When A/Prof. Ghauri Aggarwal first started practicing, she noticed the patients who were dying were often the ones who were overlooked the most. More than three decades on, and as Chair of the Asia Pacific Hospice Network, she’s still working to put the whole person back at the centre of their care.

As a junior doctor at the Royal Adelaide Hospital, A/Prof.Aggarwal recognised that the patients who were dying were often the ones who ended up at the back of the ward. It was the late 80s and palliative medicine did not existed yet as a specialty in Australia. “To me, it felt like they were in the back of the ward dying and felt they were neglected,” she says. “We, as junior doctors, were never given the scope to even know how to care for them, or address what now I understand is suffering.”

While A/Prof. Aggarwal didn’t have the words for it back then, she did have a growing conviction that something essential was missing, and a background that had already taught her to sit with death rather than look away from it. As a Hindu migrant to Australia, she says, “death and dying was something we talked about, and it was an area that you explored as part of your spiritual development.” Medicine and upbringing, she says, simply ‘married’ into one interest.

Rachel’s lesson

A few years into her training under Professor Noelle Lickiss at Royal Prince Alfred Hospital, A/Prof. Aggarwal met a young patient named Rachel, dying of a rare cancer and in severe nerve pain.

Trying to portray that pain, Rachel painted a self-portrait. One side of her face was rendered in violent colour to show the pain, the other in gold. A snake coiled around her, the cancer, “sucking the life out of her,” A/Prof.Aggarwal recalls. The artwork has stayed with A/Prof. Aggarwal, and still features in her talks on pain management thirty five years later.

“What she exemplified was the physical nature of severe pain and the human suffering,” A/Prof.Aggarwal says. But Rachel was also just a teenager, missing her final years of school, regressing at times into childlike behaviour, watching her family buckle under the weight of her illness. “There were all these components of what true palliative care is about, and this one patient, to me, demonstrated that.”

If there has been only one patient who showed A/Prof. Aggarwal why the whole person belongs at the centre of care, it was Rachel.

The human condition of suffering

“As a doctor, you’re trained to sharpen your problem‑solving skills, to make a diagnosis, develop a treatment plan, cure, treat, prevent,” A/Prof. Aggarwal says. “But suffering is something beyond that. It’s part of what makes us human, and sometimes simply sitting with someone in their suffering, being in the space with them, is the most powerful thing you can do.”

The expectation that healthcare should, or even can, eliminate suffering outright is never far from A/Prof. Aggarwal’s mind. “I don’t think you can do that,” she says. “The more we teach our community how to sit with that, I think as a community we evolve better.”

That belief carries into how she designs services too, shaping the holistic approach that has been at the centre of her work from the very beginning.

A/Prof. Aggarwal recently helped build a new program called Palliative Care for Advanced Diseases, funnelling investment into social work, physiotherapy, exercise physiology, occupational therapy, psychology, pastoral care, alongside nursing and medicine for patients and non- cancer diagnoses.

“I think the allied health exemplifies that there is so much variable need,” she says. “Rehabilitation, functional integrity, as much as psychological care, as much as financial and social care, as much as medical evidence-based care.” It’s the same instinct from the back of that ward back in the late 80s, just built into policy now.

Palliative care beyond Australia

As Chair of the Asia Pacific Hospice Network, A/Prof Aggarwal’s sense of what’s missing extends beyond Australia. The Network’s newly published Asia Pacific Palliative Care Atlas maps the region’s palliative care development, and it’s highlighted disparities A/Prof. Aggarwal says have felt disappointing for years.

“You go into other countries, people are mortgaging their homes to get basic care, or basic medications. There’s lack of morphine and simple opioids in their home, in their place of care,” she says. Even the Pacific Islands, some of Australia’s nearest neighbours, remain under resourced and largely overlooked in local conversation. “Australia is the highest leader in our region,” she says. “I think we have a responsibility, and that’s why I do what I do.”

Stronger together

Even in Australia, A/Prof.Aggarwal says the word ‘palliative’ can sometimes get in the way. “Fear of the term palliative care” is often the first thing clinicians have to work through with new patients and their families, along with the assumption that it’s only about the final days. “It’s not just about dying well. It’s living well, too.”

It’s part of why this year’s theme for the Asia Pacific Hospice and Oceanic Palliative Care Conference, a joint event between the Asia Pacific Hospice Network and Palliative Care Australia, means so much to her. Themed ‘Stronger Together: Humanity at the Heart of Palliative Care’, it’s a chance to see, in person, that humanity is what connects clinicians across every part of the region, no matter how different their resources or systems are. And it goes well beyond formal sessions.

While conferences are a chance to come together and share expertise, they’re also a way to learn from each other, not just share what Australia already knows.
“There is that diversity coming together, we can enrich us in Australia as much as the region,” she says. “I think there’s a two way learning opportunity.”

“The most important thing can be the corridor conversations,” she says. “You network, meet new people. I think that is powerful and wonderful.” But one thing A/Prof. Aggarwal says she’s really excited about is the concurrent sessions, where clinicians without major hospital resources share how they still deliver good care. “You don’t have to have all of these resources to be able to go and sit by a bedside and provide this type of care,” she says. “It challenges us, and stretches the way that we can practice medicine, no matter where we are.”

This time around, A/Prof. Aggarwal says she’s planning something bigger still. Bringing together global leaders beyond the Asia Pacific region entirely. “I want to explore an area where diversity brings us together with one global voice,” she says. “We might have some exciting stuff… in terms of landmark directions that we’re going to pitch off this conference for the future.”

Big plans aside, A/Prof Aggarwal says it’s her colleagues who keep her showing up, year after year.

“I think palliative care is really a team approach,” she says. “We feel comfortable laughing and talking and helping each other. It’s a privilege to be in that environment.”