Essential Pain Management – DEMEDCON 2014, Kolar

Alberto Granado (left) with Che Guevara (right) aboard their "Mambo-Tango" wooden raft on the Amazon River in June 1952. The raft was a gift from the lepers whom they had treated.
Alberto Granado (left) with Che Guevara (right) aboard their “Mambo-Tango” wooden raft on the Amazon River in June 1952. The raft was a gift from the lepers whom they had treated.

By Palanisamy Vijayanand

At least I am not the person I was before. The vagabonding through our ‘America’ had changed me more than I thought. Ernesto ‘Che’ Guevara, Notas de Viaje (The Motorcycle Diaries)

With the workshop manuals stacked high in its back, the personal luggage heaped into a pile of rubble, and the incessant chatter of its half-a-dozen inhabitants about hopes, dreams and change– the soul of the Toyota, which ferried us from Hyderabad to the conference of medical undergraduates at Kolar, would have felt more like the Ship of Theseus. It stopped, only briefly, to pay our customary obeisance at the now ‘world famous’ Munnawar & Mansoor motel, Jadcherla – where the acorn for the Traveling Pain School was sown a couple of years ago. Then, at Jadcherla, the acorn first hit our head, when our senior colleagues handed us over the torch of pain education over a coffee break. After our initial ‘sky is falling’ Chicken Little act drew to a close, we settled down with a ‘travel & teach’ model for pain, which has now taken us across a highly rewarding two hundred thousand kilometers. There were meaningful glances, a cup of coffee and a gleeful chuckle in the motel – not necessarily in that order – following which the Toyota devoured us back and sped past the Krishna, the Tungabhadra and the Pennar.

'World famous' Munnawar Motel
‘World famous’ Munnawar Motel

We’ve all had earworms. That catchy piece of music which sticks to the brain, repeats itself, and refuses to go away after it has long stopped playing. Ours has been one of introducing a simple framework to manage pain among health sciences students, or rather how best to do it. It has burrowed into our subconscious mind like those fleeting melodies. Like President Harrison’s rambling inaugural address, the suggested pain curriculum for undergraduates, hitherto, has been a long list of desirable elements; together threatening to gobble-up upwards of fifty unlikely hours. As was Harrison’s Presidency so were the efforts to introduce such a curriculum: spluttering and dying a premature death. They failed in design before they failed in implementation.With brief interactive lectures, brainstorming and small group discussions, all with practical implications and all done in half-a-day, the Essential Pain Management workshops are somewhat akin to George Washington’s address – shortest and memorable.

We woke up next morning to a loudspeaker crackling to life in the distance to play Suprabhātam. When we set off to meet the vice-chancellor of the university, the morning was still awash with the wakeup sounds: the brush of a broom across the walkways, the gurgle of a rock dove feeding its squab, the whistle of the water pipe tending the grass. The delight on Prof. Kotur’s face, when he broke from his assignments to greet us, was obvious. ‘These are transformative ideas,’ he commended us. ‘Will join you all for the workshop later this morning, and I wish you the very best,’ he said prophetically; perhaps picking up messages in the air on special frequencies not audible to the rest of us. For, not soon after, the email which would fill us with gratitude and joy landed in our inbox. The International Association for Study of Pain’s Developing Countries Project award for Initiatives for Improving Pain Education was ours – a critical validation of our efforts.

The places for the Essential Pain Management workshops were fully taken up weeks in advance. To jostle the muse into manifesting, however, requires a sustained effort to instruct and persuade health sciences students. To articulate the true nature of the camouflaged dimensions of pain requires the intellectual and emotional generosity of dedicated individuals. We were joined in this journey by friends from Bangalore, who helped guide the students towards a stronger grasp of their new learning. The RAT – Recognise, Assess, and Treat – acronym for managing pain was well appreciated by the participants, and there were significant improvement in their pre/post-test scores. The feedback was heartening. If facebook ‘likes’ were currency, we would have made it to the Forbes list of the ‘Indian Rich.’ The post-workshop briefing was a cause for further excitement, as plans for a train-the-trainers workshop in Karnataka were firmed up.

Intoxicated by the events of the day, and inspired by Rumi’s ‘Let the beauty of what you love be what you do,’ we stopped at Chintamani, in Chikkaballapur district, to stock up on its popular, tangy, kadlebeeja (peanuts). The best journey comes from finding the right people to join you. And if it is Mohd. Rafi, it just makes the arduous return journey feel much lighter. The travelling party reached Anantapur quite late in the evening – late enough for the quacks at roadside Himalayan dawakhanas, which treat venereal diseases, to shut shop. Famished and ever so slightly exhausted, we settled down for the first hot meal in two days. Wolfing it down with alacrity, we caught glimpses of Sehwag do something very similar to the Chennai Super Kings bowling.

The progress of our efforts with Traveling Pain School might seem so self-evident as to be not worth discussing. But the gains are due, for a major part, to the unique constellation of grit, willingness, support and goodwill. On education coming to the aid of the suffering masses, the physician in Che Guevara famously observed, ‘…there were things that were almost as important to me as becoming famous for making a significant contribution to medical science: I wanted to help those people.’ If we had also made our younger colleagues at the workshop feel that way, we have succeeded.


Images from DEMEDCON2014 – Group A

Images from DEMEDCON2014 – Group B

Image Courtesy

Dr. Palanisamy Vijayanand

Post author

FCARCSI, DPainMed (RCSI), MSc (Pain), FFPMCAI, FFPMANZCA | Hyderabad, India

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