Absurdly fun

From the start, it was an absurd proposition: we would leave Trivandrum at 3AM to get to Ponmudi early enough to hike to “sunrise rock” and see the sun rise at about 6:30 over the Western Ghats. Shriya Singh, the resourceful grants or Resource Mobilisation Manager at Pallium India, had a friend in her cycling club who made the arrangements with a Forest tour guide, Sarath.  Shriya, true to her title, also mobilized a driver, Satheesh, who used to work at Pallium India.

The drive to Ponmudi was somewhat surreal.  It is a route that we know well from home visits—tangled with buses, auto rickshaw taxis and motorcycles driving the 2 lane road in 3, sometimes 4 lanes.  However on a Sunday at 3am, we sped through the streets and onto country roads with virtually no traffic or even people.  There was a lone dog or two on the streets, and an occasional street light.  The world looked abandoned.

And in 55 minutes we were at the forest edge with a gate barring our passage.  Satheesh knocked on the door to awaken the official to let us pass.  The gate is, in part, to make sure wild animals are not hurt by speeding vehicles.  It is not officially to be opened until 8am.  We were over 2 hours early.  The official called the tour guide to make sure that our story was legitimate.  And then the official woke up the “gate opener” to open the gate.  I would have been happy to open the gate and let him sleep.

 

And on we went, picking up the official Forest Guide, Sarath, along the way.  The guide is “a tribal”—a term that has never felt clear to me.  I have come to understand that the tribal people are people who were socially  and geographically isolated (in forests in Kerala) , with defined spiritual beliefs.  There are about 100 million tribal people in India.  He spoke little English (except “Malabar Grey Hornbill”).  We arrived too early to start the hike so we waited in the cool temperatures at the top of the mountain.  

We arrived at sunrise rock.  The clouds added beauty.  Thanking Christopher Cantu for all the photos in this blog (except a few).

We saw a Malabar Grey Hornbill.  Here is a picture of it that I copied as my picture did not capture the yellow beak.

We briefly saw a Indian bison. Also a copied photo.

No elephants.  I feel about wild elephants the way I feel about grizzly bears. Best not to meet them hiking.

The vistas were breathtaking.

Sarath never broke a sweat, and while we were peeling off extra layers, he remained with his jacket on.

The company was fun:

Having just recovered from jet lag, I wondered if self care should involve more sleep deprivation.  However the awe of skies, mountains, winds, bird sounds renew me in ways that music and prayer renew others.

Thank you Shriya!

Here is your moment of Zen.

Losing yourself in the service of others…

Less than 2% of Indians who need palliative care are receiving palliative care. There are strong palliative care programs in India.  However the population of India is huge and most palliative care in centered in urban areas. Three years ago, palliative care advocates looked to Project Echo  to provide the needed education to teams across the country.  

Pioneered by Dr Sanjeev Arora at the University of New Mexico, Project ECHO uses very specific case based learning via video conferencing to teach specialty knowledge to primary care practitioners, activists, nurses, health care clinicians of all kinds.  The goal is to “democratize knowledge” to create “forced multiplication” of willing and able clinicians who are trained to deliver care that might have been only available to patients who could travel to academic medical centers.  His landmark New England Journal of Medicine paper on the use of Project ECHO to treat and CURE Hepatitis C in the rural areas and in the prisons of New Mexico showed that Project ECHO trained primary care providers can reach the clinical success rates of specialty liver physicians.

Raised in India, Dr. Arora has a special interest in the success of Project ECHO in India to disseminate medical information across his vast country of origin.  It has been highly successful at Pallium India.  

Trivandrum Institute for Palliative Studies team have been using Project ECHO to change access to palliative care. Rajalekshmi Balu, the Project ECHO coordinator organizes physicians, nurses to teach palliative care in a very specific way via video conferencing to physicians, nurses and to the public. Now that the central Indian government has expressed an interest in palliative care with a palliative care policy and the Medical Council of India has suggested that there needs to be a palliative care curriculum in the medical schools, the mandate to meet these monumental educational needs is daunting.


I was lucky enough to watch the excitement at Pallium India during Dr Arora’s site visit last Sundayto Pallium India. How can the small group of specialists in palliative care move this forward for the whole country? How does one measure success? The discussion went on for hours and included the ECHO Director in India and a researcher from the renown Public Health Institute of India, all shown here with Dr MR Rajagopal.

And then I thought about the Veterans Administration (VA) Hospital in Iowa City where I work….

instead of travelling to the VA clinics to teach about palliative care principles, why not use this technique.  In person is great, but the time investment might be better used with video technology.  Could I start Project ECHO at the VA?  Many VAs have Project ECHO currently functional to teach about pain, buprenorphine.  Why not palliative care?    Exciting to think about…

Here is your moment of Zen—my favorite fruit seller at Kovalam with Dr Theo Nguyen (also a favorite).

The best way to find yourself is to lose yourself in the service of others. Mahatma Gandhi