At this moment, over a million people in India are in unimaginable pain. We refuse to look the other way. We choose to hear the cry, and to do what we can.
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The irony of opioid access

2017 February 27

“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“, 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 increased dramatically.

“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.

Nurses and Palliative Care on focus during Oncology meet

2017 February 26

“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.

Dr Michael Minton on the IAPC Conference

2017 February 25

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 conference.

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 questions.

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 involved.

For more details of the conference and a post conference video, visit:


Scottish Parliament hosts the Religions of the World Charter for Children’s Palliative Care

2017 February 23

On the 8th of February 2017, Silvia Lefebvre D’Ovidio presented the ‘Religions of the World Charter for Children’s Palliative Care’ 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 (EMMS) International.

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.

How good is access to palliative care in Kerala?

2017 February 22

What do you think? Poor? Good? Very good? Excellent?

Read the article in the Journal of Global Oncology, 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 years.