Is a razor in your palliative care toolbox?
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I was lucky enough to be invited to the beautiful Lakshadweep Islands, off the Kerala coast,

to visit and consult with a palliative care organization, Thanal Charitable Organization.  Travel to these Islands off the coast of India is highly restricted to preserve its ecological balance  and the Muslim way of life.  Permits can take months to get.  My trip was made possible by the dogged determination of the Chairman of Thanal whose name is Moulana.

Moulana is a secondary school history teacher. He has done many other things, including 5 years as a Kathakali performer. He started Thanal Charitable Organization in 2009.

My Malayalam ( zero) and his English mean that I cannot report all the details but he saw a need for care of the house bound elderly patients and responded to it, initially on a bicycle with a shoulder bag in 2005.  Now he has recruited volunteer physicians, nurses and support staff who have committed themselves to DAILY wound dressing changes, and seeing 3-6 patients every afternoon after work. Their current census is 62. Their funding is all local, which means that they are limited on an island where almost everyone works for the government, coconut harvesting, and tuna fishing.

The importance of international palliative care visitors is to validate the importance of this  palliative care program for the island.  This was not lost on Moulana who introduced me  for 4 days to government officials, teachers, students, and community members.  In some cases, I was asked to give motivational speeches to children.

Moulana tells many stories to illustrate his points.  He tells of one man who called and requested palliative care.  Before sending his medical team, Moulana decided to groom his long nails.  He believes that physical appearance reflects the inner sense of being.

I got to see this first hand when Moulana arrived 45 minutes early one morning and said that we had a home visit to do. This was unusual since most home visits are after work. We arrived at a home to meet Nallakoya, a retired government worker from the electricity board. He appeared frail and shuffled to the stairs and Moulana helped him down the stairs into the well swept front yard.

What happened next is not in MY palliative care toolbox. Moulana started cutting his hair!  

And then he shaved him, changing the blade at least once to get a close shave. The result was subtle but real.

Moulana encouraged him to walk about the yard, and water the plants. The shuffling was gone, and he even marched for some steps with a big smile.  Moulana feels that the face, the “visage” as he calls it, is a view of the heart. Before the team of nurses and doctors started their medical assessment of the “patient,”  Moulana wanted the person to feel and look his very best.

On our way out, Moulana said “Madam, palliative care is an art.”

And here is your moment of Zen…