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A return to Cachar Cancer Centre

Author: David Brumley, Sarah Corfe and Ofra Fried
06 May 2014

Having visited last year under the auspices of Pallium India and Australasian Palliative Link International (APLI), Sarah Corfe and David Brumley decided to return to Cachar Cancer Centre, in the rural town of Silchar in Assam. This is article is a report of their visit.

Sarah and I enjoyed ourselves so much there last year and were, we thought, quite close as we were both attending the Asia Pacific Hospice and Palliative Care Network (APHN) Conference meeting in Bangkok. Sadly Oliver Haisken couldn’t be with us this time but Ofra Fried, a palliative care physician from Townsville, agreed to join us. On the way to Suvarnabhumi airport in Bangkok for our flight to Calcutta and Silchar, we were a little anxious as we listened to reports of Cyclone Phailin thrashing the East coast of India. We needn’t have worried; the worst we experienced was a windy night in Calcutta.


But there is always anxiety when returning to a place where you’ve previously enjoyed yourself. Will it be the same this time? Am I remembering correctly? We need not have worried about that!


We were once again met at the airport by the hospital ambulance, but this time we had arrived at the time of Durga Puja, which is possibly the most significant social and cultural festival in the Hindu calendar. Since the festivity includes huge numbers of processions, bound for every bridge in a place of rivers, it was a long, happy, noisy and exciting drive to the hospital. We met up with the Director Dr Ravi Kannan and his wife Seetha, and Dr Iqbal Bahar, the palliative care physician at the hospital. They were as welcoming as ever, and we were cared for very well once again, with superb meals cooked by Seetha.


The hospital itself has grown. Last year the top of the hospital was sprouting steel rods, but this year they had been converted into more levels of hospital and will soon be occupied as new wards, operating theatres and accommodation. Cachar Hospital is becoming a model for rural cancer care. It is run with great energy, enthusiasm and dedication, and it attracts resources from elsewhere including professional staff volunteering there in order to learn from the hospital’s exemplary practice. As an example, we met two volunteer gynaecological oncology surgeons during this visit.


The Palliative Care Service had developed significantly since our previous visit. Last year, Project Hamrahi funded two of the nurses to attend palliative care training in Trivandrum. Sarita, the ward manager and Achun, a senior nurse returned with new skills and ideas, and have been educating other staff since then. The atmosphere in the ward is very positive, and the nurses raised many concerns which, interestingly, were not so different from those we face in our Western palliative care practices.


Seetha had already met with the palliative care staff, canvassed ideas and prepared an extensive teaching program for the three of us to cover during this second visit. She said the nurses were like 'sponges’ in their keenness to learn, and we certainly found them so. Their level of formal nursing training was very variable, and we taught across several language barriers with the participants, who were themselves from a variety of ethnic and language backgrounds, translating amongst themselves. The biggest new initiative in palliative care at Cachar is the development of the home care service, largely staffed by senior nurses with the support of Dr Iqbal. This is no mean feat in an area of deep cut rivers and floodplain, where roads are difficult and flooding frequent in the wet season.


The service faces the same problem we face in Australia; the costs in time and transport are very high. But in other ways the situation is radically different. In this river valley live 3.5 million people, and the town of Silchar itself has a population of more than half a million.


All three of us enjoyed a day out on house calls with nursing staff. We enjoyed discussing ideas about teleconferencing and perhaps videoconferencing to reduce travel costs, and look forward to sharing more ideas about that. We enjoyed a great farewell (actually two, since I left earlier) including a very funny parade of local costumes and displays of dancing and singing. Sadly, all I could manage was a feeble and croaky rendition of Kookaburra sits in the old Gumtree! Sarah and Ofra danced the night away to Bollywood themes, to the great amusement of the locals. As I’ve said before, we always learn more than we teach in these visits, and my learning this year included some tutorials in abdominal ultrasound from Dr Iqbal. This is one of his many talents. Farewell again, Cachar, but we may be drawn back yet again by your enthusiasm, your skill, and your wonderful hospitality.


This piece is one of a series of articles that will be published on ehospice Australia from the Australasian Palliative LinkInternational (APLI).

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