
I then gave them a choice that given all this information, would they choose to be photographed or decline. Although I had worked closely with the home care team and they had a very profound influence on the patients who were full of gratitude for their service, I never exploited that relationship. I was very clear that no patient or family member should be coaxed or cajoled if they said no. So it was always left alone the moment we heard a no. I wouldn't even take out my camera until they said they were comfortable being photographed. And then be sensitive to their situation while making the photograph, always to illuminate, never to show indignity.
In the three years around 40% of the patients refused to have their photo taken, most of those who said yes, asked that their names be changed or left out, a couple asked that their faces not be shown. I respected every request. I listened to every single one and tried to understand who they were before lifting my camera up to my eyes. And I made sure I connected with each of them, human to human. All who were able were shown the photos and the others were shown to immediate family members to make sure they were ok with the visualisation.
Why am I telling you all this? Because it is important for all of us to realise the power dynamic and privileges at play when working on a project like this. And then use that awareness to act more responsibly, with care and honesty.
In 2015 the Mumbai Press Club awarded this essay with the Big Picture Award during their annual Red Ink awards for Journalism. I dedicate this and any accolade arising from this project to all the all the people who have kindly allowed me to put them in it.


One person by his bedside that day was not a family member. Somashekara Chari encouraged the family to take Kumar to Karunashraya, the pioneer Bangalore hospice that offers free palliative care for advanced-stage cancer patients who are beyond medical cure. Somasekhara might notionally be just the designated auto driver for Karunashraya, but he has been visiting the dying for almost two decades as an emissary from the hospice. He has also become an unofficial Karunashraya homecare manager in the last few years. That day, Somashekara cajoled Kumar into drinking a few sips of coconut water while cradling his head.

An hour after he left he was still on the road when Somashekara learnt of Kumar’s death. Most of Karunashraya’s patients live in destitute poverty and close to the border of death.

The Karunashraya homecare team visits 50 patients per week. Somashekara drives nurses in one of the two distinctive blue auto rickshaws.

The team drives to all corners of the city, no matter how remote or inaccessible, helping the poorest of the poor find peace and dignity before a painful death.

Karunashraya has offered free home care services for terminal cancer patients since 1995. It established an in-patient service in 1999 at its 50-bed hospice in Marathahalli, Bangalore. The hospice operates solely on cash and in-kind donations, which sometimes attracts strange items. Donors range from companies like the Tata Group and GlaxoSmithKline to concerned individuals.





Dr. Nagesh Simha is the Medical Director at Karunashraya and President of the Indian Association for Palliative Care. He is a motivational speaker constantly in motion, offering anecdotes, humour and serious insight to everyone around him. Here, he leads and instructs a team on daily rounds. In a threateningly morbid environment, the dedicated medical team operates with warmth and vibrancy to every patient, no matter how temperamental or angry or depressed.“The current state of palliative care in India is not very good and the facilities still have a long way to go,” says Dr.Simha. “There are some states where palliative care is very active. The best, of course is Kerala, which is doing a phenomenal job and involving the government, panchayats, the police, volunteers, medical institutions and students.”


Karunashraya also provides patients with images of Gods of all religions (but only if they ask for them). The emphasis here is on providing palliative care, which is a holistic approach that involves medical, psychological and even spiritual support to ensure a peaceful and dignified death for patients.



Patients have access to experienced counselors like Renuka, who strive to put bewildered and fearful minds at ease. There are group and individual counseling sessions with family members and caregivers, many of whom are illiterate and harbor common misconceptions like cancer being contagious.

Laundry might seem minor in the larger scheme of things, but Rosemary (45) in the housekeeping team has tackled the vast quantities for 11 years now. Providing clean bedding and clothing is an essential part of palliative care and it’s woman power that keeps the never ending laundry cycles moving.

Christian nuns come in pairs to spend two years or more at Karunashraya. Sisters Rani and Vimala, both in their 20s take care of everything from managing the nursing staff, labouring over paperwork, ensuring patient medication is perfect

They have even set up a chapel where they hold prayer meetings once a week. They say their religious practice helps them cope with this difficult work.

Home care nurse Pushpalatha treats a 27-year-old who was in the last stages of mouth cancer caused by chewing gutka. The nurses check vitals, change dressings and ensure correct medication is provided between visits.

Pushpamma (76) lived completely alone and had no family to help her during her last days. She depended on a nearby temple and the kindness of her neighbours for some food and shelter. The home care was the only medical aid that she received during this time.

Shazia Begum, 65, in the last stages of cancer and bedridden. With the help of the Homecare team, she showed great courage to recover enough to lead a normal, self-sufficient life.

Accessing morphine for pain relief is one of the biggest challenges for institutes offering palliative care in India. A homecare nurse labels a bottle of oral morphine solution to prevent accidental use.







