Published on: June 3, 2025

Dr. Ashwin T receiving his certificate from Dr. M R Rajagopal (Founder, Chairman Emeritus, Pallium India)
6 weeks Certificate Course in Pain and Palliative Medicine CCPPM

Dr. Ashwin T (MBBS, MD Radiation Oncology, CCPPM Attendee, TIPS, Pallium India) writes:

So this is about my 6 weeks stay at Pallium India, Trivandrum. A break from the monotonous medical entrance preparation and also from the boredom that struck being at home for a considerable amount of time, a first after entry into the medical school, I decided to make this one productive. Intentions were many, but the main objective was to unlearn and try to learn the approach towards palliative patients or otherwise patients at their end of life stage.

A small introduction:

Pallium India is a national registered charitable trust (No. 693/IV/2003) formed in 2003. It is an NGO based out of Trivandrum, Kerala, with the objective of alleviating serious health-related suffering (SHS) of 7-10 million people in India. Their main aim is to demonstrate quality palliative care, educate professionals and to facilitate development of palliative care services across India.

(https://palliumindia.org/pallium-india)

Learnings:

• “Blood is always thicker than water” – At your lowest, when you have lost everything in life, it is more often than not that, you will have to fall back to your blood bound people. Even if the whole world abandons you, they will be there trying to fix you to the last breath possible. I say this to a certain amount of clarity since I have seen husbands disowning their wives because of a terminal diagnosis, wifes filing divorces as their spouse were bedridden after a road traffic accident and sometimes siblings turning a blind eye when people are lying on their death bed. But through all these there was a parent or may be a few people related by blood who stood firm, waiting for the storm to pass or may be death to arrive gracefully.

• “The tip of Ice Berg that we see and the rest we conveniently care not to” – At Pallium, if you ask me to pick one eye opening thing that I encountered during my stay, it would be the home visits that we used to be a part off. At first, to be honest it was traumatic to see all those real life people struggling to meet their life’s ends, all while battling a life threatening or debilitating disease. We all know that there are people who are poor and they suffer because of lack of many things starting from shelter, food, money, affordable health care and the list goes on. But we conveniently mourn for them, sympathise and move on as the interactions are may be, most of the time a news article about someone who pleads for help or someone you pass on the streets as you sit in the comfort of an air-conditioned car. As doctors we are even more uncompassionate that even if we directly encounter poorest of poor in our daily OPDs, our intention will knowingly or unknowingly get restricted to their symptoms and disease not looking into deeper issues going around that person who has submitted himself before you to make him feel better. We may be masters in curing their illness but as physicians we have a broader role to play wherever feasible is what I think. During the days I had flashes of instances where I wish could have sat a little longer before my patients but chose not to. All said and done it is not easy to replicate work at Pallium at all our hospitals, but trying is what we don’t do and I think if more of us put empathy before sympathizing with our patients, world can become a slightly better place to live along.

• “Pleasure in the job puts perfection in the work” – One another thing which I noticed was how happy and at peace were staffs at pallium. They are doing the noblest of work, sometimes tiring too, but all this while being at peace and happy. I don’t think that you will hear the day today job cursing you get from our regular medical colleges here at pallium. And this can be seen imparted in the patients and their caregivers alike.

• “Things do happen even if we dont see them” – This is the part were we were met with the harsh reality of things which does happen in our society, but are not a direct observer off. Even in a very forward society like that of kerala, things do happen which we should be ashamed and be thoughtful about. Yes, domestic violence is still a reality in many of our homes, casteism among people is not over yet, our women still have a hard time navigating their way through our society, the poor is most of the time neglected, cancer is a stigma along with many other things, people are still superstitious when it comes to health and hundred of such issues. Even though palliative care training was the sole objective of our course, we were sensitised on many adjoining issues related and non related.

Summarising:

This can go very long if I don’t cut short, because that was the impact this brief stay had on all of us. The lectures we had, the rounds we attended, the team meetings we were a part of, the home visits we went along and many more happenings at pallium including the wonderful human beings we met along the way were all things to be humbled and grateful for. Last but not the least, thanks to Dr M.R Rajagopal sir for building something which caters for poor and rich alike and also practicing medicine for what it is actually meant for, “caring and comforting”.