Care Beyond Cure
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! January 2018 !
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December 31, 2017
“DIFFERENTLY ABLED” IS TOO INADEQUATE A TERM.
“Exceptionally abled” would be more like it. They are achievers
battling the odds that an insensitive society offers them.
On December 3, International Day of Persons with Disabilities, a
celebration of talents of the differently-abled was held at Manaveeyam Veethi,
Thiruvananthapuram. The program was organized by Pallium India in association
with the Manaveeyam Theruvorakuttam, the All Kerala Wheelchair Rights
Federation (AKWRF) Thiruvananthapuram unit and Cheshire Home. Please come along
next time and see the amazing talents – Rajesh singing like an angel, Jyothi
the poet reciting his own poetry, and a lot, lot more.
And they had fun too. More than 40 wheelchair users participated in art
and sports events including wheelchair race.
Officials of AKWRF, Sindhu Sudevan (President) and Binu Salam
(Treasurer) were among the participants.
_Read the report in The Hindu: Differently abled reaffirm right to live
LET’S JOIN OUR HANDS TO PREPARE A VERY SPECIAL NEW YEAR GIFT.
Geetha (_not her real name_), 57 years old, spends her days in a
wheelchair – she has been suffering from spinal muscular dystrophy, diabetes
mellitus and hypertension since 2003. Now, she can move her upper limbs to some
extent, but is completely dependent on others for almost all her activities of
Financial constraints due to out-of-pocket expenditure and separation
from spouse have added to her agony. She lives with her only son, who is a
daily wage earner.
With the Kerala government’s disability pension of ₹1000 per month and
financial aid to build a house, she has begun construction of a house; however
she needs financial assistance to complete it.
Geetha and her son had been living in a shed. Realising that the shed
would not withstand the rain, they had to move to their incomplete house.
WHAT CAN YOU DO?
You can help Geetha attain her dream of a house of her own: with
wheelchair-friendly living room, bathroom and kitchen.
This will be the greatest gift you can give a woman who has to live the
rest of her life in a wheelchair: a certain amount of independence, and
PLEASE DONATE AND MAKE GEETHA’S DREAM A REALITY.
To know more, please contact us: babu@xxxxxxxxxxxxxxxx
[mailto:babu@xxxxxxxxxxxxxxxx] / 9746745502
WHAT WE CAN SEE, WE TREAT. WHAT IS NOT MEASURABLE, WE IGNORE.
Inadequate attention to mental illness seems to be a global phenomenon,
as you can read in Atkin et al. BMC Palliative Care (2017) 16:69. Anxiety is
one of the major issues that are frequently ignored or inadequately addressed.
Despite the lack of adequate evidence, all clinicians in palliative
care need to note: “Australian guidelines provide the most specific
recommendations regarding medication, _advising selective serotonin reuptake
inhibitors (SSRIs) as first-line pharmacotherapy and advising against
benzodiazepine use due to risk of dependence, tolerance and other morbidities
including confusion, ataxia, falls in the elderly and rebound anxiety_ and
advise limiting benzodiazepines to crisis situations, including palliative
care” (Butow P, Price MA, Shaw JM, Turner J, Clayton JM, Grimison P, et al.
Clinical pathway for the screening, assessment and management of anxiety and
depression in adult cancer patients: Australian guidelines. Psychooncology.
Thank you Barry Ashpole and Media Watch for bringing our attention to
REFORM IN MEDICAL EDUCATION IN INDIA PROPOSED
The Union Cabinet of India has approved the draft National Medical
Commission (NMC) Bill, which seeks to replace the existing medical education
regulator Medical Council of India (MCI) with a new body to ensure
transparency. Currently, the MCI is the statutory body for establishing uniform
standards of medical education in India, but, with introduction of this draft
bill, MCI will be replaced with a new Commission. The bill provides for the
constitution of four autonomous boards entrusted with conducting undergraduate
and postgraduate education, assessment and accreditation of medical
institutions and registration of practitioners under the NMC. The draft bill
proposes a common entrance exam and licentiate exam which all medical graduates
will have to clear to get practicing licences, an official said.
GoM approves draft National Medical Commission bill
IMA appeals to Modi to recall draft National Medical Commission Bill
ITALY AND CANADA WORK TOWARDS MAKING END OF LIFE MORE HUMANE
Italy legalises advanced directive, making end of life care more
Canada passes legislation making it binding on government to provide
Why is it that there is so little discussion in India on access to
palliative care, while there seems to be so much talk about euthanasia? Is that
an unthinking reaction, or are we deliberately saying “We have no time relieve
your pain; come, let us discuss whether we can kill you” ?
“CARE” VS “OVERZEALOUS TREATMENT”: POPE FRANCIS SPEAKS ON END OF LIFE ISSUES
Pope Francis has advised doctors to avoid “overzealous treatment” of
patients at the end of life, saying that “burdensome” treatment may not be in
the bests interests of the person.
Addressing the World Medical Association European Regional Meeting on
End of Life Questions — a conference jointly organised by the World Medical
Association, the German Medical Association and the Pontifical Academy of Life
— the Roman Pontiff said that that the development of powerful medical
technologies calls for prudent discretion on the part of clinicians:
“greater wisdom is called for today [in end of life care], because of
the temptation to insist on treatments that have powerful effects on the body,
yet at times do not serve the integral good of the person”.
The Pope broached the much discussed topic of “overly burdensome
treatment”, and discussed a series of ethical principles outlined by his
predecessors Pius XII and John Paul II.
“…in the face of critical situations and in clinical practice, the
factors that come into play are often difficult to evaluate. To determine
whether a clinically appropriate medical intervention is actually
proportionate, the mechanical application of a general rule is not sufficient.
There needs to be a careful discernment of the moral object, the attending
circumstances, and the intentions of those involved. In caring for and
accompanying a given patient, the personal and relational elements in his or
her life and death – which is after all the last moment in life – must be given
a consideration befitting human dignity. In this process, the patient has the
Roman Pontiff’’s comments follow a statement earlier this year from the
Pontifical Academy for Life on the controversy surrounding British infant
Charlie Gard. In the statement, Academy president Vincenzo Paglia said:
“The proper question to be raised in this and in any other
unfortunately similar case is this: what are the best interests of the patient?
We must do what advances the health of the patient, but we must also accept the
limits of medicine and, as stated in paragraph 65 of the Encyclical Evangelium
Vitae, avoid aggressive medical procedures that are disproportionate to any
expected results or excessively burdensome to the patient or the family.”
_This blog was originally published here:
ESMO’S POSITION PAPER EXPRESSES COMMITMENT TO PALLIATIVE CARE DURING CANCER
“Supportive and palliative care interventions should be integrated,
dynamic, personalised and based on best evidence. They should start at the time
of diagnosis and continue through to end-of-life or survivorship.”
The position paper by Jordan K et al
[https://www.ncbi.nlm.nih.gov/pubmed/29253069] published as a special article
in the Annals of Oncology dated Dec 8, 2017 highlights the evolving and growing
gap between the needs of cancer patients and the actual provision of care. The
concept of patient-centred cancer care is presented along with key requisites
and areas for further work.
TRANSLATORS NEEDED: HINDI, BANGLA, OTHER REGIONAL LANGUAGES
Mike Hill and Sue Collins of Moonshine Agency
[http://moonshine.agency/] have done us a huge favour by creating the film
, the story of palliative care in India, highlighting the need and possible
solutions to the current situation. The producers of the movie and Pallium
India seek volunteers willing to translate the script of the narration from
English to Hindi, Bangla and possibly other regional languages, for subtitles /
voice-over, so that the message of the movie can reach more people.
Anyone with the necessary language skills and computer access, who are
interested to volunteer, please contact us: info@xxxxxxxxxxxxxxxx
E DIVAKARAN – WINNER OF PRATHEEKSHA AWARD
Dr E. Divakaran, founder of Institute of Palliative Care, Trissur, is
the winner of the annual award given by Pratheeksha Palliative Care, Koottanad.
Congratulations, Dr Divakaran! Your humility, able leadership and quiet
efficiency are a model to all. All of us at Pallium India are proud to be
associated with you.
RAJAM S. NAIR ENDOWMENT PRIZE WINNERS
Pallium India announces the winners of Rajam S. Nair Endowment Prize
Essay Competition [http://palliumindia.org/2017/10/rajam-s-nair-endowment/]
held for students from health care field.
There were several amazing submissions, and the judges had a very tough
time deciding the winners! A huge THANK YOU to everyone who participated.
The topic for the write up was the same as the theme of this year’s
World Palliative Care Day: “Palliative Care and Universal Health Coverage: Do
not leave those suffering behind.”
Prize distribution is on 23 February 2018 at 25th IAPCON at Jawaharlal
Nehru Auditorium, AIIMS, New Delhi.
These are the top three winners. Congratulations!
GUARDIAN ANGEL [HTTP://PALLIUMINDIA.ORG/2017/12/GUARDIAN-ANGEL/]
Something beautiful is evolving near Nedumbassery in Ernakulam
district, Kerala. Guardian Angel, a new palliative care centre is opening its
doors to the needy in Jan 2018.
Most palliative care centres face many teething troubles, shortcomings
and hindrances during its early days, but not Guardian Angel. With the vision
of an exceptional human being, His Grace Mar Severios and with the
more-than-capable management of His Grace Mar Eulios and a very willing
volunteer, Mr Chinnan, the centre starts with two trained doctors, several
trained nurses and enough physical facilities. We predict that this is going to
be an important institution in palliative care delivery and training in the
Best Wishes, all at Guardian Angel. Pallium India is proud to walk with
you at least a few steps in your development.
VIDEO OF THE MONTH: ON THE ART OF MEDICINE RANJANA SRIVASTAVA
[https://www.youtube.com/watch?v=vcwyN7hyXh8] What I learnt from my
experience is that while the technical things matter, what matters most of all
is the art of medicine. Ranjana Srivastava is an oncologist, award-winning
author and columnist for The Guardian. She was awarded the Medal of the Order
of Australia for her work on doctor-patient communication.
WATCH NOW… [HTTPS://WWW.YOUTUBE.COM/WATCH?V=VCWYN7HYXH8]
OBITUARY: MATHUKUTTY J. KUNNAPPALLY
Mathukutty J. Kunnappally, author and former editor of Sahayatra
[http://palliumindia.org/newsletter/sahayatra/] , sadly died on 26th December
2017. Mathukutty J. Kunnappally had helped Pallium India at a critical time
when it needed expert help. He took on the task as a volunteer. Today,
Sahayatra continues to follow many of the reforms that he had brought in.
At this time of sadness, we gratefully remember his generosity and
voluntary service for the suffering people in our country.
_(Image source: Destination Kerala
OBITUARY: JOSEPH PULIKKUNNEL
Joseph Pulikkunnel, a palliative care pioneer in Kerala, sadly died on
28 December 2017.
In 1982, Mr Pulikkunnel started what could be called a fore-runner of a
palliative care service. He felt the need and started looking after people with
incurable diseases, particularly people with poorly controlled diabetes and
incurable cancer. In the 1990s he got professionals trained and developed it as
a modern palliative care service. We pay obeisance to the departed soul.
_Read: A rebel with a cause
MEDICAL ADVISORY TO DOCTORS SOON ON WHEN TO PULL PLUG ON LIFE SUPPORT
India’s apex medical research organisation will notify next month the
conditions under which doctors can withdraw life-sustaining treatment for
terminally ill patients.
Once notified, the Indian Council of Medical Research’s (ICMR) new
glossary will become a reference point for doctors in determining limitation of
treatment and providing palliative care at end of life.
TIME TO TAKE A DIFFERENT APPROACH TO PAIN
“The neighbors describe how anxious they would get whenever they heard
Mrs. Amutha, a 70-year-old lady, as she banged her head on the walls of her
apartment and screamed. She suffered from severe headache and facial pain
caused by advanced stages of oral cancer, and this is how she dealt with it.”
These are the opening lines of an article titled “ Opioid crisis: A
” by Krithika Muthukumaran, published in Mental Health Innovation Network
Growing up as the daughter of Dr Subathra Muthukumaran, a palliative
care physician in Chennai, Krithika Muthukumaran was familiar with the
challenges arising from unavailability of pain medication and lack of awareness
of palliative care. When she moved to Canada for higher studies, she was
shocked to find the contrast in opioid situation in opposite sides of the
globe. “North American and European nations are struggling to cope with the
side effects of opioid misuse, while the remaining population does not have
access to opioids to alleviate pain and suffering.” She explores the origin of
this chasm, and discovers why opioid prescription overshot the intended use in
countries like USA and Canada. “A new strategy and possibly bringing in uniform
operational guidelines worldwide for the next set of doctors will greatly help
them approach pain with the right mindset and prevent the past errors,” she
Read the article: Opioid crisis: A global rethinking
‘OPIOPHOBIA’ HAS LEFT AFRICA IN AGONY
_New York Times_
Uganda has a strategy for giving scarce morphine to patients in pain.
But many poor nations won’t emulate it, over fear of an opioid epidemic.
Pain is only the latest woe in John Bizimungu’s life.
Rwandan by birth, he has lived here as a refugee since his family was
slaughtered in the 1994 genocide. A cobbler, Mr. Bizimungu used to walk the
streets asking people if he could fix their shoes.
Now, at 75 and on crutches, he sits at home hoping customers will drop
by. But at least the searing pain from the cancer that has twisted his right
foot is under control.
“Oh! Grateful? I am so, so, so, so grateful for the morphine!” he said,
waving his hands and rocking back in his chair. “Without it, I would be dead.”
Continue reading ->
VACANCY: PROGRAMME COORDINATOR IN TRIVANDRUM
Pallium India invites applications for the post of Programme
Coordinator at Trivandrum.
NO. OF VACANCIES: 1
NATURE OF JOB: Permanent – Full Time
LOCATION: Pallium India Trust, Arumana Hospital Building, Trivandrum
* Overall in-charge for Pallium India coordinating between Pallium
India & IACA & all training centers involved in the IACA project.
* Ensure intimation about the course to all palliative care centers,
Medical Colleges and cancer centers in the country through telephone and emails
and /or advertisements & publications.
* Prepare details of all applicants for the course & submit it to the
* Review & ensure proper documentation regarding resume of staff,
documentation of expenses & progress of partners in various centers involved in
* Prepare & ensure proper documentation of all activities associated
with the project and proper dispatch of quarterly and annual project report to
* Liaise with accounts department of Pallium India to ensure proper
utilization and documentation of the Grant.
* Visit the individual training centers as and when needed.
* Database management of Pallium India
* Arrange and coordinate travel needs of Project Staff at Pallium
QUALIFICATION: Any Graduate/Post Graduate from a recognized university
with good computer and communication skills and willingness to travel.
EXPERIENCE: Fresher /1-2 years
HOW TO APPLY
Interested candidates please send detailed and updated CV to
hr@xxxxxxxxxxxxxxxx [mailto:hr@xxxxxxxxxxxxxxxx] with subject as “_Application
for Programme Coordinator_”.
CONTACT: +91 9746745501 / HR@xxxxxxxxxxxxxxxx
VACANCY: PALLIATIVE CARE PHYSICIAN AT CANKIDS, NEW DELHI
CanKids…KidsCan [http://www.cankidsindia.org/] , a registered
charitable National Society dedicated to Change for Childhood Cancer in India,
invites applications for the post of Palliative Care Physician.
POSITION TITLE: Palliative Care Physician
JOB DESCRIPTION: A full time physician for the only stand-alone
pediatric palliative care center in close proximity to 2 leading government
hospitals in New Delhi. The center has inpatient / outpatient and ambulatory
care services and runs a special palliative care and social support OPD.
NO. OF OPENINGS: One
LOCATION: New Delhi
EDUCATIONAL QUALIFICATION: a fully qualified palliative care physician
/ MD pediatrics
EXPERIENCE: Minimum 6 weeks Training and 2-3 years of experience in
SALARY (CTC): Salary will be negotiable and commensurate with
qualification, experience and past salary history of the candidate
HOW TO APPLY:
If you are interested in this position and keen to explore a career
with CanKids….KidsCan [http://www.cankidsindia.org/] , please share your CV
mentioning your present and expected CTC, passport size photograph at
careers@xxxxxxxxxxxxxxxx [mailto:careers@xxxxxxxxxxxxxxxx] . Please mention
“Application for Palliative Care Physician – New Delhi” in the subject of your
[https://smile.amazon.com/ch/47-4504650] Support Pallium India Inc by shopping
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When you shop at AmazonSmile, Amazon will make a donation to Pallium
Support us every time you shop!
‘PALLIATIVE PATIENTS NEED SPECIAL CARE’
Unfortunately, patients requiring palliative care are being admitted to
hospitals, which shift them to their Intensive Care Units (ICU s) in absence of
facilities and trained doctors to deal with such patients in their last stages.
This deprives them of a chance to be with their family members before their
This is because attendants are not allowed into the ICU.
“Palliative care may be needed by anyone, irrespective of their social
and financial status. The poor are making a better choice, though it could be
due to financial reasons, when it comes to taking care of such patients. They
keep them at home and attend on them,” says Dr. N.S. Raju, managing trustee and
medical director of Sneha Sandhya Age Care Foundation.
Continue reading ->
WHAT IT TAKES FOR A GOOD LIFE AND A GOOD DEATH
What will help most of us achieve a good death is a mix of bravery in
acknowledging the imminence of the exit, and a candid approach
I have for months carried around in my “to read file of articles”, one that
appeared in the Journal of the Royal College of Physicians Edinburgh (2016; 46:
281-7) titled “The way we die now: a personal reflection”. Losing my father,
Dr. Krishnamoorthy Srinivas, a medical practitioner of some renown, to the icy
hands of death last month, finally made me pick up and read this article by Dr.
S.O’Mahony, a gastroenterologist in Cork University Hospital. In the article,
which draws on his eponymous book, he talks of the contradictions that exist
“in the modern deathplace”.
Continue reading ->
THANK YOU FOR YOUR SUPPORT
Nanma, the employee’s charity initiative of Asianet Satellite
Communication, donated ₹100,000 to support the 6th anniversary celebrations of
Pratheeksha children’s palliative care clinic at SAT hospital. Thank you very
Students and teachers of Navajeevan School SANS PAIN (Students Against
Needless Suffering and Pain) Unit have donated 250 packets (5kg each) of rice
to support Pallium India’s Foodkit program. Thank you very much!
On Pallium India’s 14th annual day (December 15), SBI Life Insurance
donated ₹2,44,707 worth of Medical equipment for patient care. It was handed
over by SBI Life Area Manager Prince James to Dr Rajagopal. Thank you very much
for your support!
DONATE TO PALLIUM INDIA [HTTP://PALLIUMINDIA.ORG/DONATE]
The money you give will pay for essential free medicines for the poor,
for their travel to the clinic or for schooling of their children, or other
forms of care.
PLEASE GIVE WHATEVER YOU CAN. NO AMOUNT IS TOO SMALL.
To donate, please visit:
* http://palliumindia.org/donate/ [http://palliumindia.org/donate/]
* http://palliumindiausa.org/ [http://palliumindiausa.org/] (USA)
* Write to us: info@xxxxxxxxxxxxxxxx
* Call us: +91-9746745497 (India) / +1-718-273-8597 (USA)
_ All donations to Pallium India are tax deductible._
* JAN 5, 2018: Extension for Community Health Outcome (ECHO) Season 2.
Topic: “Interventional Pain Management: Carcinoma pancreas / chronic calcific
pancreatitis” ECHO is an online learning platform through knowledge and
experience can be shared. For details and to register, visit:
* JAN 15, 2018: Kerala Palliative Care Day, programs are organized
throughout Kerala by palliative care enthusiasts.
* JAN 17, 2018: Foundation course for doctors (Reserved for doctors
from Government health service, Kerala)
* JAN 19, 2018: Extension for Community Health Outcome (ECHO) Season 2:
Head and neck. Visit: http://palliumindia.org/courses/echo/ Contact:
* JAN 31, 2018: Foundation course for doctors (Reserved for doctors
from Government health service, Kerala)
* FEB 3-4, 2018: IAPC State Volunteers Meet 2018 – Feb 3,4 at Muhamma
Alappuzha. Contact: 99477 72077
* FEB 4, 2018: Colloquium: “Compassion in Care” at Barathiya Vidya
Bhavan, Bangalore. Contact: maria@xxxxxxxxxxxxxxxx /
* FEB 23, 2018: IAPCON 2018, Jawaharlal Auditorium, AIIMS, New Delhi.
Visit: http://www.iapcon2018.com/ [http://www.iapcon2018.com/]
* FEB 24, 2018: 8th Congress on PAIN – South Asian Regional Pain
Society. Contact: bssp1997@xxxxxxxxx Website: www.bsspbd.com
* MAR 5, 2018: 6 weeks certificate course in palliative medicine and
nursing (CCPPM, CCPN) at Trivandrum. Register: http://palliumindia.org/courses/
[http://palliumindia.org/courses/] Contact: education@xxxxxxxxxxxxxxxx /
* APR 23, 2018: 10-day Foundation course for doctors at Trivandrum.
Contact: education@xxxxxxxxxxxxxxxx / 8589998760
* MAY 30, 2018: 3rd ICPCN Conference, Durban, South Africa. Visit:
Have Queries? Contact: info@xxxxxxxxxxxxxxxx.
Find out more about our courses at: HTTP://PALLIUMINDIA.ORG/COURSES/
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PALLIATIVE CARE INFORMATION CENTRE [HTTP://PALLIUMINDIA.ORG/INFO-CENTRE]
Contact Pallium India’s Information Centre (9 am to 12 noon) for
information related to palliative care and about establishments where such
facilities are available in India. Telephone: +91-9746745497 or E-mail:
Address: Pallium India, Arumana Hospital, Perunthanni, Trivandrum
For more details, please visit: http://palliumindia.org/info-centre/
WHAT DOES GOLF HAVE TO DO WITH PALLIATIVE CARE? ASK MR SANDIP JARIWALA
_Mr Sandip Jariwala, from Pleasanton, CA, USA writes:_
_Relief From Cancer_ [https://www.relieffromcancer.org/] ’s inaugural
charity golf tournament was held at the Los Lagos Golf Course in San Jose, CA,
on Friday, September 22, 2017. The tournament attracted 82 golf players and
several sponsors who supported the fundraising event to help cancer patients
and their families through donations to various nonprofit organizations in
India and the US.
The charity golf tournament event was organized to raise awareness and
funds for CanKids in New Delhi, St. Jude India Child Care Centers in Mumbai,
Pallium India in Trivandrum, Indo-American Cancer Association in Houston,
National Pediatric Cancer Foundation in Tampa, FL, and Asian American Donor
Program in Alameda, CA.
The event began with a bone barrow registration drive conducted by the
Alameda-based Asian American Donor Program (AADP) followed by lunch, golf,
dinner reception and awards ceremony. The event ended with a raffle. Sandip
Jariwala, founder of _Relief From Cancer_, highlighted facts relating to the
gaps in providing access to quality medical care for cancer patients in India
and the hardships their families go through.
Dr. Jerina Kapoor, associated with Stanford University Health Care,
represented Pallium India at the charity event and highlighted the need for
providing palliative care and pain medication to cancer patients in India and
the important work that remains to be done for bringing awareness and training
staff in providing palliative care at hospitals in India.
Volunteers from _Relief From Cancer_ will be present at other community
events in the Bay Area, including Sevathon and Tiecon, to increase awareness
about the needs of cancer patients and their families in different parts of
India and to illustrate how the nonprofits there are actively working to
provide help as a result of donations received from the USA. To volunteer or
make a donation, please write to sandip@xxxxxxxxxxxxxxxxxxxx
[mailto:sandip@xxxxxxxxxxxxxxxxxxxx] or call (510) 381 7221.