By Dr. Ann Broderick
University of Iowa is sending its 1000th student to India during Winter Term 2015 in a program that has been the brainchild of emeritus geography professor Dr Rangaswamy Rajagopal for over 5 years.
Among other programs in art, engineering, physical diagnosis and special education, Dr. Rajagopal asked the internationally renown Dr. M.R. Rajagopal (no relation) to host students in the palliative care program he leads, Pallium India. You can (and should) read Dr.Hannah Fox’s blog about the challenges of providing access to pain control in a country where morphine has not been historically available.
With their average census of 600, Pallium India teams provide outpatient clinics, home visits and inpatient care. Today I just came back from a home visit day in the countryside in which the Pallium team (doctor, nurses and volunteer) saw 9 immobile patients in their homes because they could not come to clinic. Pallium services were free to them because they meet the financial criteria for government food subsidies.
They had a variety of medical illnesses: stroke, advanced colon cancer, trauma, polio sequelae, dementia, prostate cancer. They were all cared for by their families. The nurses asked me how we did home visits and took care of the elderly in our country. They were startled to hear that the elderly frequently are cared for outside the home.
The day started early and we drove to the rural community and stopped at the home of a community Pallium volunteer who stayed with the Pallium and Iowa teams throughout the day to make sure that we found the homes easily and could provide follow up afterwards. We hiked to some homes and drove directly to others. The Iowa team felt an enormous privilege to be with this highly respected clinical team. We gathered what we could in the clinical interactions, all conducted in Malayalam, the language of Kerala.
The Pallium team stopped for lunch at a roadside restaurant. The Iowa team had decided to have snacks while the Pallium team ate their rice with curries and condiments—all super chili hot and served on a large banana leaf.
We also learned what we could about the local economy. Rubber trees were everywhere we went. The families appeared to be collecting sap in coconut shells. The sap is manipulated in some way to produce what looks like dirty dish towels hanging on the line, but has the feel of vinyl.
Our Iowa team was moved today by being invited into homes to bear witness to the accomplishments of Pallium India and the courage of families caring for their loved ones with ingenuity (see the pulleys for one of our patients) and love.
Dr. Ann Broderick, Director, Hospice and Palliative Care Program at VA Medical Center, Iowa City