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INDIA, Rishikesh, December 25th, 2016 
December Clinic

Ganga Prem Hospice’s last cancer clinic of the year fell on a cold and rainy Christmas Day. Nevertheless, it turned out to be a busy seven hour clinic, registering 93 patients in total.

Of these, 56 were suffering from cancer, including eleven terminally ill individuals and four suspected cancer cases. As usual, breast cancer (ten cases) and oral cancers (eighteen cases), were the most prevalent. There were patients whose prognosis was poor, such as a pancreatic cancer patient for whom palliative care was certainly the need of the hour, and there were other patients for whom surgery and curative treatment was possible. Patients came from all over Uttarkhand state and their ages ranged from nine to seventy years old. Ten current GPH home care patients also came for a follow up visit with the oncologist.  



Patients waiting outside the clinic
Patients waiting outside the clinic
Christmas tree at the clinic
Christmas tree at the clinic

 

 


In honor of the Christmas Day holiday, volunteers arrived early to decorate the clinic with tinsel, a Christmas tree and a welcome banner. The hospice staff were also ready to begin earlier than usual since senior surgeon Dr AK Dewan would be the only oncologist at the clinic.

Dr. Dewan was supported by palliative care doctors Aditi Chaturvedi and Brenda Ward, onco-psychiatrist Dr Dominique Cassidy, two dental surgeons from Seema Dental College & Hospital, and an Ayurvedacharya. GPH staff, nurses and volunteers, including two complementary therapists– a Reiki master and a physical therapist - were also on hand to assist and contribute. Another volunteer doctor conducted relaxing meditation sessions for patients in a quiet room nearby.


Meditation at the cancer clinic
Meditation at the cancer clinic
The boy patient with his father and sponsor
The boy patient with his father and sponsor

 

 


As Ganga Prem Hospice becomes more widely known and respected in Rishikesh, patients are now frequently referred to the clinic by local individuals such as the proprietors of Rajasthani Mishthaan Bhandaar. This restaurant provides tea, refreshments and meals for all hospice events, donates rations to poor patients and even gave a job to a young boy whose mother died of cancer. After recently reading about an ill child in the newspaper who requires weekly blood transfusions, the restaurant proprietors not only started supporting the under-privileged family but also brought the patient and his father to the GPH cancer clinic. From the clinic the child was referred to a leading cancer institute in Delhi where his condition was diagnosed as Congenital Pure Red Cell Aplasia, a serious and rare anaemia condition that can cause limited life expectancy. Dr Dewan confirmed that the pediatric oncologist's directions were correct and suggested that treatment should be continued under her guidance.

By the end of the clinic, twenty-six different cancers had been recorded among the fifty-six cancer patients. Two oncologists from a Dehradun-based cancer hospital also came to meet Dr Dewan and see the work of GPH, and an Ayurvedacharya from Kerala, who was visiting the clinic for the first time, offered free therapy for terminally ill patients. Four young nurses from Haridwar were  interviewed for employment at the Hospice.


 


INDIA, Rishikesh, 17th December, 2016
GPH Second Christmas Party

Christmas was celebrated again this year with patients, their families, bereaved family members, staff, supporters and volunteers at the GPH office in Rishikesh on Saturday 17th December, 2016. The event provided an opportunity for everyone to come together to relax, share a meal and enjoy music and dance.

Early in December, a team of volunteers began preparations for the party to ensure that the event was sponsored, food provided and entertainment arranged. Invitation cards delivered by the home care team were hand-made in order to provide a personal touch. For those not well enough to attend, close family members were invited to join the party on their behalf.  



Patients and their relatives enjoying the party
Patients and their relatives enjoying the party

Local businesses, including the supportive retreat centre Ananda Spa, were approached for donations. They kindly provided snacks, drinks, stationary and decorations for the office. Some Ananda Spa staff also attended the function to provide support. A few local individuals also gave financial support for the event and in this way all costs for the day were covered. Publicity of the event was a good opportunity to further raise awareness of GPH locally.

 

 

 


On the morning of the party, GPH staff and volunteers decorated the office with a Christmas banner, lights, tinsel and balloons. The setting looked delightful!





  Each patient (or their family member) was welcomed to the venue with chai, juice and snacks as they arrived. Once everyone had arrived, all present enjoyed a delicious meal together complements of the nearby restaurant, Rajasthani Misthan Bhandaar. A local donor provided a lovely cake, and wonderful chocolate ladoos from a visiting supporter completed the meal.
Volunteers serving the food
Volunteers serving the food
 



Children of the Ganga dance for the attendees
Children of the Ganga dance for the attendees

A mixture of Christmas music and Bollywood music added to the party atmosphere and the dancing soon began! Local children were invited to perform including children from a Rishikesh NGO, 'Children of the Ganges' who sang and danced for the party attendees. Several musicians who were visiting Rishikesh also performed including musicians from France and South America.

 




  To everyone's delight Father Christmas himself came to distribute gifts to the attendees. Each family received a book with lovely pictures of the Ganges and some rose petal perfume. Donated boxes of Indian sweets were also distributed to the guests, complements of G. Sweet shop, Dehradun.
Father Christmas at GPH party
Father Christmas at GPH party
 

 

 


The party concluded with a game of Piñata, arranged by a Mexican supporter who taught the group how to play: the players attempt to break open a decorated clay pot whilst blind folded and the winner is rewarded with its contents– sweets and small gifts– which were then shared with the children. The game inspired much laughter.

The party was attended by around 100 guests. A thoughtful 13 year old patient who has a brain tumour brought a small Christmas tree and a card for the GPH team. Although it is now difficult for her to travel, her attendance moved the team immensely; she has such a beautiful smile!

The second Christmas party at GPH was deemed by all to be a great success. Both poignant and joyful memories were shared by many of those present, some of our patients who are no longer with us were lovingly remembered. It was wonderful to see so many of our bereaved families again, and to see current patients enjoy themselves for a few hours with their team of caretakers. It was a beautiful way to end 2016 indeed.


 


INDIA, Rishikesh, 26th 27th 28th November, 2016
GPH Second Palliative Care Course

GPH carried out the Indian Association of Palliative Care ‘Essentials of Palliative Care Training’ course for health care professionals in Uttarakhand.

On 26th November 2016, fifty-five health care professionals from around Uttarakhand attended the Ganga Prem Hospice-led Indian Association of Palliative Care (IAPC) training course in palliative care. This was the second such event carried out by the Hospice. Following the success of the previous course in November 2015, this year’s course was attended by a greater number of professionals. The event was hosted by the team from Seema Dental College & Hospital, Rishikesh. Dr Hemanshu Aeran, the Principal Director of the college, is instrumental in his inspiration to both dental teachers and dental interns who, it is recognised, can play a valuable role in palliative care particularly due to the high numbers of cancers of the head and neck found in India. The course was supported by the IAPC and sponsorship came from the Maharatna company Indian Oil Corporation and Dr Rudranath Talukdar, an oncologist from the region.



The chief guests with Dr Aero and Dr Dewan
The chief guests with Dr Aeran and Dr Dewan
The Dean of Aims is honoured at the ceremony
The Dean of AIIMS is honoured at the ceremony

 

 


The inauguration ceremony of the programme saw the Dean of the prestigious AIIMS Hospital in Rishikesh, Dr Surekha Kishore, along with Dr Ajeet Gairola, Consultant at the National Health Mission, Government of Uttarakhand as the guests of honour. Both spoke of their appreciation of the GPH initiative to bring palliative care to the region. Dr Gairola was asked and agreed to support the request made by Dr Dewan, Medical Director of GPH, to ensure the local government builds a suitable road to the hospice new inpatient unit.

For three full days, the GPH team were able to share their knowledge and skills with professionals who were dedicated to improving their understanding and practice of palliative care. Participants included doctors, nurses, and dentists as well as a few non-professional supporters of the hospice who also wished to increase their knowledge of the topic.  Attendees were mainly locally based; Rishikesh and Dehradun.  Dr Ann Thyle, an experienced palliative care consultant practising in the neighbouring state of Uttar Pradesh, once again kindly agreed to be the course secretary. 

The course topics covered all domains of palliative care including aspects of oncology taught by the GPH oncologists, Dr Dewan and Sharma and the role of dentistry in palliative care by Dr Aeran. Dr Dewan and Dr Aditi Chaturvedi both gave an introduction to the concept of palliative care. Other topics included a detailed presentation on pain management by Dr Mayank Gupta (Pain Specialist and Anaesthetist from Sri Mahant Hospital, Dehradun) and symptom control lectures by Dr Brenda Ward, Consultant in Palliative Medicine from the UK. Dr Thyle discussed palliative care for HIV patients and for children and Dr Rupali Dewan described the issues faced by the elderly and provided teaching on pressure sores. Dr Dominique Cassidy, Consultant psychiatrist from Switzerland addressed the psychological and spiritual aspects of palliative care as well as the topic of bereavement. Nursing issues were taught by Srs Marie Francois Scharll (Belgium) and Christine Solly (New Zealand) and Mark Miller (USA).


Dr Aeran addresses the participants
Dr Aeran addresses the participants
Dr Dewan speaks at the course
Dr Dewan speaks at the course

 

 


In addition, time was given to discussing the importance of communication skills. The GPH trainers used demonstrations and role plays to demonstrate their teaching. The subject of ethics in palliative care was also covered by Dr Chaturvedi. The discussion included withdrawing life prolonging treatments in patients who are deemed to be dying. This is a controversial subject in India and is currently being addressed in the legal circles. The role of advance care planning (planning for future issues on health care at the end of life) was also addressed.

The team aimed to provide another view of palliative care by inviting the relatives of two patients who had been cared for by the GPH team prior to their passing. Both were glad to share their experiences. They talked about the difficulties they had faced as carers and how the support of the palliative care team, both through the control of symptoms and the emotional support for the patients and themselves had helped them.  Participants reported that hearing from those who had been in the situation added to the impact of the training.

Time was spent by Drs Thyle and Chaturvedi encouraging participants to consider ways they could take forward palliative care in their own place of work. Participants appeared inspired to address the situation. The group suggested they start up a ‘WhatsApp’ group for themselves in order to stay connected and to share information and inspiration. They will return together again early in 2017 to undertake the exam in the Essentials of Palliative Care training. They will also have to write a reflective study on a palliative care patient they have cared for in order to achieve the qualification.


Dr Aditi explains a point
Dr Aditi explains a point
Participants of the course listen to the lectures
Participants of the course listen to the lectures

 

 


Ganga Prem Hospice would like to thank Seema Dental College for their assistance in organising and carrying out the course, their sponsors Indian Oil and oncologist Dr Talukdar for the financial assistance required to support the course as well as the volunteers, both local and international who attended each day to provide assistance for the preparation and administrative tasks needed. Their help and encouragement has been invaluable. The team were delighted to have been able to provide this course through this collaboration and look forward to carrying out further such courses in the future.


 


INDIA, Rishikesh, November 27th, 2016
November Clinic

The November 2016 cancer clinic of Ganga Prem Hospice welcomed 86 patients from cities and towns all over Uttarakhand state including Dehradun, Tehri Garhwal, Roorkee, Meerut, Bijnor, Haridwar and Rishikesh.

The GPH team was split between handling the clinic and hosting a three-day palliative care training course in Rishikesh over the same weekend. Despite the extra demands, the clinic was very adequately staffed with two oncologists, two gynaecologists, a palliative care doctor, two dentists and an ayurvedaacharya. As always, the hospice team was supported by numerous volunteers including two nurses from the USA and Belgium who recorded patients’ vital signs prior to their medical consultation.



Dr Dewan giving consultation to a patient
Dr Dewan giving consultation to a patient
A patient resting at the clinic
A patient resting at the clinic

 

 


Several patients were very ill and rested on the clinic beds after being wheeled into the clinic on wheelchairs. They received gentle oil massages on their hands and feet while waiting for the doctors to attend to them. Eight existing home care patients visited the clinic to see the oncologists and four new patients were added to the home care programme, two from Haridwar and two from Rishikesh. Oncologists Dr. A.K. Dewan and Dr. S.K. Sharma had their hands full as 60% of the patients were found to be suffering from cancer and another 5% were suspected cases.




Jamuna preparing organic tea
Jamuna preparing organic tea

Free medicines and refreshments were distributed at the clinic and frequent cups of hot tea were appreciated in the cool weather. Seventy blankets for the new inpatient facility were donated by a visitor to the clinic while another visitor promised regular help after saying that the service at the clinic had deeply touched his heart.

 
 


INDIA, Rishikesh, 7th November, 2016
Oncologist from Pittsburgh Visits GPH

On 7th Nov. 2016, a CME (Continued Medical Education) was organized by Ganga Prem Hospice at Seema Dental College and Hospital in Rishikesh.



  About 150 people attended the event including students, interns, post graduate students and faculty. Dr. Gauri Keifer, Clinical Assistant Professor of Medical Oncology and Hematology at the University in Pittsburg, USA, shared her expertise on the subject of head and neck cancers in a one hour lecture followed by a question and answer session. 
Dr Gauri Keifer lectures  in Rishikesh
Dr Gauri Keifer lectures  in Rishikesh
 

 

 


She discussed the treatment plans that are implemented for such cancers at her university hospital, and particularly emphasized the role of dentists in the early diagnosis of oral as well as other head and neck cancers. Dr. Gauri highlighted the need for hospice and palliative care in the case of advanced malignancies. She explained that when a cancer has advanced to a terminal stage, it is very important to stop anticancer medicines at the appropriate time in order to provide a better quality of life for the patient.

Dr Keifer also visited the inpatient facility, met with the GPH team and accompanied them on home care visits during her five day visit to the Hospice. In addition she  met with GPH medical director, Dr AK Dewan, in Delhi to discuss how she and her colleagues in the USA could render more assistance to the Hospice.

 


INDIA, Rishikesh & Dehradun, 31st October & 1st November,2016
Palliative Care Specialists Visit GPH

Dr. David Brumley, a palliative care physician from Australia and the former Secretary of Australian Palliative Link International, visited Ganga Prem Hospice along with a palliative care nurse, Ms. Joan Ryan. Dr. Brumley was very inspired by the GPH building site and said that GPH will be one of the most beautiful hospices in the world.





Dr Brumley and Sister Joan Ryan at the Hospice site
Dr Brumley and Sister Joan Ryan at the Hospice site

On Oct. 31st, the two Australians joined the GPH home care team on a patient visit in Dehradun. The patient is suffering from end-stage breast cancer, with metastasis to the bones and brain. Dr. Brumley provided valuable input on her end of life care plan, and Ms. Ryan expressed how happy she was to see the close bonding of the patient and her daughter with the home care team. 

 

 

 


The next day, Nov. 1st, the visitors joined GPH doctors, Dr. Brenda Ward and Dr. Aditi Chaturvedi, for a lecture panel at Swami Ram Himalayan University. Dr. Brenda discussed the need to train health care professionals in appropriate communication skills for palliative care, and also conducted a small role play to illustrate different ways of communicating with terminally ill patients. Dr. Aditi spoke about how medical professionals can help to empower palliative care patients and their relatives to handle more of their own care needs, while Dr. Brumley’s talk focused on the use of morphine as the preferable opioid for cancer related pain. He also spoke about how to address some of the side effects of morphine, including drug dependence, respiratory depression, and sedation. Ms. Ryan also spoke about her experience of caring for the dying as a palliative care nurse in Australia.


 
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