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Breaking new ground in cancer care

Santosh Chaturvedi, who was awarded the Dr. Vidyasagar Award this year, shares his views about the status of psycho-oncology in India.

Santosh Chaturvedi (extreme left) receiving the prestigious Vidyasagar Award

I WAS early for my appointment with the Assistant Professor of Psychiatry, NIMHANS — Santosh Chaturvedi. He is the recipient of the Indian Council of Medical Research's distinguished Dr. Vidyasagar Award this year "for work on quality of life in health and disease" — a fitting tribute indeed to his pioneering and unparalleled contribution to the world of psycho-oncology in India.

Time stood still as I cooled my heels in the large corridors outside the Psychiatry Department, waiting. Occasionally one heard a piercing scream and then silence as the nurses escorted the patients back to their quarters after a post-lunch walk.

"I am sorry, I am late," said the soft-spoken professor as he led me to his spartan room.

Educated in Delhi and Chandigarh, where he completed his M.D. in Psychiatry, Dr. Chaturvedi joined NIMHANS in the early Eighties. "As a psychiatrist, my special area of work, interest, and research lies in the subject of terminal illness. Although this includes all medical disorders, I am primarily interested in oncology," he reveals.

"Most terminally ill patients undergo tremendous pain and cancer patients have to deal with it more than the others, soon cancer pain relief became my area of focus," he says waving his hand towards a label stuck on one of the cupboards. It read: "The Pain Stops Here".

Nevertheless, it was his two-year stint (1988-1990) at the University of Manchester that proved to be a turning point in his career. As a Commonwealth Fellow he had the opportunity to study the psychiatric aspects of cancer, with the Psychological Medicine Group and it was there he met Dr. Peter McGuire, an eminent psychiatrist and professor. Dr. McGuire also visits India to participate in seminars and conferences.

"Our observation was that in India the awareness of the psychological problems that were caused by cancer was low among doctors as well as staff in hospitals," he says and adds that the Nineties saw an upsurge in general awareness about the disease and the time was ripe for educating the masses.

Dr. Chaturvedi, along with a team of dedicated professionals, took the lead in conducting workshops and seminars all over the country. They covered pertinent issues and held talks on topics such as How to communicate with victims?, How to reach out to the victims' families?, How to read cues? and so on. He also adds that support group meetings, regularly held at NIMHANS was attended by a number of cancer specialists, social workers, counsellors, and people from all walks of life. Training is imparted to volunteers who need support in their endeavours, in order to carry out their duties well. They encounter several challenges while working with the terminally ill. "Training of the trainers remains one of the principal areas of thrust," elaborates the doctor.

However, Dr. Chaturvedi recognises that it is no easy task to provide individual care to patients in the Indian context. "In USA or UK, a doctor on an average sees three to four patients a day, his Indian counterpart has to deal with several hundreds. So, the crux of the matter is that in India, care and psychological support must be provided to patients and his families in a short span. Most cancer centres do not have a psychiatrist, psychologist, or any other mental health professional to provide psychological care and support. If they do, then they are only part-time. There are yet no separate departments of psycho-oncology, or psychiatry in cancer institutions and the Regional Cancer Centres," explains the man who appreciates the multi-disciplinary approach that is being practiced in the West. "Another thing we must borrow from the West is the equality that exists between health professionals there. The role of nurses here is hardly dynamic and most of the time they are bogged down with counting the blankets and often end up checking the temperature and blood pressure, even when not necessary," he says and adds that to train nurses here, NIMHANS invited

Gilly Burns, a cancer nurse from U.K. who taught the nurses to prioritise their work and offered them valuable tips on palliative care.

"Psycho-social support for cancer patients is quite variable, formal support is lacking in most places, NGOs are active in a few cities and absent in others. The mainstay of psycho-social support is from NGOs and cancer societies, so the future should see the development of more such agencies. One hopes as well that large regional cancer centres and hospitals will develop their own support services," says Dr. Chaturvedi, whoconsiders himself an academician first.

"The work must never stop, our volunteers now work in various places with hospitals, support groups, and care centres all over Bangalore," he says.


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