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Dr. Abhijit Dam

Past Secratary, IAPC. View profile

Interview with Dr Abhijit Dam

In perpetual Kosish to make a difference

Dr Abhijit examines a patient during his team’s palliative care visit to a village

After your MBBS in 1990 with honours in eye and ENT, what prompted you to do your MD in anaesthesia?
I was interested in critical care. So, after doing a house job in general medicine, I opted for anaesthesiology.

You almost landed a plum job in the UK after your FRCA. Tell us about it. 
I went to the UK in 1996 with a friend for my FRCA exams. He had relatives there, whereas I could hardly support myself financially. It was humiliating to stay with his people, but I did not have a choice. I still remember those days when I used to stop by windows of restaurants in London and salivate. I experienced existence without having money. I passed the FRCA exams first part in the first attempt. Sadly, my friend did not. The successful candidates were invited to have a drink with the faculty (with the chance of getting the job of a Senior House Officer). The unsuccessful candidates were asked to leave. Seeing the crestfallen look on my friend’s face, I decided to leave with him. That was the end of my golden opportunity of getting an SHO job,  a stable career and steady income! 

Any regrets?
Strangely I have never really regretted it. 

Then you returned to India?
Yes, I came back to India from the UK, and started looking for a job. I came across this vacancy in The Sri Baba Haidakhan Hospital, in Ranikhet in the Himalayas. My wife (a gynaecologist) and I were excited. We were young and we had no children then. It was a small hospital attached to an ashram and I took up the job. We lived in a small beautiful village. From our porch we had a grand view of 13 Himalayan peaks. Many evenings, we would go on shikars deep into the forest with the local people. 
I could see how difficult it was for people to access healthcare. After my stint at the All India Institute of Medical Sciences (AIIMS), New Delhi, working in this little rural hospital was indeed a challenge. I learnt to work in resource-poor settings.

I still remember the first emergency Caesarean section we handled there. My wife was operating and I was the anaesthetist. The patient, who was under spinal anaesthesia, had an anaphylactic reaction during the surgery. I managed the case successfully and that reinforced my self-confidence. 
After that small hospital in Ranikhet I joined Bokaro General Hospital in 1997. I was with the department of anaesthesia and critical care and quickly rose up the ladder. 

Why did you take up palliative care?
After more than 10 years of doing critical care, I realised that in critical care, more often than not, we are prolonging the process of dying (and making it more painful in a holistic fashion) rather than saving lives. People die lonely deaths. Often the last image your brain registers when your eyes flutter open for the last time is that of a nurse or ward boy or a sweeper, while your family and loved ones wait beyond the door, a few feet away, not allowed to be with you. You end up paying through your nose for a painful, undignified and lonely death.

I believe that the poor, who cannot afford medical care, die a more meaningful and dignified death at home with their loved ones around, holding their hands.

Palliative care without morphine

“I believe that palliative care is possible without the use of morphine. pr2
We need to optimise the use of local resources that are accessible, affordable and culturally acceptable. The Kosish cocktail is a mixture of drugs that are available all over India. It is a powerful analgesic which is given by subcutaneous boluses, administered by the family members. This gives them a sense of empowerment and participation in the care process.
We have used this cocktail at Kosish in Jharkhand and also in Nagpur and Kolkata. It is perfectly safe. Even an unintended overdose will not cause respiratory depression or death.
We must remember that morphine alone cannot cure pain. So, even if morphine becomes freely available, the scenario in which I am working will not change much.
My question to my fellow palliative care practitioners who are privileged to work with morphine is if they can provide the same care without morphine. That is the real challenge.
To repeat, palliative care is possible without morphine. But it is doomed without empathy and compassion.”

Prof. Jacek Luczack with a patient during his visit to India

When did you get into palliative care?
I was at the Bokaro Hospital for about 10 years and was quite keen that the hospital should start palliative care services. The hospital did not agree. Then, in 2006, I chanced upon Eastern and Central European Palliative Care Task Force (ECEPT). They were offering training opportunities. I applied and Prof. Jacek Luczack, the founder of modern palliative care in Poland and the President of ECEPT selected me. He even arranged free food and accommodation for me. He graciously helped me overcome the language barrier by getting me an interpreter.   It was a beautiful learning experience. I finally found my love in palliation. I consider Prof Luczak to be my guru. In 2009, I went back, thanks again to my guru. This time I spent one month at the Warsaw Hospice for Children. The nurses would drive nearly 300 km just to visit one sick child. That was devotion! I cherish those memories.

By the way, Prof Luczak was in India at my invitation in 2012. He participated in an awareness programme at Bokaro and attended the IAPC conference in Kolkata. We signed a Memorandum of Understanding between Kosish and Poznan University for scientific exchange and training in palliative medicine.

How did Kosish happen?
When I wanted to start palliative care services in my hospital, the authorities put it down bluntly. So I got together with some like-minded friends and started our own NGO — Kosish the hospice.

What were those early days like when you decided to introduce palliative care in Jharkhand? 
I had to face a lot of taunts and criticism when I started on my journey. Actually, I still do! People viewed me and my team with suspicion. Oncologists refused to refer their terminal cases, maybe they were afraid of losing out on their income. I never had any access to funding. The medical community scoffed at the idea of palliation. Most of them did not even know what the term meant! Caregivers were wary of us initially. They wondered why we were visiting them at home and giving their patients free care and medicines. However, after a few visits, they started welcoming us as if we were a part of the family! As for the attitude of the government, the less I say the better.

Spirituality and palliative care

“I was an atheist until three years ago, when a life event made me seek refuge in God. Then, I realised my stuttering inadequacy in handling religious and spiritual issues raised by my patients. I was supposed pr4to be a Hindu but I had no idea of my religion. How was I going to help my patients?

So, I undertook a one year course in “Advanced Vedanta” from Chinmaya Mission. Then I completed a six-month course in “Contemplative and End-of-life Care” conducted by the Naropa University, USA. This reinforced my conviction about the power of unconditional love and empathy.

Personally, I have found my spiritual and religious experiences to be gratifying. It has moulded my personality in a positive manner. And it has had a positive impact on my work.”

Dr Abhijit Dam has authored the book, “Spiritual issues in the last days of life…a perspective of Sanatana Dharma.”

How has IAPC helped you? 
I got an initiation grant of Rs 75000 from IAPC. We spent most of it on digging a tube-well for to provide water for our patients.

You must have started Kosish with a dream. How far are you from realising it?
At Kosish, we are all dreamers. We keep dreaming. We fulfil one, then chase another dream. 
The greatest strength of Kosish is its team. They work selflessly and without any compensation. I just hope that they will continue like that.

Where do you see yourself, 10 years down the line?
Dead, maybe! But with a smile of satisfaction for whatever little change I could bring about.

Dr Abhijit Dam has authored the book, “Spiritual issues in the last days of life…a perspective of Sanatana Dharma.”to-bottom”

The long-term care facility that Dr Dam is setting up for the elderly and the terminally ill at Pindrajhora village, Bokaro

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