Pallium India Newsletter: October 2012

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  • Date: Wed, 31 Oct 2012 13:10:43 +0000

Pallium India
Care Beyond Cure



* ~~~~~~~~~~~~ *
! October 2012 !
* ~~~~~~~~~~~~ *
http://palliumindia.org/2012/10/october-2012/
October 31, 2012

         

DEAR FRIENDS,Â

        One of our team members, Dr Nidha (she is getting married; join us in 
wishing the couple well; we are very sad that she is leaving town, though) said 
that the hardest lesson in palliative care to learn was the one about being 
non-judgmental. " 

_ âI AM TRYING HARDâ, SHE SAID IN A MOMENT OF INTROSPECTION. âBUT IT IS NOT 
EASYâ._

" 

         

        We thought it important to open this newsletter with Dr Nidhaâs thought 
as we see its importance more and more. As the palliative care movement grows 
in the country, the movement itself gets powerful and sometimes, even 
aggressive. 

        Power is always notorious for being corruptible; and here the victim 
could well be the patient â because he is stripped of all power, physical, 
emotional, spiritual, and is at the mercy of the system. 

        Till the palliative care worker has learned to avoid being judgmental, 
his basic palliative care education is not complete. It is easy to get 
self-righteous and to label patients and family members as good or bad. 

IF WE DO, IT SHOWS IN OUR ACTIONS, BODY LANGUAGE AND FACIAL EXPRESSIONS, AND 
ACTUALLY WORSENS THE PATIENTSâ SUFFERING.

        - 

WORLD PALLIATIVE CARE DAY 2012: THE SEA AND THE SAND ON THE FEET 
[HTTP://PALLIUMINDIA.ORG/2012/10/WORLD-PALLIATIVE-CARE-DAY-2012-THE-SEA-AND-THE-SAND-ON-THE-FEET/]
 

DONâT YOU LOVE THE BEACH? DONâT YOU LIKE THE FEEL OF THE SAND ON YOUR FEET AS 
THE SEA WASHES OVER THEM?

        Most of us do, and also perhaps, take if for granted. There are a few 
among us for whom this is not an every day affair, but a dream. 

        About 40 of our patients, many of them wheelchair-bound, met together 
on 13th October 2012 at ShanghumughamÂbeach to celebrate World Palliative Care 
Day [http://www.worldday.org/] . 

        The National Rural Health Mission [http://www.mohfw.nic.in/NRHM.htm] 
and District Panchayath had joined hands with PALLIUM INDIA to make it 
possible. 

MANY OF THE ATTENDEES MAY NEVER HAVE HAD A CHANCE TO SEE THE SEA AGAIN IN THEIR 
LIFETIMES.ÂTHEY HAD FUN!

        - 

WATCH A MOVIE AND HELP OUR PATIENTS! 
[HTTP://PALLIUMINDIA.ORG/2012/10/WATCH-A-MOVIE-AND-HELP-OUR-PATIENTS/] 

         

        Mr Gireesh Chandran and his father Shri Chandran, who own Sree 
PadmanabhaÂTheater in Trivandrum 
[http://palliumindia.org/2012/02/sri-padmnabha-theatres-blockbuster-generosity/]
 decided to do something toÂcommemorate the sacred memory of theater founder, 
the late Shri P Subramaniam. 

1% OF THE COLLECTION IN THE MOVIE HOUSE NOW COME TO PALLIUM INDIA FOR THE 
SUPPORT OF OUR POOR PATIENTS.

        On World Palliative Care Day [http://www.worldday.org/] during 
get-together of patients at Shanghummugham 
[http://palliumindia.org/2012/10/world-palliative-care-day-2012-the-sea-and-the-sand-on-the-feet/]
 , Her Highness Shri. Aswathy Thirunal MaharaniÂprecedesÂa cheque from 
Mr.Gireesh Chandran on behalf of Pallium India. 

THANK YOU MR GIREESH CHANDRAN. YOU NOT ONLY HELP OUR PATIENTS BUT ALSO MAKE 
EVERY MOVIE GOER BLESSED.Â

        - 

MOVING FORWARD: PALLIATIVE CARE IN GOVERNMENTâS HEALTH CARE SYSTEM 
[HTTP://PALLIUMINDIA.ORG/2012/10/MOVING-FORWARD-PALLIATIVE-CARE-IN-GOVERNMENTS-HEALTH-CARE-SYSTEM/]
 

         [http://www.cips.org.in/public-sector-systems-government-innovations/] 
Centre for Innovations in Public Systems 
[http://www.cips.org.in/public-sector-systems-government-innovations/] (CIPS) 
in Bangalore included Palliative Care in their agenda for discussion in their 
two day workshop on âBEST PRACTICES IN HEALTH SECTORâ and Dr Shoba Nair 
delivered a talk. 

        Dr Chakrapani, director of CIPS said palliative care would be included 
in the Maternal and Child Health program for next year. 

WE ARE MOVING FORWARD STEP BY STEP. THANK YOU CIPS AND DR CHAKRAPANI.

        - 

BREAST HEALTH GOBAL SUMMIT AND CANCER SURVIVORS 
[HTTP://PALLIUMINDIA.ORG/2012/10/BREAST-HEALTH-GOBAL-SUMMIT-AND-CANCER-SURVIVORS/]
 

         
[http://portal.bhgi.org/GlobalPortfolio/globalsummit/Site%20Pages/2012%20-%20Supportive%20Care%20and%20QOL.aspx]
 

        Touching stories of cancer survivors stole every heart at the Breast 
Health Global Summit 
[http://portal.bhgi.org/GlobalPortfolio/globalsummit/Site%20Pages/2012%20-%20Supportive%20Care%20and%20QOL.aspx]
 at Vienna 
[http://www.ehospice.com/ArticlesList/GlobalBreastHealthInitiativeBHGISummitinViennaFocusesonPalliativeandSupportivecare/tabid/2349/ArticleId/1076/language/en-GB/View.aspx#.UJEUZKTPxe4]
 on 3-5 October 2012. 

        The thoughtful organizers had arranged to have one talk by a cancer 
survivor on each day of the conference. 

         

        Ms Gertrude Nakiguddeâs experiences were an example. She survived 
cancer, but later when her father-in-law got cancer, he blamed her for 
âbringing cancer to the familyâ. 

        The cancer survivorsâ stories about the insensitivity of medical 
professionals made everyone think. 

        The summit analyzed quality of life issues associated with breast 
cancer in low and middle income countries from the perspectives of 
âsurvivor-shipÂand follow up care, treatment related supportive care and 
end-of-life and palliative careâ. 

        Dr Sudhir Gupta, Additional Director General of Health Services of 
Government of India 
[http://mohfw.nic.in/index1.php?lang=1&level=1&sublinkid=1&lid=13] â whom Dr 
Jim Cleary [http://www.uwhealth.org/findadoctor/Provider.action?id=5733] 
described as an official _in charge of the health of 17% of the worldâs 
population_ â put palliative care into perspective of Indiaâs health care 
system and talked about the Government of Indiaâs plans to integrate palliative 
care into health care as a whole. 

        Dr Jim Cleary 

        - 

PALLIUM INDIAâS âMANâ ON THE BEACH AT SAN DIEGO 
[HTTP://PALLIUMINDIA.ORG/2012/10/PALLIUM-INDIAS-MAN-ON-THE-BEACH-IN-SAN-DIEGO/] 

EVER NOTICED THE FIGURE OF THE MAN ON PALLIUM INDIAâS LOGO? ÂHE FORMS THE âAâ 
FOLLOWING THE FIRST LETTER P, PROTECTED ON BOTH SIDES BY A HAND EACH.

        A group of people from several countries joined hands to re-create him 
on the beautiful beach at San Diego, California. It was fun; but fun while 
learning. As four teams worked independently to make sand castles, they learnt 
how to work with strengths and weaknesses of other team members. 

         

        This is the second cohort of âleadersâ 
[http://palliumindia.org/2012/02/empowering-palliative-care-leaders/] selected 
from the palliative care field all over the world to undergo a two year program 
which includes three 7 day contact sessions in San Diego. 

        This time the 20-strong group included four Indian leaders, Dr Anjum 
Joad from Jaipur, Dr Chitra Venkateswaran from Kochi, Dr Dinesh Goswami from 
Guahati and Dr Shoba Nair from Bangalore, with Pallium Indiaâs chairman as one 
of the mentors. ÂThe group also included two of Indiaâs next door neighbours, 
Dr Bishnu Paudel from Nepal and Dr Rumana Dawla from Bangladesh. 

        The imaginative program is conducted under the leadership of Dr Frank 
Ferris, Director of San Diego Institute of Palliative Medicine 
[http://www.sdhospice.org/] , ably supported by a team including Dr Shannon 
Moore, Dr Eileen Piersa, Stephanie Whitmore, Debra Pledger-Fonte and many 
others. 

        Ms Mary Callaway of Open Society Foundation 
[http://www.opensocietyfoundations.org/topics/palliative-care] and Ms Katherine 
Pettus of Pettus Foundation represented the founders. 

KUDOS TO THE LDI TEAM!

        * Read about the leadership development initiative hereâ 
[http://www.palliativemed.org/Leadership-Development-Initiative] 

        - 

EHOSPICE OPENS WITH NEWS OF RAHUL DRAVID BATTING FOR PALLIATIVE CARE 
[HTTP://PALLIUMINDIA.ORG/2012/10/EHOSPICE-OPENS-WITH-NEWS-OF-RAHUL-DRAVID-BATTING-FOR-PALLIATIVE-CARE/]
 

         [http://www.ehospice.com/] 

         EHOSPICE [HTTP://WWW.EHOSPICE.COM/] IS NOW OPEN!ÂEstablished by the 
Worldwide Palliative Care Alliance [http://www.thewpca.org/] Âas a news and 
information sharing website for people working in hospice, palliative, and end 
of life care. 

        The India edition of ehospice 
[http://www.ehospice.com/india/en-gb/home.aspx] is edited by Ms Nisha 
Krishnadas, the national information officer of the Indian Association of 
Palliative Care [http://www.palliativecare.in/] .ÂNisha gives us Âexciting news 
about the Indian cricket icon Rahul Dravid 
[http://www.espncricinfo.com/india/content/player/28114.html] âs support to 
Palliative Care, " 

RAHUL DRAVID BATS FOR KARUNASHRAYA; PLEDGES HIS SUPPORT TO PALLIATIVE CARE 
[HTTP://WWW.EHOSPICE.COM/INDIA/ARTICLESLIST/RAHULDRAVIDBATSFORKARUNASHRAYAPLEDGESHISSUPPORTTOPALLIATIVECARE/TABID/2293/ARTICLEID/1010/LANGUAGE/EN-GB/RAHUL-DRAVID-BATS-FOR-KARUNASHRAYA-PLEDGES-HIS-SUPPORT-TO-PALLIATIVE-CARE.ASPX#.UHAEX6TYZE4]
 

        THE GESTURE FROM DRAVID IS NOT A SURPRISE. HE HAS BEEN A GOOD 
AMBASSADOR FOR THE COUNTRY AND THE SPORT. NOW, AFTER RETIREMENT, HEâS SETTING 
THE BAR EVEN HIGHER FOR EVERYONE TO FOLLOW. 

        Rahul Dravid, the international cricketer and former Indian captain has 
pledged his support to Bangalore Hospice Trust 
[http://www.karunashraya.org/NewSite/Index.html] Âas a âFriend of Karunashraya 
Hospiceâ to help suffering patients. The cricketing legend has presented a 
number of pieces of highly-prized personal memorabilia, including a signed bat 
and his India jersey to Karunashraya TO HELP RAISE FUNDS 
[HTTP://ARTICLES.TIMESOFINDIA.INDIATIMES.COM/2012-10-02/OFF-THE-FIELD/34217640_1_RAHUL-DRAVID-KARUNASHRAYA-AUCTION]
 . 

        These valuables will be put up for auction on World Hospice and 
Palliative Care Day, 13th October 2012. All funds collected from the auction 
will be directed towards the operational requirements and costs of 
Karunashraya, the âabode of compassionâ, which provides hospice and palliative 
care for suffering patients since 1994. 

READ MORE AT EHOSPICEâ 
[HTTP://WWW.EHOSPICE.COM/INDIA/ARTICLESLIST/RAHULDRAVIDBATSFORKARUNASHRAYAPLEDGESHISSUPPORTTOPALLIATIVECARE/TABID/2293/ARTICLEID/1010/LANGUAGE/EN-GB/RAHUL-DRAVID-BATS-FOR-KARUNASHRAYA-PLEDGES-HIS-SUPPORT-TO-PALLIATIVE-CARE.ASPX]
 

" 

        - 

MORE MEDIA ATTENTION ON INDIAâS SHAMEFUL FAILURE IN ACCESS TO PAIN RELIEF 
[HTTP://PALLIUMINDIA.ORG/2012/10/MORE-MEDIA-ATTENTION-ON-INDIAS-SHAMEFUL-FAILURE-IN-ACCESS-TO-PAIN-RELIEF/]
 

         
[http://articles.economictimes.indiatimes.com/2012-10-03/news/34239112_1_morphine-finance-ministry-frame-rules]
 The Economic Times 
[http://articles.economictimes.indiatimes.com/2012-10-03/news/34239112_1_morphine-finance-ministry-frame-rules]
 on 03 October 2012 carried an article by Ms Deepshikha Sikarwar pointing out 
Indiaâs failure to provide access to opioids for pain relief. 

        _âIndia is the worldâs largest producer ofÂopiumÂfrom which cancer & 
HIV pain reliever morphine in made, yet patients struggle to get access to drug 
because of legal and bureaucratic issuesâ_, the article says, and goes on to 
describe the current efforts to improve the situation â read the full article 
hereâ 
[http://articles.economictimes.indiatimes.com/2012-10-03/news/34239112_1_morphine-finance-ministry-frame-rules]
 

BUT WHILE WE, IN OUR ARROGANCE OF HEALTH, ARE PATIENTLY WAITING FOR THINGS TO 
CHANGE, HOW MANY LIVES CONTINUE TO GO THROUGH ALL-ENCOMPASSING, NEEDLESS PAIN?

LET US HANG OUR HEADS IN SHAME.

        - 

COULD A BLACK MAMBA BE WHAT WE HAVE BEEN WAITING FOR? 
[HTTP://PALLIUMINDIA.ORG/2012/10/COULD-A-BLACK-MAMBA-BE-WHAT-WE-HAVE-BEEN-WAITING-FOR/]
 

        Currently, opioids form the mainstay of pain management, at least in 
cancer pain and in post-operative pain. True, opioids are safer than most other 
currently available analgesics, but still the side effects are a nuisance. 

        May be tomorrow, snake venom may offer us a powerful and safe pain 
killer, the BBC reports: " 

BLACK MAMBA VENOM IS âBETTER PAINKILLERâ THAN MORPHINEâ 
[HTTP://WWW.BBC.CO.UK/NEWS/HEALTH-19812064] 

        A painkiller as powerful as morphine, but without most of the 
side-effects, has been found in the deadly venom of the black mamba, say French 
scientists. 

        The predator, which uses neurotoxins to paralyse and kill small 
animals, is one of the fastest and most dangerous snakes in Africa. 

        However, tests on mice, reported in the journal Nature 
[http://www.nature.com/nature/journal/vaop/ncurrent/full/nature11494.html] , 
showed its venom also contained a potent painkiller. 

        They admit to being completely baffled about why the mamba would 
produce it. 

        The researchers looked at venom from 50 species before they found the 
black mambaâs pain-killing proteins â called mambalgins." 

LONG WAY TO GO YET, THOUGH. IT IS EARLY DAYS STILL, AS FAR AS RESEARCH ON THE 
SUBJECT IS CONCERNED.

        - 

WHAT IS GODDESS KALI DOING IN A HOSPICE? 
[HTTP://PALLIUMINDIA.ORG/2012/10/WHAT-IS-THE-GODDESS-KALI-DOING-IN-A-HOSPICE/] 

         [HTTP://EN.WIKIPEDIA.ORG/WIKI/KALI] DR DAVID BRUMLEY is a great friend 
of the palliative care scene in India. He has been giving us so much! 

        As part of our HAMRAHI [HTTP://PALLIUMINDIA.ORG/HAMRAHI] Âprogram,Â
David Brumley and friends visited the palliative care program at the Cachar 
Cancer Hospital [http://www.cacharcancerhospital.org/] Âin Silchar, Assam.Â
Hamrahi, headed by DR ODETTE SPRUYT, is a program that matches Australian 
palliative care consultants with palliative care centers in India, so that 
there are annual visits for support. 

         Dr Ravi Kannan [http://www.flickr.com/photos/55725920@N07/5447619284/] 
who directs the center, his wife Sita and Dr Iqbal Bahar have been running the 
palliative care program which Dr David Brumley describes in his article, âAn 
Island of Compassionâ 
[http://informahealthcare.com/doi/abs/10.3109/15360288.2012.702201] in the 
Journal of Pain and Palliative Care Pharmacotherapy (September 2012, Vol. 26, 
No. 3 , Pages 271-273). 

        As Dr Brumley describes his visit to the center, he says, "

        To one side a figure of the goddess Kali sits in a small buildingâa 
site of her own. Her black face, protruding tongue, and garland of blood-red 
flowers are disturbing.ÂThe black face makes me shiver. 

        WHAT IS SHE DOING HERE?" 

        An interesting question. He goes on to say, "

        _I wonder how a sick devotee of another religion might react to seeing 
a crucifix on the wall of their hospital room._" 

WISE WORDS, INDEED, DR BRUMLEY. TO THE BELIEVER, GODDESS KALI WARDS OFF EVIL 
SPIRITS AND PROTECT THE PATIENTS, JUST AS THE CRUCIFIX GIVES A CHRISTIAN PEACE 
OF MIND. 

BUT WHAT ABOUT THOSE WHO DO NOT SHARE THAT FAITH?

        - 

A LIFE LIVED WITH DIGNITY 
[HTTP://PALLIUMINDIA.ORG/2012/10/A-LIFE-LIVED-WITH-DIGNITY/] 

         
[http://www.livemint.com/Leisure/roy6c44JpwP50DYmK496yN/A-life-lived-with-dignity.html]
 An article on livemint.com 
[http://www.livemint.com/Leisure/roy6c44JpwP50DYmK496yN/A-life-lived-with-dignity.html]
 Âpoints out the relevance of palliative care in health care and particularly 
highlights its importance for the family members of the patient, who often 
suffer as much as the patient, and continue to suffer even when the patient is 
gone. 

        It highlights the point that palliative care is not just for the last 
few days of life. It quotes Dr M.M Sunil Kumar, Deputy Director of Trivandrum 
Institute of Palliative Sciences [http://tipsindia.org] , " 

â REGARDLESS OF THE TYPE OF DISEASE, OR HOW ADVANCED IT MAY BE, THERE IS ALWAYS 
SOMETHING THAT CAN BE DONE TO IMPROVE THE QUALITY OF LIFE OF THE PATIENT.

" 

        To read the full article by Sujata Kelkar Shetty here: A LIFE LIVED 
WITH DIGNITY 
[HTTP://WWW.LIVEMINT.COM/LEISURE/ROY6C44JPWP50DYMK496YN/A-LIFE-LIVED-WITH-DIGNITY.HTML]
 

        - 

PARTING SHOT

         

        Pallium Indiaâs volunteer Ms Sunshine Mugrabi sends us the heartrending 
story of a man who seems to wish he could choose a gentler death, but has 
decided to hang on so that he can be legally married before he dies: 

BILL NEMITZ: IN THE END, THAT MARRIAGE CERTIFICATE MEANS A LOT 
[HTTP://PALLIUMINDIA.ORG/2012/10/ONE-LAST-WISH/] 

WE MAY NOT KNOW HOW YOU REACT TO THIS TOUCHING STORY.

        Some may think more about the issue of gay marriages or of the legal 
system. Some would be judgmental, some forgiving (there is not all that much of 
a difference, perhaps) and some, understanding. Some may latch on to the issue 
of advance directives and some may start wondering how to get the man to a 
state of acceptance of ârealityâ. 

WE JUST SHED A TEAR FOR ALL THOSE WHO DIE WITHOUT FULFILLING A LAST AND 
OVERPOWERING DESIRE FOR SOMETHING â TO SEE A LOVED ONE AGAIN, TO HAVE ONE LAST 
MEAL AT HOME WITH THE FAMILY OR JUST TO DIE IN ONEâS OWN BED AT HOME â JUST 
BECAUSE THEY ARE PHYSICALLY HELPLESS BECAUSE OF A DISEASE AND BECAUSE THE 
MEDICAL SYSTEM HAS TAKEN OVER THEIR LIVES AND CHOSEN TO IMPRISON THEM IN 
INTENSIVE CARE UNITS.

        - 

         [http://palliumindia.org/manifesto] 

DONâT FORGET TO SIGN THEÂ MORPHINE MANIFESTO 
[HTTP://PALLIUMINDIA.ORG/MANIFESTO] !

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