One doctor has a new goal in the second-most populated country in the world: To improve the physical, mental and spiritual well-being of patients nearing the end of their lives.
“Doctor, can you help me die?”
This is a question most of us find hard to imagine. Kelle Brogan, MD, Medical Director of Palliative & Supportive Care at Renown Health says it was this question that resonated with her the most during a recent trip to India.
As a doctor who has dedicated her work to improving end-of-life care, this question also brings clarity to why she helps patients and their loved ones at this stage of life.
What is End-of-Life Care?
The National Institute on Aging describes end-of-life care adequately: “When a doctor says something like, ‘I’m afraid the news is not good. There are no other treatments for us to try…’ it may close the door to the possibility of a cure, but it does not end the need for medical support. Nor does it end the involvement of family and friends.”
In the Beginning: Understanding India’s Care System
Dr. Brogan shares her experience in Hyderabad, Telangana, India.
I was first introduced to the lack of India’s end-of-life care by a local Oncologist named Sowjana Reganti. Her mother-in-law, Rohini Reganti is a retired Medical Oncologist and Palliative Medicine Physician who practiced in Burlington, Iowa for 30 years and returned to her hometown of Hyderabad.
There she started volunteering her time and expertise at Sparsh Hospice, a 14 bed hospice, the first and only hospice in Hyderabad, where Dr. Rohini Reganti manages patients’ pain and other distressing symptoms with limited access to medications.
To understand why this diverse country of more than 1.2 billion people is lacking end-of-life care, I planned a trip to India with my daughter Amanda who is also passionate about palliative and hospice care. Thanks to funding provided by Reno South Rotary, our vision to help care, educate, learn and immerse ourselves into the culture was made possible.
Meeting the Patients
Most of the patients we visited were suffering from cancer and had severe physical and financial difficulties, as well as spiritual distress as it’s not culturally acceptable for the Indian peoples to discuss end-of-life issues.
This obviously created very complex issues surrounding truth telling, fear, how to address questions surrounding the meaning of suffering and the need for closure with family, friends and their community.
Amanda and I made daily rounds to visit patients accompanied by a medical student and nurses. This was undoubtedly the best part of our trip. The patients and their families were grateful for our care and attention. Despite the limited supply of medications, we were able to improve their comfort considerably.
It was difficult for me to speak about the issues with those who did not speak English; however, we could converse to some extent with the help of the medical student. Dr. Rohini Reganti is an absolute master at this and it was humbling for me to watch her gently bring peaceful, spiritual awareness to the patients and their families.
The Mission Moving Forward
End-of-life care is often non-existent in India, especially for the impoverished. When a cure is not possible, the healthcare system will place pressure on families to pay for expensive treatments with state insurance — if they are fortunate enough to receive funding at all.
In the end, many families are left with little to no money and the patient continues to suffer with terminal illness and pain. The solution: Continue education on the topic and bring change through philanthropy.
Hope on the Horizon
Dr. Brogan hopes to take University of Nevada School of Medicine fourth year medical students; her son Gary, who is also an EMT 2; and her daughter Amanda, who is applying to Physician Assistant school, to Kerela, India next year.
With end-of-life care programs being somewhat more developed in the southwestern region of India, Dr. Brogan says she plans to learn what projects worked and incorporate those ideas into Sparsh Hospice to continue to grow the program.
She is also working to secure financial assistance through local Rotary Clubs and foundations to fund the project.
Despite the many difficulties with poverty, limited healthcare and India has, the people are gracious and kind. Wherever Dr. Brogan and Amanda went, they were offered considerable hospitality. In return, they wish to continue inspiring compassion for one of life’s most poignant moments — the end-of-life.