The wonder drug we should all be talking about is Morphine, not Viagra. And why is this so?
Morphine is the wonder drug that can relieve excruciating pain of five million Indians with life-limiting illnesses. And it’s cheap, costing about Rs 10 for a day of pain relief, says Padma Shri Dr. MR Rajagopal, popularly Dr. Raj, in ‘Hippocratic’, a documentary on his work and life, in that order.
The film takes off from the famous Hippocratic oath most young doctors mindlessly take before stepping out of medical schools, and builds on it. The oath ends with, “I must not play God”, words spoken with scant realisation of their import by fledgling doctors who walk out of institutions which teach them how to cure, but not how to care or comfort when they reach a juncture where cure is no more an option.
'Hippocratic' is not a regular movie, with a story about a person, his views, or philosophy, though all of these are part of it. It is a documentary about a tiny, and brave doctor who has been tirelessly promoting, for more than 25 years, palliative care (comfort care or compassionate care for the uninitiated) and offering pain relief to patients, mostly in his home state Kerala,, and beyond.
Dr. Raj is also on a mission, to make politicians (those who are empowered to frame laws) and bureaucrats (who have the power to turn these laws into compulsory practice) understand the urgent need to prevent and remove pain from critically ill patients and others generally, rich and poor.
“You and me, we all are potential patients,” says the good doctor in one scene. Doctors deal with patients at the most vulnerable point in their life, which puts an added responsibility on them -- to be human first.
“Morphine is matchless in the sense that for two-thirds of all people with cancer pain in India, there is no other medicine that can relieve their suffering. It's an essential medicine in WHO's essential medicine list. It's an essential medicine in the Indian government's essential medicine list,” says Dr. Raj. “It's a medicine that's made out of opium, which is produced from poppy plants, and most of it is exported to Western countries. Though we grow poppy, though we produce opium and morphine, though we export it to the rest of the world, our own people are denied -- they need it."
And yet, 15% of the world uses 93% of the world's medicinal opioids. "Pain medication -- basic pain medication -- can be very inexpensive. It's there, it's lying there. It's just not getting to the man who needs it,” he says.
Dr. Raj says he was inspired by the courage of conviction in Mahatma Gandhi. So, he tried Gandhi’s 18 experiments with truth (‘My Experiments with Truth’ being Gandhi’s well-known autobiography). In doing so, Dr. Raj gently shook the world, the world of apathy, greed and callousness of the medical fraternity and the healthy population who went about their lives as if pain of the bedridden were none of their business. And it still is business as usual for doctors who prescribe expensive alternatives of essential medicine to hapless patients, advancing the interests of giant pharma companies, and their own, shamelessly promoting the "heathcare industry".
The story thread of the film entwines two parallel stories, Dr Raj’s personal and professional lives, and weaves in some more stories, which act as working models of pain relief, on how simple medication can change a hopeless moment into one of immense relief so effortlessly, inexpensively. The story of palliative care, or simply comfort care, which becomes the life of one dedicated doctor, loosely binds the story elements into one organic whole.
Dr. Raj warns young physicians against falling into the routine twin traps of over treatment and therapeutic nihilism. In the developing world, the profit-making industry (pharmaceutical) goes unchecked, he says. "The same medicine that's available for a few hundred rupees is also sold by another company in India at about 50 times that cost. And doctors will prescribe the more expensive formulation. That kind of practice -- which destroys families totally -- is going on unchecked.”
Even the process of diagnosis, the imaging, the MRI scans, and everything will financially destroy many families. That's the reality, and then, comes the treatment.
“We can certainly try to avoid the infliction of needless treatment and needless investigations to patients," he says.
"How can we justify a medical system which today, in India, is 80% in the private sector, which is not controlled by any national authority, which is free to do as it wants without standard operating procedures? Without any monitoring system!”
'Hippocratic' is not a painful watch, disturbing, yes, thought-provoking surely. There are lighter moments, the love story of Dr. Raj and the then classmate-now wife Dr. Chandrika for instance, or his views about the young Raj, who was timid and shy. We get an idea of how long and tiring the journey of a mission to transform the mindset of a nation is, and how difficult and challenging it is to influence a small world of the mighty ignorami who decide the fate of the rest of their countrymen. The film also allows us to witness the struggle of an ordinary man to conquer pain in the most adverse circumstances.
Shocking facts like 1.5 million people in India get no relief from cancer pain, and another 5 million suffer due to untreated pain from other diseases shake our conscience.
Many beautiful images, some disturbing frames and stories that shake us out of a delusion that we will die cool deaths by default gives this documentary a power to transform. Produced by Moonshine Agency, 'Hippocratic' is a wakeup call for healthcare professionals, and an eye-opener to the rest of us. Filmmakers Sue Collins and Mike Hill have done a great job in capturing the essence of what Dr. Raj and his life’s mission is all about. Of course, a closer edit would have elevated the project to a different level.
‘Hippocratic’ is a must watch for any health professional in India, a must screen for any medical school, and a must experience moment for anyone else.
Watch a trailers here: