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INDIA, Rishikesh, December 24th, 2017
December Clinic
For the second month in a row, the percentage of cancer patients at the Ganga Prem Hospice monthly cancer clinic remained above sixty percent; forty-five of the seventy-two patients seen were suffering from cancer.

Since September 2007, Ganga Prem Hospice has been hosting a free, walk-in cancer clinic in Rishikesh on the last Sunday of the month. Specialists from Delhi and beyond join local physicians to perform cancer screening, provide medical/diagnostic advice, and to offer GPH palliative care services to those who are terminally ill. Free medicines and supplements are provided to the needy, and refreshments are donated by local businesses


   
Dr (Mrs) Dewan writes a prescription
Dr (Mrs) Dewan writes a prescription
Dr Dewan shows visiting doctor a patient’s report
Dr Dewan shows visiting doctor a patient’s report
     

 

 

To avoid holding the clinic on the last day of the year Sunday the 24th was chosen for the December clinic. Dr AK Dewan, the lead oncologist at the clinic, was supported by senior gynaecologist Dr Rupali Dewan and general physician Dr GS Vats. These three together have more than a hundred years of clinic experience between them. Two visiting palliative care doctors from UK, a young visiting emergency physician from Spain who was happy to sit with Dr Dewan and learn from his experience, an ayurvedacharya and a second gynaecologist were also present at the clinic.


     

The seventy-two patients came from eight different towns around Uttarakhand and the neighbouring state of Uttar Pradesh. Forty percent of the total number of patients were women. Five GPH home care patients came for an oncological consultation and one patient with advanced cancer of the stomach was admitted to the inpatient facility for management of his symptoms.

A patient is wheeled from the clinic
A patient is wheeled from the clinic
 
     

 

 

There were fourteen patients in the oral cancer category. Cancers of the breast and tongue were the most prevalent types seen; there were six cases of each. A post-surgery patient had his incision dressed at the clinic while another had his tracheostomy tube changed. Some patients spoke to multiple doctors depending on their ailments, and the palliative care doctors spent time with the terminally ill patients.

Medicines were given out free of charge to the needy, as were nutritional supplements and health products from Organic India. A local laboratory offered discounted pathology tests to the patients at the clinic and a technician was sitting on the verandah taking blood samples . A neighbouring restaurant once again provided refreshments for everyone.

 


 

INDIA, Gohri Maphi, December 25th, 2017
Christmas Party at the Hopice
Inpatients, home care patients, families, staff and volunteers all came together at the inpatient facility on 25th December to celebrate Christmas Day.


   
Children enjoy snacks at the party
Children enjoy snacks at the party
Christmas puja altar
Christmas puja altar
     

 

 

Christmas decorations were hung around the main balcony, a small altar was made and Christmas music played. Inpatients rested on the balcony as the visitors joined them to celebrate the first Christmas at the new hospice.

It did not take long for the dancing to begin! All enjoyed themselves taking part in the dance or watching others. The children present joined in too. Our two child patients participated with delight. Although Reshu is now confined to bed and unable to move the left part of her body due to her brain tumour, she still sang and danced on her bed with great enthusiasm; jingle bells being her favourite song!


   
Dancing at the Christmas party
Dancing at the Christmas party
Reshu joins in the dancing
Reshu joins in the dancing
     

 

 

Following a lovingly prepared meal by the hospice kitchen staff, the party continued with games and the distribution of sweets and fruit. Monika, the daughter of a previous GPH patient sang a beautiful solo Hindi carol. Those of us who knew her mother reflected on how proud she would have been to see her lovely daughter perform.

The party would not have been complete of course without Christmas cake. Two large iced plum cakes ensured no one went without! Santa was present to distribute presents brought by recent visitors to the hospice including Dr Hemlata Dhaundiyal, member of Uttarakhand Human Rights Commission.

The party finished by remembering the birthdays of Vikas, an inpatient who celebrated his seventeenth birthday on this day and of staff member Sister Priyanka Nainwal whose birthday had been a few days earlier.

It was a lovely, memorable Christmas Day.  All agreed the first Christmas party held at the new hospice was a great success!

 


 

INDIA, Rishikesh, December 7th, 2017
Bereavement Meeting
On December 7th2017, Ganga Prem Hospice volunteers held a Bereavement Group meeting for families of deceased patients.


     

 

 

Those bereaved in Rishikesh were invited to attend, five women participated. Bereavement is an important aspect of palliative care provision.  A warm welcome was offered to those attending and they were all thanked for having the courage to come.

Basic but important ground rules for the group were set; each person’s grief is unique, it okay to talk or just listen, respect confidentiality, and thoughts and feelings are neither right or wrong. 

The opening for the group included lighting a candle and sharing the ‘Mustard seed’ story.  Do internet search “mustard seed story” if you are not familiar with it.  It is a powerful story about grief and loss.  As part of the introductions, the group shared their names, who they had lost, and why they came.  Discussion included some common struggles people experience when they are grieving and how their friends and family are responding to the loss.  Some basic grief education helping to normalize some of the common physical, emotional, cognitive, and behavioural reactions to grief was provided. The importance of self-care during this period of grief was also discussed. 

     

There were tears but also connections and hope within the group.  The women all brought photos of their loved ones and shared them with the group.  The event finished with time for socializing over masala chai and biscuits.  All the women left with a small container holding a few mustards seeds; a reminder that they are not alone in their grief.

Sr Mamta dispenses free medicines
 
 
     
 

INDIA, Rishikesh, November 30th, 2017
GPH Staff Support Session
When taking care of people at end of life it is essential that we also take care of ourselves. In hospice, the word team is at the core. Every staff member and every role they carry out is a very important part of the team.

We are taking care of people at a fragile time in their life.  It’s import for us to take time to reflect on how this work impacts us?  This work is a privilege and at times it feels like we get so much more out of it than we could from any other job or volunteer work.  We give a lot but we get a lot.  The moments that we can offer a smile, a beautifully arranged meal, a clean room, clean clothes, the physical, emotional, social, and spiritual care that the hospice team so lovingly offers – these moments are experiences that fill us too.  We are helping people to live fully until they die.  Helping to make this moment the best it can be.  This work provides us constant reminders about the inevitability of death, what is important in life, and how to live each day as if it’s the last.

Doing this work it’s helpful for us to understand grief and the various ways (physically, emotionally, and cognitively) it can impact us.  It is important for us to be mindful of our own self-care when doing this work.  We need to find ways to develop or increase our attention to and techniques for self-care.What do you do to unwind?  What do you do to help you continue to do this work? Supporting one another is essential. We need to take care of ourselves in order to be effective and to continue to do this work.Yoga, meditation, and relaxation techniques can help us.

On November 30th , 2017 the Ganga Prem Hospice staff was offered a Staff Support Session during which these topics were explored, discussed the privilege of this work, and some yoga, breath awareness, and meditation were shared with them.  The session was led by Laurie Farmer and Rose Gordon, hospice workers from the USA.

 


 

INDIA, Rishikesh, November 26th, 2017
November Clinic
Even though the November cancer clinic of Ganga Prem Hospice did not attract as high a total number of patients as the monthly service generally does, the percentage of cancer patients was sixty percent as forty-one of the seventy patients seen were cancer patients, with another two as suspected cases.


   
Dr Sharma consoles a patient
Dr Sharma consoles a patient
Dr Dewan and Dr Keifer study a patient’s reports
Dr Dewan and Dr Keifer study a patient’s reports
     

 

 

Three oncologists were present at the clinic, and were supported by two palliative care experts, an internal medicine physician, a gynaecologist and an ayurvedacharya. Surgical oncologist Dr AK Dewan and radiation oncologist Dr SK Sharma were supported by Dr Gauri Kiefer, medical oncologist from the University of Pittsburgh School of Medicine, USA. who was visiting the Ganga Prem cancer clinic for the first time. Drs Swati Narain from Mumbai and Laurie Anderson from UK from also joined the clinic for the first time.

Patients were offered home care as well as inpatient admission when found in need of the services. An eighteen-year-old patient suffering from advanced stage cancer of the larynx was admitted to the hospice as he was not a local, and needed to be close to his hospital for his ongoing treatment. Detailed instructions were later given to the hospice staff about the patient's specific dietary needs.

   
Dr Aditi counsels the young patient
Dr Aditi counsels the young patient
Sr Mamta dispenses free medicines
Sr Mamta dispenses free medicines
     
A total number of seven patients were counselled by palliative care doctor, Aditi Chaturvedi, who assessed patients' needs, whether for hospital treatment, home care, or other forms of support. A terminally ill patient who had symptoms of distress but had consistently refused home care was gently advised that there was no shame in seeking assistance and professional care in time of need, and that hospices were meant to provide succour in exactly such circumstances as being faced by the patient and his family.
Sr Mamta dispenses free medicines
Dr Vats examines a patient
 
     
     

 

 

The seventy patients at the clinic came from fourteen different towns, namely Rishikesh, Haridwar, Dehradun, Uttarkashi, Kotdwar, Mussoorie, Tehri Garhwal, Rudraprayag, Roorkee, Sahranpur, Muzaffarnagar, Srinagar, Chamoli and Sahranpur.

Breast cancer has consistently been the single-most common type of cancer found. At the November clinic, again it saw the most patients with eight cases. As a category, head & neck cancers were most pre-dominant with fifteen cases. In all, twenty-one different kinds of cancers were seen among the forty-one patients suffering from cancer.

 


 

INDIA, Rishikesh, November 24,25&26th, 2017
GPH 3rd IAPC Training Course
On 24-26th November 2017, twenty-one health care professionals from around Uttarakhand attended the Ganga Prem Hospice and Indian Association of Palliative Care (IAPC) training course in Rishikesh.


   
the Tibetan group sing together
Sr Priyanka makes a presentation
The participants liten to a lecture
The participants liten to a lecture
     

 

 

The GPH Presents Third Annual "Essentials of Palliative Care" Training Course was once again hosted by Seema Dental College & Hospital (SDCH), and the curriculum was managed by the leaders of the GPH medical team. For three full days the GPH hosts enjoyed sharing their knowledge and skills with other professionals who are dedicated to improving their understanding and practice of palliative care. The course material covered all domains of palliative care and was presented by fourteen different experts in the field. Participants included doctors, nurses, dentists and psychologists as well as some lay supporters of the hospice who wished to increase their knowledge of palliative care topics. A ‘WhatsApp’ group has been created so that participants can stay connected and to share information and inspiration. 

The group will reconvene early in 2018 for a final exam. In the interim, participants are requested to write a reflective study about a current or previous palliative patient under their care. Both the exam and the essay are required in order to receive IAPC advanced training certification.

For details of the course lectures and faculty please visit http://gangapremhospice.org/pages/03hospice/palliativecare.htm

 


 

INDIA, Rishikesh, November 24th, 2017
GPH and the Rishikesh Rotary Club
On 24 November 2017 some of the team from GPH attended a Rotary Club meeting to discuss the importance of palliative care and to request support from the Rotarians.

Whilst some members of the Rishikesh Rotary Club have already been assisting GPH in a variety of ways, the talk given by volunteers from the hospice allowed for a greater understanding of the issues needing to be addressed. Visiting palliative care doctors from the UK presented the concept of palliative care and explained the role of GPH in providing hospice services. This was followed by an account of the value of volunteering by visiting hospice supporters. The Rotarians were encouraged to consider the variety of ways they could offer their assistance.

After the formal presentations, a stimulating discussion occurred which then expanded over a group dinner. Stories of difficult situations for deceased family members were shared and all agreed on the importance of improving access to quality palliative care for the people of Uttarakhand. Several of the Rotarians were inspired to commit to supporting the hospice and agreed to attend the planned training for volunteers. The GPH team appreciated the kindness and willingness of the Rotarians shown to them at this meeting and look forward to their continued support.

 


 

INDIA, Gohri Maphi, November 9th, 2017
Tibetan Cultural Programme
On 9th November students and teachers from the local Hermann Gmiener Tibetan Homes School performed at Ganga Prem Hospice.

Patients and staff enjoyed a special treat when some of the young people from the neighbouring Tibetan School in Gohri Maphi visited Ganga Prem Hospice. The students presented their traditional song and dance in the circular courtyard near the front of the hospice temple. The previous week the school had invited staff from the hospice to attend their yearly sports function. In turn, the GPH doctors then requested the students to perform at the hospice.


   
the Tibetan group sing together
the Tibetan group sing together
Traditional Tibetan dance
Traditional Tibetan dance
     

 

 

The Tibetan children and their music teacher performed for an audience of hospice inpatients, visiting home care patients, staff, volunteers and local children. Their performance with Tibetan dress, musical instruments, song and dance was superb. The audience had a lot of fun joining in the dance later in the program. The music teacher sang nostalgically of Tibet and their ancient traditions in a wonderful voice. He also sang a moving song for world peace and two well known songs in Hindi which delighted the audience.

Reshu, a young girl who was recently an inpatient, returned to the hospice with her mother and baby brother – much to the delight of the staff– to enjoy the event. Reshu loves interacting with young people. The performers had snacks at the hospice and mingled with the staff. They explained how they try to keep their culture alive even though they are in exile. One young man said tearfully that he had never seen his country but longed to go there one day.

GPH is grateful to the Tibetan youngsters and the staff of the Tibetan Homes Foundation who appeared so genuinely pleased to contribute to the hospice cause. Everyone looks forward to their promised return visit in the new year.

 


 

INDIA, Delhi & Shimla, November 5,6th & 18,19th, 2017
GPH & Paediatric Palliative Care Training
During November members of the Ganga Prem Hospice medical team assisted in two palliative care conferences in North India to train health care professionals in the care of children with life threatening illnesses.

Provision of palliative care for children is poorly resourced throughout the world and particularly in India. There are very few specialists in the country so it was with great enthusiasm that the doctors joined experts from India and abroad to assist in training.

The first conference was in the AIIMs Hospital Delhi; a joint venture between Cankids, the Delhi based charity supporting children with cancer and AIIMs hospital, Delhi (November 5-6). It was attended by over 100 health care professionals. Alongside lecture presentations, the participants also took part in workshops and discussed ethical issues.

The second conference was in Shimla, a hill station in the Himalaya which is the capital of the state of Himachal Pradesh (Nov 18-19). This conference was well attended by medical students as well as paediatricians and Intensive care specialists and provoked interesting discussions on end of life care which gave the team plenty to consider.

The team are committed to increasing the number of children on the GPH home care program and have made efforts to ensure child patients are identified. Two such children have been admitted to the inpatient facility this month.




 
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