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.
Please join us. Your help is needed.

The time to retrospect, and to plan forward

2014 December 19

Well, friends, it is Christmas time. The year is almost over – it is time to look back at the year gone by and to say a few thanks.

It has been a great year – a year that certainly holds promise for reduced burden of disease-related suffering in our country. At the national level, the NDPS Act has been amended, though the state rules are yet to be announced. The National Program in Palliative Care is slowly making progress. Many people stood with us in this difficult journey, and no words are enough to express our gratitude.

This year, Pallium India organized a task force to create curricula for MBBS and Nursing undergraduate education and also for training of doctors, so that they can qualify to man Recognized Medical Institutions for stocking and dispensing opioids. Palliative care enthusiasts from different parts of the country came together to make this happen. To them also, our heartfelt gratitude.

There have been many more exciting events this year which made us feel that our efforts are closer to bearing fruit, though the path forward is long and hard. For everyone who supported the work, for everyone who helped to lay this foundation on which we have to build our future work, for everyone who continues to stand by us, Thank You very much!

Merry Christmas. Happy New Year.

Dextropropoxyphene stays banned

2014 December 18

The whole of palliative care community of India feels that the ban of inexpensive analgesic Dextropropoxyphene is unreasonable. We also suspect that it is the onslaught of the industry which wants to promote more expensive medicines, which creates evidence against inexpensive drugs.

Following our representations, a technical committee of the Department of Health in April 2013 recommended that the ban be withdrawn conditionally. A year and a half later, the ban continues to remain in force. The result: people are forced to use the several-times-more-expensive alternatives.

While action is delayed, poor families starve because all available resources go towards the purchase of the fearfully expensive painkiller, now the only one available to most people in a country where less than 1% of the needy have access to morphine.

We understand from the Ministry of Health that officials are concerned with the stories of abuse of the drug, especially in North-Eastern states. The Ministry asked for our arguments against this fear. Tramadol is as prone to misuse as Dextropropoxyphene.

Those of you who would like to do something against this unjust ban, please write with your arguments to the Secretary of Health, Ministry of Health and Family Welfare, Nirman Bhavan, C-Wing, New Delhi- 110001.

Tramadol causes hypoglycemia

2014 December 18

We thank Dr Vijayanand Palanisamy from Hyderabad for bringing our attention to the findings published in Journal of American Medical Association of December 8, 2014 by Fournier. J et al., showing that Tramadol could cause hypoglycemia. Though rare, this certainly gives cause for concern, especially when Tramadol is used in diabetics.

The conclusions from the paper are:
“Although rare, Tramadol-induced hypoglycemia is a potentially fatal adverse event.”

Indian Palliative Care to attract Medical Tourists?

2014 December 16

“The low cost, better hospitality and up to the mark palliative care were the factors that will make India a global leader in health tourism,” says Hakan Tarakcioglu, international head of Turkey-based Kent hospital. (Read the complete news: Centre Gears up to Regulate Medical Tourism)

Did you notice – palliative care – that’s the catch! Let us make note of the fact that at the Medical Tourism Congress, it had to be a voice from abroad that had to mention palliative care. Isn’t it rather clear that the need for palliative care is not felt by the healthcare industry at large, in India?

Please look at Dr Esther Munyoro’s message in Pallium India’s Newsletter (October 2013, Parting Shot). Dr Esther came to India for her aunt’s treatment and she says, “Even in a country with such advanced medical care, patients do not have physical pain adequately addressed.” She asks, “In a country that has a robust medical healthcare system with evidence-based practice why is pain not adequately dealt with?”

Food for thought, indeed.

Would a doctor fetch a pitcher of water for a thirsty patient?

2014 December 16

If it is beneath you to fetch a pitcher of ice water for a thirsty patient, so is the practice of medicine. 
– Mark Reid, M.D.

This quote reminds us of a story told by Dr Richard Lamerton, who was Dr Cicely Saunders’ first assistant and the World’s second palliative care physician, in his book, East End Doctor. Richard was called to see a patient in the middle of the night. He arrived to find that the patient had vomited all over the living room floor. She was now apparently all right, and resting comfortably. There was little medical attention that was needed at that time. Richard got a bucket and a mop and cleaned up the living room floor, and left.

Maybe, Mark Reid and Richard Lamerton teach a lesson to every one of us who ask, “Is that the duty of a doctor?” or “Is that the duty of a social worker?” They remind us that more than a doctor or a nurse or a social worker, each one of us is a human being and, if we are unable to do what is most needed at that time, we are failing, both as human beings and professionals.

This train of thought leads us to congratulate nurses in palliative care to whom this sort of thing seems to come so naturally. Like the time when our nurse Jaya and colleagues found an elderly person in a home, very unclean and with ants crawling over the foot. The wife, partially blind, was staggering around, doing essential chores. Jaya and colleagues left their nursing and medicine kits, fetched some water and towels, and cleaned up the man and the bed, before they left.

Jaya and all nurses in palliative care, with Max Reid and Richard Lamerton, you also teach us the value and dignity of our profession and the true meaning of health care.