Pallium India

Learning Experience

Delamy Keall has recently been appointed as a palliative care specialist with Arohanui Hospice in New Zealand. The following is an extract written after her time working and learning with the Pallium India team at the end of last year.

As part of my Palliative Medicine Advanced Training programme, I arranged to spend three months observing and working at Pallium India.  I chose this elective attachment at the end of my three years of specialist training to deliberately push myself out of my comfort zone. My hope was to reconnect with the essence of palliative care in a resource-poor working environment.  I also wanted to gain some understanding of how it felt to be part of a cultural minority and to experience a language barrier.

I learned so much simply by keeping quiet and not offering my opinion!  I saw that there were different ways to deliver good palliative care.  I was humbled by the communication skills of staff who gave patients and their families their full and unhurried attention.

I was asked to do more teaching as the weeks passed. I helped to deliver Pallium’s first distance-learning Foundation Course using the ECHO (Extension for Community Healthcare Outcomes) learning platform. It was a joy to see the doctors and nurses develop in their confidence around prescribing opioids and having difficult conversations.  Many of them finished their course with the vision and skills to become leaders in the expansion of palliative care services in India.

I have been deeply touched by the nurses and doctors who deliver such compassionate care and work so hard in a physically demanding work environment.  I am humbled by their dedication to the mission of educating their community and health professionals about the philosophy of palliative care and how to deliver it well.  I am inspired by the quality of care that can be provided in a basic hospital building with no hot water, a limited choice of opioids, home-made wound dressings and limited IT infrastructure.

Dr Rajagopal and his team demonstrated daily that to listen is to love.  The doctors, nurses and social workers listened to their patients, families, staff and students and adjusted their care to suit each individual.  I have been reminded to lean in to my patient, of the importance of being fully present and to expect answers to emerge from the silences.

Delamy Keall.

Please find below Delamy’s report in full: