South to chennai

The gonging of the bell could be heard blocks away, mixed with the sounds of singing voices and blasting instruments like trumpets and clarinets. I step out of my auto rickshaw in front of the oldest temple in the city. Sadly, the gorgeous colourful temple spires are draped in tarps as they restore and repaint. (For that I'm grateful, but it's sad I won't see it) I walk a few circles around the inside of the temple, watching people pray, light oil in tiny clay pots, prostrate, and just sit. I see gurus in bright orange wraps and long beards giving blessings to the temple goers. Today I send my own bit of gratitude up for the "all clear" on my brothers CT scan. 

And then I'm on foot, through the small streets of the 'old part' of chennai....past fruit and veg stands, where I buy a small bunch of small sweet bananas to munch on. Past temples of various sizes and colours; weaving through people, bikes, cars and of course cows. I stand on a corner and look up. There is a spotless white cathedral, towering into the sky. I walk into this place of worship too, and light a candle of gratitude for my brother, my family, and my friends. As I wander out, and the light is turning to the dusky part of day, these bells ring out too. 

I attempt to walk at the beach, but it is filthy, and not at all pleasant there. So I find myself an auto and sit back as the streets come alive even more. Lights and music come on, the temples seem crowded now and it feels like every vehicle in the city is now on the streets. My driver is getting frustrated in the insane traffic, but I feel quite content to sit in the back and take in all the chaos.

The next morning I wake before the sun. I have a sand coloured royal enfield 500cc Classic motorcycle waiting for me in the driveway. My host sees me out, and as the first light of day hits the streets, I'm on my way out of town. Turns out Sunday mornings are a fantastic time of day to drive here.... Only a handful of vehicles on the road make it easy. But I still get it. I give a little honk to tell the bike I'm coming by, I inch over to the left when I hear a car or bus do the same to me. I watch as people and bikes and cows inch onto the road....timing their entrance just so. (Ok, the cows don't time anything ....they are just there) and every so often, the road opens up and I can push the bike just a little bit faster (which is not even close to Canadian highway speeds....cause you never know what's going to pop up next). I catch glimpses of the ocean on my left and pass many a beach resort. I wind through banyan and palm tree lined roads, past rice patties and over rivers. And I come to the old French colony of Pondicherry. At this point the clouds have opened up and I'm soaked as I duck into a restaurant for some breakfast, and by time I'm done, the rain is done. The clouds keep moving and the promenade is bathed in warm sunlight. A walk in the sunny sea breeze quickly dries me and spend a pleasant morning wandering the streets of old French architecture. I am ever so pleased to realize that this is also coffee country, and I indulge in more than one cup.

My ride home is split by a visit to the ancient temples of mahabalipadam, carved out of huge monolith rocks. Of course by late afternoon, the streets are more crowded now, and my ride back into the city takes a little bit longer. But I make it back to the shop with both me and the bike in one piece. Success!

Second week of work

We parked on a small side street and walked another 400m down a narrow alley, and at the first corner on the right, stepped up to our clients home. Here we find a small two room home; a kitchen and a bed. A young women, very thin and tiny is writhing on the bed in pain. She is able to answer some questions if prodded, but most of the time she is lost in her world of pain. Her young daughter is looking after her, along with her own small child and husband. This woman has a feeding tube because of cancer in her esophagus and this tube is coming out. Her daughter knows that it's time to stop using the tube and make her mother comfortable. She doesn't have much time left. 

My home care nurse gets the information about this woman's condition, what is happening now, and how things have changed in the last 2 days. A doctor is contacted and orders received. The nurse inserts and butterfly needle into the woman's thin arm and administers morphine. Within 10mins we can see the start of the woman beginning to settle... The pain is not gone yet, but it's improving. The nurse gives her a medication to settle her restlessness. And another dose of morphine. All the while, counselling the daughter about what the options are and what would be the best thing for her mother. 

An hour and a half later, we leave the daughter with some more doses of morphine and a promise to check in again later. This woman is now resting calmly. The daughter asks "how much time ?" We answer as gently as we can "not much time". 

This woman dies peacefully 4hrs later with a daughter grateful for the nurses expertise and support.

This is the work this team in Hyderabad does. This is the work we try to support. We are attempting to raise excellence so this team can continue to serve their community with dignified and quality end of life care. 

What a privilege to see them at work and walk side by side in this journey of learning palliative care. I take my leave renewed in hope of world wide pain and symptom management and expert end of life care. 

Thank you mnj and palliative care society for welcoming us into your world. Thank you Two Worlds Cancer Collaboration for the amazing opportunity and for your support of this team and many others!

Jagratada undu! 

Rural program

Today we traipsed along with the team to some rural villages as part of the pain and palliative care society program.... Providing medical and symptom management. It was lovely getting out into some villages for a change from the city. We saw some brothers struggling with living with muscular dystrophy, children with diabetes or seizure disorders and of course patients with cancer needing pain control and wound care management. We met such beautiful people in these villages and it's so nice to see a program that is trying to support them (growing from 10 villages to 30!) 

Teaching, kites and more food

Yesterday was festival day; a holiday for Hindu harvest and a kite festival. But education gets no rest. We all spent the day at the hospice..... I, with my home care nurses and others teaching the month long intensive palliative care course. 

My day was spent reviewing assessment skills for nurses. What questions to ask and how to organize all the information for sharing it with docs or coworkers. We reviewed case studies and did role play. We discussed follow up and how to document effectively. We reviewed universal precautions and how to catch hypo active delirium. 

What a great group of ladies this team has! All were eager to learn and able to express knowledge they already have. It was such a great day spent with that bunch!

And of course we ate! 😉 another delicious lunch was served with dhal and chutney, curry and sweets. After which we drove out to the edge of the city to a kite festival where tons of people were flying a variety of kites.... With a variety of skill level! Good fun, great way to end a busy day.

The swing of things

We have been in Hyderabad for 3 full days now and i have to say it's been pretty easy getting back into the swing of things. It feels good to be back! The warm air, frangipani trees, chaotic traffic, and 'Indian time' have a familiarity that is nice to me. (Considering this is the first time going back to the same place twice)

It has also been very nice to know a little about what I'm stepping in to. Yes, there are some new faces, but plenty of familiar ones too. 

Our first day at the hospital included education sessions on radiotherapy, meeting the docs that head the home care team to sort out what my plan and goal was for my time here, meeting the director et al of the hospital, and of course eating . Man! I love the food!

The last two days I was riding along with the home care team like last year. This year I see them using the assessment form I created last year, and using the sharps containers in the vans!!!! Both those make me a very happy girl! 

And last night we were whisked about in cars with drivers (thanks to our influential Doctor) to shopping for nice outfits, then to the home of the rich benefactor of our home care program to change into our new outfits and then on to this home of a doctor who happens to live in indias high society but volunteers her time for our home care teams for a lovely evening and dinner! I saw the opposite side of India than we see doing home care visits that for sure!!

Here I go again

Well folks, I'm off to India again. I will be going back to the same cancer hospital in Hyderabad India. I will be working with the same community palliative nursing team but this time I am bringing along two other nurses: One is a palliative care nurse I work with here in Kelowna and the other is a nursing professor from UBCO that has lots of experience working in Zambia: in fact both of them do. I'm very much looking forward to working with these two and gaining from their knowledge as well.I will attempt to update this blog again like last year and share on Facebook. Please feel free to share with any other people that may be interested.

I'm so excited to be doing this again and feel so fortunate to have the ability and wherewithal to be able to go. This year I will only be gone for about a month. So stay tuned, adventure awaits!

Catching up...varanasi

After agra we got on another train to varanasi...which turned into 20hrs on the train! ! :p but we had a lovely quiet guest houae booked with a great little courtyard garden space. It's amazing how a little green can make such a huge difference when you dont have it for so long.
Varanasi is a smallish city along the banks of the holy river Ganga.  Im not sure how many people know already, but the Ganga has actually been proven to have a microbial uniqueness with higher than normal oxygen levels which actually maintains a "cleanliness" to it....despite the obvious uncleaniness it is subjected to every day. Not only is the water severely littered with the usual garbage, but it is also the place to bathe and perform morning puja, the final resting place of the cremated bodies, the bath for the cows, a toilet, and a swimming pool. Truthfully, its not the most inviting water, despite knowing the science.
However.... the morning and evening pujas to shiva (creator god) are colourful and somewhat inspiring. The candles and flowers in the water are even pretty. I tried to imagine what the opposite banks would be like during the MASSIVE holy festival, where tens of thousands of pilgrims cram into a very small looking place for a chance to dunk in the river. But I know my imagination doesn't even come close.
We took both a sunrise and evening boat ride along the river...watching the activities along the ghats.
This is a city of steps. The whole river front is one set of stairs after another (ghats). We spent hours wandering up and down the ghats...watching children play cricket or badminton, holy men in bright orange wraps heading to or from temples (of which there are tons as well), laundry being washed and laid out to dry, and people just plain loitering.
Then there are the burning ghats. The place where a persons body is brought to the river, placed on a wood pyre and after holy ceremony, is burned. The ashes are then carried down to the water and washed into the river. Cremation is of course a very natural form of body disposal. And I have to say im glad most indians dont waste precious amounts of land in the overcrowded country. One of my first observations however, was how matter of fact the final process is/was. There was a part of me that like that. The person is no longer there and they are disposing of the earthly body. But there didnt seem to be much in the way of emotion....either celebrating or grieving. That makes me think that sort of thing has already happened elsewhere. There were also never any women in these families. It is something I need to learn more about because we only saw the outside. There were a few graphic moments here and in the river that took a little processing...but im not going into details here. If you're interested in the stories please just let me know and I would be happy to discuss further.

This city by far had the most cow poop in the steets out of any one we were in, and it got old fast to constantly be sidestepping it. (The rain one day didnt help either)
The one contradiction I couldn't get my head around was for such a holy city and reverence for the river etc...there seemed to be zero attempt at keeping the place remotely clean.
Which is so sad to me because it is such a cool little place. It really was an unforgettable experience.....