The Regional Cancer Center (RCC) at Dr B Borooah Cancer Institute has created a full time position in Palliative Care.
Dr Kabindra Bhagawati has been appointed as a palliative care physician in that position.
The relevance of this cannot be underestimated.
Dr Goswami
Dr Bhagawati
In Assam, as in the rest of the country, Palliative Care started as a charitable activity. Dr Dinesh Chandra Goswami founded the Guwahati Pain and Palliative Care Society (GPPCS) in May 1999. Since then, GPPCS has been providing palliative care to the patients in the RCC.
One major weakness of the whole palliative care movement in the country has been that integration with mainstream medicine has been poor. But this development in Guwahati is encouraging.
Kabindra underwent a Basic Certificate Course in Palliative Care from Calicut in 1999 and a Diploma in Palliative Medicine from Edith Cowan University in Perth, Australia.
Congratulations, Kabindra and Dinesh! And thank you from all of us for your hard work and commitment that made all this possible.
Thank you, Doordarshan!
The national television channel Doordarshan (Malayalam) has been exceptionally supportive of palliative care. In their live phone-in program, Snehasparsham, palliative care has had a strong presence for the last several months.
Dr MC Rajasree on DDTV Malayalam
One recent phone-in program was conducted by Dr M.C. Rajasree from Pain and Palliative Care Society, Calicut. The nature of questions clearly indicated how commonly patients and families were at a loss about whom to approach for help.
This is particularly relevant in India, where the “general practitioner” is practically non-existent and in practice, patients are left to find out for themselves which specialist to approach.
Dr Rajasree directed each questioner to the nearest palliative care unit for advice. This clearly demonstrates a hidden service that palliative care services are doing. They explain. They talk to patients and help to direct them to the appropriate medical service that would be suitable for them.
But the need for this service is not taken seriously, perhaps. Palliative care services in Kerala have by and large catered to general health needs of people.
Perhaps we need to give more attention to patient navigation?
Picking up on the white paper from the Economist Intelligence Unit, the Lancet points out that 40% of the World’s population dwell at the bottom of the end-of-life care rankings:
Painfully slow progress on palliative care
The Lancet
To meet death without a surfeit of pain and discomfort is a fundamental right. Yet, according to The Quality of Death, a report published by the Economist Intelligence Unit, it is a right denied to all but 8% of patients who need palliative care worldwide every year. The authors used a range of indicators to rank 40 countries by the quality and availability of their end-of-life care. The UK holds the top spot overall, bearing testament to the strides made since the foundation of St Christopher’s Hospice—the first dedicated palliative care hospice in the world—in 1967. Globally, however, the picture is one of low standards and slow progress.
Brazil, Russia, India, and China—which account for 40% of the world’s population—occupy four of the bottom six places in the list, along with Mexico and Uganda. But even patients in developed nations such as South Korea (32nd), Japan (23rd), and Denmark (22nd) are being denied access to good end-of-life care through a combination of inadequate policy, poor training, poor access to painkillers, and cultural barriers.
In a world where death and taxes are the only certainties, taxes are considered the more palatable topic for discussion. Death and dying remain taboo subjects in many cultures, which presents a major barrier to improving end-of-life care. Deeply embedded attitudes will not change overnight, but campaigns such as Dying Matters, which launched in the UK earlier this year, show that it is possible to engage with the public and foster an acceptance of death as a natural process.
A more pressing practical concern is that about 5 billion people worldwide lack access to opioid pain relief, mainly because of fears the drugs will reach the black market. Even where opioids are available, inadequate training often means doctors are unable to safely administer them. What is clear is that none of the impediments to improving end-of-life care will be overcome without strong leadership and detailed support from policy makers. With people older than 65 years soon to outnumber children younger than 5 years for the first time in recorded history, time is very much of the essence.
Food for thought, is it not?
Visit the campaign site: DyingMatters.org
We are happy to announce that SAHAYATRA, our monthly Malayalam newsletter, is now available for download from our website.
SAHAYATRA is meant for anyone interested in palliative care – patients and families, palliative care professionals, volunteers and well-wishers.
Download PDF: Sahayatra July 2010
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Future editions will be available here: palliumindia.org/sahayatra
Great news! The Indian Journal of Palliative Care has been indexed by PubMed!
Hearty congratulations to the editor Dr Sushma Bhatnagar for her hard work and commitment in making this happen. We are all proud of your achievement, Sushma!
The IJPC is now available through: AMED, Caspur, DOAJ, EBSCO Publishing’s Electronic Databases, EMCARE, Expanded Academic ASAP, Genamics JournalSeek, Google Scholar, Health & Wellness Research Center, Health Reference Center Academic, Hinari, Index Copernicus, OpenJGate, ProQuest, PubMed, Pubmed Central, Scimago Journal Ranking, SCOLOAR, SCOPUS, SIIC databases, SNEMB, and Ulrich’s International Periodical Directory.
But perhaps our greatest achievement has been that the journal is available online free! Just visit: www.jpalliativecare.com
And at this happy moment, let us also gratefully remember the founders of IAPC and of the journal along with its former editors, Dr Mrs. Shah, Dr Prabha Chandra, Dr Reena George and Dr Jacob Alexander who built up the standard of the journal step by step and helped in realization of this dream.
Pallium India-USA Sevathon Stall
Pallium India-USA had it’s very first event at the Sevathon at the Sunnyvale Baylands Park in California.
It was attended by an estimated 2,500 people, and the atmosphere was full of enthusiasm and good cheer. It was a great opportunity for us to introduce ourselves to the local community as well as the other Indian charities.
People were very curious about palliative care issues and the work being done by Pallium India. Our colorful booth was manned by Uday, Abhilash and Jerina, and people found our collage informative. Many promised to attend our upcoming event on Sept. 26th.
Thank you Neethu Raj, Arnavaz Wadia, Rashna Wadia and Pushpa Menon for helping us put this together. A very special mention and thanks to Smita Patel and Abhilash Rajagopal without whose selfless work this event would not have been possible.
Uday, Jerina & Abhilash from Pallium India-USA
Where is Sunnyvale?
A Palliative Care Toolkit Training Programme was conducted at the Sanjay Gandhi Post Graduate Institute of Medical Sciences between 21st and 25th June 2010.
Palliative Care Toolkit Training Programme, SGPGI, Lucknow
It was led by Dr Mhoira Leng, the director of the international organisation Cairdeas International and the palliative care team at SGPGI consisting of Dr Shakeel Ahmad, Dr Sanjay Dhiraaj and palliative care nurse Alice among others. The group also had interactive sessions with medical personnel from nearby medical colleges.
Around 20 people were trained in 5 days and more than 40 were sensitised to the compelling need for palliative care services in the region. Significant coverage in the media ensured that more and more people who need such services but had no prior knowledge of this form of treatment will now be able to access it.
We are also happy that the team has been able to increase their home care services in the last few months.
Download a PDF of press clippings about the training programme - articles printed in English and Hindi.
EIU/Lien White Paper
The Economist Intelligence Unit of the Economist and Lien Foundation in Singapore joined hands to produce a white paper on Quality of Death (pdf) that was published on 14 July 2010.
A poor quality of death means intense suffering for the dying person and his family and the situation can improve only with improved access to palliative care services.
The white paper lists 40 countries and ranks them according to Quality of Death. UK ranks first, and sadly, India comes at the very bottom as the 40th, next to Uganda. As a redeeming feature, the exceptional performance of Kerala in this field is highlighted in the paper.
Grim reapings: An attempt to rank end-of-life care in different countries
CUSTOMER-SATISFACTION surveys are commonly used to improve the service in hotels and shops. Alas, they are unsuitable for rating the quality of death. So the Lien Foundation, a charity, commissioned the Economist Intelligence Unit, our sister company, to devise a ranking of end-of-life care. The report, published on July 14th, rates 40 mostly rich countries by how well they care for the dying.Quality of Death Ranking
Britain tops the table. For all the health-care system’s faults, British doctors tend to be honest about prognoses. The mortally ill get plentiful pain killers. A well-established hospice movement cares for people near death, although only 4% of deaths occur in them. For similar reasons, Australia and New Zealand rank highly too.
Some countries, such as Denmark and Finland, that normally score higher than Britain on human-development indices rank lower on the quality-of-death index. They concentrate more on preventing death (which they see as a medical failure) rather than on helping people die without suffering pain, discomfort and distress. America scores poorly because of the health insurers’ rule that they pay for palliative care only if a patient relinquishes curative treatments.
The report combines hard statistics such as life expectancy and health-care spending as a share of GDP with weighted assessments of other indicators. One is the public awareness of the availability of hospices. Another is whether a country has a formal policy or legislation on treating the terminally ill (only seven of the 40 do).
Brazil, China, India and Russia, the four largest emerging economies, cluster at the bottom of the table. Their health-care systems still take little account of dignity in death (a sprinkling of hospices in places such as St Petersburg in Russia, or Kerala in India, are honourable exceptions). The report’s authors blame cultural factors as well as bureaucratic resistance. In China, for example, a strong taboo hangs over discussing death. The ranking may spur improvement. But for those who mind most, complaining about poor deathbed treatment is unusually difficult.
Index Methodology
The Index scores 40 countries (30 OECD nations and 10 select others) using data and interviews with a variety of doctors, specialists and other experts across four categories: Basic End-of-Life Healthcare Environment; Availability of End-of-Life Care; Cost of End-of-Life Care; and Quality of End-of-Life Care. 27 main indicators fall into three broad categories:
- Quantitative indicators: Eleven of the Index’s 27 indicators are based on quantitative data, such as life expectancy and healthcare spending as a percentage of GDP.
- Qualitative indicators: Ten of the indicators are qualitative assessments of end-of-life care in individual countries, for example “Public awareness of end-of-life care”, which is assessed on a scale of 1-5 where 1=little or no awareness and 5=high awareness.
- Status indicators: Three of the indicators describe whether something is or is not the case, for example, “Existence of a government-led national palliative care strategy or agenda”, for which the available answers are Yes, No or In Progress.
Palliative care features strongly in the key findings:
- The UK leads the world in quality of death.
- Combating perceptions of death, and cultural taboos, is crucial to improving palliative care.
- Public debates about euthanasia and physician-assisted suicide may raise awareness, but relate to only a small minority of deaths.
- Drug availability is the most important practical issue.
- State funding of end-of-life care is limited and often prioritises conventional treatment.
- More palliative care may mean less health spending.
- High-level policy recognition and support is crucial.
- Palliative care need not mean institutional care, but more training is needed.
The full report can be downloaded here in PDF format…
& visit the Lien Foundation’s interactive website: Life Before Death
The Palliative Care Training Center at MNJ Institute of Oncology (MNJIO) which was started in 2006 as a joint project between Pallium India, MNJIO and Canada’s International Network of Cancer Treatment & Research (INCTR) will be holding a “One Month Certificate Course in Pain & Palliative Care for Doctors, Nurses, Social Workers & Volunteers“.
Internationally renowned faculty like Dr Stuart Brown, Director, PAX Program for INCTR will be the external faculty for the course.
The course will held in Hyderabad at MNJIO, starting on August 2nd and finish on August 28th, 2010.
All details of the course including Objectives, Learning Process, Schedule, Fees and Application Form are available in Word or PDF format, please download here:
PDF .pdf or Word .doc
Email contact details for course administrators is included in the documents above.
For details of Pallium India’s other courses, please visit: palliumindia.org/courses
