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Messiahs of pain relief

The proliferation of nuclear families and the changing focus of hospitals make centres for pain relief inevitable, says an expert in hospice care.

THOSE NURSING terminally ill patients go through a different routine altogether.

For one, the relationship is based on the premise that it is temporary. But, learning to dispassionately view the death of someone you have cared for takes a lot of training, says Dr. Rosalie Shaw, Executive Director of the Singapore-based Asia Pacific Hospice Palliative Care Network.

In town recently to inaugurate "Raksha'', the hospice run by the G. Kuppuswamy Naidu Memorial Hospital, she said staff in such units felt bad only when things did not go as well as expected.

"We worry only when a family rift does not heal, the death is painful or the patient does not pass away peacefully.

Since we start the association knowing about the patient's condition, the reaction to death is different," she adds.

Buildings are incidental for palliative care, the expert feels. "A hospice is a way of giving compassionate care. And, home care is an invisible but important part of the process." In today's world, where nuclear families are the norm, leaving patients at day care hospices is inevitable, she observes.

"After a point of time, families start feeling the pressure of keeping life on hold while caring for the terminally ill. Hospices step in to make life easier for both parties."

Though hospices initially catered to cancer patients, they have grown to include those with heart and lung diseases.

Dr. Shaw also refutes the misconception that a hospice is meant for the elderly. "Sometimes, you even have new-borns and infants coming in," she adds.

In the field of pain relief since 1981, Dr. Shaw is a storehouse of knowledge on palliative care. She was 33 when she entered medical school.

After the loss of someone very close, she learnt about the hospice movement, which was started in 1967, and set a centre in the hospital she was working in in Australia.

She says palliative care is not about ending medical treatment; it is about giving appropriate treatment to make life easier for terminally ill patients.

The staff working in such centres also have to console families, who are racked by guilt, wondering if they have done enough, she remarks. "We encourage the families to talk to the patient and complete all unfinished business. That way, any existing misunderstandings are cleared and the patient feels at peace."

So, how did palliative care assume such importance?

"In the second half of the 20th century, doctors were taught about diagnosis, but not about pain management.

Hospitals became places of investigation and treatment. But, where would people go if they did not get cured?" she asks. And, the doctor has a lot of good words for the kind of work being done in this field in India.

"In the West, you have swish places... it is wonderful to see what they have achieved here."

She feels home care should constitute the core of the hospice programme in India. In-house treatment should only be a back up. That also makes economic sense, she says.

She also pooh-poohs worries of sedative abuse, saying such a possibility does not exist.

And, what do doctors like her get out of relieving patients of their pain, even if it is temporary?

"The trust that builds up is very rewarding," she notes.

SUBHA J RAO

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