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Man on a mission to reduce unnecessary suffering

Dr MR Rajagopal with documentary maker Mike Hill.

Dr MR Rajagopal has successfully fought draconian laws in order to prevent large numbers of people suffering from severe pain. The Indian doctor is an outspoken critic of the modern medical industry and an inspiring global health leader. His story is told through an uplifting Australian documentary that premieres next week; ‘Hippocratic – 18 experiments in gently shaking the world’.

Palliative Matters speaks with documentary maker Mike Hill, founder and CEO of Moonshine Agency, about how he and filmmaker Sue Collins met Dr Rajagopal and why they made the film. Moonshine specialises in making impact films, and is “passionate about making the world a better place, one story at a time”.

View the trailer here.

Most people who work in palliative care are pretty amazing. What made Dr Rajagopal stand out?

We met Dr Rajagopal in 2009 when we were making LIFE Before Death which is about health professionals in 11 countries who are battling an epidemic of untreated pain. When we first interviewed him he totally blew us away. It totally changed our lives. It was kind of inevitable that we make this film.

Raj is a global leader. He regularly travels all over the world and is often one of the few voices speaking for developing countries at an international level about pain and palliative care. Most recently, he’s contributed to the Lancet Commission on Global Access to Palliative Care and Pain report, which will be released next week, giving a report on the state of palliative care services globally.

Aside from palliative medicine, Raj is a great humanitarian. He has been nominated for next year’s Nobel Peace Prize. His colleagues refer to him as the Gandhi of modern medicine.

After the release of LIFE Before Death, which is a collection of films, we realised we needed to have a single person telling the story of palliative care and the need to revolutionise health care more broadly. The field of palliative medicine is full of really amazing people, but we realised that Raj was unique, even within this amazing group, largely because of his range. He is a very compassionate and articulate person who is treating patients daily at the bedside but also actively working at an advocacy level, nationally and internationally, to relieve suffering by changing laws and policy.

What difference has Dr Rajagopal made?

Famously, he sued the government in India for failing to provide pain medicine. He also worked for 25 years to get a law changed which was limiting the ability for most Indians to get access to medicines like morphine. In 1985, the Narcotic Drugs and Psychotropic Substances Act was passed in India, entombed in a 1400 page book. It effectively saw access to essential medications like morphine for pain control drop to zero.

Because of the law, they stopped training doctors and so they stopped prescribing. So, now the law has changed there is much more work to be done.

Raj is also the leader of a movement that has integrated palliative care at a grassroots level, like nowhere else in the world. In his home state, he now has more than 400 community-based palliative care services serving a population of 37 million, which is almost universal access to palliative care.

Since 2003 he has been doing the same work on a national scale, rolling out those programs across India more generally.

What can we learn in Australia from what Dr Rajagopal has achieved?

In rural and remote areas of Australia, we have poor access to palliative care, so there is a huge amount to be learned from this model, in terms of delivery of palliative care at a community level.

There is an example in the film, which I think is quite innovative, though it’s hard to imagine this in an Australian context. On a weekly basis, Raj’s palliative care team will travel to different parts of the state – remote and regional – and established pop-up palliative care clinics in places like primary schools. They are free and anyone who needs palliative care from the community can come and get seen by a doctor or nurse and get medication. This is in addition to an extensive home visiting service. Together, the services get palliative care to people who need it, everywhere.

There is a training college that is part of Raj’s charitable organisation. It has provided extensive training to thousands of doctors and nurses.

What is Raj like, as a person?

The first footage we took for the film is from 2009, so I have known Raj for eight years; it has been a long journey.

He is an incredibly good-natured, articulate and good humoured person. On top of his absolutely overwhelming workload, he is always taking time out do little human things – as far as I call tell he never screens a phone call, always has time for everyone, is quick to share a smile and his a penchant for practical jokes. He is very present in the moment and connects with people one-on-one.

What drew Dr Rajagopal into palliative care?

He fell into medicine. He didn’t want to be a doctor – his passion was literature.

Mahatma Gandhi’s writings were really critical in his childhood and he considers Gandhi to be his greatest mentor. He was a good student and got the grades to get into medicine, and his father encouraged him. He has never regretted that decision.

In the film, he reflects on how he was quite confused when he got into medical practice because of the inhumane treatment he saw around him.

Raj became head of anaesthesiology in a regional hospital in India. After the suicide of one of his patients, he got to thinking there might be something more to medical practice than what he was offering. He had treated the patient with a nerve block but hadn’t provided any psycho-social support.

After that event, he started to look for options to deal with psycho-social suffering and that led him to palliative care. In 1985 he met a British nurse, who referred him to palliative care training at Oxford in the UK and that is where his formal training in palliative care began. He was one of the first doctors in India to study palliative medicine.

So, from the age of 38, he dedicated his career to palliative medicine. He reflects on that and says it was like falling in love for the second time.

Where can we see the film?

It is screening around Australia during October and Raj is visiting Australia to speak at 11 of those public events. You’ll find the latest list of screenings here.

We’re also presenting it online as a Demand.Film, so if you can’t get to a screening then you jump on this site, register and host your own 90-minute screening at a theatre near you or attend an upcoming screening in your city.

From 14 October the film will be available on VOD (video-on-demand), DVD/Blu-ray and on campuses via Kanopy. Click here for details.

Raj’s Australian Speaking Tour will be driving donations for national registered charitable trust, Pallium India, to pay for essential free medicines for the poor, for their travel to a clinic, schooling for their children or other forms of palliative care. Donations can be made here.


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