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A meeting of mind and hearts: Lakshadweep Hamrahi 2013

Author: Dr Sophia Lam, Clinical Nurse Specialist Sarah Rose
11 April 2014

Australian Doctor Sophia Lam and Clinical Nurse Specialist Sarah Rose travelled to Jaipur, India for the Hamrahi Project, an intensive six week palliative care course in collaboration with Pallium India. This article is a reflection on their experiences over those six weeks.

As the Air India ­fight landed on turquoise water surrounded the runway on Agatti Island, this ‘months in the planning’ adventure finally felt like a solid reality.


Stepping onto the tarmac where the humidity enveloped us, we pulled out our cameras to record this first landing on Lakshadweep whilst excitedly anticipating the upcoming helicopter journey to the capital Kavaratti Island. This fight was the final step to bring us to our hosts and Project Hamrahi colleagues. Twenty minutes later, via our first helicopter ride ever, the three of us alighted at Kavaratti Helibase to be greeted by a delegation of staff from the Lakshadweep Institute of Palliative Medicine. The warm, earnest and enthusiastic hospitality which welcomed us from this moment would be present in all the rich experiences we would have over the next five days.


Dr Abu Laize Nd Jumaila, Assistant Project Manager with Pallium India in Trivandrum,

Clinical Nurse Specialist Sarah Rose and I were visiting a palliative care service in Lakshadweep as part of Project Hamrahi. It had taken many months of administrative navigation to allow this historic first visit by a foreign NGO to the island of Kavaratti. The Lakshadweep Institute of Palliative Medicine had inaugurated only eight months previously and was driven by the vision and passion of a local teacher and unofficial community leader, Moulana.


The service was community based palliative care and at the time of our visit actively seeing over 50 patients either as regular visits or via a 24 hour on call service. The service was tirelessly staffed entirely by unpaid volunteers and led by Moulana acting in a social worker capacity. His dedicated team included one ‘fulltime’ doctor and nurse (Dr Ali and Brother Khafee) who had both undergone a six week training course at the Trivandrum based Pallium India Institute in February 2013, six other nurses and 13 ‘volunteers’ who had the rather nebulous role of identifying suitable patients and supporting families.


The service had good initial support from Pallium India and was a registered morphine prescribing service. Medications, equipment and staff time were all provided free of charge to patients and referrals were taken from all sources with quite varied needs across the physical, social, psychological and spiritual spectrum. Operating in an isolated area that had no home based medical or nursing services at all, the complexity of patient needs was also quite varied. Sarah and I saw patients with very basic wound care needs to others with more complex psychosocial issues.


Over five intense days, Abu, Sarah and I were immersed in the culture, sights and community of Kavaratti Island. Zooming around the island’s roads, beneath the swaying coconut trees, we visited around 30 patients in their homes as well as a handful of consult patients in the Indira Gandhi Hospital. In addition, a grand round presentation on palliative care was delivered at the hospital, an inauguration ceremony attended as honoured guests on the dais, and formal teaching sessions with the palliative care staff prepared. To assist in raising the profile of a palliative care service in need of financial support, we also presented ourselves before numerous officials and administrators.


Amidst this activity, innumerable cups of sweet tea with snacks were consumed in offices, patient homes and the homes of our hosts and their friends. It was immensely rewarding to see patients and their families in their homes and to appreciate the real difference the presence of palliative care services made. A key challenge for this service is the lack of consistent funding. It was established with the help of a one year medication supply grant from Pallium India and otherwise relies on donations mostly from staff.


In addition, only two staff have received limited formal palliative care training. However while the service was quite resource limited, it was remarkably well resourced in spirit and enthusiasm. Those at the service need a political and administrative will to fund an ongoing service and we hope that the Hamrahi collaboration can help not only with knowledge and experience sharing, but also with awareness and perhaps fundraising.


Already planning our return visits, Abu, Sarah and I left deeply moved by our experience and quite motivated to try and help this community and service sustain a long term presence.


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


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