EXPLORING GERIATRIC CARE in India - 2019

United nations International day of older persons

Preparing for International Day of Older Persons

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The Janaseva Foundation has led annual celebrations of this day. This year the celebration will be held on October 9th in Pune and is expected to bring over 2500 seniors from the city! This is one working meeting that I had the opportunity to participate in. The day long program will include breakfast and lunch, entertainment, group physical activity, education seminars and a fair to exhibit services available to older adults in Pune.

Preparing for International Day of Older Persons

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Here are some leaders who will participate in the annual celebration, including the Janaseva Foundation, Help Age India and the Navchaitnya Hasyayog Pariwar.

Hasya club- navchaitanya hasyayog pariwar

Laughter club

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I finally had the opportunity to observe a laughing club in action! I had heard about this concept but had not experienced it until now. I was up at 6am to make it to the 6:30am gathering.

Announce coming events

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The club had a few leaders who took charge of encouraging range of motion exercises for everyone. The latter half of the hour focused on practicing different kinds of laughs- some prompts included: a welcome laugh, the belly laugh, and the "I ate something spicy" laugh.

Socialization for all

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This club benefits from the philanthropic support of its members. For example the space provided for for meeting is donated by a member.

Club leadership

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These leaders helped to create the club which now has multiple locations all across the city of Pune!

Spreading the word about Geriatrics

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At the end of the session I had the opportunity to talk about geriatric medicine and framed my presentation around the 5Ms. 

Dr. D.Y. Patil medical college, hospital and research center

Geriatrics CME

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Thanks to Dr. Karnitgar at Dr. DY Patil Medical College and Dr. Tamane of the Geriatrics Society of India/Pune Chapter, I participated in the CME course and presented Geriatric Palliative Care to both faculty and medical students. 

Medical College Leadership

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Faculty had the opportunity to thank the medical college leadership for supporting this CME course for Geriatric Medicine. As part of the program, a famous Marathi poet eloquently shared his perspectives on aging.

madhurbhav senior living and assisted care

Leadership

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I visited MadhurBhav, another privately owned senior living facility. I learned about the range of services provided, including intergenerational activities, home care, subacute care and longterm care. I was particularly impressed by their initiatives to help care for older adults with dementia. 

Caregiver Training

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MadhurBhav recruits some of its caregivers from villages in Maharashtra. In addition to promoting employment, this program also helps to fill the demand for more caregivers. 

Busy schedules

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Older adults living at MadhurBhav can maintain a routine that includes meditation, exercise, arts and crafts and music. The facility also encourages its residents to participate in the numerous festivals and celebrations that occur throughout the year in Pune.

CIPLA Palliative care and training centre in pune

Founders

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This palliative care center was established in 1997 and has been providing palliative care to the Pune community. The center has a true interdisciplinary model, with nursing, physicians, physical therapists, social workers, nutritionists and volunteers. 

Meeting a fellow PCEP alumn

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Dr. Dighe and I met during a panel discussion last week and through discussion about our interests and experiences, found out that we both participated in the faculty development course at Harvard, the Palliative Care Education and Practice Program.

Impressive campus

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As I walked around the campus, I was impressed by the beautiful courtyards and patient accessibility to the outdoors.

Research at Cipla

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In addition to patient care, I learned that the palliative care center hosts the ELNEC nursing training and has a research arm.

Remembering each other

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This Tree of Memories reminded me of the work that my colleagues do at NYP.  Cipla Palliative Care Center has also created a space to share stories about patients and families that they have provided care to. 

sensitization program on intergenerational bonding

Janaseva Foundation at SNDT College of Home Science

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The Janaseva Foundation held its One Day Sensitization Program on Intergenerational Bonding on August 22 at SNDT College in Pune. The goal of this program is to educate the youth about the role of family and the unique needs of the growing elderly population in India. This program is supported by the government of India. 

Program Leadership

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The Janseva team, led by Shri Jaydev Naik and Adv Balwant Nisal met with Dr. Muktaja V. Mathkari, principal of the of SNDT College of Home Science. She shared her eagerness to collaborate with Janaseva and bring this unique program to her students.

Diverse Speakers

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The program began with an overview of the changing population demographics in India. I had the opportunity to discuss ageism and myths in aging as well as introduce the concept of intergenerational activities and programs. This was followed by a discussion about ageing with dignity and legals aspects related to aging in India.

Combatting Ageism

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I tried out some audience participation with true and false questions to engage the crowd as we discussed ageism in India.

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Geriatric society of India - Pune chapter

Aging and Palliative Care CME

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I had the opportunity to present at a Geriatric Society of India CME program. The Geriatric Society of India/Pune Chapter collaborated with Cipla Palliative Care Training Center.

Promoting Healthy Aging

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I organized my presentation around the 5Ms. Ending with a discussion about "what matters most" worked well with the rest of the sessions that focused on palliative care in India. 

Inpatient Palliative Care

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I learned about how palliative care is integrated into an inpatient and outpatient setting at Deenanath Mangeshkar Hospital, a private institution in Pune.

Legal/Ethical Issues in India

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This was a fascinating overview of the legal aspects related to palliative care in India. For example, instituting a health care proxy and then being able to use that proxy requires multiple steps.

Panel Discussion

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The CME session ended with an engaging panel session where we fielded multiple questions from the audience regarding geriatrics and palliative care.

Janaseva Foundation PAnel discussion

Panel Discussion

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Dr. Vinod Shah, the heart of the Janaseva Foundation organized a panel discussion to discuss all of the activities that this NGO is directing, with particular focus on the aging population.

Diverse Audience

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The participants included professors and other interdisciplinary providers who have collaborated or plan to collaborate with the Janaseva Foundation 

Speakers

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My dad stumbled into geriatrics when he moved to the US and had to give up his ENT experience to complete a medical residency. Over the past 40 years he has worked in and directed a few long term care facilities. He spoke about his experiences. 

Speakers

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I had the opportunity to share the work being done at Weill Cornell and NYP. I also presented the 5Ms in Geriatrics. 

HN Reliance Hospital - Mumbai

Geriatrics Clinic

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This was the first time I saw a Geriatrics Clinic in a hospital! I met with the one doctor here who is leading the geriatric initiatives at this hospital. We talked about the variety of opportunities for future collaborations. 

Geriatrics Symposium

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I participated in a Geriatrics Symposium which highlighted the importance of multidisciplinary care.

Presentations

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I had the opportunity to present an overview of both the geriatric assessment and palliative medicine.  

Thank you

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Participating in this symposium also provided the opportunity to meet prominent medical providers in Mumbai.  I continued to learn about the Indian medical system as well as the expanding interest in Geriatric Medicine. 

BJ GOvernment Medical College, PUNE

Warm Welcome

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I was invited to speak at the 4th Annual Respirare Conference at BJ Medical Center in Pune. This is a multi-day student-led initiative! 

Insider's Tour

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Prior to my presentation, I had the privilege of taking a tour of this prestigious government hospital. I met some of their HIV researchers.

Geriatric Assessment Overview

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The people that I have collaborated with have been kind and generous. The Respirare team thanked me with this plaque.

Medical Student Audience

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As I spoke to the medical students, I surveyed their exposure and interest in geriatric medicine. 

Student Organized Conference

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Here is the team behind this year's conference. 

Prestigious Government Medical College

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My visit reminded me of my own residency experience at a city hospital. Lots of great patient care being provided here.

Traveling with Gait Instability

Amer Fort

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Amer fort was one of the first sites we visited when we arrived in Jaipur. The road leading to the fort is cobblestone and was used by elephants and other animals to carry materials like marble and sandstone to build the fort. This is where I began to think about other visitors like my dad who may have trouble navigating the steps and uneven roads.

Architecture and durability

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Within the fort is a grand palace where we observed its detailed design. I was most struck by the resilience of the fort over time. 

Jaleb Chowk

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The main courtyard at the entrance of the fort is grand. The views are stunning and the kids enjoyed the space!

Built in ramp

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This was the ramp leading to the top of the main courtyard.

Queen's wheelchair

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Here is the example of the mechanism used to transport the queen throughout the palace.

Evening views

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The fort looks across a vast valley and the views  are stunning after dark.

Adult Day Center

List of daily activites

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If you look closely you can see that the center opens from 6am to 7:30am and then again from 4pm to 8pm.  Residents pay a nominal monthly fee to be a part of the center. 

Special Visitors

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I thought it would be nice to take the kids to visit the center as well! They were excited to see the ping pong table.

Cards and Carrom

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In addition to ping pong, center members were playing cards and carrom.

Carrom

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Carrom is a popular game in India and I remember playing it during my summer vacations. Two to four players can play together. The game requires good hand range of motion and can become very competitive!

Meeting Leadership

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I had the opportunity to sit down with the center's leadership and some of its members, There are so many activities that the center has led over the past 19 years, from health seminars, to day trips and medical check ups. The center even has on site physical therapy.

Assisted living facility

Nursing station

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I learned that the ALF I visited compared most to a long term care facility in the US. The ALF here had a doctor in house, nurses, nursing aids and could support a wide variety of residents from functionally dependent to independent. 

Weekly Menu

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I practiced my skills in reading Marathi as I looked over the week's menu.

Resident Art

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One of the activities that the residents can participate in is art class. This is an example of artwork done by some of the more independent residents.

Senior Living community

Athashri

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I took my aunt on a visit to Athashri, a senior living community on the outskirts of Pune. We met with site representatives who shared an overview of their offerings. I even found out that they are now developing a community in northern California

Athashrians

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We met a group of women who referred to themselves as Athashrians. They were choreographing a dance for an upcoming celebration. They were kind enough to sit down with us to share their experiences in the senior living community thus far. 

Senior friendly construction

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In addition to grab bars in the bathroom, some rooms have beds that can be elevated. 

A view from the terrace

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This facility is located on the outskirts of Pune and has views of the surrounding landscape. 

Spacious room

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Although there is a dining room, each apartment is also equipped with a kitchen for those who enjoy cooking. 

Promoting Healthy Activities

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Here is a glimpse of their gym. 

Visit to SMT Kashibai Navale medical college and general hospital

Visiting the medical wards

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Two faculty members gave me a tour of the hospital. I learned that the hospital has over 1000 beds. I was so impressed by how the hospital was organized. There were separate male and female wards as well as teaching spaces. The space above is used for medical education.

Meeting medical faculty

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On this auspicious day of Guru Purnima, a special Hindu tradition, where teachers are revered, I had the opportunity to meet some senior faculty mentors at the institution all of whom are supporters of geriatric education. 

Physical therapy unit

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The physical therapy team had a unit divided into med/surg PT and neuro PT. This is a glimpse of one of their rooms.

Patient registration

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This large space was designated for both inpatient and outpatient patient registration. 

Overview of geriatric assessment

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I had the opportunity to present to medical students, physical therapy students and faculty. During our discussion session there were great questions about caregiver stress, geriatric myths and importance of geriatric medical education.

Visit to Ambi Ranawadi Old Aged Home

Ambi Campus

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The rainy season created a luscious green backdrop for this beautiful Old Aged Home campus.

Long term care unit

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I visited four units and had the opportunity to speak with some of the residents here. This is a picture of one of the female wards.

Long term care unit

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Through philanthropic support, the Old Aged Home at Ambi has been able to expand over the past 20+ years. 

Solarium

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The residents are able to come together in the Solarium for events such as poojas and yoga sessions. 

Visiting medical students

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I also had the opportunity to talk to medical students who were making their bimonthly visit to the long term care unit. We talked about the growing need for geriatric care.

Meeting the Janaseva Foundation Team

This week, Dr. Vinod Shah and Mrs. Meena Shah introduced me to a whole host of people. I met geriatricians, educators as well as the Janaseva Foundation trustees and staff. 


Dr. Shah and his team have also introduced me to a variety of geriatric leaders and providers in the city, from mental health to medical providers. I am now in the midst of scheduling site visits and presentations during my stay in Pune. 




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Arriving in Mumbai

We finally landed in Mumbai. Thankfully it was much drier than expected. Here's a view from our airport hotel.

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