Andhra Pradesh comes together for palliative care development
My third visit to Andhra Pradesh, and my first to Vijayawada, was to attend an opioid availability workshop. Quite different from the usual scene, this workshop was led by the Director General, Drugs & Copy Rights, Andhra Pradesh, and CEO of Dr. NTR Vaidya Seva Trust, Dr Ravi Shankar IPS, a rare combination of healthcare and bureaucracy. Dr Nandini Vallath (Consultant- TIPS), Dr NS Raju (Age Care Foundation-Pallium India), Dr Vidya Viswanath (Asst Professor, HBCH&RC), Dr MBR Prasad (Director, AP Drugs Control Administration) and Dr Ravi Shankar IPS were the key speakers. After the presentations, came the panel discussions. The participants included doctors in various specialities, pharmacists, dealers and concerned government officials from across the state.
Many questions were raised, regarding Narcotic Drugs and Psychotropic Substances (NDPS) Amendment Act (2014), NDPS 1, NDPS 2 and transport license in the state of AP and palliative care training.
By the end of the day, we were hopeful that palliative care will be taken forward by the state with the support of Dr NTR Vaidya Seva Trust which is already planning to include “palliation” in their empanelled hospitals.
Age Care Foundation, our collaborators in AP, received Recognized Medical Institution (RMI) status after meeting all the criteria recommended in the amended NDPS Act. This now helps them stock and dispense less expensive but strong opioid analgesics meant to relieve excruciating pain.
Following the workshop, a sensitization meeting for doctors was facilitated by Dr Ramanamma through IMA Vijayawada. Dr Nandini Vallath gave a talk on palliative care and emphasized the importance of communication and symptom management. The session ended by 10:00 pm and then the team travelled to Visakhapatnam. Our train was at 1:25 a.m. but none of us was tired, because the day had given us a lot of hope – a lot of hope indeed, for palliative care in Andhra Pradesh.
The next day, in a hospice at Vizag, we met a young Mathematics graduate from Odisha. She speaks Oriya, Hindi, English, and a little Telugu. I had a very interesting conversation with her. She said, everything in this world is related to Maths. I informed her that my grandfather, who was a maths teacher, used to tell us the same. I learnt an Oriya phrase from her: “tome kemethy acho” which meant “how are you”. She kept asking for her “favourite smiling doctor” – Dr Vidya Viswanath. It had been two days since Dr Vidya came to the hospice. I apologized and told her that her doctor was travelling to attend some important meetings.
This young girl in end stage with metastasis had reached AP with pain but now she is free from pain. This could be why Dr Vidya became close to her heart, as she had given her pain medications.
As I speak to her, I reflect… These very effective and affordable pain medications can relieve suffering, but do not reach all the people who need it. Why is it that we are unable to make everyone pain-free? Why should one travel all the way from Odisha to Andhra Pradesh? Why can’t all doctors be close to their patients? Does pain include only physical pain? Absolutely NO. This maths graduate was reading her favourite book in the hospice when we were there. Mrs Satya, a social worker and volunteer enquired about her favourite dish and prepared it for her the very next morning. The young patient’s smiling face reminds us of so many people who could not smile at this stage of their illness. This hospice is a pivot of caring doctors, nurses and volunteers.
In the evening my colleague and I went for a walk in the beach at Vizag. The entire beach was spic and span, in spite of the crowd – this is something we should learn from VUDA (Visakhapatnam Urban Development Authority). Dustbins are placed at fixed distances. I managed to get scolded in Telugu from a man when I unknowingly dropped a piece of paper into his black bag, mistaking it for a dustbin. However, I am glad it happened, as he also directed me to a real dustbin rather than nowhere.
The delicious food of AP is also worth a mention, with a special thanks to pessaratu dosa made by aunty. Our thanks to Satish (our project manager) who took us for a very special tea, to the sea port and to a Punjabi Dhaba, and to Raju sir for providing us with an Andhra meal. “Good food is to be enjoyed always!”
On our last working day in AP, we had a meeting with Sathya Sai Seva Trust. Dr Raju explained to them about palliative care and sought their help in reaching out to the common man. The way he advocates for palliative care is so convincing that nobody could say no.
We request you all to help us reach out to everyone who is enduring health-related suffering, in every part of our country.
I learnt a lot from Dr Raju, Dr Vidya, Dr Ravi Shankar IPS, Dr Nandini Vallath, Dr Ramanamma, Mrs Sathya, hospice and Sathya Sai Seva Trust. Thank you all for giving us a space and special thank you to Satish for putting in all his efforts to make this happen.