in December 2006 and they have managed to provide oral morphine through this service. However, given the rural nature of this remote state, there is a need to further develop palliative care throughout the 8 administrative districts as well as provide a more comprehensive service in the capital Aisawl. There is a very high rate of cancer and a significant HIV/AIDS challenge.
My visit was hosted by Dr Jeremy Pautu and his small team, Dr Vani and nurse Puii who run the palliative care service and who received training from Prof Rajagopal and the Pallium India team. We visited the government offices, Civil Hospital, ART centre, Presbyterian Hospital and Shalom HIV/AIDS service. Our seminar on palliative care was warmly received and the standard of care offered with limited resources very humbling. It was also very clear that there is government support for palliative care and strong networks throughout the state.
To help you understand the challenges come with me on a journey from the capital Aisawl to the major town of Lunglei. Houses are built into the hillsides from the simple rural dwellings to the twisting, winding streets of the capital. Not a place for those made nervous with heights! At every turn is a stunning view and in every small town a tea stop for a hot, sweet cup of tingpui. An emphasis on fruit growing and lush soil provides vibrant markets and the beautiful weaving traditions is shown in the women's puan designs. At the end of a long hot day you arrive at Lunglei to be welcomed by the family of Puii, the palliative care nurse. My thanks to the Medical Superintendent of the civil hospital Dr KK Ghose and colleagues at the Christian Hospital Serkawn for showing us round the hospital. We were able to hold a seminar on palliative care and to meet many of the leaders of health care in this district.
What of palliative care here in Mizoram? We are looking to support development in a joint project with Pallium India. At present we are drafting a plan to offer training at community level, to support a cohort of trained trainers and to help with strategic planning. The existing clinic is only able to offer outpatient review and there is a need to develop a community based model to offer support in patients homes. In Aisawl we visited a young man with advanced cancer, looked after by his family who was not well enough to come to the hospital clinic. His family had cared for him with amazing dedication yet needed help and advice to manage his pain. This kind of support is not possible at present yet so clearly needed. I very much hope we will be able to visit with a team in January, and that the service will continue to develop so that many more will receive the care they need and deserve.

I take with me memories of crazy precipices, new and generous friends, amazing hills rolling into the horizon, inspiring colleagues, strong community support for the patients and families, Christian fellowship and the warm welcome of all shared with a cup of tingpui. It was an amazing place to spend my birthday - and my special thanks to Lalrinmawii (Teteii) for her wonderful Mizo feast!