Intitally shared on the AIDEM, 10th October 2022: On the eve of World Mental Health Day, Dr. Chitra Venkateswaran, Psycho-Oncologist and Clinical Director of Mehac Foundation, interviews Dr. Mhoira E.F. Leng, a renowned international palliative care expert from the United Kingdom. Dr. Mhoira has been instrumental in coordinating pain and palliative care work across the globe. Her vision of palliative care encompasses the values of compassion, dignity, hope, and community involvement.

Highlights from the interview:

[Regarding palliative care]: “we recognize that it's something that needs to be connected deeply, to individuals; individuals affected by palliative care need, individuals who are offering palliative care need, but actually, they together form communities. And if we can connect with meaning, and hope, and values, and what we're going to say about the most marginalized in our communities, to our core humanity, then I think palliative care begins to make sense. If we see it simply as a medical specialty, it stays in the hospital setting and the medical setting.” – Dr Mhoira Leng

“We have a role as a doctor as, as medical professionals, as healthcare professionals, to take care of people who need palliative care. That is probably one of the most important sections of palliative care. But I believe that palliative care as a philosophy has much more relevance in the dimensions of people's lives or in communities.” – Dr Chitra Venkateswaran

“At the core of everything we do are our values, and the values that are distilled out in palliative care, because it deals with such crucial issues such crucial times in our lives, it makes us reflect on and maybe even challenge and develop our values. And I think we've seen this in these last few years with the pressures of a pandemic. We've seen it in Kerala [India] with the floods, and the pressures and challenges that came from that, and different parts of the world different ways. But it brings us back to what's important, what gives our life meaning.” – Dr Mhoira Leng

“Access to medicines like morphine as painkiller [are] absolutely vital. But why is it vital? It's so that when we have our pain controlled, we can have those conversations with our loved ones, we can make the decisions we want to make for our families. And I think it's that transformational ability that palliative care has. And there's one value I think we talk about a lot: compassion, yes. There's … an equation, people are talking about at the moment that compassion is awareness, plus empathy, plus action. And that equals compassion. And I think that's something that we see in the journey of palliative care.” – Dr Mhoira Leng

“That sense of being there for people, even when you don't have all the answers … and you're walking alongside that presence and holding that presence. Again, you can describe it almost like a candle, and you're holding those places between fear and doubt and hope and despair, those you're holding those places, not necessarily with all the answers, but saying ‘we are there,’ ‘we are going to do all we can to improve the quality of what's happening for you.’ But most of all, ‘we won’t abandon you.’ – Dr Mhoira Leng 

“I think that [there is a] balance between all these domains, you know; having a good symptom control, taking care of all the physical symptoms that a person has, but as well as looking into all those spiritual, these emotional aspects, the mental health issues, which again, came up really visibly, you know, noted during the COVID pandemic. I mean, we saw so much of a surge of mental health issues. We saw, you know, the grief that came in; the cumulative grief due to the losses.” – Dr Chitra Venkateswaran

“We're seeing it in different ways, where we are kind of defining ourselves by who we are and who somebody else is not. You know, we're increasingly defining ourselves, we're this and you're this. And I think what palliative care teaches us isn't the end of the day do these things matter? They don't. What matters is me as a human being connecting to you as a human being, at times in our lives, which are, are some of the most meaningful, the most difficult, but also the most precious. So I think more than ever, we should say to societies and settings, what is it that unites us? … perhaps palliative care brings us right back to that. It's about our common suffering, or common humanity and the compassion that we, we as individuals, but we as societies, and we as a global community, and need to remember, discover, celebrate, [and] develop to respond to the need.” – Dr Mhoira Leng

“If we just take end of life care: it's such a precious time, it's the last time we spend with loved ones. It's such an important time to make sure that things like pain is controlled, that people are not distressed … there's everything we can do, to support families, to support the process. So that, that, that can be as meaningful and gracious as possible so that the loved ones can hold their hand and be there together, they can say the things that are important to them. That things like saying, ‘I'm sorry,’ reconnecting, building relationships, seeing priorities can happen. And perhaps we need to bring that into our conversations.” – Dr Mhoira Leng

“The clinical or the, the medical fraternity also perceives death as a failure. Isn't it like, when somebody dies, someone with a chronic illness (or even any illness dies), they perceive it as their own failure to cure them, because cure is the ultimate success. So to gently let go, you know, for the physicians or for the medical professionals, as well, to know when to stop …” – Dr Chitra Venkateswaran

“When we talk about clinicians, you know, changing their perspective about how to manage, I think the start should be also discussion about death openly in the society. And I have seen it, there's been a lot of efforts from colleagues and friends across India, they, they have these death cafes, where people talk about it talk about death and dying in a much more open way. Because we usually do not—that is a taboo word isn’t it—you do not talk about that. It's as if that it has not happened to me, it happens to somebody else.” – Dr Chitra Venkateswaran

“Palliative care allows us to move back again. Maybe countries like India, or many other countries in Africa, and Palestine can teach also about what it means to be a collectivist, absolutely collectivist community orientated. But still, we need to make sure we're discussing life and death and all its glory, and its joys, and also its pains and its challenges. So I think it's important to also remember that palliative care and being human is something that brings laughter and joy, as well as tears and sorrow—and it's that whole package that makes us human.” – Dr Mhoira Leng

Feedback from the interview:

“Dr. Chitra and Dr. Mhoira,
It was really an excellent conversation. Really everyone needs to listen to this, within a short time what is palliative is clear. Hats off to both of you.
Watched the whole interview.” 
– Stella Alice Verginia

“Great to hear such a comprehensive, global, yet relatable aspects of Palliative Care from Mhoira. Thank you for that.
Excellent conversation Dr. Chitra. You should do this more often.”
– Dr Biju Rhagavan

“Beautiful, explained the profound philosophy of palliative care.
Congrats Mhoira and Chitra.”
– Dr Geetha Vijay

“Mhoira, I just listened to your excellent talk with Chitra about compassion & dignity. I found myself taking notes again! 
I loved your expansion of ‘compassion’. Many in my circle had awareness but lacked empathy & action.
Thank you for your Gaza stories, a situation that distresses me greatly.”
– Dr Ann Thyle