Pallium India Newsletter: September 2011

  • From: Pallium India Newsletter <info@xxxxxxxxxxxxxxxx>
  • To: "" <palliumindia@xxxxxxxxxxxxx>
  • Date: Fri, 30 Sep 2011 14:17:37 +0000

Pallium India
Care Beyond Cure





         

WE WAITED A LONG TIME FOR THIS DAY! 
[HTTP://PALLIUMINDIA.ORG/2011/09/WE-WAITED-A-LONG-TIME-FOR-THIS-DAY/] 

        FOR TRIVANDRUM INSTITUTE OF PALLIATIVE SCIENCES ( TIPS 
[HTTP://TIPSINDIA.ORG] ), THE FLAGSHIP OF PALLIUM INDIA, THE 5TH OF SEPTEMBER 
WAS A SPECIAL AND JOYOUS DAY. 

         

        The PALLIATIVE CARE CLINIC at Government Medical College, Trivandrum 
[http://www.tmc.kerala.gov.in/] , was formally inaugurated on that day by the 
Hon. Minister for Health, Mr Adoor Prakash 
[http://www.stateofkerala.in/niyamasabha/adoor.php] . 

        Many dignitaries including the Director of Medical Education and the 
Deputy Director of Health Services attended. Even more remarkable was the fact 
that the hall was full despite the medical students being on a week’s holiday!  
With that sort of enthusiasm for the project, we are bound to succeed. 

        The clinic has been on a trial run for a few months now, but it is 
official now! 

        It is run by the department of Community Medicine (led by Dr 
Vijayakumar) with the support of Pallium India. A doctor, a nurse, a social 
worker and volunteers from Pallium India attend the clinic which functions 
three days a week – Monday, Wednesday and Friday. Three doctors from the 
department of Community Medicine have already completed palliative care 
training at TIPS and more of them plan to follow. 

        This is a large hospital where mostly poor people go to, and there is a 
vast sea of suffering there. 

THANK YOU JIV DAYA FOUNDATION [HTTP://JIVDAYAFOUND.ORG] , FOR YOUR GENEROUS 
SUPPORT TO PALLIUM INDIA FOR THE PROJECT!   

        - 

“SNEHASANTHWANA SAMGAMAM”: COMING TOGETHER IN LOVE AND CARE 
[HTTP://PALLIUMINDIA.ORG/2011/09/SNEHASANTHWANA-SAMGAMAM-COMING-TOGETHER-IN-LOVE-AND-CARE/]
 

         

        PALLIUM INDIA, together with National and District government 
authorities, is organizing a get-together for patients in and around 
Trivandrum, Kerala, particularly those who are bed-bound round the year – a day 
full of fun, laughter and entertainment. 

        We  hope that the event will give our patients and people from the 
community the opportunity to interact, empathise and join hands to further the 
cause of palliative care. 

        There will be a discussion with officials from the Kerala Social 
Security Mission [http://www.socialsecuritymission.gov.in/] on the different 
schemes and benefits available to patients. 

        Volunteer artistes will come together to sing to celebrate Voices for 
Hospices [http://www.worldday.org/voices-for-hospices/] , followed by a magic 
show to entertain the audience. The patients along with their families will be 
then taken on an outing to the Museum [http://www.keralamuseumandzoo.org/] . 

PLEASE JOIN US!

        Those who can, please join us on WORLD PALLIATIVE CARE DAY 
[HTTP://WWW.WORLDDAY.ORG/] for this uplifting event! 
        * WHEN? 9am–5pm Saturday 8th October 2011 
        * WHERE?  Salvation Army Youth Hall 
[http://www.salvationarmy.org/ind%5Cwww_ind.nsf/vw-sublinks/80256E520050A2E280256CB000688B8B?openDocument]
 , Kuravankonam, Trivandrum – MAP 
[HTTP://MAPS.GOOGLE.COM/MAPS?VIEW=MAP&CID=12281908823687372879] If you can’t 
make it to Trivandrum, there are plenty of events around the World, look for 
your nearest location here… [http://www.worldday.org/events/] 

        - 

UNION HEALTH MINISTER MENTIONS PALLIATIVE CARE AT UN GENERAL ASSEMBLY 
[HTTP://PALLIUMINDIA.ORG/2011/09/UNION-HEALTH-MINISTER-MENTIONS-PALLIATIVE-CARE-AT-UN-GENERAL-ASSEMBLY/]
 

        The Union Health and Family Welfare Minister Shri Ghulam Nabi Azad, 
while addressing the High-level Meeting of the United Nations General Assembly 
[http://www.who.int/nmh/events/un_ncd_summit2011/en/index.html] on the 
Prevention and Control of Non-Communicable Diseases which began on 19th 
September 2011 at New York, made a special mention of palliative care as one of 
the strategies for controlling Non-Communicable Diseases (NCDs). 

        He mentioned that by 2012, 100 district hospitals in the country would 
have palliative care facilities. "

        Shri Ghulam Nabi Azad informed that alarmed by the rising incidence of 
the non-communicable diseases and its impact on the health care delivery, a 
national summit was held in India subsequent to the Global Health Ministerial 
Conference on Healthy Lifestyles and Non-communicable Disease Control in Moscow 
in April 2011. 

        “Besides the Delhi Call for Action from the national meet, we now also 
have 10 key messages from the recently held WHO South-East Asia Regional 
meeting at Jaipur in India”, he added. 

        The Union Health Minister emphasized that Non Communicable Diseases are 
not only a health issue but also a development issue as they impact 
productivity and also impoverish the society due to high health expenditures. 
Therefore, the Government of India has launched a “National Programme for 
Prevention & Control of Cancer, Diabetes, Cardio Vascular Diseases (CVDs) and 
Stroke (NPCDCS)” and the “National Programme for Health Care of Elderly 
(NPHCE)”. This has been taken up for implementation as a pilot project covering 
150 million population in 100 inaccessible and most backward districts during 
the current financial year (2011-2012) at a cost of 275 million USD. 

        The program includes several components such as: Establishment of 
Non-Communicable Diseases (NCD) clinics at 100 district hospitals and 700 
Community Health Centers (CHCs) for diagnosis and management of Cardiovascular 
Diseases (CVD), Diabetes & Stroke and Cardiac Care Unit in district hospitals; 
ensuring availability of life saving drugs – wherein an additional 1,250 USD 
will be provided to each district hospital in 100 districts; For early 
detection of cancer common diagnostic services are being provided at these 100 
district hospitals. Provision is also being made for basic surgery, 
chemotherapy and PALLIATIVE CARE at these hospitals; For supporting 
Chemotherapy, drugs will be provided in these 100 district hospitals for 10,000 
patients at the cost of 25 million USD; In addition, 65 centres are being 
strengthened as Tertiary Cancer Centres (TCCs) to provide comprehensive cancer 
care services at a cost of 1.5 million USD each. 
        * Read the full press release here:  Shri Azad Leads High Level 
Delegation to United Nations Assembly on Prevention And Control of 
Non-Communicable Diseases  
[http://pib.nic.in/newsite/erelease.aspx?relid=76096] " 

        - 

TELEMEDICINE, A NEW ENDEAVOUR WITH HP INDIA 
[HTTP://PALLIUMINDIA.ORG/2011/09/TELEMEDICINE-A-NEW-ENDEAVOUR-WITH-HP-INDIA/] 

         Hewlett Packard India [http://hp.com/in] , under its Corporate Social 
Responsibility Program 
[http://www.hp.com/hpinfo/globalcitizenship/society/social_innovation.html] 
(CSR) has taken a decision to join hands with PALLIUM INDIA in supporting its 
continuing endeavour to bring palliative care to those in pain and despair. 

        HP’s objective is to support Pallium India with innovative technology 
solutions to multiply its ability to reach out to the community at large  in 
providing palliative care. HP India and Pallium India have signed an memorandum 
of understanding (MOU) through which HP will be providing Information and 
information and communications technology (ICT) based solutions, static as well 
as mobile  to maximize its capabilities by introducing ‘Virtual Health’ 
concepts which will be fully funded by HP India. 

        VIRTUAL HEALTH and TELEMEDICINE facilities can bridge a lot of 
gaps and imbalances in doctor patient ratio in rural area. 

        VIRTUAL HEALTH is all set to become a reality starting with EMR 
(Electronic medical records) which will effectively reduce paper work by 
digitizing medical records like lab reports, diagnostic images and 
reports, medication and inter department communication. 

        The mobile TELEMEDICINE unit will be of great service to the patients. 
The unit will have all the digital medical equipment necessary to bring quality 
health care to the patients door step. 

        What is more laudable is that HP’s health division is handing over the 
equipment free of cost to Pallium India, the ultimate result being the 
immeasurable relief to the helpless suffering patients who have no where else 
to turn to. 

        - 

HEALTH FOR OLDER PEOPLE 
[HTTP://PALLIUMINDIA.ORG/2011/09/HEALTH-FOR-OLDER-PEOPLE/] 

When our team goes out on home visits, every single day we are confronted by 
the plight of the elderly in our society. Globalization and nuclear family 
system having destroyed the support system that existed in the last generation, 
the elderly are too often left with  no one to attend to their health or their 
well being. 

        The problem of course is not specific to India, but holds true for most 
of  low and middle income countries. Mr Diederik Lohman of Human Rights Watch 
writes to inform us about the call for action by Navanetham Pillay, UN high 
commissioner on human rights who specifically refers to the need for palliative 
care for older persons. "

         [http://www.un.org/apps/news/story.asp?NewsID=39583&Cr=pillay&Cr1=] 

         GOVERNMENTS MUST MAKE HEALTH OF OLDER PEOPLE A PRIORITY, SAYS UN 
RIGHTS CHIEF 
[HTTP://WWW.UN.ORG/APPS/NEWS/STORY.ASP?NEWSID=39583&CR=PILLAY&CR1=] – New York, 
Sep 16 2011 

        With the number of people aged over 60 expected to reach 2 billion by 
2050, or more than a fifth of the total global population, discrimination 
against old persons should rank among the most pressing policy issues for 
governments and societies, the United Nations human rights chief said today. 

        “REGRETTABLY, PREJUDICE AGAINST AND STIGMATIZATION OF OLDER PERSONS 
[KNOWN AS AGEISM] ARE CONSISTENTLY REPORTED EVERYWHERE IN THE WORLD,” High 
Commissioner for Human Rights Navi Pillay  told 
[http://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=11387&LangID=E]
 the UN Human Rights Council’s panel on the right to health of older persons, 
citing discrimination based on age in areas as vital as social protection 
policies, employment laws, and access to public services. 

        “ITS INTIMATE LINK WITH THE RIGHT TO HEALTH HAS PARTICULAR RELEVANCE. 
HEALTH LIES AT THE HEART OF ALL HUMAN RIGHTS ISSUES WHEN WE AGE. RESEARCH SHOWS 
THAT HEALTH TOPS OLDER PERSONS’ ISSUES OF CONCERN. PROBLEMS SUCH AS LACK OF 
ADEQUATE DIAGNOSIS OR TREATMENT, LACK OF TRAINED STAFF OR HOME-BASED SERVICES, 
OR DIFFICULTIES TO ACCESS RELIABLE HEALTH INFORMATION ARE OFTEN CITED.” 

        She cited a report on ageing by Secretary-General Ban Ki-moon to the 
General Assembly highlighting the fact that age often defines whether someone 
is allowed access to medicines, treatment, devices or long-term care. Many 
older people say that their age alone is handled as a disease and that they are 
often dismissed without proper diagnosis. 

        Ms. Pillay underscored the lack of adequate services, facilities and 
care, or their prohibitive costs, with estimates showing that only one in five 
persons aged 60 or more has a pension. Without a pension, older persons may 
well be confronted with poverty, while stress about the affordability of health 
services leads to or is compounded by unattended chronic diseases, malnutrition 
and lower standards of living, she noted. 

        “A SOCIAL PROTECTION SYSTEM IS CRUCIAL, AND STATES ARE REQUIRED TO 
ALLOCATE SUFFICIENT RESOURCES AND FACILITIES TO COPE WITH THESE DEMANDS NOW AND 
TO PREPARE FOR THE FUTURE. THE UNIQUE REQUIREMENTS OF OLDER PERSONS MUST BE 
INCORPORATED IN NATIONAL HEALTH SYSTEMS, ESPECIALLY IN LOW- AND MIDDLE-INCOME 
COUNTRIES.” 

        She said tackling the lack of specialized services such as residential 
centres, home care programmes and geriatric services, age-friendly primary 
health care, and palliative care must be a priority. 

        “ADEQUATE ACCESS TO PALLIATIVE CARE IS ESSENTIAL TO ENSURE THAT THESE 
PEOPLE CAN LIVE, AND ULTIMATELY DIE, WITH DIGNITY,” SHE DECLARED." 

        - 

WHAT IS IT LIKE TO BE A 13-YEAR-OLD WITH CEREBRAL PALSY IN INDIA? 
[HTTP://PALLIUMINDIA.ORG/2011/09/WHAT-IS-IT-LIKE-TO-BE-A-13-YEAR-OLD-WITH-CEREBRAL-PALSY-IN-INDIA/]
 

        And what is it like to be his single parent when the boy is unable to 
walk, stand or even sit up without support? 

        The single parent who can no longer earn a living because there is no 
one else to look after the boy? 

        Please take a minute to read an article from the New Indian Express of 
16 September 2011: " 

CARE FROM A MOTHER’S HEART 
[HTTP://EXPRESSBUZZ.COM/CITIES/THIRUVANANTHAPURAM/CARE-FROM-A-MOTHER%E2%80%99S-HEART/314235.HTML]
 

[HTTP://EXPRESSBUZZ.COM/CITIES/THIRUVANANTHAPURAM/CARE-FROM-A-MOTHER%E2%80%99S-HEART/314235.HTML]
 

        Could it be sheer coincidence that we came across a 13-year-old spastic 
child Arun  G Raj at Panathura, near Kovalam, and perhaps the most personal 
book by Arun Shourie on his spastic child, the same day? 

        The answer eludes us, but seeing Arun and his absolutely devoted mother 
Ajitha leaves us with the same question Shourie asked – ‘Does He know a 
mother’s heart?’, the title of his book. 

        Confined to a brick-walled room, that is so dark that one has to squint 
to see the twisted body of a teenager on the floor, Arun looks up at the light 
streaming in through the open window. Then suddenly you realise that he was 
responding to a crow crying on the tree outside. The crow stops and he loses 
interest. 

        His lips move, but you don’t hear a thing. 

         READ THE FULL ARTICLE AT EXPRESS BUZZ… 
[HTTP://EXPRESSBUZZ.COM/CITIES/THIRUVANANTHAPURAM/CARE-FROM-A-MOTHER%E2%80%99S-HEART/314235.HTML]
 " 

        To add to what Reema Narendran says in the article, the boy needed to 
see his doctor regularly to keep his convulsions under control and for the 
myriad ailments that he is subject to. He could have free consultations in the 
Government Hospital, but with his condition being what it is, it was impossible 
for them to handle the hours of waiting in the crowded hospital corridor that 
would be necessary. 

        A kind pediatrician offered to see him at her residence free of cost in 
the evenings, and that was such a relief for Arun’s mother; but then Government 
of Kerala banned private practice by doctors in Government service, and the 
pediatrician no longer wanted to risk being seen seeing patients at home. 

        Fortunately, at this time, Pallium India’s TIPS [http://tipsindia.org/] 
found him and started giving him home visits. 

        Now our doctor, usually the pediatrician in our team, visits him 
periodically. We provide him not only his diapers, but also all his medicines 
free of cost and a monthly food kit. 

BUT, HOW MANY TENS OF THOUSANDS OF CHILDREN AND FAMILIES LIKE HIM ARE DENIED 
ANY CARE IN OUR COUNTRY?

        - 

AN INDIAN BOOK ON PALLIATIVE CARE 
[HTTP://PALLIUMINDIA.ORG/2011/09/AN-INDIAN-BOOK-ON-PALLIATIVE-CARE/] 

BUT, NOT JUST _ANOTHER_ BOOK ON PALLIATIVE CARE!

         

        Dr Dinesh Chandra Goswami, the palliative care pioneer from Guwahati 
Pain and Palliative Care Society, Assam 
[http://palliumindia.org/clinics/assam/] , India, has published a book, 
“PALLIATIVE CANCER CARE: OUR PERSPECTIVE”. 

        And before anyone says to oneself, “Oh, yet another book on palliative 
care?”, let me add that this book is special. 

        It is special because it has such strong roots in India. It certainly 
draws on what the West has learnt and taught on palliative care, but has a 
solid foundation built on experiences on Indian soil. 

        Looking at it superficially, you will notice that the book is bilingual 
– with English as well as an Assamese version. 

        When you look deeper, you will also find an all-pervading air of 
spirituality. I am sure many would find the sections on Yoga and Self-Awareness 
interesting. 

        This is not a _textbook _on Palliative Care. It is a collection of 
essays from the author, translated into English by his wife Mandira Sarma. 

        Published by Lakshmi Prakashan, Mathura Nagar, Guwahati, 781 006, 
India. Contact Dr Goswami at: goswamidcg [at] gmail.com 

        - This news was also published in the IAHPC’s September newsletter 
[http://www.hospicecare.com/news/11/09/announcements.html?] 

        - 

SHARE TO CARE NEWS [HTTP://PALLIUMINDIA.ORG/2011/09/SHARE-TO-CARE-NEWS/] 

         [http://palliumindia.org/sharetocare] 

        Here in Trivandrum, Kerala, we have just finished celebrating Onam, the 
harvest festival in Kerala. It is a time of family reunions and celebration, 
with sumptuous feasts on banana leaves and gifts of new clothes to the near and 
dear. 

        Soon after Onam, we got a visitor, Dr S. Valsala Devi, a Professor of 
Pathology, one of the many who had signed up for our “SHARE TO CARE” 
[HTTP://PALLIUMINDIA.ORG/SHARETOCARE/] program. "

         [http://palliumindia.org/sharetocare] 

        _Every Onam, my three sons bring me gifts of new clothes. Too many!  
__This time I told them, if you want to give me some gift for Onam, give it for 
“Share to Care”_ 

        _A__nd here is the money!_" 

        Thank you Dr Valsala Devi for this thoughtful gift! 

         “SHARE TO CARE” [HTTP://PALLIUMINDIA.ORG/SHARETOCARE/]  is the program 
that we launched three months ago, where well-wishers sign up to share 
something for the needy when they celebrate something like a birthday or a 
festival or when they observe a loved one’s death anniversary. 

        We already have more than 100 people who have signed up for “SHARE TO 
CARE” [HTTP://PALLIUMINDIA.ORG/SHARETOCARE/] . Would you care to?  It would 
take only 3 minutes of your time. 

PLEASE GO TO:  HTTP://PALLIUMINDIA.ORG/SHARETOCARE 
[HTTP://PALLIUMINDIA.ORG/SHARETOCARE/] 

        - 

NEW EDITION OF THE PALLIATIVE CARE FORMULARY 
[HTTP://PALLIUMINDIA.ORG/2011/09/NEW-EDITION-OF-THE-PALLIATIVE-CARE-FORMULARY/] 

         

        Dr Michael Minton from UK writes to tell us about the new 4th edition 
of the PALLIATIVE CARE FORMULARY 
[HTTP://WWW.PALLIATIVEBOOKS.COM/INDEX.PHP?ACT=VIEWPROD&PRODUCTID=282] (4e). 

        Over the last 13 years the Palliative Care Formulary 
[http://www.palliativebooks.com/index.php?act=viewProd&productId=282]  has been 
the definitive source of reference for the drugs we use in palliative and 
hospice care, published in the UK and edited by Drs Robert Twycross and Andrew 
Wilcock. 

        They and the editorial team have just updated and expanded the 
formulary, the 4th edition will be available from the 1st October 2011. Press 
release at  palliativedrugs.com 
[http://www.palliativedrugs.com/press-news/september/palliative-care-formulary-4e-pre-publication-offer.html]
 , buy online at PalliativeBooks.com 
[http://www.palliativebooks.com/index.php?act=viewProd&productId=282]  for a 
pre-publication 10% discount. 

        If Pallium India may add: " 

_EVEN WITH THE PRE-PUBLICATION DISCOUNT, THE PRICE OF £45/RS3,300/$72 IS A LOT 
FOR RESOURCE-POOR COUNTRIES._

" 

        IF ANY OF OUR WELL-WISHERS WOULD LIKE TO GIFT THE BOOK TO US, IT WILL 
BE MORE THAN WELCOME!  

        We shall keep the first copy for the training center at Trivandrum and 
send any additional copies to other training centers in India that we are 
associated with. 

        - 

EAPC OPIOID GUIDELINES FOR CANCER PAIN 
[HTTP://PALLIUMINDIA.ORG/2011/09/EAPC-OPIOID-GUIDELINES-FOR-CANCER-PAIN/] 

        The  European Association of Palliative Care [http://www.eapcnet.eu/] 
(EAPC) are updating their guidelines on opioids for cancer pain. 

        As part of this review they have undertaken 22 systematic reviews of 
topics relating to opioid treatment in cancer pain. These are published in the 
journal Palliative Medicine July 2011 vol. 25 no. 5389-390 
[http://pmj.sagepub.com/content/25/5.toc]  ( pubmed 
[http://www.ncbi.nlm.nih.gov/pubmed?term=Palliat%20Med.%202011%2025(5)] ). 

        WHILE THEY DO HIGHLIGHT THE LIMITS OF RESEARCH IN THIS FIELD, THEY DO 
PROVIDE THE MOST UP  TO DATE  AND COMPREHENSIVE REVIEW OF WHAT WE KNOW ABOUT 
THE USE AND SIDE EFFECTS OF OPIOIDS. "

         [http://pmj.sagepub.com/content/25/5.toc] The EPCRC project to revise 
the European Association for Palliative Care (EAPC) guidelines on the use of 
opioids for cancer pain [http://pmj.sagepub.com/content/25/5/389.extract] 

        In this special issue of _Palliative Medicine_, systematic reviews 
contributing to the development of the revised European Association for 
Palliative Care (EAPC) guidelines on opioid analgesics for the management of 
cancer pain are published. This brief comment tries to put this quite unique 
collection of coordinated articles in the context of the overall guidelines 
project and to help readers to make the best use of them. 

        The European Association for Palliative Care (EAPC) guidelines on 
opioid analgesics for the management of cancer pain were published in 1996 and 
2001 and were seen as an evolution of the World Health Organization (WHO) 
recommendations, developing in detail the role of opioids in the analgesic 
ladder. The impact of WHO and EAPC guidelines on clinical practice and patient 
outcomes has never been demonstrated empirically, but it is likely that they 
had a profound influence. 
        * Full text here… [http://pmj.sagepub.com/content/25/5/389.full] 
(subscription required) " _Thanks to Dr Michael Minton for sending this news_ 

        - 

DISTRICT LEVEL PALLIATIVE CARE IN ANDHRA PRADESH 
[HTTP://PALLIUMINDIA.ORG/2011/09/DISTRICT-LEVEL-PALLIATIVE-CARE-IN-ANDHRA-PRADESH/]
 

        In 2006, the Regional cancer center at MNJ Institute of Oncology 
[http://www.mnjiorcc.org/]  (MNJIO), Hyderabad joined hands with  International 
Network for Cancer Treatment and Research [http://www.inctr.org/]  (INCTR) and 
Pallium India to start a palliative care training center. 

        We had recently reported to you the success of this center in starting 
a pediatric palliative care fellowship 
[http://palliumindia.org/2011/03/major-development-in-hyderabad-pediatric-palliative-care-training-program/]
 as well as in working with the Government to simplify narcotic regulations in 
the state and to sanction a full-fledged department of Palliative Medicine 
[http://palliumindia.org/2011/08/important-step-forward-in-andhra-pradesh/] at 
MNJIO. 

        NOW ADVOCACY BY MNJIO’S PALLIATIVE CARE TRAINING CENTER HAS HAD ANOTHER 
SUCCESS! THE GOVERNMENT HAS PLANS TO MAKE PALLIATIVE CARE AVAILABLE AT DISTRICT 
LEVEL. 
        * Read the report in The Hindu: “PLANS TO LAUNCH PALLIATIVE CARE 
PROGRAMME IN DISTRICTS” 
[HTTP://WWW.THEHINDU.COM/TODAYS-PAPER/TP-NATIONAL/ARTICLE2416171.ECE] 

        - 

GLOBAL WAR ON DRUGS DENIES MORPHINE TO PATIENTS 
[HTTP://PALLIUMINDIA.ORG/2011/09/GLOBAL-WAR-ON-DRUGS-DENIES-MORPHINE-TO-PATIENTS/]
 

        We recently blogged 
[http://palliumindia.org/2011/07/documentary-freedom-from-pain/] about a 
documentary, “Freedom from Pain” [http://www.internationalreporting.org/pain] 
, on the need for pain relief created by a group of students at the  University 
of British Columbia School of Journalism 
[http://www.internationalreporting.org/pain] .  The documentary was broadcast 
by Al Jazeera, watch it here… 
[http://palliumindia.org/2011/07/documentary-freedom-from-pain/] 

        The work, and with it the pain problem in the World, is receiving more 
international attention. Most recently, in Canada’s Vancouver Sun 
[http://www.vancouversun.com/health/Global+drugs+denies+morphine+patients+study/5426601/story.html]
 , examples from India, Uganda and Ukraine are quoted and special mention of 
the positive movement in Kerala: " 

[HTTP://WWW.VANCOUVERSUN.COM/HEALTH/GLOBAL+DRUGS+DENIES+MORPHINE+PATIENTS+STUDY/5426601/STORY.HTML]
 GLOBAL WAR ON DRUGS DENIES MORPHINE TO PATIENTS: UBC STUDY 
[HTTP://WWW.VANCOUVERSUN.COM/HEALTH/GLOBAL+DRUGS+DENIES+MORPHINE+PATIENTS+STUDY/5426601/STORY.HTML]
 

        A study by University of B.C. journalism students says the global war 
on illicit drugs is preventing patients suffering terminal illnesses in some 
countries from having sufficient access to morphine to control their pain. 

        The year-long study done by the UBC Graduate School of Journalism 
involved teams travelling to India, Ukraine and Uganda to see how those 
countries manage pain. 

        The results of The Pain Project can be found at 
www.internationalreporting.org/pain 
[http://www.internationalreporting.org/pain] . 

        The report was released in advance of a United Nations conference in 
New York this week on the global challenges of treating cancer and other 
diseases. 

        Prof. Peter Klein, UBC’s acting graduate-school director, said that 
unlike many global health problems, pain treatment is not about money or lack 
of drugs, as morphine costs pennies per dose and is easy to manufacture. 

        He said bureaucratic hurdles and the chilling effect of the war on 
drugs were the main obstacles to morphine access in some countries. 

        “The story of global morphine shortages is one of those issues that 
both the media and the medical community has overlooked,” said Klein. 

        He said he became interested in pursuing the story after talking with a 
member of Doctors Without Borders who’d found a lack of morphine in a number of 
countries he’d visited. 

        “For instance in India, which is the largest supplier of medical 
morphine in the world, it’s virtually unavailable in most parts of the country 
except for one state [Kerala],” said Klein. 

        Klein said some countries, such as India, had over-reacted to UN 
regulations regarding access to opiates — an unintended result of the war on 
drugs. 

        Uganda was chosen an example of a third-world success story on how the 
issue could be overcome, while Ukraine was a case study in the problems caused 
by too much bureaucracy in cancer care. 

        The website offers videos from each country showing how patients there 
struggle with pain. 

        One shows a former Ukrainian KGB officer dying of prostate cancer who 
sleeps with a gun under his pillow “in case the pain becomes unbearable” while 
another shows an Indian doctor frustrated with drug laws who mixes readily 
available analgesics to ease the pain of his cancer patients. 

        A third shows a Ugandan nurse who led a movement to reform that 
country’s drug laws around morphine distribution and palliative care." 

        - 

GOOD NEWS FROM GUATEMALA! 
[HTTP://PALLIUMINDIA.ORG/2011/09/GOOD-NEWS-FROM-GUATEMALA/] 

        HERE IS A PIECE OF GOOD NEWS FROM THE DEVELOPING WORLD. The palliative 
care pioneer from Guatemala, Eva Rossina Duarte 
[http://videos.med.wisc.edu/videos/21004] , writes to say: "

         [http://sites.google.com/site/especializacioncp/] I’m happy to let you 
know that, on Sept 21st we will start our first PALLIATIVE CARE SPECIALIZATION 
STUDY FOR PHYSICIANS 
[HTTP://POSTGRADOMEDICINAUSAC.COM/BLOG/2011/08/ESTUDIO-DE-ESPECIALIZACION-EN-CUIDADOS-PALIATIVOS/]
 at University of San Carlos [http://medicina.usac.edu.gt/] , the public 
university in Guatemala. 

        I’m in the academic commission that organized it, I’ll be one of the 
professors and also a student. 

        In this first cohort, 25 Faculty of Medicine Professors will be invited 
to participate in order to start a palliative care network in public _“school 
hospitals”_, and in future introduce palliative care into doctors’ Medical 
careers. 

        We’ll invite also physicians that are working in Palliative Care 
already to recognize their practice." 

WE WISH EVA AND HER COLLEAGUES AT UNIVERSIDAD DE SAN CARLOS DE GUATEMALA THE 
BEST FOR THIS IMPORTANT STUDY!

        - 

LIFE BEFORE DEATH SERIES CONTINUES… 
[HTTP://PALLIUMINDIA.ORG/2011/08/LIFE-BEFORE-DEATH-15-NURSE-IN-THE-HOUSE/] 

         [http://www.lifebeforedeath.com/movie/] 

        The “Life Before Death” series of short movies continue to be released 
one every week. They are not only very informative to the public; but also make 
powerful advocacy material for the palliative care community. Here are the 5 
films released in September: 
        * #20: Finding a Balance 
[http://palliumindia.org/2011/09/life-before-death-20-finding-a-balance/] 
        * #19: Fight for the Right 
[http://palliumindia.org/2011/09/life-before-death-19-fight-for-the-right/] 
        * #18: A Little Goes A Long Way 
[http://palliumindia.org/2011/09/life-before-death-18-a-little-goes-a-long-way/]
 
        * #17: Pain in China 
[http://palliumindia.org/2011/09/life-before-death-17-pain-in-china/] 
        * #16: Chronic Pain 
[http://palliumindia.org/2011/09/life-before-death-16-chronic-pain/] 

        Thank you, Mike Hill and team of Moonshine Movies and thank you, Lien 
foundation,International Association for the Study of Pain, The Mayday Fund, 
the Union for International Cancer Control and The Institute for Palliative 
Medicine at San Diego Hospice International Programs. 

        For more information and to view the entire series, visit the Life 
Before Death website… [http://www.lifebeforedeath.com/] 

        - 

THE “D” WORD [HTTP://PALLIUMINDIA.ORG/2011/09/THE-D-WORD/] 

        From the Widow’s Voice (_“We write about widowhood as we live it. 
Together we examine the good, the bad, and the ugly parts of life as a widowed 
person.”_) blog: " 

[HTTP://WIDOWSVOICE-SSLF.BLOGSPOT.COM/2011/09/D-WORD.HTML] THE “D” WORD 
[HTTP://WIDOWSVOICE-SSLF.BLOGSPOT.COM/2011/09/D-WORD.HTML] 

        In preparation for my son’s first day of Kindergarten today, I attended 
an interview with his teacher yesterday. It mostly entailed questions of, “Can 
he tie his shoes?”, “Does he feel shy in new situations?” and “Can he wipe his 
own bottom?” 

        At the end of our little meeting, his teacher asked about his special 
interests. I listed off his favourite play things (Lego, cars, his bike), the 
things he likes to do with his friends (swim, play hide-n-seek, jump on a 
trampoline) and his favoured topics of conversation (monster trucks, chickens 
and death). 

        His teacher stared at me for a moment after the latter item. “Oh…,” she 
replied, “What does he say when he talks about death?” 

        “He often ponders over what it feels like or what you see when you die. 
Sometimes he wonders when he or I will die,” I told her in a tone that 
suggested this was common-place and not really worth a huge amount of detail. 

        She listened with a faint look of concern on her face. This look turned 
soft as she asked, “Do you think he would benefit from speaking to our school 
counsellor?” 

        I suppose with the fact that this, death, is such a common topic in our 
house it hadn’t occurred to me that this type of conversation might be cause 
for concern at his school. I thought for a moment about her suggestion. An 
avalanche of thoughts tumbled around in my brain, “Is it bad that he talks 
about death? But I want him to feel comfortable talking about his concerns! Are 
other parents going to be upset when their child quotes my son’s occasional 
morbid thinking? I can’t guarantee that he will even say anything to other 
children. Are his questions abnormal? This IS normal to him!” 
        * READ THE REST OF THIS ENLIGHTENING BLOG POST AT WIDOW’S VOICE… 
[HTTP://WIDOWSVOICE-SSLF.BLOGSPOT.COM/2011/09/D-WORD.HTML] " 

        - 

AUGUST 2011 ISSUE OF SAHAYATRA MALAYALAM NEWSLETTER 
[HTTP://PALLIUMINDIA.ORG/NEWSLETTER/SAHAYATRA/] 

         [http://palliumindia.org/newsletter/sahayatra] 

        We are happy to announce that the AUGUST 2011 issue of SAHAYATRA 
[HTTP://PALLIUMINDIA.ORG/NEWSLETTER/SAHAYATRA/] , our monthly Malayalam 
newsletter, is now available for DOWNLOAD HERE… 
[http://palliumindia.org/newsletter/sahayatra/] 

        - 

IAHPC MEMBERSHIP RECOGNITION – WIN AN IPAD! 
[HTTP://PALLIUMINDIA.ORG/2011/09/IAHPC-MEMBERSHIP-RECOGNITION-WIN-AN-IPAD/] 

         

        If you are not a member of the International Association for Hospice 
and Palliative Care [http://www.hospicecare.com/] , please consider becoming 
one. 

        They have a graded membership fee structure which makes it affordable 
even for people from poorer countries. Traveling scholarships for 
training anywhere in the world form an important opportunity for members. In 
addition come many fringe benefits. 

        Please see the announcement about the IAHPC: " 

IAHPC MEMBERSHIP RECOGNITION CONTEST [HTTP://WWW.HOSPICECARE.COM/CONTEST/] 

        We are delighted to announce that the IAHPC have designated October as 
our MEMBERS’ RECOGNITION MONTH in order to build awareness and understanding of 
the vital function that our members play in the advancement of our mission as 
well as to formally acknowledge their support. 

IAHPC WILL BE GIVING A PRIZE IN THE FOLLOWING TWO CATEGORIES…

1. RECOGNIZING LOYALTY

        GOAL: to maintain the loyalty of members by giving a prize among those 
individual and institution(s) who keep their membership active. 

2. INCREASING MEMBERSHIP

        GOAL: to increase the number of members by giving a prize to the 
current member who brings the highest number of new or renewed members. 
        * ENTER HERE:  HTTP://WWW.HOSPICECARE.COM/CONTEST 
[HTTP://WWW.HOSPICECARE.COM/CONTEST/] " 

        - 

NEW PARTNERSHIP WITH CHILD FAMILY HEALTH INTERNATIONAL 
[HTTP://PALLIUMINDIA.ORG/2011/09/NEW-PARTNERSHIP-WITH-CHILD-FAMILY-HEALTH-INTERNATIONAL/]
 

        We are glad to report that Pallium India has entered into a new 
alliance with CHILD FAMILY HEALTH INTERNATIONAL [HTTP://WWW.CFHI.ORG]  (CFHI) 
for a cultural immersion program. 

        CFHI was started by Ms Evaleen Jones when she was a young student. It 
has grown to a very successful organization, and Pallium India is proud to be 
associated with CFHI, thanks to the introduction by Dr Jerina Kapoor, founder 
of PALLIUM INDIA-USA [HTTP://PALLIUMINDIA.ORG/USA] . 

        Recently, two representatives from CFHI, Mr Steve Schmidbauer and Ms 
Hema Pandey spent a few days with us in Trivandrum before rushing off on their 
numerous projects in various parts of India. 

        They have reported [ 
http://globalhealthimmersionprograms.org/rotations/visit-father-palliative-care-india/]
  on their visit at the CFHI blog, here’s an excerpt: " 

A DAY IN THE LIFE – IMPLEMENTING PALLIATIVE CARE IN INDIA 
[HTTP://GLOBALHEALTHIMMERSIONPROGRAMS.ORG/ROTATIONS/VISIT-FATHER-PALLIATIVE-CARE-INDIA/]
 

         [ 
http://globalhealthimmersionprograms.org/rotations/visit-father-palliative-care-india/]
 

        As we drove into some of the poorest communities in Southern India, Dr. 
Raj and his team, a nurse, a social worker, and a driver went about their 
routine. Patient files are reviewed as we travel in the van. The size of the 
patient files is notable. After Dr. Raj read the file a bit, he begins to tell 
us the context of the family we are about to see. 

        We get a succinct yet thorough description of the family composition 
and history. The level of detail is impressive and we even had a few questions 
about the family that Dr. Raj answered from the record.  I asked him when he 
last saw the family and he said that this was his first visit to them. 

        There are three other teams conducting home visits and so the family 
has been seen by the other teams in the past.  It is amazing to see the level 
of detail that is recorded from the home visit.  From these notes, other 
services from nutrition, to physical therapy, to social work are provided –all 
driven initially from the teams’ weekly or fortnightly visits. 
        * 

READ THE FULL REPORT HERE… [ 
HTTP://GLOBALHEALTHIMMERSIONPROGRAMS.ORG/ROTATIONS/VISIT-FATHER-PALLIATIVE-CARE-INDIA/]
 

" 

THANK YOU, STEVE AND HEMA!

        - 

PALLIPEDIA AND PALLIUM INDIA 
[HTTP://PALLIUMINDIA.ORG/2011/09/PALLIPEDIA-AND-PALLIUM-INDIA/] 

         [http://www.pallipedia.org/] 

         Pallipedia [http://www.pallipedia.org/]  is an initiative of the 
International Association for Hospice and Palliative Care 
[http://www.hospicecare.com/] (IAHPC) – a palliative care “dictionary” edited 
by IAHPC’s chairman Dr Roberto Wenk and its executive director Ms Liliana 
DeLima. 

        For the last few months, Pallium India has been working with IAHPC, 
contributing as many as 15 words a week. 

        Read more at IBN Live “ Pallium India emerges a major contributor 
[http://ibnlive.in.com/news/pallium-india-emerges-a-major-contributor/184032-60-123.html]
 ” and in the September 2011 IAHPC news 
[http://www.hospicecare.com/news/11/09/] . 

WOULD YOU LIKE TO CONTRIBUTE?

        Please help us in our effort to give clarity to phrases and concepts, 
PLEASE WRITE TO US… [/CONTACT] 

        - 

RAHMATH LIVES ON IN MEMORIES AND MORE! 
[HTTP://PALLIUMINDIA.ORG/2011/09/RAHMATH-LIVES-ON-IN-MEMORIES-AND-MORE/] 

         
[http://palliumindia.org/2011/08/one-more-of-us-died-this-week/#comments] 

         Sunshine Mugrabi [http://www.twolongspoons.com/] , from California, 
visited Pallium India’s Trivandrum Institute of Palliative Sciences 
[http://palliumindia.org/about/tips/] (TIPS) in early 2011 where she met a 
patient who touched her heart. Her name was Rahmath and suffered from an 
advanced incurable illness. 

        Sadly, Rahmath died recently 
[http://palliumindia.org/2011/08/one-more-of-us-died-this-week/] at TIPS. 
Rahmath was a humble person, poorest of the poor in material wealth, yet when 
she died, obituaries came in from many parts of the world! (see the comments  
here [http://palliumindia.org/2011/08/one-more-of-us-died-this-week/#comments] 
) 

        Earlier this month Sunshine just gave a talk 
[http://www.sfeol.org/event/role-and-mission-pallium-india] at the San 
Francisco End of Life Coalition [http://www.sfeol.org/] . As a follow up she 
was interviewed 
[http://blog.sevenponds.com/opening-our-hearts/a-legacy-of-compassion]  by the 
SevenPonds [http://blog.sevenponds.com/] blog, where Sunshine talked about 
Rahmath. Here are some quotes: "

        _“The thing that was so amazing about her was that she was always 
smiling. I can’t think of her face without thinking of her smile and her 
beautiful shining eyes.”_ 

        “She was calm, even though it seemed as if she had more hardships that 
any person should have. She had had a very, very challenging life. And somehow 
she took it in this spirit.” 

        _“I feel like her smile is with me for the rest of my life. I was 
incredibly sad, but it was also bittersweet.”_ 

        “Death is the most profound experience you’re going to have, besides 
birth.”" 

        Please read the full interview at SevenPonds: 
        * 

A LEGACY OF COMPASSION: HOW MY TIME SPENT WITH THOSE DYING IN INDIA AFFECTED ME 
[HTTP://BLOG.SEVENPONDS.COM/OPENING-OUR-HEARTS/A-LEGACY-OF-COMPASSION] 

        - 

PARTING SHOT

        Rahmath’s story does not end there! Sunitha, her daughter, called us 
the other day. 

        She says she wants to do something for her mother’s memory. Something 
that will help others. She has nothing to give; so she wants to pledge her eyes 
and her organs on her death. She seeks our help to get this done! 

DO YOU KNOW THIS FEELING, WHEN ONE FEELS SO VERY SMALL AND HUMBLED?

_TRULY, WORDS FAIL!_

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  • » Pallium India Newsletter: September 2011 - Pallium India Newsletter