By Palanisamy Vijayanand
It is not down on any map; true places never are.
- Herman Melville, Moby-Dick; or, The Whale (1851)
If there ever was a ‘true’ place in our journeys with Traveling Pain School, then it would be the blooming of regional centres for management of pain in our country. Our obsession towards getting there matched Captain Ahab’s madness in hunting down Moby Dick, the ferocious sperm whale. There is a difference, however. This one has a map. If the International Association for Study of Pain’s curriculum has served as our shipping map, then support from India’s learned societies have been our travel guide. After watching the bow of our ship slice through the waves, more than 30,000 kilometres of it, we recently moored at a fascinating port – Warangal. It is in this historic capital of the Kakatiyas, where we reached out to the 500th doctor on the importance of effective management of pain. Invoking Moby Dick, America’s greatest epic, may not be the best metaphor to chalk out our travels, but the hyperbole can’t be better. Ours was more of a canoe than a whaling ship, and the ‘port city’ of Warangal lies a solid 500km away from any largish water body.
For long, we have been in the crosshairs of pseudoscientific treatments for pain (by both modern and traditional medicine) peddled out on unsuspecting Indian sufferers, and were tired of ducking the bullet. To provide credible remedies strong enough to cure this social malaise, by advocating science-based medicine, has been our raison d’être. The junior doctors at Warangal, despite being on strike, turned up in scores to fill up the hall, and we were grateful that they did what they did. There were no buzzword-encrusted Big Ideas, only practical tips, which when put together would merge into a coherent understanding of pain. To understand pain and suffering is not a mere tangent of understanding biology, but a centripetal force to recognize our limits and discover the meaning of our working lives. The case discussions had a depth of purpose, and brought forth creative suggestions to fine tune our own quest for perfection. Managing pain is a multi-disciplinary endeavour and so is the teaching of it. For the first time we had a physiotherapist in our team, who talked about self-management, ergonomics and rehabilitation. Then there was the Monk Who Bought His Ferrari. The top prize in our test went to an under-graduate for the first time. Many congratulations Dr. Robin Sharma.
The importance of teaching pain management to medical undergraduates in India might seem so self-evident as to be not worth discussing. It is the commonest symptom a doctor has to alleviate. To try and implement the teaching, however, is to suffer the twin issues of lack of concerted effort and apathy. This year, due to the pioneering efforts by our senior colleagues across the country, the initiative had started to gain a modicum of traction. There are still many unknowns, chiefly regarding the content and delivery which would appeal to the youngsters. There is much to be learnt in the teaching of pain. The key indicator, the canary in the coal mine if you will, is how this added knowledge is translated to better care. To supplement these efforts, Traveling Pain School has now launched a nationwide survey of medical students, to try to decipher their needs. In addition, to refine the content and delivery to match the students’ needs, we have organised a couple of pilot programs in far flung parts of the country this year. We have been supported in this endeavour by national and international organisations, which obsess about the same things as we do.
Back to Warangal; ‘If you wish to make an apple pie from scratch,’ Carl Sagan eminently observed in Cosmos, ‘you must first invent the universe.’ One wouldn’t go that far if the intent is to rustle up a continuing pain education program in India. In our ‘home-delivery’ model, the faculty had traveled to Warangal to deliver the pie. That way the finely textured crumbs were all in one place. The ingredients too were put together with pragmatism, keeping in mind the resource poor settings in which the delegates practiced. It wouldn’t be a terrible calamity for the world if personal and cultural narratives, and anecdotes from an Indian context, were used as a touch of spice to deliver the science effectively. A bit more cinnamon rarely spoils an apple pie. At a personal level, like Melville’s main characters, we have had the opportunity to meditate upon our personal beliefs and how it has changed over the course of our journeys. In this, the farther we went, the clearer it got. Unlike Melville’s epic, we have all survived to tell the tale. The distances we have traveled inside, due to our collective force of conviction, are as good as the distance we have traveled outside. For some of us, at least, our personal philosophies have changed beyond recognisable – like one’s own photograph on the ‘Aadhar card.’
Banner image courtesy: Creative Commons license (CC BY-SA 3.0)
Event sponsored by Modi-Mundipharma and Sparsha Pharma