For most of the students as well as the faculty of the college, the concept of palliative care was new. At the end of the training, several students expressed interest in getting a better understanding of the practice of palliative care.
There is no palliative care service available at Silchar Medical College Hospital. Apart from one doctor, Dr.Iqbal, and two nurses, Ms. Sarita and Ms Achun, at Cachar Cancer and Research Centre, there are no trained palliative care healthcare professionals there. Dr. Iqbal, Ms. Sarita and Ms. Achun had undergone 6 weeks certificate training in palliative medicine / nursing from Trivandrum Institute of Palliative Sciences.
- doctors must give attention to the cost of medicines
- doctors must write names of medicines legibly in capital letters
- doctors must write the generic name first
- doctors must look for the least expensive brand, and prescribe them
In all our enthusiasm, let us not allow the pendulum to swing too far the other way. The world is still suffering from the backlash in the USA.
Opioids have their role in treatment of chronic, non-cancer pain. No doubt. The American Pain Society’s recommendations of 2009 include this sentence, which summarises the situation: “Although evidence is limited, the expert panel concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic, non-cancer pain.”
However, they need to be used with caution. Read the article in Forbes.com, Opioid Misuse In Chronic Pain Patients Is Around 25%, New Study Shows, which states that the rate of addiction to opioids, when used in chronic non-cancer pain, can be as high as 10%. Depending on the social environment, up to 30% have been shown to be misused. Diversion to illicit channels must be guarded against.
We are happy that in India, though we were so keen to overcome the regulatory barriers to opioids, from the beginning we did not argue for unrestricted access to opioids through all pharmacies. When the “Narcotics Amendment Act” comes to be implemented, strong opioids will be available only through “recognised medical institutions”.
In an article published in the Guardian, Hannah continues, “I looked after a young man with multiple myeloma, paralysis and the worst bedsore I have ever seen eroding through his left buttock to the bone. When I first met him he was smiley with a gentle manner and few complaints. Over a month his physical condition and spirit declined. When he developed a severe infection, his wife was the one to say ‘I think he is dying’. She was right, and a plan was made to withhold antibiotic and continue symptomatic treatment. The next morning I found he had been admitted to intensive care overnight. He had had a central line inserted, was hooked up to monitoring with pumps delivering expensive antibiotics and medication to maintain his blood pressure. He was no longer able to communicate, semi-conscious and distressed. His family was only allowed to visit for a few hours each day. Despite my best efforts the treatment continued until he died a week later”.
We hope the medical system in India will see the writing on the wall. There are many injustices; we need to focus on some in our advocacy. Every year, there are more voices raised against the social evil of torturing patients and families at end of life. This unethical practice has to stop.