#1 Making dying less painful and more dignified
When she saw her mother-in-law suffering in pain from liver cancer, Dr Odontuya Davaasuren felt helpless and realised how pain could deprive people of peace in their last lap.
"I cared for her. I fed, washed and changed her—but I could not relieve her pain, because I didn't know how," she expresses.
According to her, the only medication available for dying patients in Mongolia at that time was for muscle pain or headaches—and not to relieve the persistent pain of a tumour pressing on nerves.
"I felt shame and that I am a bad doctor because I didn't know how to help," she reminisces.
Dr Davaasuren was only 17 when her father died of lung cancer in Mongolia. She was then studying paediatrics far from home in Leningrad. "I didn't have the opportunity to care for my father or say goodbye," she recalls. "When I returned to Mongolia, my sister told me that our father had been in constant pain."
"Many, many patients died at home, in pain, with great physical and psychological suffering," she shares. "Many times, the families bought so much traditional medicine and other expensive medicines. But that was just false hope."
“A good death... and a good life before death—it is a human right," the 59-year old doctor says.
But this was a far-fetched hope 15 years ago in a country where the sick was left to reel and die in pain. Palliative care was unknown in Mongolia; and in such excruciating circumstances and without pain relief, people can only hope to die and many have considered suicide.
She says, “People asked, 'Please kill me'—they preferred to die than suffer.”
In 2000, her trip to the European Palliative Care Association conference rekindled her conviction—to afford Mongolians a less painful way to die.
"Before I went to Stockholm in 2000, I had never heard these words, 'palliative care'," she expresses, considering such care was not available in Mongolia or other post-socialist societies.
Back in Mongolia, she visited dying patients at home and filmed their desperate testimonies. Terminally ill patients were routinely sent home once doctors concluded there was nothing left to be done.
"They preferred to die than suffer. After [filming], I would come back in the evening. I just watched and cried, watched and cried. I saw so much suffering."
The shocking liver cancer statistics in Mongolia convinced the health authorities to establish a national palliative care programme, which will lend support to the dying and their caregivers. Each provincial hospital in the country provides palliative care, and five hospices care for dying patients on wards and at home.
She has also asked for morphine to be made more accessible though many officials believed the move might fuel addiction. Thousands of doctors were trained by her to administer pain relief and provide psychological support to the dying.
For the doctor who upholds human dignity, providing end-of-life care is vital.
"Spiritual care is sometimes much more important than morphine. Spiritual care can relieve pain. Patients lose their anxiety, fear, insomnia... and there are very good changes after accepting death,” she adds.
She recounts an episode in the palliative care ward of Mongolia's National Cancer Hospital, where she initiated an end-of-life chat with her patient and his family. "She said she had hoped for a cure,” says Dr Davaasuren.
Her reply was direct. “It is the terminal stage. Now, it is not the time to bomb by medicine, it is time to surround him with love.'
"It's very difficult for me still. I sometimes cry together with my patients,” says the doctor who never fails to whisper love to her patients.
#2 Going beyond the call of duty to save lives
The scenario is bleak: a crumbling health system and lingering economic crisis coupled with a highly-sensitive procedure that makes medical accessibility impossible for its people.
But it takes a courageous spirit and a caring heart to go the extra mile to deliver hope to thousands who are at risk of dying from heart disease. A team of doctors—led by William Novick—travelled to Benghazi, Libya to bring relief to at least 30 children from destitute families battling with life and death on a landscape filled with bloodshed and devoid of hope.
Libya, one of Africa’s most dangerous and impoverished countries, had some of the highest life expectancy rates and lowest malnutrition rates.
Novick and his team initiated their first trip in 2012, making numerous visits to eastern Libya. Conditions at the Benghazi Medical Centre have become worse, according to Novick, the founder of the medical group.
“We have more than 300 kids waiting for open heart surgery, maybe 400," Novick said.
Reida El Oakley, health minister for the eastern government, said a private clinic in Tripoli is the only medical facility in the country that offers heart operations. Many have died due to lack of treatment.
#3 Making dreams come true
Like most teenagers with big dreams, Kamiar Alaei and his brother Arash wanted to be doctors even though they were witnessing the ongoing Iran-Iraq bombings right outside the tents where they had classes.
Today, Arash, 47 and Kamiar, 42, who live in the United States, have not deleted that scene from their minds. They are determined to help aspiring doctors—medical students in Syria—displaced in their own country by the civil war, which has left the country with a dwindling population and a shortage of healthcare professionals.
With the attack on universities in Aleppo and Damascus, many students fear returning to school. A programme called Free Aleppo University is set up to protect students from being targeted, and underground lectures are conducted in secret locations and safe houses.
The challenge is to rebuild the healthcare sector. To send Syrian students to medical school is a virtually impossible task.
Inspired by a Skype session with the dean of faculty for medicine at Free Aleppo while attending a workshop at Yale university, the Alaei brothers initiated a long-distance learning programme using two things they never had when they were students—the internet and mobile phone—to train Syrian medical students. Heading the Global Institute for Health and Human Rights at the University at Albany, State University of New York, both brothers provide live lectures via mobile phones where students can hold discussions on the call.
A chance made possible because of a dreamSince June 2016, the programme has enrolled 525 students, with hundreds on the waiting list. Most of them are first- and second-year medical students living inside Syria.
One cannot earn a medical degree by phone," says Dr. Alison Whelan, chief medical education officer of the Association of American Medical Colleges.
"Clinical skills—physical examination, taking a history, clinical reasoning and learning how to talk with a patient about their health, their treatment options—can be acquired only through practice. Simulations can play a role, but real work with real people—with supervision by real physicians—is critical."
For Mohammed Almarhoun who aspires to be a cardiologist, these classes give him a chance to forget about guns and drones and bombs, for a moment.
People get one chance to live and for him, this chance comes at a time of war. "My dream will not wait," he says. "I want to build my own hospital. It may be so hard to have it, but I didn't lose my hope to study medicine—and now I'm studying medicine."
This bears testament to an achievement made possible because of a dream within a dream. "It's a way for us to show the students that we care about them, and don't want them to lose their hope," says Arash. "Someday there will be peace, and they will be the new generation of doctors." MIMS
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Loss of two scientific heroes who revolutionised healthcare
A look at healthcare systems across Asia