Care Beyond Cure
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! March 2017 !
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February 28, 2017
PALLIUM INDIA JOINS INTERNATIONAL PALLIATIVE CARE ORGANIZATIONS TO URGE
GOVERNMENTS TO ENSURE BALANCED ACCESS TO OPIOIDS FOR PAIN RELIEF.
Pallium India has joined nine palliative care organizations from around
the world to promote the safe and balanced use of opioids – drugs that act on
the nervous system to relieve pain.
The “ Access to Controlled Substances for Medical and Scientific
Purposes: Ensuring and Restoring Balance
” statement asks governments to ensure access to opioids for medical and
scientific purposes and to reduce their abuse.
This comes as India’s medical and legal fraternity continues to wrangle
over the controversial subject and data compiled by the National Crime Records
Bureau (NCRB) showing that 26,426 suffering from various ailments, including
cancer, AIDS and paralysis, chose to end their lives in 2013. The data also
shows an increase in the number of suicides by people with cancer, with most
patients losing their will to live following setbacks during diagnosis or
Though India had amended its Narcotic Drugs and Psychotropic Substances
Act (NDPS) as early as in 2014 in order to make opioids available for pain
relief and preventing misuse, 29 state governments have not ratified it, and
hence not implemented.
Severe under-treatment of pain is reported in more than 150 countries,
accounting for about 75 per cent of the world’s population. At least 5 billion
people live in countries affected by the crisis of under consumption, and more
than 18 million annually die with treatable pain. Global studies show that up
to 84 per cent of patients suffer from pain due to cancer, HIV and other
Access for pain treatment and palliative care is lacking in several
countries, mainly in Asia, the Gulf States, Africa and Latin America), while
diversion and abuse is prevalent in high consumption countries of North
According to the World Health Organization (WHO), governments should
strengthen measures, in collaboration with the WHO, to ensure that
pharmaceutical companies do not unduly influence policy makers and health
professionals with financial interests in opioid production and marketing. They
should ensure collaboration between global, regional, and national pain and
palliative care organizations to train healthcare providers to prescribe
opioids safely for the treatment of pain.
Besides Pallium India, the other collaborating organisations to the
statement are the International Association for Hospice and Palliative Care
(IAHPC), Worldwide Hospice Palliative Care Alliance (WPCA), International
Children’s Palliative Care Network (ICPCN), African Palliative Care Association
(APCA), Union for International Cancer Control (UICC), European Association for
Palliative Care (EAPC), Pain and Policy Studies Group (PPSG), Kenya Hospices
and Palliative Care Association (KEHPCA).
According to the statement, to ensure and restore balance, governments
across the world should evaluate their drug control systems for balance, using
the WHO Ensuring Balance in National Policies on Controlled Substances
guidelines, and follow recommendations for it.
They should implement, in collaboration with WHO, INCB, and UNODC, the
recommendations from the WHO Palliative Care Resolution 67/19 and the UNGASS
2016 Outcome Document on the safe and effective use of controlled medicines for
pain and palliative care, including enhanced data collection mechanisms
throughout the controlled medicines supply chain to better detect diversion in
THE IRONY OF OPIOID ACCESS
“Imagine having a tumor so large on your leg that you can no longer
walk without excruciating pain. It has caused you to lose your job as a farmer,
the only source of livelihood where you live. You have exhausted your meager
savings to afford costly chemotherapy and without it, your doctor, whose clinic
is 250 miles away, grimly informs you that you will die.” In an article titled
“ Opiates for All, Opiates for None
[https://healingpointsblog.squarespace.com/opiates-for-all] “, Ramya Sampath, a
post-baccalaureate pre-medical student at Harvard University, explores the
irony of opioid access – in the US, 91 people die every day due to opioid
overdose, whereas on the other side of the globe, in India, less than 1% of the
population has access to opiates for pain relief in advanced illness.
India’s restrictive opioid policy originates in the 1985 Narcotic Drugs
and Psychotropic Substances Act (NDPS), which was passed after pressure from
the United States to join its global cry for its “War on Drugs.” Although an
amendment to the NDPS Act passed in 2014, simplifying the licensing process for
medical opiate prescription, access to opiates for medical use has not
“For India’s population,” writes Ramya, “the result has been an
epidemic of pain whose remission is still not in sight.”
Please read the article published in Healing Points Blog, _ Opiates for
All, Opiates for None
VIPS HAVE NO HUMAN RIGHTS?
The recent death of the Parliamentarian and former Minister of State
for External Affairs, E. Ahamed [https://en.wikipedia.org/wiki/E._Ahamed] ,
has created disturbance in the Indian Parliament and in the media for several
days. It is sad that he died a horrible death, at the age of 78 – it is
reported that he was put on ECMO (Extra Corporeal Membrane Oxygenator, an
artificial lung that could take over the function of the lungs for several
hours) in the middle of the night without the consent of the family that was
present but unable to see him. The religious rites could not be performed.
Let us hope that some good will emerge out of all the discussions on
the terrible tragedy – that the medical system and the legislators wake up to
create sane end of life care protocols and law. And when created, let us also
hope that the two will be complementary to each other.
Please watch Extremis [https://www.youtube.com/watch?v=TJiY8duVgz0] ,
the Oscar-nominated documentary on End of Life Care. (Thank you, Rakesh Menon,
for the link).
JOIN PALLIUM INDIA’S AWARENESS CAMPAIGN FOR HUMANE END OF LIFE CARE
PALLIUM INDIA INVITES YOU TO JOIN A NATIONWIDE AWARENESS CAMPAIGN
AGAINST TORTURING INCURABLY ILL PATIENTS IN INDIAN HOSPITALS IN THE NAME OF
MEDICAL TREATMENT EVEN WHEN THEY DESERVE COMPASSIONATE END OF LIFE CARE.
Over the years, Pallium India has been making steady progress in the
field of palliative care, providing free pain relief and palliative care to
people with life-limiting diseases undergoing unbearable suffering even in
We have trained doctors, nurses, volunteers and support staff in pain
relief and palliative care and has been tirelessly campaigning to bring about
state policies that favour pain relief. A very receptive public, a bunch of
self-motivated officials; dedicated staff members, selfless volunteers and
generous patrons have supported the cause.
From a difficult-to-pronounce name to a respectable health option for
vulnerable and voiceless patients, palliative care has come a long way; though
it reaches only 1% of the needy Indians even today.
As part of the Pallium India’s hope to extend its services to the rest
of India, a new campaign is being launched, which could make palliative care a
familiar name in the world of health care throughout the country. This can only
be done with an intensive and expansive campaign involving all palliative care
enthusiasts, institutions and professionals.
We are planning a number of programmes, among them a focussed
nationwide campaign to promote painless end of life care. We invite volunteers
from the medical community and others, retired professionals and students, who
wish to be actively involved in our upcoming projects, either contributing
ideas or with direct participation.
We are also seriously working on setting up state-wise Pallium Advocacy
Groups that will be tasked with building meaningful rapport with hospitals,
hospices, non-government organisations and other palliative care units and
endeavour to join our campaign to promote pain relief, and to stop
administering painful and unnecessary intrusive medical procedures on dying
patients. Pallium India intends to form advocacy groups that can make dying as
natural and painless an experience as possible.
Those who are interested in joining the campaign, in setting up
advocacy groups on behalf of Pallium India in their state or city or
coordinating with like-minded institutions and organisations in the field of
palliative care and hospice may please write in to national@xxxxxxxxxxxxxxxx
[mailto:national@xxxxxxxxxxxxxxxx] . Together, we can promote palliative care
as a human right and compulsory option for people with life-limiting diseases.
Do mention your area of interest, expertise and level of participation
(city/state, intense campaigning/moderately active or regular
volunteer/participation in special campaigns only).
Can you take the initiative to set up an advocacy group in your
If you cannot, would you like to join one if someone sets it up?
Write to us: national@xxxxxxxxxxxxxxxx
PALLIATIVE CARE INCLUDED IN KEY DOCUMENTS ON CANCER AND DEMENTIA AT WORLD
HEALTH ORGANIZATION EXECUTIVE BOARD MEETING
_By Kate Jackson, ehospice International_
The World Health Organization Executive Board met in Geneva during the
week of 23 January to set the agenda for the 70th World Health Assembly (WHA)
Top of the agenda was the election of the new WHO Director General, who will
succeed Dr Margaret Chan as leader of the WHO.
Six candidates from Europe, Asia and Africa are in the running: Dr
Sania Nishtar, Pakistan’s former health minister; Tedros Adhanom Ghebreyesus,
Ethiopia’s foreign affairs minister and former health minister; Dr Philippe
Douste-Blazy, a former health and foreign minister of France; Italian Dr Flavia
Bustreo, WHO assistant director-general for family, women’s, and children’s
health; Dr David Nabarro of Britain, special adviser on Sustainable Development
to UN Secretary General Ban Ki-moon; and Dr Miklós Szócska, former Hungarian
Minister of Health.
Worldwide Hospice and Palliative Care Alliance (WHPCA) Executive
Director, Dr Stephen Connor, attended the meeting, along with International
Association for Hospice and Palliative Care (IAHPC) Advocacy Officer, Dr
Katherine Pettus, to speak out for palliative care and its inclusion in key WHO
Continue Reading –>
INTERNATIONAL FOCUS ON POOR ACCESS TO PAIN RELIEF IN INDIA – AGAIN.
An article published in January 2017 in the Journal of Global Oncology,
titled _End-of-Life Care and Opioid Use in India: Challenges and
Opportunities_ [http://ascopubs.org/doi/full/10.1200/JGO.2016.008490] brings
the world’s attention again on the poor access to pain relief in India, despite
the amendment of the NDPS Act in 2014. The authors, Aasems Jacob and Aju Mathew
from the USA, make an astute analysis of the current situation and point out:
“Integration of palliative care as an academic discipline into the
undergraduate medical curriculum and establishment of more postgraduate
educational programs in palliative care would greatly improve provision of
appropriate pain relief to thousands of patients suffering from cancer and
other life-limiting illnesses”.
Indeed, education is the need of the hour.
LANCET TRAINS A CRITICAL EYE ON INDIA’S HEALTH SPENDING
_By Disha Shetty, DNA India_
Two months in a row, UK’s premiere medical journal has analysed the
country’s bleak future in healthcare.
Peer-reviewed UK medical journal The Lancet — in an analysis of India’s
annual budget — has questioned why healthcare for all citizens is not a
priority for the state and the central governments. In an article titled
‘Accounting for the future of health in India’, the journal said that different
government agencies in the country need to collaborate to deal with challenges
in its healthcare system.
“In India, the challenge is that health has a low status as a popular
demand. This has meant that the discussion on universal health coverage (UHC)
has remained almost entirely confined to academic and policy circles,” the
Continue Reading –>
HOW GOOD IS ACCESS TO PALLIATIVE CARE IN KERALA?
WHAT DO YOU THINK? POOR? GOOD? VERY GOOD? EXCELLENT?
Read the article in the Journal of Global Oncology
[http://ascopubs.org/doi/abs/10.1200/JGO.2016.007872] , titled “ Oral Morphine
Use in South India: A Population-Based Study
” by M.R. Rajagopal, Safiya Karim, and Christopher M. Booth.
Access to palliative care is notoriously difficult to measure. The
world has accepted per capita morphine consumption as _THE _index.
If you want the good news, access to pain relief in Kerala is at least
four times better than the national average.
But wait, there is some bad news to follow. If we take UK and some West
European countries as ideal (USA and Canada are _NOT _ideal as their high
consumption is suspected to reflect some diversion of prescription drugs to
illicit channels), 150-200mg of morphine (or its equivalent) per year would be
optimal. Unfortunately, the consumption in Kerala is still only about one
hundredth of that. And, only 1/4th of the global average.
You find it difficult to believe? Yet this is a fact despite the
widespread recognition of the Kerala model. Why? The main reason is that
hospitals do not use morphine for pain relief following operations, after
accidents or even in cancer pain. The _ESSENTIAL _morphine is not available in
majority of the hospitals.
Moreover, even in cancer, pain relief reaches too few, too late. There
is almost unbelievably high variation in opioid access between various
districts of Kerala.
We are glad that the Government of Kerala is considering palliative
care as one of its focus areas. Things are bound to improve in the next few
WHAT’S MOTIVATING HUNDREDS IN KERALA TO SPEND TIME WITH DYING PATIENTS?
_By M R Abraham, Youth Ki Awaaz_
Hamsa lay on the bed, his arm propping up his head. His tall frame
nearly filled the entire bed. His wife Jasmine stood behind him, her hand
resting on his shoulder. Both smiled and nodded as they listened to the young
visitors in their hospital room.
Every few months, Hamsa and Jasmine leave their own home and take up
residence in this tranquil corner of the Medical Centre campus in Kozhikode,
Kerala. After more than a decade of visits, this room at the Institute of
Palliative Medicine is like a second home and the doctors, nurses and staff
like family members. Volunteers – high school and college-age men and women –
from the area’s well-established palliative care network make frequent visits
to chat with the couple.
Fifteen years ago, life was very different for Hamsa and Jasmine. They
were newly married. Befitting his strength and stature, Hamsa was a karate
instructor. But an accidental fall from a bridge left him paraplegic. For
years, they visited hospitals and specialists searching for a cure, until
realising that his paralysis was permanent. The physical and psychosocial care
at the palliative care institute helped them to accept his condition and create
a new yet still meaningful life.
Continue Reading –>
THE PEOPLE WHO HELP YOU DIE BETTER
_By Jeremy Laurance_
A network of compassionate volunteers caring for their terminally ill
neighbours is allowing more people in Kerala, India, to end their days at peace
and at home.
Thirty years ago a young anaesthetist, newly appointed as head of
department at Calicut Medical College Hospital in the Indian state of Kerala,
encountered a case that would change his life.
A college professor aged 42 with cancer of the tongue had been referred
to him by an oncologist. The man was in severe pain and the anaesthetist, Dr M
R Rajagopal, was asked if he could help. He injected the mandibular nerve in
the jaw in a procedure known as a nerve block, and told the patient to return
in 24 hours. Next day, the pain had almost completely gone and Dr Raj, as he is
known, was pleased with his work.
“He asked me when he should come back. I told him there was no need to
come back, unless the pain returned. I thought he would be happy I had cured
the pain. Instead, he went home and killed himself that night.”
It turned out that the oncologist had avoided explaining to the college
professor that his cancer was terminal. Instead he had said he was referring
him for further treatment.
“It was only when I told him there was no need to come back that he
realised his cancer was incurable. He went home and told his family it was all
Continue Reading –>
QUEST TO MAKE UTTARAKHAND REAL DEVBHOOMI
Uttarakhand, the land-locked small state in North India, is often
called _Devbhoomi_ (Land of the Gods).
In a quest to make the Devbhoomi a really compassionate state,
palliative care activists have been trying hard to increase the reach of
palliative care, which, at the moment, is confined to tiny pockets.
Under the leadership of the mission director, Dr Neeraj Kharwal IAS,
the government officials in health, National Health Mission and Drug Control,
got together with palliative care activists on a planning exercise, discussing
problems and seeking solutions. There was no doubt in anyone’s mind that
palliative care needed to be brought into health care in the state. The
inevitable question about addiction potential of morphine did come up, as it
The issue was discussed and doubts cleared. Dr Neeraj Kharwal (right)
has created an action plan and we are so very hopeful of the future.
Pallium India is proud to be associated with the palliative care
pioneers Dr Aditi Chaturvedi and Dr Brenda Ward from Ganga Prem Hospice, Dr Ann
Thyle of Emmanuel Hospital Association (EHA) and Dr Mayank Gupta, with whom
Pallium India has initiated a pioneering project in Shri Guru Ram Rai Institute
of Medical & Health Sciences (SGRRIMHS), Dehradun, with the help of Tata Trust.
_[Top: The palliative care pioneers of Dehradun: Dr Ann Thyle, Dr
Mayank Gupta, Dr Aditi Chaturvedi, Dr Harish Chaturvedi.]_
CARE, COMPASSION AND THE COMMUNITY IN UTTARAKHAND
_Dr Rajagopal, Chairman of Pallium India writes about his visit to
The community is deeply involved in palliative care delivery in Kerala.
A question that often comes up is, would that be always unique to Kerala? Can
it not be replicated elsewhere?
I personally believe that the biggest barrier to involvement of the
community in health care is the simple fact that it is a massive change from
the way health system functions now. There is a natural resistance to change.
Everyone, including administrators, doctors and nurses, wonders how that can
_[Dr Aditi Chaturvedi with the President of the Rotary Club, Mr Sumit
The simple truth is that it is already happening all around us. We are
simply unable to see it and allow it to grow. When I visited Dehradun in
Uttarakhand, I saw two examples of this. First, when the rotarians of the city
invited palliative care activists to speak to them and to have a discussion.
They have already constructed a building; they want help to convert it into a
palliative care centre.
As I joined the local team on a home visit, I saw a second example. One
of the patients, Beena Devi*, was in Prem Dham, a home for the aged. Beena Devi
was in pain from advanced cancer, now partially relieved with morphine. A young
woman who was waiting, approached us with a lot of queries – just exactly the
kind of question that any family member would ask about a relative undergoing
treatment. Would she have more pain? Would this tablet cause any harm? How can
we make her better than she is?
The young woman, Shalini*, was a volunteer from the neighbourhood. One
who would drop in at Prem Dham just to give companionship and to help the
residents. She had already found one answer to the last question: she pointed
to the yard where a car was waiting with a young man and an eight-year-old
girl. Shalini explained; the girl was her daughter and the young man was a
friend who had offered them a ride. They were planning to take Beena Devi out
to the coffee shop for a snack and a coffee.
And here we doctors were wondering how to get the community involved!
The community is already involved. We only need to take the trouble to engage
them and welcome them to our fold.
_*Not real names_
AGEING WITH DIGNITY
_Editorial, The Hindu_
We may be a young nation, but we need to gear up to meet the needs of
While India’s celebrated demographic dividend has for decades underpinned its
rapid economic progress, a countervailing force may offset some of the gains
from having a relatively young population: rapid ageing at the top end of the
scale. This is a cause of deep concern for policymakers as India already has
the world’s second largest population of the elderly, defined as those above 60
years of age. As this 104-million-strong cohort continues to expand at an
accelerating pace, it will generate enormous socio-economic pressures as the
demand for healthcare services and tailored accommodation spikes to
historically unprecedented levels.
It is projected that approximately 20% of Indians will be elderly by
2050, marking a dramatic jump from the current 8%.
However, thus far, efforts to develop a regime of health and social
care that is attuned to the shifting needs of the population have been
insufficient. While more mature economies have created multiple models for
elder care, such as universal or widely accessible health insurance, networks
of nursing homes, and palliative care specialisations, it is hard to find such
systemic developments in India. Experts also caution that as the proportional
size of the elderly population expands, there is likely to be a shift in the
disease patterns from communicable to non-communicable, which itself calls for
re-gearing the health-care system toward “preventive, promotive, curative and
rehabilitative aspects of health”.
Continue Reading –>
PALLIATIVE CARE: AN EVOLUTIONARY TURN IN DARK TIMES.
_By Katherine Pettus, in The Huffington Post_
The word palliative is derived from the Latin palliare, or cloak.
Cloaking, or palliative care teams, manage the pain and symptoms suffered by
patients diagnosed with life-limiting illnesses. Pain is often a complex
synergy of the physical, emotional, spiritual, and social issues a person and
family are undergoing, and because few modern medical students are trained to
treat such pain and symptoms, doctors feel unprepared to address it. Palliative
care teams intentionally address pain and symptoms: they include specially
trained doctors, nurses, pharmacists, social workers, and spiritual care
advisors who providing care beyond cure, as necessary. Palliative care, not
medically assisted dying or euthanasia, is the appropriate response when
doctors concede “there is no more we can do.” Provision of palliative care
requires policy, though: budgets, training, and accreditation of providers
These, in turn requires advocacy to build political support. Without that, the
default rational option for long-suffering patients is support for medically
assisted dying and euthanasia.
Palliative care has value in itself, though, apart from serving as an
ethical foil for the medically assisted dying movement. It heals the deficits
of bio-medicine and preserves the profession from harm by completing it,
expanding it to its natural limits, restoring it to its original self as
Continue Reading –>
MEDICAL MORPHINE CONTINUES TO REMAIN OUT OF REACH
_By M. Sai Gopal, Telengana Today_
There are two lakh cancer patients in Telangana and Andhra Pradesh of
which an estimated 1.5 lakh cancer patients need medical morphine.
The World Health Organisation (WHO) considers medical morphine as the
gold standard to combat pain, which is essential to provide end-of-life care
for patients struggling with life threatening ailments such as HIV/AIDS and
Despite its recognition as a proven drug, access to medical morphine
continues to remain a challenge for patients from the two Telugu speaking
States. Roughly, there are two lakh cancer patients in Telangana and Andhra
Pradesh of which an estimated 1.5 lakh cancer patients need medical morphine.
However, at present, every year 13,000 patients from TS, AP, a few patients
from border towns of Maharashtra and even Odisha have access to it at MNJ
Institute of Cancer Research in Hyderabad.
Continue Reading –>
JO ELAND LIVES! [HTTP://PALLIUMINDIA.ORG/2017/02/JO-ELAND-LIVES/]
On 26th September 2016, we had informed you all with great sorrow of
the demise of our dear friend from Iowa, Professor Jo Eland
[http://palliumindia.org/2016/09/goodbye-jo-we-love-you/] . A couple of days
ago, we received into our bank account Jo’s handsome gift to Pallium India that
she had bequeathed in her will.
We cannot find the right words to express how we feel. Happy about the
money, of course, which will help so many of our patients and support our
activities, but how do we describe the love that came with it, the goodwill,
the strength that she infuses into us, and such precious memories she has given
Thank you, Inez Dawes (Jo’s sister) and thank you, Dr Ann Broderick.
Both of you had to go through a lot of trouble and frustration with the
bureaucratic wrangles, even when struggling with your grief.
Dear Jo, we don’t know how to celebrate you. We have no doubt that you
would have wanted us to celebrate. Inez suggests an ice cream together. We can
see you smiling at the thought!
YOU ARE WITH US, DEAR FRIEND.
Ever forward [http://palliumindia.org/2017/02/ever-forward/]
The Indian Association of Palliative Care has been growing from
strength to strength. But the growth in the last couple of years has been
exponential in many ways – for example, as evidenced by the number of
registrations at its annual conference, the IAPCON.
In 2016, the attendance was the largest ever – around 600.
Guess what the number was this year?
The organizing committee led by Dr Balaji put up an impressive
performance. Systematic conduct of scientific sessions, excellent audio-visual
support and truly enjoyable but not ostentatious food. Congratulations, Dr
Balaji and team.
_[Picture: Pallium India team at IAPCON 2017, Coimbatore.]_
DR MICHAEL MINTON ON THE IAPC CONFERENCE
_Michael Minton, Palliative Care doctor and long-term friend of Indian
palliative care from Oxford, UK, writes about the 24th Indian Association of
Palliative Care conference (IAPCON), 10-12 th February 2017 in Coimbatore:_
It has always been a pleasure to attend the annual IAPC conferences
over the last 18 years and observe the ever increasing growth and maturity of
the event. This year was no exception and the combination of the Coimbatore
team led by Dr Balaji and the scientific programme led by Dr Chitra
Venkateswaran proved to be a winning partnership. Attention to detail was the
order of the day.
The venue was spacious and allowed everyone to have easy access to all
the presentations so important when one has parallel sessions. Equally
important and achieved was space and visibility for the poster presentations in
the appropriate location which was where everyone gathered for refreshments and
to network. I make no excuse for highlighting the importance of location as it
is critical to provide equality of access to all the components of the
For this reason I could move around the presentations and posters
freely although obviously with 3 parallel sessions I could only appreciate a
third of the conference at most.
The conference opened with a confident overview of the progress of PC
in India from the current president Dr Mary Ann Muckaden. It was outward
looking, highlighting achievements, while acknowledging the ever present
challenges. There feels to be a forward momentum in the country finally
reflecting the hard work of the IAPC over the last 25 years.
The content of the conference similarly was progressive with a wide
range of topics from the palliative care needs of people effected by natural
disasters e.g. the Nepal earthquake, to the ever-increasing volume of refugees
in the world and then the needs of marginalised communities such as the
elderly, abused and transgender people.
There was, of course, traditional sessions e.g. symptom control,
education, mental health, and psycho-social needs for both children and adults.
This included topics that recognised the interests of volunteers. I would love
to know how the volunteers evaluate these conferences?
The theme of each parallel session was clearly identified and one that
I attended on qualitative research was well planned and exemplified the value
of linking the 3 presentations into a coherent progression of knowledge.
One should never underestimate the work involved in preparing a talk or
poster especially when it is your first conference. So it is valuable to
receive questions and feedback. As there is always a shortage of time in
sessions for questions and many feel intimidated by the enormity of the
audience, it would be helpful for all presenters to highlight their email
addresses and maybe the organisers could consider identifying a space in the
refreshment area where the speakers would be following their session to answer
This year there were over a thousand delegates, a tremendous
achievement by the organisers, but a challenge for the delegates trying to
locate a speaker!
However, as I have mentioned, the posters were very visible and given
good promotion by identifying the refreshment sessions as also a “Poster Walk”.
Good ideas like this reflected the planning and thoughtfulness of the
organisers. I thoroughly enjoyed my time in Coimbatore. Well done to all those
For more details of the conference and a post conference video, visit:
CHILDREN’S PALLIATIVE CARE AT IAPCON COIMBATORE 2017
_By Prof. Julia Downing, in ehospice International Children’s Edition_
Empowering bereaved parents is an important aspect of children’s
palliative care but is often not focused on.
The 24th International Conference of the Indian Association of
Palliative Care opened today in Coimbatore. The opening plenary presentation
was given by Prof Mary Ann Muckaden, the President of the Indian Association of
Palliative Care and former Chair of the International Children’s Palliative
Care Network (ICPCN). Her presentation on Taking Palliative Care Forward
challenged us to think about what we need to do and how we can continue to move
palliative care forward, both in terms of adult and children’s palliative care
and how we need to provide an integrated and comprehensive service for all in
Continue reading –>
BRUCE DAVIS GOLD MEDAL 2016 AWARDED TO ROHANTI RAVIKULAN
In an elegant inaugural function of the 24th International Conference
of the Indian Association of Palliative Care [http://iapcon2017cbe.com/]
(IAPCON 2017) held at Coimbatore on 10th February 2017, the coveted Bruce Davis
Gold Medal was handed over to Dr Rohanti Ravikulan with a citation and a cash
award of ₹25,000.
The Gold Medal was instituted by Institute of Palliative Medicine,
Kozhikode [http://www.instituteofpalliativemedicine.org/] , in honor of Wilfrid
Bruce Davis MBE, who has been a godfather of palliative care in the country
from early years.
Congratulations, Dr Rohanti Ravikulan, and thank you, Bruce, for your
contribution to relieving disease-related suffering in this country.
NURSES AND PALLIATIVE CARE ON FOCUS DURING ONCOLOGY MEET
“Nurses are the backbone of the society; not only of the health care
profession,” said Padmashri Dr. D. D. Patel, winner of the prestigious Dr. B.
C.Roy award in 1998.
Food for thought indeed! Are nurses not the ones who look after each
one of us and our loved ones, when we need care most in our lives?
During a half hour session at a workshop on palliative care on 24th
February, the first day of a three-day Indo-Global submit on head and neck
cancer at Jaipur, Dr. Patel chose to speak on the role of nurses – how they are
not treated with respect in India and how they are not allowed do their best.
During a whole day devoted to palliative care, there were discussions
on various aspects of palliative care including end of life care.
Congratulations to Dr. Anjum Khan Joad and team at BMCHRC- one of
Pallium India’s partners in promoting palliative care education in the country.
THE ELEPHANT IN THE ROOM: AN EXTERNAL VIEW
_There’s an elephant in the room._
_It is large and squatting, so it is hard to get around it._
_Yet we squeeze by with, “How are you?” and “I’m fine,”_
_ and a thousand other forms of trivial chatter._
_We talk about the weather. We talk about work._
_We talk about everything else, except the elephant in the room._
– _“The Elephant in the Room” by Terry Kettering_ "
There is indeed a large elephant in the room – we have become quite
adept at squeezing past it. That large elephant is the burden of
disease-related suffering and the room is India.
How does it all look to someone looking in from outside?
Jesse Bossingham is a volunteer from USA. According to his blog
[https://letsstartattheendblog.wordpress.com/] , he is “interested in the ways
medicine is culturally, spiritually, and institutionally located.”
Specifically, he wishes to “study different modes of death and dying around the
As a part of that quest, Jesse spent two weeks at Pallium India this
February, observing the way we function, trying to understand the culture and
methods. “I had hoped to fade into the background and watch, but it is clear
that won’t work.” As he does not understand Malayalam, he has to rely on body
language and hasty translations.
In the course of a fortnight, he senses the elephant in the room –
huge, clear and ominous. In his blog titled “ Talking About the Elephant: Two
Weeks at Pallium India
“, Jesse writes about his experiences as he shadowed the home visit team, and
at the outpatient clinic, and in the inpatient ward. The little things that we
do not perceive, that we consider normal, that we take for granted, jump out at
us from Jesse’s words. Do read Jesse Bossingham’s blog
SCOTTISH PARLIAMENT HOSTS THE RELIGIONS OF THE WORLD CHARTER FOR CHILDREN’S
On the 8th of February 2017, Silvia Lefebvre D’Ovidio presented the ‘
Religions of the World Charter for Children’s Palliative Care
[http://religionsworldcharter.maruzza.org/] ’ to Members of the Scottish
Parliament, faith community leaders, child-patients and their families,
international palliative care advocates and members of the press, in a
ground-breaking initiative promoted by The Edinburgh Medical Missionary Society
This is the first time that an important political institution has
acknowledged the significant value of this Charter and the role that religions
can play in the development and diffusion of palliative care for seriously ill
and dying children around the world.
EMMS International commented: “This event represented a historic moment
for Scotland’s Parliament; it was an ideal opportunity for MSPs to learn more
about this unseen problem and contribute to creating a fairer world where every
child receives palliative care should they need it.”
Let us hope that this initiative will be taken as an example and
reproduced in other institutions around the world.
INTERNATIONAL FELLOWSHIP IN PEDIATRIC PALLIATIVE CARE
MNJ Institute of Oncology (MNJIO) Hyderabad, in collaboration with Two
Worlds Cancer Collaboration-INCTR Canada, and Pallium India, calls for
applications for one year integrated international Fellowship in Pediatric
Palliative Care [http://palliumindia.org/courses/ppc/] .
COURSE INTAKE: 1ST APRIL 2017
Click here to read more about the course and to apply
ABOUT THE COURSE:
Duration: Full time one-year program
Training will be primarily be carried out at MNJIO, Hyderabad. The
training aims to provide the skills, knowledge and attitudes required to
practice palliative care for children with cancer, HIV and AIDS and other life
threatening illnesses. The program will be conducted under the supervision of
renowned national and international faculty.
The candidate should have a M.B.B.S degree with permanent registration
with medical council and MD/DNB or post graduate diploma in any clinical
specialty. Preference will be given to candidates with qualifications in
pediatrics and a long-term commitment to palliative care.
HOW TO APPLY
Download the application form [http://palliumindia.org/courses/ppc/] ,
fill it up and send it to mnj.palliative@xxxxxxxxx
Course coordinator, Department of Palliative Medicine, MNJIO, Red
Phone: 09177238901 , 040- 23397000 (Ext: 148)
Email: mnj.palliative@xxxxxxxxx [mailto:mnj.palliative@xxxxxxxxx]
Course information and Application form can also be downloaded from
http://www.twoworldscancer.ca [http://www.twoworldscancer.ca] and
IAHPC TRAVELING SCHOLARSHIPS TO IPHPC CONFERENCE IN CANADA
The International Association for Hospice and Palliative Care
[http://hospicecare.com/home/] (IAHPC) announces that it will provide the
* TEN (10) SCHOLARSHIPS to support the travel of palliative care
workers to attend the 5TH INTERNATIONAL PUBLIC HEALTH AND PALLIATIVE CARE
CONFERENCE [http://www.iphpc2017.com/about/] . The conference will take place
in Ottawa, Canada on September 17-20, 2017. DEADLINE TO APPLY: MAY 15, 2017
In order to apply for a traveling scholarship, applicants must be
current members of IAHPC and should not ave received grants from IAHPC in the
past 3 years. (If you wish to apply and are not an IAHPC member, you may join
by clicking here [http://hospicecare.com/join-iahpc/] .)
PREFERENCE WILL BE GIVEN TO APPLICANTS:
* Living in Lower, Lower-Middle and Upper-Middle income categories as
per the World Bank income classification data. See here
* Applicants who have been IAHPC active members for two or more
* Actively working in palliative care.
* Graduated less than 10 years ago from specialty or medical school
* Have an accepted abstract for poster / oral presentation. Proof of
acceptance of the poster will be required.
More detailed information about the application process and the online
form are available at the IAHPC website here
[http://hospicecare.com/about-iahpc/iahpc-programs/traveling-scholarship/] . If
you need information on how to apply please contact Genevieve Napier, IAHPC
Manager of Programs and Projects at gnapier@xxxxxxxxx
WHAT A LOVELY OUTCOME! THANK YOU, ASIANET.
Receiving the coveted TNG award from Asianet News Channel
[http://palliumindia.org/2017/01/tng-award-conferred-on-dr-rajagopal/] , the
Chairman of Pallium India explained what difference the amount would make to
Pallium India’s patients and their families.
The response came almost immediately from Sri K. Madhavan, Managing
Director of Asianet, that Pallium India can expect an additional contribution
The donation of ₹100,000 has already reached us from Sankaran Nambiar
Smaraka Trust, the family trust of Sri Madhavan. It is not only the money that
makes us full of gratitude. It is also the goodwill and the message that Sri
Madhavan conveys to everyone that the society has a responsibility to lend a
hand when a fellow human being suffers.
DONATE TO PALLIUM INDIA [HTTP://PALLIUMINDIA.ORG/DONATE/]
[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: palliumindia.org/donate
Write to us: info@xxxxxxxxxxxxxxxx [mailto:info@xxxxxxxxxxxxxxxx] /
PALLIATIVE CARE IS ABOUT LIVING, NOT DYING, SAYS EXPERT
_Published in ehospice Canada_
Palliative care is about living and celebrating life and should begin
much earlier than a during a patient’s last days and weeks of life, palliative
care physician Dr. Jose Pereira. “We need to change a culture … that palliative
care has to do with death and dying,” Pereira told an information session in
Palliative care is about living, compassion, dignity and person-centred
care, he said. Fear and depression associated with sickness and dying can be
greatly reduced if palliative care principles are introduced earlier along with
If the “p-word” is only introduced when physicians have given up on
attempts to cure or control the disease, the anxiety will only increase, he
“It’s not a matter of taking away hope; it’s a matter of reframing
Introducing palliative care earlier in the disease process does not
shorten life because its principles — quality of life, patient-centred care,
symptom management and spiritual and personal life goals — can be applied while
treatments are underway, he said.
“Palliative care and treatments to cure and control are not mutually
exclusive. They go hand in hand.”
Continue Reading –>
UPCOMING EVENTS [HTTP://PALLIUMINDIA.ORG/COURSES]
MARCH 6, 2017: 10 days Foundation Course
[http://palliumindia.org/courses/foundation/] for doctors at Trivandrum,
Kerala. Contact: info@xxxxxxxxxxxxxxxx [mailto:info@xxxxxxxxxxxxxxxx]
MARCH 6, 2017: 6 weeks certificate course
[http://palliumindia.org/courses/#Trivandrum] for doctors and nurses at
Trivandrum, Kerala. Contact: info@xxxxxxxxxxxxxxxx
MARCH 17-18, 2017: Food Festival at Trivandrum organized by volunteers
of Pallium India. Contact: info@xxxxxxxxxxxxxxxx
APRIL 8-9, 2017: Kerala state volunteers meet at Aluva, Kerala.
Contact: info@xxxxxxxxxxxxxxxx [mailto:info@xxxxxxxxxxxxxxxx]
APRIL 27,28,29: Kuttikkoottam Summer Camp for children of our patients,
Trivandrum. Contact: info@xxxxxxxxxxxxxxxx [mailto:info@xxxxxxxxxxxxxxxx]
MAY 5-7, 2017: Painting exhibition at Trivandrum. Contact:
JUNE 5, 2017: One month certificate course
[http://palliumindia.org/courses/hyd_ccppm/] in Pain and Palliative Medicine
for Doctors, Nurses, Social Workers and Volunteers in Hyderabad, Telengana.
Contact: mnj.palliative@xxxxxxxxx [mailto:mnj.palliative@xxxxxxxxx]
JUNE 29-JULY 2, 2017: Rehabilitation products sale at Saphalyam
Complex, Trivandrum. Contact: info@xxxxxxxxxxxxxxxx
OCTOBER 14, 2017: International conference on Peri-operative Cancer
Care at Jawaharlal Nehru Auditorium AIIMS, New Delhi.
Register: irchoncoanaesthesia.com [http://www.irchoncoanaesthesia.com]
For details on these programs, contact: info@xxxxxxxxxxxxxxxx
[mailto:info@xxxxxxxxxxxxxxxx] . Find out more at:
INTERNATIONAL VISITORS [HTTP://PALLIUMINDIA.ORG/PROGRAMS/VISITORS/]
We welcome international visitors at Pallium India and appreciate the
support from our colleagues around the world. We request that you contact us at
least 2 weeks prior to your visit so that we can make the necessary
arrangements. Sorry; we would discourage “drop-ins” for fear of the impact on
We have observership programs for interested professionals and
students, collaborative visits, and long term placements. Click here
[http://palliumindia.org/programs/visitors/] for more information. Contact:
JOIN OUR FACEBOOK PAGE [HTTPS://WWW.FACEBOOK.COM/PALLIUMINDIA]
Pallium India’s Facebook page has over 5000 Likes. We regularly post
articles related to palliative care from around the world. Click here to Like
our page [https://www.facebook.com/palliumindia] !
We’re also on Twitter: @palliumindia [https://twitter.com/palliumindia]
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/
WAITING FOR THE EXIT VISA
_By Jean Jacob_
[http://palliumindia.org/2017/02/waiting-for-the-exit-visa/] The small
(8 by 8 feet) room has a broken cot, an old television, a few utensils, and an
Eastern style toilet.
This is the world of M. Arjun.
Arjun is awake at 8a.m., but he waits, his body resting on its side; he
waits for someone from the neighbourhood to come over and set it upright. Once
somebody sits him up on the floor, Arjun remains sitting in that same position
all day, his back straight and arms and legs half bent in front of his torso,
watching television. He cannot flip the channels. If anyone passes by, he calls
out to them but sometimes he is stuck watching the same channel all day. This
is his day, every day.
Today, he is watching a Telugu news channel. We ask him if he wants it
to be changed.
“I am following the developments in the Sasikala story,” he says. “It
looks like Palanisami will become chief minister. I am waiting to see what
happens in Tamil Nadu.”
To me, Arjun’s life is a life of waiting.
He used to work as a driver. He had a wife. Three years ago, at 32, he
developed weakness in his legs and was diagnosed with a rare and incurable
condition called limb girdle muscular dystrophy. Doctors told him it would
spread to his arms as well.
Soon, everything changed, his life changed. He lost his job. His wife
left him a month later. Today he is almost a quadriplegic. The horror is that
his mind is unaffected by the disease, making his life a waking nightmare. He
has had to watch his body slowly slip into disuse.
“There is no strength in my legs and left arm. But there is still some
strength in my right arm. I can’t lift it, but I can press down with my
He demonstrates this by pushing buttons on the mobile phone lying in
front of him. A call goes to our physiotherapist, Ashok, who is standing
nearby. We laugh. Ashok has been seeing him for two years as part of our
palliative care rural outreach program.
Continue reading –>