Retraining as a palliative care physician in India

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Published: 24 Mar 2017
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Dr Sharmila Choudhuri - Ishpremalaya Cancer Hospice, Pune, India

Dr Choudhuri meets with ecancer at IAPCON 2017 to describe her journey of re-training from a clinician to a palliative care physician in India.

She talks about the spiritual aspects of palliative care and also the difficulties with the number of different languages spoken in India.

Dr Choudhuri’s training is still ongoing and is mainly self-directed with the help of various resources, including ecancer’s training modules.

She talks about how these have helped her, what other resources she would like to see available for training palliative care doctors and how more support is needed in marrying together theory and practice in the palliative setting.

I was initially into gynae and obstetrics and I’ve been practising for the last 28 long years and somewhere down my practice years I suddenly realised I’ve had enough of this and there were certain things which I didn’t like about it. You could say maybe it was because purely about making money and some parts of it I decided I’ve had enough of it. I just needed to change my place, my type of service, my attitude towards my education. Also, as I grew older I realised that my education had a lot of deeper and different meaning than actually what society was expecting me to be. I realised that being a doctor is a blessing, it’s a boon from God, and maybe because we are all deep down very spiritual people and we don’t discover it, when I started discovering the spirituality in me I realised that all of us when we are gifted with a certain talent we need to channel it in the correct way and not what we are groomed into thinking or doing. It’s good that I realised it, although quite late, but then it’s good that I did and I came into palliation. I think it was destiny that pulled me into palliation because I’m fitting into palliation very well.

As I go through this journey of palliation and also in parallel I’m pursuing spirituality, I’m reading a lot of Hindu scriptures,  I discovered that all of us actually are meant to be palliative people, all of us. It’s sad that we don’t discover it and maybe we don’t discover it at all or we discover it late but whenever I meet a person in front of me I try to educate that person, just trying to tell him to discover the palliation in him, meaning to say the compassion in him, the empathy in him, all those things. It was a very challenging thing for me because I migrated from the state of Bengal and Jharkhand into the state of Maharashtra, a different language, different people, a different social structure. I was not able to communicate because Marathi was a foreign language to me. Then I realised suddenly that the language of love and affection is universal, it’s absolutely universal. So my first contract was with a cancer hospital and just a few days into my work I realised that my language was not stopping me from communicating. I would just go in front of a patient and surrender and say, ‘I don’t know your language so much. Maybe I’ll be able to communicate with you in Hindi because Hindi is a common language.’ But people in Maharashtra, some of them knew, some of them didn’t know and also I know English but maybe they found a thing that I know a foreign language also, they found it fanciful. So they just welcomed me and slowly, slowly I realised, like I said before repeating, that the universal language of empathy, love and affection just reaches out to everybody around you. You just have to touch them, just have to say a sweet good morning to them, just have to know in the morning, they said you just have to be there like Dr Downing was saying, you just have to be there for them and that is more than enough. The other rest of the things that you are doing, that is OK, the topping on the cake or the icing, we could say, but those things are very important.

So I realised that, OK, I’m fit for this even though I’m not earning anything, I’m just losing all my savings. But it’s alright and at this juncture in my life when my family is all settled and all I don’t need all that. Once I start thinking about money, that’s a big hindrance. That’s a big hindrance because now that I’m not thinking I can just go out, be myself and give whatever is inherent in every one of us actually. So it’s become very simple for me now, now I just need to educate myself more because of course it’s a different stream and education knowledge is the basis. Unless I don’t equip myself more with more knowledge I will not be able to do justice to the people I am treating.

So I’m feeling slightly handicapped because I am not that educated in this stream, I’m relatively new to this and, yes, I’m just going out and meeting people and asking them for help. I’m seeking and because I’m seeking I’m getting also. I’m sure in another year I’ll be quite equipped and I think I’m made for palliation so I know I’m just going to flourish in it.

How were you introduced in palliative care?

After my MBBS and my practice with gynae obs I came into palliation. So naturally before coming into palliation I did my certification courses. I was introduced into it so I went to supply, did my part A, then I did my part B and I trained in a cancer hospital then in a neurosurgery hospital and now I am working in a cancer hospice in Sawantwadi. I got my certain in-house trainings, no doubt, but I always wanted to just learn more, just learn more. So I would be Googling and then I am into this IPC journal, I have that also, so I’d be reading that online. But still I wanted to explore, know more, so as I was going through I attended the last conference last time, last year. So I had come to know about Karunashraya and also about Cardiff and all that. So I got to know.

I had wanted also to do certain courses but I knew I had other priorities. This time when I was just going through the net I came across these modules and I found them very interesting when I tried also some of them. I tried also some of them and it was quite interesting. What I found interesting with the modules was I was into a stream where I was coming with little knowledge, I was reading up because I was working in a neuro hospital in onco, so I was reading up also certain textbooks and all. So I had certain knowledge about palliation. I was testing myself, not finding myself very adequately equipped. I was slipping in some places so as I was reading through the modules that I was going through were you test yourself first and then you know where you stand. Once you know where you stand then you educate yourself. I think that was what I was going through.

I found that very interesting because I realised as I was going through the modules that I had read but I’m not that well equipped, I was making mistakes. I thought I knew but actually I did not know all of it. So I got less marks, it was alright, but then I thought let me try again. So I would try again and the second time I did I got more marks, I don’t know how I got more marks, but that prompted… more or less it challenged me. So I thought now I’m going to read up and I will read up and I will sit for these again. Sadly I had so many priorities then so I couldn’t come back again into it but from that time that thing kept trying my brain. It kept coming into my brain and telling me that I need to go through all that again, I need to give my exams, because when you become a student again the challenge part is something which eggs you on. It eggs you on and then you discover you don’t know. OK, you are in a stream, you are practising, you are taking up patients and really you don’t know all of it correctly then you don’t like it. So you want to educate yourself more and that’s how I’m exploring more, I’m going to educate myself more and I think the modules will come very handy.

Now I’m going to finish all of it the same and go back home. I’m going to finish all of it, of course with the help of all the people, all of you, and I’m sure it’s going to make me… I was feeling very handicapped, actually and I am sure after I have gone through all of it, because the few that I flipped through they were very practical. I was coming across all of that in my hospice; I was coming across all of that in my neuro hospital. The treatment that the neuro people were giving, that was very different from what palliation tells us to do. It was very different, maybe there were certain similarities but also they were different. So I thought I needed to know it from the palliation aspect, I needed to do the correct things. So now I’m going to go through the modules and sincerely I’m going to take all your help and crack them this time.

What other types of modules would you like to see produced?

What a doctor requires during the study material is the clinical aspect also. I’ve read certain things, now I need to go back. Once I have read I know it, I need to go back and experiment… not experiment, I need to use it on my patients. I need to see those patients then remember what I have read and also then try to put those two together. Now, because I’m alone, in the hospice I’m alone, I’m the only one working there so I might falter, I might make some bad mistakes also. There I need somebody senior telling me, ‘This is the way to go about,’ why I made this mistake. So I don’t know, from the module if I could have that also, a part where I go back, I interact and tell them, ‘This is how it went,’ and then get my whole thing polished again, maybe that would help me. Because any knowledge is incomplete without practical so the theory part would need a practical honing and also that practical part was done correctly or not, or correctly but could be more refined. That also I need to know. So I have to honestly open up on a forum and say this, all I did – I blundered or I came out with flying colours – and then I need a guidance.

Do you think an interactive forum would help doctors in this case?

Then what I would do is, say I have these ten cases and in the neuro sector I have many cases, in the cancer hospice now we have a few patients, it’s coming up. So then I would do work, I would take each case, make a case study and use my theory part to help me out with these patients then I would make my jottings and then I would do it in a correct way. I would be prompted to do it in a correct way because now I know something like I am going to a classroom, I have a teacher there, I am not able to see the teacher now but I’ve gone to a classroom, I am doing my homework and presenting my homework and then getting it corrected.

So I will look at it simply like that because in palliation I consider myself now a pure student. I need to hone my skills a lot. Your modules will naturally help me but then I would need a senior teacher to guide me more. You can’t do something alone, not only with theory material. So that is how I think it should be.