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.

A labour of love, in memory of a departed son

2014 July 22

Mr Prabhakaran Nair lost his son, a young engineer, to cancer. Now eight years later, he conducts an exhibition of his paintings, all profits to go to support Pallium India’s patients in Trivandrum. Please visit and support the venture. 
Date: 24 to 28 July, 2014
Time: 9.30 AM – 7 PM
Venue: Museum Auditorium, Trivandrum
Painting Exhibition

Thank you, everyone, for your compassion.

2014 July 22

Amazing how many people responded to our plea for help on behalf of our American palliative care volunteer. People from all over the world, including palliative care pioneers like Dr Kathy Foley, Dr. Jim Cleary and Dr Eric Krakeur, pain specialists like Prof Prithvi Raj, Human Rights Activitists like Mr Diederik Lohman, palliative nursing professionals like Prof Jo Eland and Janette Elliot and many many others responded, contacting people they know and directing us to possible sources of support.

Though we made a few false starts, we are glad that finally she is getting excellent care at University of California, San Francisco Department of Pain Medicine. She is taken seriously, is attended to as a whole person and we are hopeful that their help will restore her health.

Thank you, everyone, for caring.

Pallium India Office and Training Centre shifted from Pattom to Arumana Hospital

2014 July 16

Pallium India’s Pain and Palliative Care office and Training Centre have been moved to Arumana Hospital at Vallakadavu, from Pattom. This change has been effective from July 4, 2014.

With this, the inpatient clinic, administrative office and training centre have been brought under one roof. Pallium India’s inpatient clinic has been functioning from Arumana Hospital since January 2014.

The new address of Pallium India is:

Pallium India,
Arumana Hospital,
Airport Road, Subash Nagar,
Vallakadavu P.O., Thiruvananthapuram – 695 008, Kerala.

Phone: +91 471 2451366, +91 9387296889

Urgent: Will someone please help?

2014 July 14

Dear friends

This is a painful message to write. I am writing about one of our colleagues, an American palliative care volunteer from San Jose, California. She has been helping Pallium India for many years in a variety of ways.

She was, in her own words, “absurdly healthy” till about 3 and a half months back. One day, when having a cup of coffee in a restaurant, a heavy lamp fell on the side of her head and her neck was twisted into an awkward position. About half an hour later, a pain started. She had significant stiffness of the neck and severe vertigo. She underwent several investigations, which seemed to have showed no significant anatomical abnormality. The vertigo was so bad that someone suggested a dental device for which she had to undergo an X-ray in an awkward position. The position was very painful for her and in less than a minute, she had a severe worsening of the pain. This happened about a month back and has been steadily getting worse.

When I saw her for the first time after this accident socially about a week back, I could not believe my eyes: she had lost 30 lbs already in 3 months. She was constantly in agonizing pain and was able to tolerate nothing but a supine position without movement. She was hardly able to eat because of constant nausea, her gall bladder seemed to be acting up and one doctor actually suggested gall bladder surgery at this stage, which fortunately she did not undergo.

Very recently she was seen at the Pain Medicine Department at one of the most prestigious medical institutions in USA. They suggested several means of treatment for the pain, including intravenous Lidocaine, local anesthetic injections for the muscles, followed by possibly Botox but all this would be possible only after a psychologist’s evaluation and a physiotherapist’s evaluation from their own team. Unfortunately, they can give her an appointment for these consultations only after three weeks, and it would cost her thousands of dollars from her own pocket. Till then, they cannot prescribe any analgesics for her; that, they say, is their policy. It is for her primary care physician to do it. Though in this case, the primary care physician has prescribed no analgesics. Both she and her husband have not been working for almost four months; they have had to spend a huge amount of money from their pocket and though they have a health insurance, these consultations were not covered by their insurance and that happened to be out of pocket expense.

Last Friday, after one week’s waiting time, she got an appointment with a pain physician in her own locality at 5.30 PM. He said his service mostly takes care of chronic pains, and not this kind of pain, yet was ready to treat her for the time being and gave a prescription. But a little while later, they found that the prescription could not be filled, because some number was missing on the prescription. Her husband rushed back to the doctor to find only that he had left for the weekend. Messages to him have not fetched any response. A return to the pharmacy did not yield any results – without getting the prescription corrected, the medicine would not be given.

Her husband will go back to the pain physician when the establishment reopens on Monday. She will be lucky if she responds to the prescribed medicine in that dose. If not, or if she feels any adverse side-effects, she has been warned that the pain physician may not be available to her for several days, till he can give her another appointment. The whole of the most expensive health care system in the world seems to be failing her and leaving her with no pain management at all.

Back home in Kerala in not-at-all-affluent India, our palliative care unit would take her care up immediately, pending definitive treatment for any problem or treatment by any pain specialist later. We would not be limited by questions like, “does she really come under the definition of palliative care?” For us, the fact that she has disease-related suffering would be enough. But still, just in case the question comes up, I would strongly argue that by any standards, she needs palliative care now, for palliative care by the WHO’s definition “is applicable early in the course of illness, in conjunction with other therapies”. I would point out to any sceptic who may be bound down by the expression “life-threatening illness” in the WHO definition of palliative car that her condition is indeed life threatening. Somebody who has lost 30 lbs in less than 4 months and who is now able to consume just about 100 calories per day is indeed in a life-threatened state.

I am making this appeal to anyone who cares. Can you contact a palliative care unit in San Jose or in the Bay Area in California? Would somebody please help her by treating her symptoms now and by coordinating her care of any basic problem that may be co-existing? You can contact me at

M.R.Rajagopal MD
Chairman, Pallium India
Director, WHO Collaborating Centre for Training and Policy on Access to Pain Relief

Arumana Hospital, Airport Road
Subash Nagar, Vallakadavu P.O
Thiruvananthapuram – 695 008

Ph: 0471-2451366, 9387296889

International Doctors for Healthy Drug Policies speak up for global drugs policy

2014 July 14

True, a lot of suffering is caused by professionals being unaware of principles of pain management. But when they are indeed aware of pain management, lack of access to essential medicines stands as a huge stumbling block. You are aware of the role that Pallium India’s WHO Collaborating Centre and many other organizations, especially the Indian Association of Palliative Care, WHO CC at Madison-Wisconsin, Human Rights Watch etc. have played in overcoming these barriers. In the article in the Lancet (383:9923, 29 March 2014), please read about the efforts that the organization ‘International Doctors for Healthy Drug Policies’ is playing in overcoming the problem. You can also watch a short video in which Dr Khuat Thi from Vietnam, Dr Jim Cleary of WHO CC, Madison and Mr Diederik Lohman of Human Rights Watch speak about the need for a friendly policy.