when two worlds meet
TRANSCRIPT
Journal of Pain & Palliative Care Pharmacotherapy. 2012;26:278–279.Copyright © 2012 Informa Healthcare USA, Inc.ISSN: 1536-0288 print / 1536-0539 onlineDOI: 10.3109/15360288.2012.708392
NARRATIVE ON PAIN SUFFERING AND RELIEFEdited by M.R. Rajagopal
When Two Worlds Meet
Lyndsey M. Brahm
ABSTRACT
The author is one of four American premedical students traveled to India to spend a month with Pallium India(palliumindia.org) to learn about palliative care at Trivandrum Institute of Palliative Sciences, in the south Indianstate of Kerala. The program was arranged by Child Family Health International (cfhi.org). They attended class-room sessions and joined the palliative care team during home visits and hospital consultations. They learnednot just what palliative care is, but also how to understand and adapt to another culture. It was shocking to learnthat all health care expenses are often out-of-pocket for most of the developing world and to see the extentof the suffering involved in life-limiting diseases. The students saw how the medical professional could adopt abasic and simple approach to medicine, acting as a mix of scientist, humanist, and spiritualist. She concludesthat we in the United States too seem to be learning the value of such an approach and to make better use ofavailable resources to improve the quality of life of those who are suffering.
KEYWORDS cultural immersion, India, pain, palliative care
Often times, when you step into someone else’sworld, bringing with you a piece of yourself, thereis bound to be an exchange from one culture to an-other. The experience you have with the world be-yond your own borders, learning from one another,sharing stories, taking the time to overcome miscon-ceptions that too often divide us, is an experiencethat has the power to shape you and open your mind.When two worlds meet, the world as we know it growssmaller and more connected.
I arrived in Thiruvananthapuram, the capitol cityin the southern state of Kerala, India, for a month-long global health education program. Three otherAmerican students and I were invited to learn aboutpalliative care from a well-known and influentialcharitable organization, Pallium India (Pallium). Aspremedical students from Child Family Health Inter-national, a leading United States nongovernmentalorganization (NGO), we were fortunate enough tobe placed under the guidance of Pallium India to
Lyndsey M. Brahm is a premedical student who traveled to India un-der the auspices of Child Family Health International, San Francisco,California, USA, in May 2012.
Address correspondence to Lyndsey M. Brahm (e-mail: [email protected]).
learn about palliative care and the true story of thosefaced with life-limiting or life-threatening illness insouthern India.
This journey was especially unique in that cultur-ally India was very different to my own culture andto others I had become familiar with and felt com-fortable around. Immediately, I was struck with anabundance of new sights, sounds and smells, brightvibrant colors, aggressive horns, an array of spices,and the familiar scent of the tropics. It took hold ofmy senses! I was surrounded by the magic and won-ders of India. However, in the same breath, as is of-ten spoken of India, the so-called land of paradoxes,so too were perpetual signs of misfortune and sorrowseen everywhere.
The need for an organization like Pallium India isabsolutely vital in a health care system that receives nofinancial assistance from the government nor is therea functioning insurance system for people to seek eventhe slightest amount of support. It is taxing enoughto bear the emotional weight of having a loved oneafflicted with disease, but in addition when illness ortragedy strikes a family, too often they are left to fendfor themselves, feeling neglected and helpless. Manyfamilies do not have the financial means to support
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Narrative on Pain Suffering and Relief 279
the cost of treatment, and sometimes family mem-bers are forced into the role of caretaker, having toperform tasks that they never expected of themselves.Others are forced to leave their jobs only to increasethe family’s financial burden, passing on a debilitatingdebt to future generations. And worst of all, standingby as disease shows its ugly face and threatens theirloved one with the possibility of dying an undignified,painful death. When this happens there is no placeto hide. Pallium India refuses to accept this unfor-tunate and unjust fate of people burdened by thesesituations. With the help of donations they are able toextend medical care into the community. It is an enor-mous responsibility to shoulder, but one that has theproven power to relieve not only the patient, but alsothe family, of potentially destructive physical, mental,and emotional pain.
To grasp the complexity of managing a life-limitingor life-threatening illness and the enormous impactPallium India has on the lives of these people, we trav-eled daily with doctors and nurses from the organiza-tion to observe their work in the community. Often wewere packed tightly into a small van that at times feltlike the inside of an oven if it was left idle for long pe-riods. We traveled for most of the day through heavilycongested city streets and on small village roads, thatarguably could be called anything but, to monitor andtreat patients in their homes and various inpatient andoutpatient clinics. Some of these homes were difficultto access, sitting atop hills or on rocky, unstable ter-rain. However, by bringing highly qualified doctorsand nurses, good treatment, and effective medicinesto those who either cannot afford transportation or donot have the physical strength to make the trip to thehospital, these efforts significantly helped to decreasetheir worries.
In each home, each patient was tended to as if theywere the only person being treated that day. I wit-nessed first hand a wholesome approach to medicine.And I came to understand that to treat patients as awhole means to address not only the physical com-ponents of illness, but also the mental, social, andspiritual components of the person, as well as theirfamily. I watched intently as doctors and nurses satnear the patient, making certain to establish a com-fortable rapport, one of equality and gentleness. Welistened as patients and family members expressedfears, concerns, and hopes. Patients appeared to feelsafe under the care of Pallium India. Even those whowere ill fated, abandoned by family because of so-cial pressures from stigmas associated with their dis-ease or disinterest in being a caretaker, even theycould muster a smile and were happy for the com-
FIGURE 1. American premedical student Alex Macy and Dr.Sithara tending to a young patient at Sree Avittom Thirunal Hos-pital for Women and Children, where Pallium India has a newlyestablished pediatric palliative care clinic.
pany. There were also many homes filled with fam-ily members who wanted to help. They welcomed us,offering seats and a cup of tea, curious about why wewere there. Even in the midst of so much sadness andconfusion, they showed us the best of hospitality.
It is difficult to piece together the right words toexpress my gratitude and appreciation for all that Ilearned and all that I felt throughout my time in Indiaand upon returning home. My mind was opened toan entirely new world. It was a refreshing experience,one that invited new thoughts, ideas, and beliefs. Mytime spent learning from those at Pallium remindedme to recognize signs of peace even in chaos, to listenwell to peoples’ stories, and when treating patients,to do my best as a prospective medical practitioner toadd life to a person’s days not merely days to their life.
Ironically, it seems that the United States, with ahealth care system in a current state of disarray, hasfinally begun to recognize the importance of a ba-sic and simple approach to medicine, concepts andpractices that have long been used in the develop-ing world. The focus has shifted towards making bet-ter use of resources and training health care pro-fessionals to be well-rounded practitioners, an evenmix of scientist, humanist, and spiritualist. The ironicpart is that much of these developments are a reflec-tion of what I learned in India. As I have discov-ered, time and again, that when two cultures meet,the world as we know it grows smaller, more con-nected and we can all benefit by learning from oneanother.
Declaration of interest: The author reports noconflicts of interest. The author alone is responsiblefor the content and writing of the paper.
C© 2012 Informa Healthcare USA, Inc.
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