A first impression of working with Palliative Care in India: February 2008 [Новость добавлена - 14.11.2008]

Written by: Administrator Account, Friday, Jul 04, 2008

The palliative care movement in India is 22 years old. During that time much of the palliative care development has been mainly in Kerala in South India. Instrumental in much of the development of palliative care services and education has been Dr. Rajagopal, founder and chairman of Pallium India, a trust working to improve access to palliative care.

I had the privilege to meet Dr. Rajagopal at the bi-annual Asia Pacific Hospice Network conference in the Philippines, where he presented several plenary lectures and where he heard my presentations.

Dr. Rajagopal has been very instrumental in setting up palliative care services in India.
He invited me to submit the papers for presentation at the 15th International India Association Conference on Pall. Care in Kochi, Kerala, India and as a follow on, to join the teaching-faculty of the refresher course in Palliative Care for the Trivandrum Institute of Palliative Sciences.

The conference title was “quality and coverage”. Throughout the conference it became clear how huge the task is for the development of Pall. Care in India to be able to reach people in need, especially in the rural sectors. India has 1 million new cancer cases each year. Pain management and alleviation of suffering is still scarce, eg. at present oral morphine only reaches 1% of the needy in India. As well as cancer, the other large group of people in need of care are people with HIV/AIDS. Estimates are between 2 and 3.1 million people infected.

Also because of the general lack of Support health Services, eg. rehabilitation throughout India with its population of over 1 billion people, Palliative Care Services find they are caring for a wider range of suffering then what usually involves the Pall. Care Service, services for stroke patients, accident victims, paraplegics to name a few.

Palliative care projects, hospices and clinics are still scarce in India. This has given me a much clearer idea of the scope of coverage needed.

After my presentation on “The power of Hope” at the conference, I was approached by Dr. Dinesh, professor in the Department of Radiation Oncology at the Amrita Institute of medical Sciences in Kochi, Kerala. He invited me to present the hope lecture to medical staff at the Institute. Unfortunately a general strike made it impossible to reach the Institute and hopefully I will be able to conduct some training with staff on my next visit to India.

After the conference I travelled from Kochi to Trivandrum to be part of the teaching faculty on the 3-day refresher course in palliative care. The course was offered to 29 doctors and nurses all with previous training and experience in palliative care and was run under the auspices of the Trivandrum Institute of Palliative Sciences.

The faculty consisted of several prominent Indian and overseas presenters with a huge range of expertise.

There was a series of 7 workshops in total with case-studies as frameworks and examples of difficult issues. The delegates were divided in 3 groups and each group (with faculty facilitators) had time to explore and discuss the cases, then feeding back to the whole group the outcome of their deliberations.

Other teaching methods were role-play and video demonstrations.

Some of the topics were: Ethical decision making, difficult psycho-social issues, difficult pain, the pain of children, hope, care for the carer, rehabilitation, palliative care in the Intensive Care Unit. The further the teaching program progressed, the more it became a shared learning-experience for faculty and delegates alike.

For the delegates the workshop format was apparently a new way of learning and the response was very positive.

I have been very humbled and impressed by the dedication and passion of the delegates as well as the faculty. I have come away with much new knowledge as well as feeling privileged to have been able to share my knowledge with a very committed group of health-care professionals. I am looking forward to continuing to build on these contacts and hopefully for us all to share more knowledge.

See Also:

In India, a Quest to Ease the Pain of the Dying
The New York Times
Published: September 11, 2007
It was a neighbor screaming in pain 35 years ago that set Dr. M. R. Rajagopal on the path to his nickname: India’s “father of palliative care.” Read

Quality of life in death: Dr. MR Rajagopal
Sunday, June 1, 2008
An interview with Dr. MR Rajagopal  Read