Mangaluru : Although I had so many close encounters in the past with Dr Jochen Becker, a German who is an expert in Palliative Care and Psychotherapy at various talks/seminars that were held at Kasturba Medical College Hospital-Attavar, and wanted to have a exclusive interview with him then, but my efforts were all in vain, since Dr Becker had either a tight schedule or he had to rush back to his country. Until couple weeks ago, while he was in Mangaluru for his Palliative Care teaching at Yenepoya Nursing College, he spared some of his precious time in his room at Hotel Gold-Finch, where we both chat and discussed some issues pertaining to Palliative care, over a cup of hot brewed English tea. The interview was quite exclusive where Dr Becker shared some of his thoughts and also gave some ideas how Palliative Care can be improved in Mangaluru for the betterment of the end-of-life patients.
On the outset let me give a brief description as to what is Palliative Care? The physical pain arising from a terminal illness may be debilitating and frightening. Hospice providers have the skills and resources to help a patient to live as pain-free, as comfortable, and as full a life as possible. Palliative care is a system of pain management. This system begins with an agreement between the individual, physician(s), primary caregiver, and the hospice team that the expected outcome is relief from distressing symptoms, the easing of pain, and/or enhancing the quality of life. The decision to intervene with active palliative care is based on an ability to meet stated goals rather than affect the underlying disease. It is a time when comfort for both the patient and the family becomes the focus, not curing the condition.
Considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury, hospice and palliative care involve a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patients needs and wishes. Support is provided to the patients loved ones as well. At the center of palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so. Hospitals are now looking into palliative care as a component to traditional care. However, few hospitals in Mangaluru, like KMC Hospital, Yenepoya Hospital have taken this step.
Remember that treatment of pain can come in many forms. It can be: medication, therapeutic exercise, heat therapy, cold therapy, electrical nerve stimulation, cognitive behavioral techniques such as meditation and guided imagery, psychological approaches, acupuncture, massage, anesthesiology approaches such as epidurals, nerve stimulation, and surgical approaches. Palliative medicine is a medical sub-specialty provided by doctors who offer palliative care for people who are seriously ill. Palliative care relieves suffering and improves quality of life for people of any age and at any stage in a serious illness, whether that illness is curable, chronic, or life-threatening.
Prof. Dr. Jochen Becker-Ebel -CEO MediAcion / PalliAction.com and Prof. for Palliative Care Nursing and Palliative Care Teaching is a very simple, friendly and dedicated man-he has a special way that warms the hearts of everyone who knows him and meets him. His qualities has made him a lovable person among all those he has associated with during his frequent visits to India/Mangaluru. Soft spoken, Dr Becker respects everyone with dignity and pride, and he is very courteous, friendly and kind to all. One thing that I have noticed in his personality is that Dr Becker never acts proud of his CEO post and other designations, instead leads a very simple life. He is truly a man of quite personal grace.
Dr Jochen Becker studied Roman Catholic theology and served at church for 7 years. He came to India 30 years back because of Sri Ramana Mahrshi and Vedanta Meditation- during that time he stayed at a remote village near Tiruvannamalai/central Tamil Nadu, giving social service to the poor for 15 months and then later served as finance administrator of the Shanthimalai Trust from 1996 till 1999. At present he is in-charge of a 30-people staff medical education company in Germany dealing on the topics of end-of-life-care and psychotherapy
Since four years, Dr Becker has been frequently visiting India with the support of secretary health and Family welfare central Government and recommendation of German Government. During his visits, he is a faculty at Manipal University, KMC Hospital -Attavar and at Yenepoya University, where he teachs and trains staff in palliative care (= end-of-life care) and with the methodology he knows from psychotherapy (= psychodrama). He also teaches psychotherapists at Bengaluru and HRD staff/business consultants at Chennai in Psychodrama.
Dr Becker is one out of three foreign experts who has written together with 16 Indian experts the UG curriculum in Palliative Care for Nurses and doctors in 2012 (under survey at the medical and nursing council for approval). He was appointed adjunct faculty professor palliative care nursing and palliative care teaching at Yenepoya nursing college for one year as visiting professor, and on that day a tree was planted. He conducted the first train the trainers course in India according to the European median level (diploma level) with 20 days duration at Manipal University from Aug. 2014 to Feb. 2015. Currently he is performing research work on that together with the university of Aachen under the guidance of the university of Liverpool.
Nurses and faculty of Yenepoya nursing colleges are getting trained in a specalised palliative care course. They will serve and communicate better with dying patients and with their relatives. The local faculty of Yenepoya Nursing College got assisted by the German Palliative Care Expert Dr. Jochen Becker-Ebel. On the occasion of Dr. Becker`s appointment as Professor at the Adjunct Faculty in Palliative Care a Rohitaka tree was planted in front of the Nursing College. Dr Becker is very closely associated with his buddy Er Jerardin D’Souza-the founder of Mangalore Alzheimer’s Association, and together they have planned various projects/programmes in dealing with Alzheimer’s and Dementia patients.
There has a wide range of discussion and sharing of information on Alzheimer’s Care Giving. Since the inception of Mangalore Alzheimer’s Association [MAA],there has been lot of awareness of this affliction, and the association has got more information from the hugely experienced Dr. Becker from Germany. “In Germany people are well aware of Alzheimer’s and there are eighty thousand facilities in Germany to take care. In an advanced Alzheimer Case, the patient can NOT be kept at home, there has to be a separate facility to Care for this very unfortunate affliction” stressed Dr. Becker, who has promised to train the Alzheimer’s Volunteers in a batch of 25 each.”The Family of the Alzheimer’s affected needs to be counseled and made to understand the specific needs of the affected” said Dr.Becker.” It is fun,interacting with the affected, and one should not be paranoid or scared to face the reality, once diagnosed, we should handle it creatively and involve the patient too” Dr Becker had advised .
In response to Dr Becker’s suggestions, Jerardin Dsouza had indicated that the cost of rehabilitating or building facilities for the Alzheimer’s affected would be a restraining factor- ”Let the Rich ,who can afford, pay for the facilities, care ,etc and from the income generated, the poor can be supported”. ”We should never make the Facility look like it’s running on Charity, because the rich will shun it. In Germany there are Gated Old Age Communities,where Alzheimer’s affected too stay. There has to be nursing & medical facility & facility for physical activities” said Dr. Jochen Becker. ”We will discuss the commercial viability of building a Modern ,scientific and Old Age Friendly structure & get a builder involved right away” assured Jerardin Dsouza, who is an Engineer by qualification. Dr.Jochen Becker -Ebel & Dr.Prabha Adhikari of KMC had signed a MOU, for getting Doctors trained in Palliative Care. On behalf of The Manipal Academy& MediAcion ,Hamburg,Germany MOU has been exchanged- and progress is going on very smoothly.
The following are the excerpts from the exclusive interview with Dr Jochen Becker Ebel :
Q :What led you to work in palliative care?
A : After my Plus 2, I worked as a nursing-helper in a hospital. They assigned me a job of taking care of dying patients. Somehow I liked this job in taking care of persons who are on the verge of dying. Some had questions, but most of them liked to be cared for in silence. As I started to perform regular Vedanta meditation at that time, I did not mind this silence at all. From time to time I had been present when a patient died. In this intense moments I received more, than that I served and gave.
Q :What is palliative medicine? What’s the difference between palliative care and hospice care? Who provides palliative care?
A :Palliative Care is a way of “end-of-life”-care and symptom control to strengthen well-being in own´s last days. It is combination of palliative medicine, palliative nursing and palliative care taking (social, emotional, spiritual) and includes help of voluntary workers (the Kerala Model of palliative and hospice care on the community level). In India there are a few palliative care wards for cancer patients in larger (university) hospitals like KIWDAI, Bangalore; AIIMS New Dehli and others. There are hospices – even at Mangalore.
The home visit of voluntary workers, nurses and medical doctors is working well only in Kerala and New Dehli and a few other places. There is a lot of possibilities to improve pain control and care for Cancers patients. And even beyond: There is a need to help the old ones and geriatric patients in the last weeks of life. KMC- Attavar is the only such place in a private university hospital in India, where Prof. Dr. Prabha Adhikari is following such a supportive palliative care in a geriatric ward for some 20 patients. Palliative Care should be extended to all in need, especially for patients with dementia too, as Jerardin D`Souza, president of MAA points out.
Q. What does a palliative doctor or a care-taker do that’s different from what my other doctors do?
A : Most doctors see there is task in “curing”. Palliative care is “caring”, when there is no curation possible any more. New drugs (like pain remedies) and approaches had been developed. The most important for a palliative care specialist is to listen to the patient and his family to find out the need and give hope for the last days. It is not a false hope of getting cured, but a hope, that these days can have at least a certain quality of life. These days can be important for the family to say “good bye”.
Q. Shouldn’t all doctors be concerned with alleviating the suffering and improving the quality of life?
A :In my country (Germany) one out of ten doctors get a training in the palliative care approach. It helps the communication between patients and doctors. And quality of life should not only be improved in the last two days of life, but in the last weeks and months.
Q. If a patient receives palliative or hospice care, will he/she still be able to see their personal doctor?
A : The palliative care specialist and the personal doctor of the life-time will jointly do the work needed. I believe, that as many doctors as possible should join such courses as to know how to communicate and treat their own patients in the end-of life. 5-day Courses for doctors will be held in Dec. 2015 at Manipal and Jan. 2016 at KMC Attvar.
Q. If a person agrees to palliative care, does that mean it’s time to ‘give up’?”
There is no need to forgo all possibilities of curative medicine when the patients accepts palliative care:
Q. How can people find palliative care? Does insurance cover palliative care or hospice?
The Indian Association for Palliative Care IAPC has a list of centers and practitioners who provide palliative care. Old aged palliative care is given at KMC Attavar. Hospice care is given at Ave Maria Hospice. There are subsidies in some palliative care centers and hospices. For those, who have an insurance, there is no discrimination, which doctors you approach and for what kind of care you use the money, which is covered by your insurance. And even two doctors of the Governmental Hospital (and some of other hospital like Father Muller and Yenepoya) have got training in Palliative Care.
Q. How do a person know that they are receiving the most beneficial or appropriate treatment under palliative care?
A : Ask them, who got it. They can tell you by their own experience. The quality control for the best treatment can be there only, after this kind of treatment is given. Sorry to say: At this point of time, India (outside Kerala) is ranking on place 40 out of the 40 most developed countries in the world in the delivery of good palliative care. This is the reason, why Indian Central Government brought in new laws for pain control and dispersion of opioid last year. And in the next weeks / months the guidelines will be published on the state levels together with a plan to improve palliative care area all over India.
Q :What do you see as the biggest challenge facing palliative care in Mangaluru at the moment?
The possibility of palliative care needs to be given to the notice of the public. There should be more skilled experts and we need a functioning home care system.
Q : What do you have to say about the palliative care in India compared to Germany? What is lacking here in India?
A :Great Britain, Australia, Ireland and US are quite good in Palliative Care at this moment. There palliative care started in the early 1970s. Germany has picked up after a late start in 1995 (rank 14 now to rank 7). India needs rules to give good pain remedies to cancer patients. Doctors needs skill in palliative care. Nurses have to do the day to day work – even at the home of patients, who can´t move any more. Funds shall be given, even if cure is not possible any more. This life span should be meaningful and not a disaster.
Q : Is there anything I haven’t asked about that you would like to add?
A: Giving palliative care – even if you treat dying patients most of the time – can be very joyful and is extremely meaningful.
Q : What would be your message to the readers of mangalorean.com ?
A : Inform yourself. Get help for your family members, once they need this. Do not despair but share your needs. Ask your doctor to listen. And doctors: Join the course at KMC Attavar in January 2016. Let’s unite and work together to make a difference in palliative care and give the best care and service to these dying patients.
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