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Project Hamrahi – Pushpagiri, Kerala

October 2010

Participants

Pushpagiri Palliative Care Service
Dr Thampi Thomas (Medical Director of Unit)
Dr Jacob, volunteer and physician

APLI
Dr Sok-Hui Goh
Dr Andrew Goh

Pallium India
Prof. Rajagopal, Chairman and Founder

Summary
The Pain and Palliative Care Society, Pushpagiri began in 2002, where the main thrust is to look after cancer patients at the last stage of their lives. It largely caters for the poor and those from the lower strata of society. Apart from symptom control, the society also helps families of patients who die or those who become incapacitated at the early stage of their illness in the form of construction of homes (2) and education – putting 5 girls through nursing school. Apart from caring for cancer patients, the Society embraces patients who are bed bound from various causes such as paraplegia from MVA, spinal cord compression, paraneoplastic syndrome, myositis ossificans etc. They manage regular foley cather change monthly (sialastic catheters too expensive) as well as supervising pressure area care. There are no domicillary care services and all the care is provided by family members.

Pushpagiri provides all the infra structure facilities such as Out-Patient Clinic, In-patient ward, an office, as well as doctors, nursing and other paramedical staff. The donation of a van has enhanced the service, enabling them to conduct home visits and operate an outreach outpatient clinic. Often patients are found to be too poor to find the fares to attend the outpatient clinic at Pushpagiri Hospital.

The unit is glued together by Reverend AC Kurian, Vicar General who tirelessly campaigns for financial support and volunteerism. There is a core of dedicated volunteers who enables this service to run on donations from both local and overseas benefactors. There is no social security or medicare funding for patients – this unit’s major thrust is for the poor, by covering patient’s costs of medical treatment including consultations, investigations and medication. Pushpagiri hospital (a private Catholic hospital) provides the infrastructure (a 20 bed ward and OPD clinic) and pays the salaries of Dr Thampi and nurse aides.

Morphine availability – they have access to 1.5kg oral morphine tablets (10 & 20 mg tabs) per year through Dr Thampi (the only person who has the permit to access and prescribe the medication)

Dr Sok-Hui’s main activities were clinical, attending ward rounds with Dr Thampi, an anaesthetist, and Dr Jacob, outpatient clinics and going on home visits. The home visit team included a volunteer coordinator, intern, auxillary nurse and driver. The team saw a total of 11 patients. Some of the homes were far away, in the poorer areas. Some were over 20kms away. The home visits proved to be “the highlight of my experience as I was able to engage the whole team in informal hands on teaching and general discussion on the precepts of palliative care”. Other teaching included to the interns who rotated weekly through the unit, and to nurses, including an interactive session on self care and spiritual care of patients and demonstrating the subcut route of giving injections.

Finally, it was agreed that further visits would not be planned for this unit, as they had a well developed and developing model of care.

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

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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