Moment of hope during the humanitarian crisis in Manipur

– Dr Nandan Choudhary, Imphal

There is no denying that the world is in a state of chaos. But amidst all the turmoil, there are moments of hope and inspiration. Quoting Archbishop “Do your little bit of good where you are; it is those little bits of good put together that overwhelm the world.”

On Wednesday, 3rd May, 2023, an ethnic communal violence descended in Manipal, one of India’s north-eastern States. Due to this unrest, several people in the State were displaced and were forced to stay in the temporary relief camps constructed by the Government. Curfew was imposed and movement was restricted throughout the State?

As expected, the first knee jerk reaction was panic across the State. Several of my patients and their caregivers began calling me over the telephone, in despair, as they wanted to share their concerns regarding the continuity of their / their loved one’s treatment. I vividly remember two of such telephonic interactions with two different caregivers of patient’s that I was treating at that time. Both of them were crying all through our conversation as they were worried and anxious about having to discontinue / the challenges in overcoming the possible hindrances towards the treatment of their loved ones. I listened to them actively, and then began advising and appraising them of possible avenues to ensure that their loved one would continue to receive treatment. I also reassured them that my team and I would make sure that the chemotherapy regime would continue, after identifying healthcare centers closer to their homes. 

Over time, we were plagued by curfews and restricted travel. This meant that patients were unable to freely visit the hospital for follow ups. Several patients and their families were now requesting for me and my team to make home visits, as they were too scared to come out of their homes. The limitations in public transport also made local commute difficult. Despite increased teleconsultations, I felt that I was unable to do justice to some of my patients. I then took a bold step and decided to begin home visits, come what may. The innumerable roadblocks or the curfew didn’t deter me from visiting my patients who were suffering immensely and in desperate need of pain or other symptom management. 

One such home visit was that of a patient who was diagnosed with carcinoma lung with metastasis. The patient had severe breathlessness which was precipitated by cardiac failure. It was quite a challenge to reach the patient’s home as the ground situation was dangerous for even healthcare professionals to commute due to the fear of sudden clashes between the army and the public and the frequent army checks. My social worker and I changed from commuting by a car to a scooter, mid journey, as we realized that being on a scooter will make it easier for us to navigate the curfew. As we were about to reach the patient’s home, we sensed that a clash was about to erupt between the army and the public. We reached the patients home finally around 6:00 p.m. and within a few moments, we heard gun shots being fired very close to where we were. But you see, that became ‘sort-of-normal’ in that situation. We checked the patient and noticed that they were out of medicines as stores were shut. Once we arranged for their medicines and provided the care that was needed, the family expressed their gratefulness and happiness for our visit. That one moment, made it all worth it for us!

The other interaction that stood out for me was when I met an 83-year-old cancer patient who had come to our center from a tribal area which was in the thick of violence. The patient’s frailty, medical condition, the need for ongoing treatment, the lack of access to care and medications back home, and the challenges in freely travelling, forced the family members to stay back here instead of returning to their place. The patient and the family prioritized being close to the care center so that they would have access to the continuous care that the patient required. The situation here was also relatively better for the family in terms of safety and access to essentials for daily living. Hailing from the tribal village, the family needed support in arranging for their stay and other things. My team helped the family in arranging for their stay and also for their other needs, all while also ensuring that the patient’s treatment didn’t stop. As the patient was terminally ill, most of the family members also decided to stay with the patient. The patient did breathe his last after a few days, in dignity and comfort.

It is heart wrenching to share that since the day this communal violence began, over 50,000 people have been displaced from their homes and are continuing to live in various relief camps (such as tents put up in large open grounds, or in schools and community halls) arranged by the Government. Each camp provides shelter to an approx. 50 individuals. While the Government is able to arrange for shelter with beds, water, and food, the state of mind of the individuals living there continues to be filled with fear and uncertainty (future, their current security etc.), and distress (social loss, job loss etc.). The Palliative Care Society Imphal has also reached out to the Government officials to request details of those who are in need of palliative care services. We are preparing to then visit these camps to manage the spiritual and psychosocial distress that is prevalent among this group of people and also render palliative care services to those in need of such services.

As I look back over the past few months, I was once again reaffirmed that putting in a little bit of ‘extra’ effort to care for and help our patients and their caregivers, we provide us with the opportunity to make a positive and meaningful impact in the quality of their lives.

About the Author:

Dr Nandan Choudhary is a Senior Resident at the Shija Academy of Health Sciences, Imphal, Manipur. He is also the Joint Secretary of the Palliative Care Society Imphal.

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