Soaring Strong: The Transformative Power of Palliative Care Social Work

Ms Manisha Mary Marshal, Bengaluru

Growing up, I was a child who lacked a clear aim and ambition in life. People around me had very high expectations of me. They presumed that I would become a medical doctor. Confused and uncertain, I couldn’t decide which path to follow.

Eventually, I decided to pursue my Bachelor’s degree in Physiotherapy after which I realized that I wanted a broader connection to society, exploring human rights advocacy and mental health. This led me to the field of Social Work, where I pursued a Master’s Degree. It offered me the opportunity to make a meaningful impact and bring about a positive change in the society.

After completing my Master of Social Work (MSW) degree, I found myself at a crossroad. Should I pursue a career as a social worker, utilizing my newfound skills and knowledge? Or should I hold on to my background in physiotherapy, ensuring I don’t lose touch with that field? It was a challenging decision to make.

But then, destiny intervened. The unexpected arrival of the COVID-19 pandemic changed the landscape for everyone. I finally made the decision to embark on my journey as a palliative care social worker.

Pallium India, the place I affectionately call ‘the repository of stories’, became my haven; a sanctuary where I would come to understand the essence of palliative care and strive to become a better human being each day. Here, I encountered individuals facing terminal illnesses, each with their own unique story and need for palliative care. The sheer volume of people requiring this support startled me, and also shed light on the vastness of this field.

In my previous experiences within the medical world, I always sensed something was missing. Stepping into palliative care, I discovered that missing piece: Empathy. It became clear that empathy was the essential ingredient, the key that unlocked profound connections and meaningful care for those in need.

Through my experience, I have witnessed how various healthcare professionals contribute to the overall well-being of patients. While physical needs often take precedence, it is crucial to address other aspects such as social, spiritual, and emotional well-being. This requires the involvement of professionals specialized in those areas: social workers and psychologists.

Armed with this knowledge, I embraced a new dare to join my current workplace, a prestigious medical college hospital in Bengaluru. Initially, I had no idea how palliative care could be delivered in a medical college setting, especially outside of Kerala. This journey has been a challenging learning experience, as I encountered individuals from diverse cultures, religions, socio-economic backgrounds, and linguistic and ethnic identities.

What amused me the most was the limited awareness of palliative care among the medical fraternity. This raised a question in my mind: If healthcare providers themselves are unaware, how can we expect the general public to seek out palliative care from the point of diagnosis of a life-limiting illness or at least know that there is an option even when a cure may not be possible?

Deep within, I hold the belief that many individuals like us, are working tirelessly to raise awareness about palliative care and be advocates for patient rights. Whether in medical college hospitals, palliative care NGOs, or hospices, numerous professionals are wholeheartedly dedicated to a common cause. I firmly believe that by collaborating, assigning equal importance to all aspects of care, and setting aside hierarchies and egos, we can undoubtedly make this world a better place.

I’m well aware that many people have this question in their mind:

How does a social worker contribute to palliative care?

Let’s take an example of a young man who suffers with quadriplegia. The major challenges encountered by him being grief, suicidal ideations, distorted family situations, livelihood concerns and other general circumstances faced by a spinal cord injury patient.

Upon initial contact, a social worker recognises the profound impact of the young man’s loss on his sense of self. Having lost his mobility, dreams, and hopes for the future, he might experience feelings of isolation and overwhelm. The social worker prioritises the establishment of a trusting relationship, ensuring the young man feels heard, understood, and supported. By engaging in empathetic conversations and active listening, the professional could aim to restore a sense of identity and empower him to embrace a new chapter in his life.

The social worker could provide individual counseling sessions as a safe space for him to express his grief and navigate his feelings of despair. Emphasis may be placed on building resilience, developing coping strategies, and fostering a positive self-image. A social worker encourages him to explore his interests, talents, and potential avenues for personal growth.

The family would also be engaged in therapy sessions to promote healthy communication, establish boundaries, and address underlying issues that contribute to the family’s challenges. Collaborating with local community resources, the social worker would connect the family with support groups and counseling services.

The social worker engages with the local authorities and organizations to advocate for accessible housing options. By liaising with government agencies and charitable organizations, efforts would be made to secure suitable housing that accommodates the young man’s specific requirements, including necessary adaptations and equipment to enhance his quality of life and foster independence. Additionally, the scope of support with also include coordination with healthcare professionals to ensure regular access to medical services and therapies such as physiotherapy and occupational therapy, addressing his physical needs and optimizing his functional abilities.

The social worker identifies the importance of promoting dignity in the young man’s life. Opportunities would be explored for him to earn a living and contribute to society. Through vocational training programs and initiatives aimed at developing skills, potential employment options which align with his interests and capabilities would be examined. The social worker would then connect the young man with local employment resources and organisations supporting individuals with disabilities, encouraging him to pursue financial independence and regain a sense of purpose.

The young man’s suicidal ideations will be a very significant concern. Immediate action would be taken by the social worker and the psychologist / counsellor, involving an assessment of the severity of the situation and the engagement of mental health professionals for comprehensive evaluation. A safety plan will be implemented and ongoing support need to be provided to manage and address the issues.

Now, imagine the fate of this young man in an ordinary scenario where he was confined to bed, with only his basic physical needs being met.

What if a social worker or a mental health professional was not involved in his care?

To conclude, palliative care social work is a vital profession that emphasizes compassion, empathy, and advocacy. Through their expertise, social workers in this field offer invaluable support, guidance, and resources to patients and their families, promoting holistic care and even facilitating meaningful end-of-life experiences. Their contributions have a profound impact on the lives of those facing life-limiting illnesses, allowing them to find comfort, dignity, and support, as they navigate their unique journeys.

About the Author:

Ms Manisha Mary Marshal is a Medico – Social Worker at the St. John’s Medical College Hospital, Bengaluru.

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