Fear is the key!

Working with the dying reveals two aspects of our nature…the first being our sense of compassion, which is bountiful and healing; not only for the patient and their family and friends, who too suffer, but also for our own self; for by practicing compassion, we are being kind to our self and fortifying our compassion. So in essence, by aiming to help others, we are healing ourselves as well. No wonder that the best palliative care professionals are persons who have undergone a lot of sorrow and suffering…and have evolved over the years to be better humans.

The second, and more primitive aspect of our nature, is the fear of death…it could be death in the sense of dissolution of our physical body or death of our ‘grasping nature’. We spend our whole lives acquiring relationships, money and fame…but little do we realize the fleeting nature of these acquisitions. Facing death in its raw and physical form while caring for patients, brings us face to face with our own ‘sense’ of mortality. And that is exactly where the confusion begins. For there are now no clear cut guidelines! What little scattered ‘evidence’ is there is refuted by science. Sadly, our minds have been programmed to ‘believe’ in science.

OK…now for a little task…you just have 10 seconds for this…name any three diseases of non-infective origin that has a cure.

Well you may now realize how ‘advanced’ our medical science has been over the last 300 years! What we have achieved by our ‘technology’ is to make the process of dying more prolonged, painful and undignified! No wonder, most health care professionals shudder at the prospect of having a ‘taste’ of their own medicine…and I yet to see a doctor or a nurse who would want to die in their own ICU!

I was in the same boat…a strong atheist. Working with the dying and for the reasons stated above, I started looking for answers…and I found them, which could satisfy an arrogant person like me. Little did I realize at that time that I was doing ‘Self care’!

The first step is re-learning to believe…with humility.

Remember, at least in our generation, how in our childhood we used to nestle in the laps of our parents and grandparents and listen wide-eyed to fairy-tales and other stories. Those are fond memories and I daresay that a part of our character too has been moulded by those experiences. Those experiences are ingrained in our memory as ‘good and soothing’…for we had believed!

I believe that death is comforting…blissful. You just have to be aware…being mindful!

I have ‘designed’ a ‘Retreat session’ on Self care based on these perspectives at our rural center in the tribal state of Jharkhand in India starting Jan. 30 2016, for a week. I intend to introduce you to your SELF in the retreat.


I have been pioneering the cause of palliative care in a resource-poor and virgin community in the tribal state of Jharkhand in India since 2006. Illiteracy, poverty, ignorance are the rule of the day. Most people do not have access to basic health amenities. Care of the terminally ill remains a low-priority issue with them. Death means a mouth less to feed – economics simplified!

Faced with such challenges gave me an opportunity to innovate focusing on resources that are available, accessible, affordable and acceptable to the community. I put in my personal savings to buy a land and then construct the first and only ‘Long term care facility for the Elderly & terminally ill’ in a rural setting. I realized that the Elderly are the largest group requiring palliation and combining care of elderly with palliative care helped to remove the stigma associated with hospices which are often seen as places of dying. I also learnt to focus on spiritual, psychological and social aspects of care, which are often neglected….and I found that the use of medications came down! Sadly now, we have no funding to support ‘staffing’ for the unit. We are in desperate need of funding to support staffing and a vehicle for our ‘home-care’.

Details can be found on www.kosishthehospice.webs.com and our page, www.facebook.com/kosishthehospice

- Dr.Abhijit Dam, MD, FCCP, FPM, MSc Pall Med(Cardiff)

Project Focus

As some of you may be aware, in early 2016 the Asia Pacific Hospice Palliative Care Network (APHN) held four ‘APHN Dialogs’, in which clinicians across the Asia Pacific region could link in through Skype to attend a webinar. The following webinars took place:

- A discussion of palliative care service development in the Asia Pacific region, presented by Odette Spruyt
- Pain control in palliative care by Yoshiyuki Kizawa from Kobe, Japan
- Management of the cancer wound by Edward Poon from Singapore
- Bereavement care by Jun-Hua Lee from Taiwan

These sessions were well received and provided a valuable opportunity for clinicians in different countries to learn from an expert in that field and also to share their own professional experiences. Unfortunately, not all countries in the region have reliable internet coverage or sufficient bandwidth so some attendees were unable to join the meetings. In response to this, in recent months APLI has been looking at a new educational initiative in partnership with APHN.

Project Focus aims to set up online discussion groups between palliative care clinicians in specific countries in the Asia Pacific region and APLI mentors. Some nascent palliative care centres struggle with isolation, limited practitioner experience and variable institutional support. In effect, Project Focus would work towards similar objectives to Project Hamrahi: to improve the capacity for best practice patient care in the local setting and to reduce the isolation of palliative care providers in emergent services.

APLI is therefore calling for expressions of interest for mentors to volunteer their services to help support our regional partners. Project Focus would particularly suit clinicians who might otherwise find it difficult to travel overseas for mentoring work, as the contact will be online using a small group discussion format on the ‘Slack’ communication platform. APHN has already identified local clinicians in two separate services in remote and regional Indonesia who would like to be partnered with APLI mentors. In addition to this, there has also been some interest from doctors in Vietnam, Brunei and Nepal whose learning needs were unable to be supported by the APHN Dialogs.

Although the exact process will be flexible, it is proposed that education would begin with case presentations from the local APHN clinicians. These would then serve as a springboard for the APLI mentors to explain current evidence based practice recommendations. The subsequent discussion would then take into account local factors such as medication availability, local resources, staffing and other factors such that a viable and culturally appropriate management plan can be formulated.

I hope that you will share our excitement for this initiative. Project Hamrahi has demonstrated the value of teams of mentors made up of both doctors and nurses working together with local Indian clinicians over a sustained period of time. Project Focus has the potential to broaden the scope of such partnerships to other countries and so I invite you to contact me via chairman@apli.net.au with a short biography and reflection on why you would wish to work as a mentor.

- Anil Tandon


Your donations to APLI help in the following ways:

assist with training of doctors and nurses in palliative care practice in developing nations

support nurses to travel and teach as part of Project Hamrahi

help with purchase of critical site resources such as essential equipment and supplies,  medicines and educational materials