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INDIA, Rishikash, July 29th, 2018
July Clinic
Monsoon rain in July is the norm, but the continual rainy weather that hit Rishikesh on the last weekend of July, threw life out of gear for the Ganga Prem Hospice team, as travel became difficult, staff had to stay back at the hospice doing marathon shifts, and patients, their families and visitors were stranded at the hospice as the roads were blocked.

Despite the weather, patients wanting to visit the Ganga Prem Hospice cancer clinic continued to enquire over the telephone, wanting to make sure that an oncologist would be there.  Radiation oncologist Dr SK Sharma led the clinic on July 29th , 2018, and was supported by palliative care doctor, Aditi Chaturvedi, Ayurvedacharya JP Rathi, and Drs Amrinder Singh, R Muthunagai, and Yogeshwari Krishnan from the Seema Dental College & Hospital of Rishikesh.


   
Dr Sharma with a patient

Dr Sharma with a patient

Dr Aditi listens to a patient’s
Dr Aditi listens to a patient’s husband
     

 

 

Sixty-eight patients came for consultation, of which thirty-nine were either suffering from cancer or suspected of having cancer.  Six patients were counselled at the clinic, their issues ranging from needing diagnostic tests to confirm or rule out cancer, needing home care, and requiring inpatient admission at the hospice.

Tertiary hospitals in and around Rishikesh referred patients needing palliative care to Ganga Prem Hospice. The family of a patient with an advanced malignant gall bladder condition, who was still admitted to a hospital, came to the clinic with her reports and the hospital's advice that she needed to be referred to a hospice.


   
Seema Dental College doctors at the clinic

Seema Dental College doctors at the clinic

Nani Ma and Dr Aditi with the destitute patients
Nani Ma and Dr Aditi with the destitute patient
     

 

 

A destitute patient suspected of having cancer had been moving from one town to another and sleeping near ashrams and on Ganga ghats was given pain medication, and arrangements for his stay was made in a dharamshaala in Rishikesh. Volunteers discussed his case and one volunteer offered to accompany him for tests at a hospital.

Home care patients also came for consultation at the clinic.

Cancers of the breast, buccal mucosa, tongue, and thyroid constituted a majority among all the cancer types seen.

 


 

INDIA, Dehradun, July 27th, 2018
Palliative Care Sensitisation Talk


     

As part of the Pallium Ganga Prem project Dr Jyotsna of Seema Dental College gave a talk on palliative care to Asha workers at the Rural Development Institute at Jolley Grant, Dehradun. The programme was arranged by Shareena Bhaya, project manager of Pallium Ganga Prem.


 
 
 

 

INDIA, Gohri Maphi, July 26th, 2018
AIIMS MBBS Students Visit Hospice
On 26th July 45 MBBS students from AIIMS , Rishikesh, visited the inpatient facility of the hospice and after being shown around attended a palliative care sensitisation led by Nani Ma and Shareena Bhaya.


   
Medical Camp at Uttarkashi District Hospital

 

Medical Camp at Uttarkashi District Hospital
 
 

 

INDIA, Uttarkashi, July 20th- 22nd, 2018
Expanding Palliative Care: Uttarkashi
At the end of July, four members of the GPH team spent a long weekend in Uttarkashi to support the development of new palliative care initiatives.


   
Medical Camp at Uttarkashi District Hospital

Meeting with DM and Uttarkashi team

They met with local officials, medical professionals, students and volunteers over the course of the visit. The District Magistrate (DM) has taken a personal interest in the joint efforts of GPH and Pallium India to expand palliative care awareness and services throughout the rural areas of the Garwaal Himalayan region.

   
 

On July 20th the DM met with the team to discuss publicity plans for new services, progress on morphine availability and sources of local support for home care. Following this meeting, GPH’s Dr. Aditi gave an educational presentation to twenty doctors and nurses including an interactive role-play training focusing on oral mucositis and bed sore management. In the afternoon, fifteen local volunteers met with the visiting GPH team to share their ideas and plans for expanding palliative care awareness. Several of these volunteers are teachers who are eager to educate their communities about the new palliative care outpatient department at the district hospital and other newly available services such as home care visits. For this purpose, GPH is preparing posters and pamphlets for distribution.

 

 

 

 

On July 21st, Dr. Aditi presented a lecture on pain management, palliative care emergencies and wound care to an audience of fifteen at the district hospital. This event was immediately followed by the monthly free medical camp and a home care visit by the team. In the afternoon the GPH doctor and nurse offered another training to fifteen medical professionals focusing on the psychological and social issues that arise in palliative care. In the evening a talk was given to local ladies at the Vishwanath temple, some of whom were eager to become volunteers.

Before leaving on the 22nd, Dr. Aditi and a local nurse provided some much needed personal care to a 90 year-old destitute woman.


   
Medical Camp at Uttarkashi District Hospital

Medical Camp at Uttarkashi District Hospital

Home Care in Uttarkashi
Home Care in Uttarkashi
     

 

 

On July 21st, Dr. Aditi presented a lecture on pain management, palliative care emergencies and wound care to an audience of fifteen at the district hospital. This event was immediately followed by the monthly free medical camp and a home care visit by the team. In the afternoon the GPH doctor and nurse offered another training to fifteen medical professionals focusing on the psychological and social issues that arise in palliative care. In the evening a talk was given to local ladies at the Vishwanath temple, some of whom were eager to become volunteers.

Before leaving on the 22nd, Dr. Aditi and a local nurse provided some much needed personal care to a 90 year-old destitute woman.

 


 

INDIA, Gohri Maphi, June 29th, 2018
Kirtan at the Inpatient Facility
The patients, carers and staff at the inpatient facility absolutely love to have kirtan so they were all excitement when they heard that there would be kirtan on the morning of the 29th June.

GPH supporters Priya and Sanjeev Ahuja visited the hospice on the 28th June along with their adorable 5 month old little girl who kept on smiling as she was cuddled by patient after patient. Sanjeev is a member of a kirtan mandali in Sahranpur where he lives and he has taught Priya to enjoy kirtan too. They decided to return the next morning for a couple of hours of singing with the staff and patients. One of the nurses borrowed some musical instruments and a drum from her community as the couple had not brought their harmonium with them.


   

 

 
     

 

 

Everyone gathered together at 10am with those who could coming out onto the veranda and others sitting in their rooms. Sanjeev led the kirtan in his beautiful voice and also sang some bhajans with Priya. He invited the staff and patients to sing bhajans which some did with great enthusiasm. A few minutes quiet meditation was also held in the middle of the session which finished with some devotional dancing and helwa as prasad.

Sanjeev and Priya promised to come each month to have a kirtan morning and said that next time they will bring other members of his group along with their musical instruments.

 

 

INDIA, Rishikesh, June 24th, 2018
June Clinic
The Ganga Prem Hospice nurses did a wonderful job at the June 24, 2018, cancer clinic, taking care of some very ill patients with terminal stage cancer.

The nurses tended to the ulcerating wounds of the patients, doing their dressings with utmost care even though the smell from the wounds was overpoweringly unpleasant.  They offered other patients consolation and served cooling drinks to those waiting in the heat.  It was not easy for patients to travel to the clinic with temperatures soaring above the forty degrees centigrade mark. A patient who had travelled from a hundred kilometres away, and was in a markedly worse condition than on his visit to the clinic the previous month, was immediately offered a bed to lie down. His fungating wound was examined and the dressing replaced by two hospice nurses. As the patient regained his bearings after the long car ride, a GPH nurse lovingly offered him a glass of water, patiently holding the cup as he slowly took small sips of the liquid. He was given a pain medicine before his horrific wound was cleaned and dressed. As whatever he ate or drunk leaked from the gaping hole in his throat he was directed to a local hospital where he was fitted with a feeding tube. He lived too far away to be given home care so he was given a supply of pain medicine to take home.


   
Dr Sharma checks a patients wound before the dressing

Dr Sharma checks a patients wound before the dressing

Serving cold drinks to the patients
Serving cold drinks to the patients
     

 

 

Volunteers and the rest of the GPH team soldiered on despite the heat, wheeling patients in and out of the clinic, and keeping visitors hydrated with fruit juices kindly donated by the Rajasthani Sweet shop and by Patanjali  Ayurveda.


     

Among the seventy patients who attended the clinic the percentage of patients with cancer was high—66% and every fifth patient seen at the clinic was above the age of sixty-five. The seventy patients that arrived to seek consultation had come from ten different towns, and from four different states.

GPH staff help wheel in a patient
GPH staff help wheel in a patient
 
     

 

 

Six doctors, including two oncologists, a senior general physician, and two gynaecologists offered their consultation to the patients. Two other doctors were also available to counsel the patients, some of whom had come alone, and could not speak due to their health conditions. A sixty-year old who came alone and had cancer of the larynx had to write down what he wanted to say. He wrote on a piece of paper for the GPH team, "My throat is constricted. I put a finger inside to be able to breathe. I have a growth inside, and swelling on the outside. I find it difficult to breathe. Droplets of blood are coming out." The patient needed a tracheostomy, for which he was guided to a nearby hospital. The hospice team will offer him home care visits, to take care of his symptoms. 

As always volunteers assisted with the clinic operations. The canopy and pedestal fans, provided by a local tent-house as a free-of-charge service, helped tremendously with the waiting area arrangements, shading people from the blazing sun and helping to keep them cool.


   
Volunteers meeting at the clinic
Volunteers meeting at the clinic

As the clinic operations went on, a meeting with Rishikesh-based volunteers was held, to ensure better exchange of information between each other and with the GPH staff. Some of the volunteers have already assisted several patients with their socio-economic problems. A WhatsApp group was formed to keep the members up to date with needs and arrangements for service.

   
 

INDIA, Gangotri/Tehri Lake, May 29th June 1st, 2018
GPH Children’s Outing to Gangotri
A GPH supporter took five of the hospice children for a special outing to Gangotri and Tehri Lake. Four of the children were bereaved and one was a cancer patient.


     

Just to make sure that the children had a really good time, ten other children and four adults were invited to accompany them. The party set off early on Tuesday morning in a 12 seater bus and a 7 seater car. The host travelled by motorbike with the older children taking it in turns to have a thrilling pillion ride in the fresh mountain air.

Getting ready to leave
Getting ready to leave
 
     

 

 

The first day was a long drive and the group arrived in Gangotri tired but happy at 9 pm at night where their rooms had already been booked. By the next morning all the children were great friends and the wonderful day included a bath in the Ganga for those who braved the cold water followed by a visit to the temple. Later there was a trek for 4 kilometres up the path towards Gomukh where the children marvelled at the beautiful mountain peaks and shining Ganga river. In the afternoon the party walked through the sweet smelling pine and cedar woods to visit the Pandava cave and enjoyed watching Gangaji far below in the gorge.


   
Buying souvenirs in Gangotri

Buying souvenirs in Gangotri

In Gangotri Forest
In Gangotri Forest
     

 

 

After another good night’s sleep the party drove down the mountains past Harsila and Uttarkashi to spend the afternoon having a wonderful boat ride on Tehri lake which was followed by swimming and water games. The last night of the trip was spent at New Tehri with a fabulous view of the lake and the Himalayas.


   
Going for a ride on Tehri Lake

Going for a ride on Tehri Lake

A ride on a speed boat
A ride on a speed boat
     

 

 

As the little cavalcade wound its way back down the mountain towards Rishikesh, the children were bubbling over with exhilaration from the trip and danced and sang in their seats until they reached home. Thank you Ludo!




 

INDIA, Rishikesh, May 27th, 2018
May Clinic
An end-stage oral cancer patient with a gaping wound on his lip undertook an eight-hundred kilometre journey from near Lucknow to Rishikesh, in search of help.


     

The patient and his brother boarded a train from Rai Bareilley in Uttar Pradesh, and they arrived at the clinic carrying a flask of water, a bag with his medical reports, and a newspaper in which news about the Hospice had been published earlier. The patient is now admitted to the Hospice inpatient facility.

Sister Mamta and Dr Painuly comfort the young widow
The patient from Rai Bareilley
 
     

 

 

This patient's arduous voyage summed up the tenor of the May 2018 cancer clinic of Ganga Prem Hospice. Patients had travelled from nineteen different towns to reach the clinic, braving the searing heat, and the summer holiday traffic rush, as they were all looking for relief from their condition. The hospice team did its best to meet the challenge, and to offer support to patients. No patient was turned away, even when some arrived much after the clinic hours were over. The last patient was given as much time and attention as the first one of the day had been given.



   
Dr Vats writes a prescription

A patient with advanced cancer waits to see the doctor

Sister Priyanka with a patient
Dr Dewan explains the prognosis the a patient’s son
     

 

 

Eighty-seven patients were seen at the clinic, out of which a staggering sixty-one patients (70%) suffered from cancer. Another three patients were found to have symptoms that pointed towards possible malignancy, and needed diagnostic tests as follow-ups.

Not only were cancer patients in majority, but it was patients from outside of Rishikesh who out-numbered local patients. Fifty-one patients came to the clinic from towns other than Rishikesh, many of them from western Uttar Pradesh, the state that borders Uttarakhand. Some of the more financially secure patients turned into donors as they saw the service that was being provided by the Hospice team. 

With two oncologists seeing patients, and two other senior doctors providing support in consultation, the waiting time for patients was cut down, even though the clinic footfall was heavy.  Patients were also given counselling support, medicines and refreshments, and were offered home care and inpatient care, wherever needed.




 

INDIA, Pauri/Srinagar, May 22nd -27th, 2018
Pallium Ganga Prem in Pauri/Srinagar
In the last week of May 2018 Ganga Prem Hospice team visited Pauri and Srinagar as part of the Pallium Ganga Prem project to bring palliative care to all corners of Uttarakhand.


     

 

 

The GPH project manager, Shareena Bhaya, went ahead on 21st May to prepare meetings and engagements for the medical team which followed on the 24th May. Shareena took help from the Srinagar Rotary club to organise a cancer camp on the 25th May and also to have a meeting with the SDM at Srinagar to hand over the letters concerning applying to the State government for opening a palliative care centre with access to opiates. Arrangements were also made to hold a CME on palliative care on the 25th and for a meeting with the DM on the same day.


   
The Alakhananda at Srinagar

The Alakhananda at Srinagar

GPH Cancer Camp at Srinagar
GPH Cancer Camp at Srinagar
     

 

 

On 25th May Dr Aditi Chaturvedi and Sister Mamta Krishali from GPH conducted a CME on palliative care at the Government Medical College which was followed by a palliative care camp at the Sanyukta District Hospital in Srinagar. In the meantime Shareena met the District Magistrate in Pauri to explain what was needed and to arrange for a meeting with the GPH medical team in the evening. A second CME was conducted at the CMO’s office in Pauri and was followed by a successful meeting with the DM who was keen to open a palliative care centre in his district.


   
GPH team with the DM of Pauri

GPH team with the DM of Pauri

Dr Aditi leads a CME at Pauri
Dr Aditi leads a CME at Pauri
     

 

 

The 26th of May saw another CME for the doctors of the district hospital and was followed by homecare visits to patients in the town of Srinagar and in nearby villages. A rotary member sponsored a taxi to bring one of the patients down to the GPH inpatient facility.

The visit to Pauri and Srinagar were very successful with a plan to return in August for the inauguration of a local palliative care centre. Pauri already has a doctor and nurse who have received basic palliative care training and the DM has assigned a room to be readied to serve as a centre.



 
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