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Dr Alex Jadad is on a world-wide mission to achieve a pandemic of health, happiness and love

Dr Alex Jadad says no one wants to die badly but we don't really know what a good death is.

A hardened cynic might suggest that Dr Alex Jadad is on a hiding to nowhere. Who in their right mind sets out to tackle inequities in order to improve health for everyone across the globe?

But that is the essence of the Colombian-born doctor’s inspired mission, in both of his high-flying roles in Canada. And the more you learn about his life and achievements, the more it seems likely he – if anyone – might just have the reckless courage, genius and charisma required.

Dr Jadad is so comfortable with his daunting mission that he ramped it up a notch. When the University of Toronto asked him whether he’d like to take over its Institute for Global Health Equity and Innovation, Dr Jadad says he replied “Sure, but I want to unleash a pandemic of health”.

“I extended it to happiness,” he tells Palliative Matters. “And now I am trying for love.”

Love, and in particular self-love, is something that delegates attending the Australian Palliative Care Conference 2017 are set to learn more about, as keynote Dr Jadad shines new light on seemingly simple concepts, like what makes for a good life and a good death. He considers palliative care to be full of acts of love. He knows love is a loaded word, easily trivialised to saccharine, but he uses it often and with conviction.

“I am a character in a love story,” he says with warmth but no hint of a smile.

“My family and I decided our lives are going to be a love story. We work on love, and write about love. For us love is the most important thing. This is not hokey, soapy kind of stuff. This is very serious, and informed by rigorous work contributed by sages from all cultures. It involves willing good, doing good, seeing good – especially in difficult times – and feeling good.”

Dr Jadad is working on his world-wide pandemic with “hooligans” he has unearthed across the globe; they’re that special kind of constructive troublemaker touched with genius, who is prepared to cause upset by questioning what is bedded down as fact.

“We have this effort called the global good death initiative,” explaining one of six wild projects.

“We are joining forces with people around the world and asking how we would like to die. No one is saying they want to die badly. But we don’t know what a good death is,” he says.

“There are some elements that every human being will say ‘Yes, that is part of a good death’. The question is, ‘Is there a minimum set of elements we humans will consider part of a good death?’. We really don’t know.”

Dr Jadad and his hooligans reviewed more than 800 publications in order to arrive at a thematic analysis, which was used as the basis for a survey of health professionals and for events known as conversations that matter. In 2016 they invited journalists, palliative care physicians, ethicists and a death doula to explore “A good death for all: What would it take?”. Using those results and information on how physicians would like to die, they have identified three things that serve as the foundation to a good death, which Dr Jadad will explain at the September palliative care conference in Adelaide.  

Trying to nail down a nebulous concept like ‘a good death’ is consistent with Dr Jadad’s previous efforts to add meaning to the hairy concept of ‘good health’; a global conversation triggered by a possible diagnosis of cancer (which was ruled out) that left him thinking about palliative care “in the first person” and wondering whether it was possible to be healthy and ill at the same time.

Dr Jadad and colleagues spent three years poking their fingers into the World Health Organization’s definition of health, which hadn’t been updated since 1948: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. His quest was supported by the British Medical Journal, which published the suggestion that health had more to do with the ability to “adapt and self-manage in the face of social, physical and emotional challenges” than a complete state of well-being.

Dr Jadad’s approach to health, love and life starts to make sense when you get an insight into his Colombian childhood and what triggered his career. His family had challenging dynamics, which created a happy childhood followed by a particularly traumatic parental divorce. While trying to “endure some crazy stuff and survive to tell the tale”, Dr Jadad was sent with his brother to a tough, rigorous school from the age of 14, where he was largely isolated from his parents and left to fend for himself.

“I couldn’t fight with my fists so I had to learn how to fight with my brain. I became a learning machine,” he says.

“I broke every possible [academic] record in the country just to protect myself. The price I paid was my joy. I lost my joy at fourteen.”

Accepted to study medicine at 16, he met his wife, Martha Garcia, on his first day at university.

“This girl was born happy; she saved my life,” he says.

“This young, beautiful creature became my best friend. A year later we were dating. She rescued that happy child I had inside and ever since this little child has been there, trying to relieve suffering and spread joy throughout the world.”

It was while studying his second year of medical school in Colombia that Dr Jadad met a group of impoverished and inquisitive kids, who he now credits with setting him on his life’s path. Regarding the young student as an approachable source of information on illicit drugs, an eight-year-old asked whether he would still be able to make love if he smoked basuco, a drug Dr Jadad – and the medical profession internationally – knew virtually nothing about. A young girl asked if she drank a case of beer on Friday morning and then smoked basuco on Saturday morning, would she would get a hangover.

The interaction left Dr Jadad concerned and inquisitive, so he paid a visit to the local school principal who said most people in the area made a livelihood selling the drug. The principal was concerned about an orphan who had been adopted and made to smoke basuco before being sexually exploited.

Dr Jadad’s innate sense of social justice kicked in and he became determined to learn more. A thorough search of his university’s pharmacological and psychiatric resources unearthed nothing meaningful, which triggered him once again to become “a learning machine”.

He visited the botanic gardens to study the coca plant. He met patients at the hospital, asked about their experiences and dealers, and how much they paid. He visited a shop that sold the drug and spent a night dressed like a thug, accompanying a dealer he met as a patient.

“Soon after that, this drug became known as crack cocaine and at that time I was one of the very few people who knew anything about it in detail, in a very down to earth way,” he says.

Before he’d graduated from medicine, at the age of 17, his knowledge brought him considerable fame. He became something of a media personality, regularly appearing on television and writing a newspaper column. He was called by the United Nations to give educational lectures on the drug and its effects, which were simultaneously translated into multiple languages. At the age of 20 he became an advisor on drugs to the Colombian Ministry of Health.

Meanwhile, Dr Jadad had found himself a mentor; one of many extraordinary people whom Dr Jadad decided to adopt as family (in order to make sense of Dr Jadad’s extensive family tree, you need to understand that most of his direct kin have been chosen).  

“He was my first father, by choice, and such a role model for me that he swayed me to become an anaesthesiologist.”

A colleague from the US mentioned there were no text books on neuroanaesthesia or neurosurgical care in Spanish, so before beginning to study the speciality he and his ‘father’ wrote the first.

Then in the late 1980s he received his first laser-printed letter. His work on cocaine had impressed people in high places at Oxford. He was invited to spend a year as a research fellow at the university’s pain relief unit. 

“By that time I had great interest in pain. I realised a lot of patients had inappropriate prescriptions, or appropriate prescriptions that were not given, or bad pain management programs that were given badly.”

But there was a hitch. He needed permission to practice medicine in the UK. He couldn’t speak English, and needed to get a special scholarship from the British government in order to work as a physician.

“It was practically impossible,” says Dr Jadad.

“Thousands would apply for these scholarships and many of the applicants had gone to bilingual schools. But thanks to my ‘obsessive learning machine’ habits, I passed the Cambridge English exam and got one of about 16 scholarships available that year.”

He learned English in 18 months, moved to Oxford, and successfully challenged the dogma that morphine could not relieve neuropathic pain (which occurs in numb areas of the body).

One year at Oxford became five; in addition to working at the university’s famed pain relief unit, he spent time at the local hospice, researched morphine and pain relief, became fascinated by distilling and challenging research used to support treatment decisions, and achieved a doctorate on the synthesis of health knowledge. Having collected and coded most of the clinical trials in pain relief, and led the development of the Jadad scale, used to assess the quality of clinical trials, he became a founding member of the Cochrane Collaboration and his work supported the creation of the pain, palliative and supportive care group, and the Cochrane Consumer Network.

“Through my visits to the hospice I became more familiar with palliative care, which in Colombia was almost completely unknown at the time. At the hospice, people were devoting their lives to enabling a good end,” he says.

“I hadn’t been exposed to death much in my entire career. Death was the enemy, something to fight; a taboo. If someone died in intensive care it was because we failed. I was coming from that hard core tradition.”

Just as he was starting to appreciate a gap in what the health system offered to people as they were dying, and what they needed, the internet started to emerge, and as an academic, he was among the first privileged to have email.

“I also became aware of the web before it was commercially available. I said if this thing were available to everyone, it would allow every human to have access to the best knowledge about everything. I could see how it could bridge that gap between what people need and what the health care system is offering them.”

Dr Jadad moved to Canada after scoring a plum role within McMaster University’s clinical epidemiology, where he led the health informatics research unit, the Canadian Cochrane Centre and Network and founded the McMaster Evidence-based Practice Centre.

Several books, and high-flying evidence-based roles later, Dr Jadad went on to become the founding Rose Family Chair in Supportive Care, the Canada Research Chair in eHealth Innovation, and founder of Canada’s Centre for Global eHealth Innovation, which has a space designed as a simulator of the future. He describes the centre as being like a movie set, with moveable floors, walls and ceilings, which can be used to create a prototype of schools, clinics or the hospices of the future. The Centre’s many projects range from designing web-based tools to improve management of chronic pain, creating a sleep app for teenagers, and improving workflow in teams responding to critical care incidents.

Dr Jadad has also recently co-authored a book titled “Beginning from the End”, which will flavour his Australian conference presentation. Consistent with how he lives his life, and how his career has unfolded, he says he will be encouraging delegates to dream, see how far they can push the envelope, and not be restricted by history or how things have been. He will also pose the question, “Does humanity need palliative care?”.

“I want to propose that we die, as individuals and as a species, with panache, in style. This would require making collective efforts to ensure that we support each other to live in fully until the very end. To achieve this, we must figure out the best way to enjoy the interval from the time we are born to the very end. At a minimum, we must make explicit the way in which we would not like to die, and get reassurance that our desires would be granted, whenever possible, with compassion and proficiency, and free of judgement and barriers,” says Dr Jadad.

“The palliative care community has a unique opportunity to go beyond the medical model, leading a serious discussion as to how we should live our lives, and view the end as a great starting point to re-imagine and transform the whole.

“The only way to achieve a good death is to live a good life, until the last breath.

Learn more about the Australian Palliative Care Conference 2017 and register here.


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