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INDIA, Rishikesh, 25th October, 2018
November Clinic
The November 2018 Rishikesh monthly cancer clinic of Ganga Prem Hospice followed the trend of cancer patients being in the majority (63%) among the total number of patients.

As fifty-two patients needed oncological consultation, the three oncologists, and a thoracic surgeon who were present to offer their services, free-of-charge, were kept busy. A dental surgeon, an Ayurvedacharya, and a team of nurses, a social worker, support staff, and volunteers made sure that the clinic operations ran smoothly.


   
Dr Pallavi Purwar giving consultations

Dr Pallavi Purwar giving consultations

Dr AK Dewan and Dr Gauri Keifer discuss a case

Dr AK Dewan and Dr Gauri Keifer discuss a case

   

 

 

Each patient was given due attention, advised on future course of treatment or care, and offered palliative home care and inpatient hospice service, wherever needed. Some patients were coming to the clinic for the first time, others were long-time clinic patients while some were home care recipients already. Patients with simple wound dressing needs were also catered to.

A young woman with Apert syndrome who also had progressive cancer had the oncologists deliberating what would be the best line of care for her. At the other end of the age spectrum, an eighty-three year old man with suspected lung cancer but who needed a biopsy to prove the condition, was given the offer of a home visit for symptom palliation, as he got further investigations done.


   
 A dentist gives consultation to a sannyasi

A dentist gives consultation to a sannyasi

Sr Lalita explains his medicines to a patient

Sr Lalita explains his medicines to a patient

   

 

 

Some patients who came from mountainous districts, had cancerous condition that needed palliative care, but were too far away from the hospice to receive home care visits. The Ganga Prem Hospice counsellor still made sure that some way of helping them was found out. They were assured of telephonic follow up and the offer to come to the hospice anytime if they felt their pain was causing them discomfort they could not bear alone.

 


 

INDIA, Almora & Udham Singh Nagar, 12 - 16th November, 2018
Pallium-Ganga Prem in Almora & US Nagar
Pallium – Ganga Prem project manager and GPH social worker visited Almora and Udham Singh Nagar in November to introduce and advance the development of palliative care in those areas.

The team met the District Magistrates of both towns and also the Chief Medical Officers and other local health officials. There was considerable support for the idea of introducing palliative care in the districts and at Udham Singh Nagar where a doctor and two nurses had already been trained in palliative care, the district hospital were ready to open in a palliative care ward early in 2019.


   
View from Almora

View from Almora

A talk given to the Asha workers

A talk given to the Asha workers

   

 

 

In both districts talks were arranged with the ASHA workers who visit the remote villages. The team explained the basics of palliative care to the nurses and spoke about how to identify patients needing palliative care. Feedback from the ASHA workers highlighted the challenges they faced in working in the remote village areas.

 


 

INDIA, Gohri Maphi, 8th November, 2018
Deepavali at the GPH Inpatient Facility
Deepavali or Diwali which is also known as the’Festival of Lights” is one the most important festivals celebrated at Ganga Prem Hospice. On the 8th November, it was celebrated with great enthusiasm and joy by both patients and staff.


   
 The Hospice temple

The Hospice temple

 A patient enjoying a firework

A patient enjoying a firework

   

 

 

Preparations started several days before the festival with the hospice being cleaned and decorated with lights. Sweets were distributed to patients as well as carers and staff. Some patients had gone home for the festival but the Hospice made sure that those who could not go home had an enjoyable time. Every patient was given a diya to light. Simple fire-works and crackers were also brought at the request of one patient who had gone home a few days before Divali but had had to return as his complicated dressings could not be managed at home, These fireworks were lit by the patients with the help of  staff, who took great care that their wishes could be safely fulfilled.

 


 

INDIA, Rishikesh, 28th October , 2018
October Clinic
With ten terminally ill patients coming to the clinic among a total of forty-eight cancer patients, the Ganga Prem Hospice October clinic saw many patients in different kinds of circumstances, needing different forms of support.


   
GPH social worker counselling

GPH social worker counselling

A GPH volunteer dentist sees a patient

A GPH volunteer dentist sees a patient

   

 

 

There were those patients whose cancer had gone largely undetected or untreated, and was now in an advanced stage, warranting the need for palliative care. These included an eighty-three year old with cancer of the larynx, a sixty-seven year old whose breast cancer not been diagnosed as she did not get her symptoms examined - it was pain that led her to eventually seek oncological consultation.


   
Dr Sharma carries out clinic examination of the child

Dr Sharma carries out clinic examination of the child

There were young patients as well as old. A thirteen-year old younger sister of a nineteen year old cancer patient was examined for a lump on her jaw and her subsequent x-ray test was sponsored by Ganga Prem Hospice.

     

 

 

Patients were spoken to and counselled extensively, not just by the counsellors but also by the oncologists themselves. Senior surgical oncologist Dr AK Dewan explained to the families when the patient's cancer was beyond curative treatment, and deciphered the scans and reports for them to help them understand.


   
Dr Vats examines a patient

Dr Vats examines a patient

 Dr Dewan examines a patient

 Dr Dewan examines a patient

     

 

 

One home care patient sobbed convulsively when he was told he needed further palliative radiotherapy. He said that he didn’t want his daughter to know that he was not well as she had failed her school exams last year when her father was undergoing treatment. He said he didn’t want to have any treatment until she had passed her exams when he then intended to get her married.


   
Patients welcome a hot cup of tea

Patients welcome a hot cup of tea

As the winter season has started to make its presence felt, patients and their carers welcomed the cups of tea served to them by the Hospice team as they waited for consultation. Patients who looked especially frail or were wheeled in on a wheelchair were prioritized to see the oncologists ahead of their turn.

     

 

 

At the end of the camp a very thin and weak home care patient was wheeled in who was suffering from the side effects of chemo and radio therapy. He was unable to swallow due to an oversensitive throat condition and had sunk into depression. The oncologist advised 15 days at the hospice where he could be fitted with a ryles tube and fed on a nourishing liquid diet until he recovered. Although he and his wife were very willing to follow the suggestion, his mother did not agree and so the team was not able to help him. Alternative ways to help him are being considered.

 


 

INDIA, Uttarakhand, 13th October, 2018
Uttarakhand World Hospice & Palliative Care Day
Ganga Prem Hospice team members initiated or joined a number of different palliative care initiatives on the World Hospice and Palliative Care Day which fell on 13th October this year.


     

A Cancer Awareness Camp was conducted by Ganga Prem Hospice at Haridwar. Approximately 50 local people attended. Basic hygiene, cancer symptoms, diagnosis and annual checkups were discussed at length by Dr. G.S. Vats and Nurse Priyanka Nainwal of GPH.


Dr Vats and Sister Priyanka at talk
Dr Vats and Sister Priyanka at talk
 
     

 

 

At the Hospice inpatient facility, posters and charts were prepared by Nurses Mamta, Surbhi, Sheetal and Lalita at GPH and displayed on the notice boards


   
GPH staff at palliative care rally

GPH staff at palliative care rally

At Subharti Medical College, Dehradun, GPH palliative care consultant, Dr Aditi Chaturvedi organized a programme in which MBBS students and faculty spoke and wrote on the topic, “Before I Die”. A wall pasting of their writings will soon be put up on the college wall. 

Members of the GPH team joined a palliative care awareness rally that was organized by Seema Dental College in Rishikesh.

     

 

 

A Seminar on FAQ’s on Palliative Care which was organized at BD Pandey District Hospital, Nainital  Nurse Shashi shared her experience as the mother and caregiver of her 17 year old daughter, Parul who has cerebral palsy – a home care visit had been conducted for this patient by Dr. Aditi Chaturvedi in the month of September. Students at Nainital schools also prepared posters supporting palliative care.

The palliative care team at Uttarkashi showed an example of palliative care by providing extra care and bath to a bedridden quadriplegic patient with CVA, at the District Hospital of Uttarkashi.

Students nurses and volunteers commemerated the day in Srinagar with role plays and talks on palliative care.

A workshop on palliatve care was conducted at the Cancer Reasearch nstitute in Jolley grant, Dehradun.

 


 

INDIA, Rishikesh, 30th September, 2018
Second September Clinic
September was a peculiar month for Ganga Prem Hospice as two Rishikesh cancer clinics were held in the month instead of the customary one out-patient clinic.


   
A patient waits to see the doctor

A patient waits to see the doctor

A family receives counselling from GPH social worker

A family receives counselling from GPH social worker

   
     

 

 

Among the total number of 79 patients, the number of cancer cases seen at the second clinic of September was high (46), as was the number of suspected cancer cases found (05), In all, 65% of the patients seen had a malignancy, or suspected evidence of it. 

Patients came from diverse places - as many as twelve different towns or districts. 

Two oncologists, a thoracic surgeon, a gynaecologist and an internal medicine specialist led the clinic, assisted by an anaesthetist, an Ayurvedacharya and a dentist.   Due to number of experienced doctors present, the waiting time for the patients was very short and the clinic finished on time although one patient who arrived from Srinagar arrived well after the clinic but was able to see the oncologist who had not yet left to catch his train.


   
Dr Pallavi examines a patient’s mouth

Dr Pallavi examines a patient’s mouth

Dr Aditi listens to a patient’s
Dr Vats and Dr Rathi check an x-ray
     

 

 

Cancers of the oral cavity continued to be the most common types of cancers, followed by cancer of the breast. As always touching cases were seen particularly two young couples with school going children. Both patients were suffering from cancers of the mouth, one being male and one being female. The respective partners left the clinic with red rimmed eyes after speaking with the doctors about the severity of the disease and its prognosis.

 


 

INDIA, Pauri/Srinagar, 24, 25th September , 2018
Pallium-Ganga Prem Pauri/Srinagar 2nd Visit
Dr. Brenda Ward, Dr. Aditi Chaturvedi and Project Manager, Shareena Bhaya travelled to Pauri on 23rd September for a two day palliative care sensitisation programme.


     

 

 

On the 24th September, the team met up with the ADM, Mr. Ramji Sharan Sharma, who was very supportive towards the stocking of opioids for pain relief. 

A CME on Pain Management was conducted with the support of PMS, Dr. R.S. Rana at the District Hospital, Pauri. Twenty doctors and nurses attended. One doctor was identified for Palliative Care Training.

On 25th September, the team met up with the acting principal of Srinagar Government Medical College, Dr. Beant Singh. They discussed the possibility of a Palliative Care Training to be held for their doctors and nurses in January,2019. The GPH team was also introduced to the HOD Anaesthesiology, Dr. Surinder Singh. 


   

 

A Volunteers' Training was conducted at Srinagar by Dr. Brenda Ward and Dr. Aditi Chaturvedi - 30 local volunteers and government student nursing attendants attended.

Two home care visits were done to a lady who had suffered a brain stroke and a man with lymphadenopathy   
   
 

INDIA, Gohri Maphi, 22nd September , 2018
Tibetan School Performance at the Hospice
Once again some of the teachers and children from the local Tibetan School visited GPH and performed for both the patients and local home care patients as well as for families from nearby.


   
Patients watch the performance 

Patients watch the performance 

Tibetan children perform in the GPH foyer
Tibetan children perform in the GPH foyer
   

 

 

This was their third visit to the hospice and was much appreciated. The children wore their traditional outfits and performed both traditional and modern Tibetan songs and dance. Although it started to rain during the performance, this did not dampen anyone's spirits. Fortunately the hospice has ample covered space for the performance to go ahead undercover. All enjoyed the event with some of the audience joining the children in their dance. The event was complete with chai and snacks, which were mainly donated by the team.

 


 

INDIA, Nainital, 10th –13th September, 2018
Pallium-Ganga Prem in Nainital, 2nd Visit
On 6.9.2018, an official letter was issued to the CMO's of Tehri, Pauri and Nainital by the Director, NHM requesting them to render support to the Pallium-Ganga Prem team, to promote Palliative Care in their respective districts and to encourage their doctors/nurses to get trained in Palliative Care.


     

 

 

Project Manager, Shareena Bhaya reached Nainital on 10th September, and was joined by Dr. Aditi Chaturvedi on 12th September.     

A Volunteers' meeting was organised at the New Club in Nainital to brainstorm on the way forward for palliative care in the region, and methods to reach out to more patients with life limiting disease. With the help of Dr. Geeta Bhandari of Sushila Tiwari Hospital at Haldwani, the team was able to procure a patients' list for home care visits.

A meeting was conducted with the DM of Nainital, Mr. Vinod Kumar Suman on 11th Sept, 2018.

A CME on Palliative Care was conducted by Dr. Aditi Chaturvedi at the BD Pandey District Hospital on 12th September, 2018 which was attended by 65 doctors, nurses and Asha workers. Two nurses and four doctors were identified for training in Palliative Care.


     

Three home care visits to patients in the area were conducted on 13th September. The patients, the youngest of whom was only 17 years old, suffered from cerebral palsy, cancer of the hypo-pharynx and cancer of the oesophagus.


 
 
 


INDIA, Rishikesh, 2nd September , 2018
First September Clinic
The month of September 2018 is an unusual one for Ganga Prem Hospice as there are two cancer clinics scheduled in Rishikesh on the first and last Sundays of the same month.

This was done to avoid the festival day of Rakshabandhan that fell on the last Sunday of August, and would have inconvenienced many patients if they had had to travel on that day.

The Ganga Prem Hospice helpline phone kept on buzzing for days before the clinic, as patients wanted to make sure they would have an appointment.


   
GPH staff and media leaving the facility

Reception

The morning time was the busiest at the September 2nd clinic, as the  majority of the ninety-four patients who came for consultation, arrived in the first three hours of the clinic. Ten medical professionals, including three oncologists, were available to offer consultation to patients. There were fifty-nine cancer patients in all, and another two who were suspected of having cancer.

   

 

 

Eight patients were counselled extensively at the counselling desk by a palliative care doctor and a social worker, who assessed their needs for home care, treatment, diagnostic test support, and medication support. A two year old boy with thalassemia major was brought to the clinic by his parents all the way from Bijnor which is a hundred kilometres away. The parents were under-privileged and while the child was getting free blood transfusions, they had come to look for a more permanent cure. The doctors explained to the parents in detail exactly what thalassemia major means, what precautions should be taken, and what treatment options such as a bone marrow transplant exist, the chances the child would have of successful treatment, and the financial implications involved. They were also guided about internet sources available for more information and support.


   
Dr Sharma with a patient

Dr Sharma examines the child 

Dr Aditi listens to a patient’s
Dr Vats explains the child’s condition to his parents

 

 

 

A patient who had stayed at the inpatient facility for two months and had returned to his home town when he had got stronger, returned to the clinic to see the oncologists and once again admitted t the inpatient facility as his cancer had spread to other areas of his face and neck.

Volunteers and donors continued to offer their support to the cancer clinic initiative. A dental surgeon from the Seema Dental College & Hospital, Rishikesh, volunteered his services, as did an anesthesiologist from AIIMS Hospital, Rishikesh, who came to assist at the clinic.

 


 

INDIA, Gohri Maphi, August, 2018
Courage in the Face of Adversity
August was a month that brought weather-related troubles to Ganga Prem Hospice.

As the over-active monsoon raged on with days of continual rainfall; Rishikesh, which is criss-crossed by rivers, saw flooding in many areas. Rivers overflowed their embankments, and the Gohri Maphi area where Ganga Prem Hospice is located, saw unprecedented flooding. The village was turned into an island and those few days were fraught with worry for everyone.


     

Some villagers were displaced by the floods and needed a safe and dry place to shelter in, and food to eat. It was at this juncture that the Ganga Prem Hospice team rose to the occasion and showed great character in helping the local community in their time of distress.


Villagers eating at Ganga Prem Hospice
Villagers eating at Ganga Prem Hospice
 
     

 

 

On the one hand, the Hospice staff kept the facility safe and the inmates comfortable, and on the other hand, the village people who had sought refuge in the hospice, were provided with food and other necessities. The hospice dining hall turned into a temporary shelter for children, women, and men, young and the old, able-bodied and infirm.

With road links to the area severed, it was a challenge to keep the facility running. Our courageous staff did not demur in working long hours. Their work shifts continued for days, but those staffers who were caught in this demanding situation did not complain even once. The other team members who were on the other side of the swollen river were no less brave. They would come to the river every day, looking for a way to cross it to relieve their colleagues who were under tremendous strain. The State Disaster Relief Force raft was the only link to the area, and the Ganga Prem Hospice staffers used it to reach the hospice so that their hard-working colleagues and friends could be given a break.


   
GPH staff and media leaving the facility

GPH staff and media leaving the facility

The food supplies logistical challenge was also dealt with. The team took stock of the food and cooking gas reserves at the hospice and arranged for more supplies to reach, as meals were being cooked for forty extra people every day. Government officials and media persons also visited the facility to speak to the villagers and assess the situation. The hospice staffers did admirably in being ambassadors of goodwill and hope during this time.

   

As a gesture of appreciation for the commitment and courage shown, the Ganga Prem Hospice medical director awarded letters of commendation and monetary award to those team members who had served, helped and supported people during their time of need, and had gone way beyond the call of duty, and done Ganga Prem Hospice so proud.

 


Nurse Sheetal receives her letter
Nurse Sheetal receives her letter
 
 

 

INDIA, Rishikesh & Dehradun, 17th & 30th August , 2018
Volunteer Coordination and Sensitisation
As part of the Pallium – Ganga Prem Project there was sustained effort during August to coordinate and sensitise the GPH volunteers.


     

Despite the weather, patients wanting to visit the Ganga Prem Hospice cancer clinic continued to enquire over the telephone, wanting to make sure that an oncologist would be there.  Radiation oncologist Dr SK Sharma led the clinic on July 29th , 2018, and was supported by palliative care doctor, Aditi Chaturvedi, Ayurvedacharya JP Rathi, and Drs Amrinder Singh, R Muthunagai, and Yogeshwari Krishnan from the Seema Dental College & Hospital of Rishikesh.


 
 
 

 

INDIA, Rishikash, 16th & 24th August, 2018
Palliative Care Sensitisation in Schools & Colleges
As the monsoon was heavy during August the Pallium-Ganga Prem team was unable to go into the mountains due to landslides. Instead the team worked on explain the concept of palliative care to the young people of Rishikesh


   

 

Rishikesh volunteers identified schools and colleges where they felt there would be an interest in hearing about palliative care and the project manager made initials visits to request an opportunity to address the students. Whenever the request was accepted then an introductory talk on palliative care was delivered by Dr Jyotsna Seth.

     

 

 

During August talks were given at Saraswati Vidya Mandir and at Sri Bharat Mandir Inter College. The 500 students that attended the talks were from the 11th and 12th classes. A number of students and teachers showed an interest in volunteering.



 
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