Written in retrospect

By Tanzil Miah, Specialist Dietitian

Above all else I wanted for my experience of volunteering with Rama Foundation to be a rewarding one not just for those we were supporting, but for myself too. I promised myself that I would maintain a positive mind-set from the offset - as cliché as it may sound I felt this was the driving force behind our accomplishments.

In the development stages, I was sure to let go the thought that maybe we were being too ambitious with our aims. I told myself I would not compare Ganga Prem Hospice (GPH) to Addenbrooke’s - the two centres are at complete parallels to one another, and the practices, technologies and infrastructure of a charity funded hospice in rural India to those of a nationally recognised hospital in the UK, are incomparable of one another. Our ambition was to provide guidance and direction to help build upon an already great cause.

Upon arrival I was impressed to find a large, open facility, with lots of modern features, offering a standard of care that exceeded my expectations.

I was aware there was no Dietetic presence at all at the hospice, and anticipated seeing severely malnourished patients, but had not processed this concept in its entirety. There are certain nuances (e.g. tube care and maintenance) associated with our job roles, and it had not until this moment occurred to me that without Dietetic input, these aspects of care would too fall a-miss.

Bringing up these issues was not easy, I was fearful of seeming critical of the work of established professionals which was simply not the case. Discussing the areas of differing practice was eye-opening; whilst faced with the shortcomings in funding, equipment, and clinical presences, GPH is blessed with an incredibly forward thinking and resourceful team, who demonstrate innovative thinking despite these limitations.

They say “If you change the way you look at things, the things you look at will change” and for GPH, a truer word could not be spoken.

What appeared at first glance to be poor or out of date practice were actually carefully considered clinical decisions. For example wide bore feeding tubes were favoured over finer ones (generally better tolerated) as in the absence of ready-to-hang feeds, the risk of blockage was greater, and with no access to x-rays or an endoscopy unit re-siting tubes in patients with head and neck cancers in such a remote geographical location would prove no easy feat . Patient’s had been trained to gravity feed through syringes - clearing their tubes of any remnants of the liquid meals, due to a lack of feeding pumps.

I can think back to a particular patient where we felt artificial feeding was impairing the quality of life, and the focus should move to comfort-based care. This had the potential to be a very difficult conversation to have, yet the team were incredibly open-minded when presented with our thoughts on the topic.

In my years of practice I have delivered many training sessions but never to this intensity. In all honesty I have yet to come across a team of clinicians that have been as receptive to new ideas and learning as those at GPH.

Witnessing the creativity of the team has been a key learning point for me - it had me questioning my own resilience when faced with challenges, my tendency to only see things in black or white, often forgetting that there is a whole palette of greys to explore. It is with this refreshing new perspective that I look forward to continue working in partnership with GPH and supporting their remarkable work.