February 2010 Newsletter

2010 February 16

Reflections on Our Cultural Immersion Course

“Four years ago, I lost my mother and my aunt in a road accident. My sisters aged 4, 2 and 1 though injured, survived. As they cried out in pain, I didn’t even know if they were getting the right medicines to reduce their pain. All of us suppressed the pain of losing our mother. What might have gone through the minds and hearts of my little sisters?- I have never enquired. Till today, I had never felt that those were things I should have found out. It never struck me that even my grief was something I should discuss with anyone else.

But, after coming here and experiencing the special interest and care all of you have given us, I can’t help but cry. The solace in sharing one’s grief and in crying- I have realised today. When I get back home, I will talk to my sisters; I will try to understand their fears and grief. I am grateful to you for having given me the awareness and the capability to do this…”

This was what Jeanette George – one of the seven students who came to Trivandrum from Iowa University in USA for a three week cultural immersion course on palliative care – shared with us. There were also participants from various parts of India – Assam, Andhra Pradesh, Tamilnadu, Uttar Pradesh and Kerala.

We are happy that the participants acquired not just professional training, but also gained valuable lessons in living life holistically.

Thank you participants, and thank you Professor Rajagopal Rangaswamy, Professor Joann Eland and Ms Donalda Carson.

Annual Conference of IAPC

Trichy, 11-14 February 2010

The Annual Conference of the Indian Association of Palliative Care concluded on 14 February 2010 at Trichy. All delegates were extremely appreciative of the arrangements and hospitality offered by the team lead by Dr Mohanasundaram Thyagarajan.

At this conference Dr Sukdev Nayak stepped down as president, and Dr Nagesh Simha was installed as the new president. Thank you for your performance as president, Dr Sukdev Nayak and congratulations Dr Nagesh Simha.

Tamil Nadu’s Gift to Palliative Care Offered at Trichy

At the inaugural function of the Trichy conference Dr Mayilvahanan Natarajan, the vice chancellor of the Dr M G R Medical University of Tamilnadu announced the decision of the University to start a Post-Graduate Fellowship in Palliative Medicine. Thank you Dr Mayilvahanan for this contribution to the palliative care movement in India.

Lucknow, 11-13 February 2011

We shall look forward to the next annual conference at Lucknow, Uttar Pradesh. Mr Piyush Gupta of Cancer Aid Society is the organizing secretary. For details please see the IAPCON website…

Bruce Davis Gold Medal

This year’s Bruce Davis Gold medal was won by Dr Bhaswant Dhanireddy from PGI, Chandigarh.

The medal was founded by Mr Wilfrid Bruce Davis from UK who has supported the palliative care movement in India for more than a decade now.

The medal is awarded following a competitive examination held by the Institute of Palliative Medicine at Calicut. We congratulate the winner and thank Mr Bruce Davis for his contribution to the palliative care movement in the country.

Hannah Gardner on Opioid Availability In India

Please read Hannah Gardner’s article at the problem of unrelieved pain in India:

Laws Leave Millions in Pain

Every day in his work at the regional cancer centre in Rohtak, in the north Indian state of Haryana, Dr Ashok Chauhan sees patients in the agonising pain that accompanies the final stages of cancer. Most of them are too sick to be cured, so Dr Chauhan and his colleagues try to do the only thing they can – provide relief from the intense suffering.

Read more at The National…

Thank you Hannah, for strengthening the cry for justice from people in pain!

Students’ Corner

Postgraduate Qualifications (MSc) in Palliative Medicine and Palliative Care

15 Commonwealth Scholarships available to cover Diploma/MSc course fees for students in developing Commonwealth countries. Two pathways are available:

  1. The Postgraduate Diploma/MSc in Palliative Medicine (open to doctors)
  2. The Postgraduate Diploma/MSc in Palliative Care (open to healthcare professionals)

Each qualification can be studied as an adult or paediatric option. These qualifications are designed to help busy professionals enhance their knowledge and inform and improve patient care. They are:

  • modular and include symptom control, advanced communication skills, ethical issues & understanding the evidence
  • immediately clinically applicable & Culturally sensitive
  • delivered mostly by e-learning
  • interprofessional & based on reflective learning

Courses start in September and will be conducted at Karunashraya Hospice, Bangalore followed by online learning.

Fees for 2010-2011 £1950 per year.

Closing date for scholarship applications: April 30th 2010

For further information:

Accolades

Pallium India is thankful to Lions Club District 324 E1 for the recognition it has given Pallium India and to palliative care.

On 13 January, Melvin Jones Day, the day of remembrance of the founder of Lions International, Dr Rajagopal received an Award of Excellence on behalf of Pallium India.

It was a particularly gratifying experience to receive it from the chief guest, Dr Sandhya IPS, Inspector General of Police, and a long-time friend of the Palliative Care movement. We thank Mrs Indira Ravindranath, the District Governor of Lions Club, Mrs Bhagawati Marthandan who got us in touch and all members of the Lions District.

And while mentioning this occasion, it would be relevant to quote the great man Melvin Jones himself, “You cannot get very far until you start doing something for somebody else.”

Human Rights Watch Report: “Unbearable Pain”

Over 7 million people in India suffer avoidable pain simply because they have no access to morphine, says a Human Rights Watch report on India’s obligation to ensure palliative care.

People in agony are often unseen and unheard because they drop off the social radar, unless they happen to be family or close friends. They are people battling life-threatening conditions including cancer, HIV/AIDS, tuberculosis and renal disease. Many paraplegics too suffer extreme pain.

People in agony are often unseen and unheard because they drop off the social radar, unless they happen to be family or close friends. They are people battling life-threatening conditions including cancer, HIV/AIDS, tuberculosis and renal disease. Many paraplegics too suffer extreme pain.

Read the summary from Info Change India…

Download the complete report from HRW (pdf links in right column) & a PDF with photos of Pallium India at work

MV Govindankutty Memorial Award For Social Work

This year’s M V Govindankutty Memorial Award for Social Work instituted by Pratheeksha Pain and Palliative Care Clinic, Koottanad, Palakkad, goes to Shri Y Philippose, Founder President, Health Care Charitable Society, (Karunya Pain and Palliative Care Clinic), Thiruvankulam, Ernakulam.

The award was given away at a function held in connection with the Community Based Palliative Care Day on 15th January 2010.

Staff Club

Featured website: PalliativeDrugs.com

The site provides essential independent information for health professionals worldwide about drugs used in palliative and hospice care. The content is based on the UK Palliative Care Formulary (PCF, 3rd edition) which was Highly Commended in the British Medical Association 2008 book competition. It includes details about unlicensed (unlabeled) indications and routes, and the administration of multiple drugs by continuous subcutaneous infusion.

The bi-monthly Newsletter has been replaced by the regularly updated ‘Latest additions’ and ‘News’ sections, and the Bulletin board expanded to cover non-drug issues. The search facility has also been improved. To access the site, it is necessary to register and create your own username and password. We will ask you to provide contact and other details, including your registration number with a professional body like the Medical, Nursing or Pharmacy Council of India.

Once registered, we recommend that you first read: Getting the most out of the PCF3

What You Should Know About NSAIDs

A review article published in the December 15 2009 issue of the American Family Physician offers recommendations for prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) in the primary care setting.

  • It should be avoided by those with significant upper intestinal tract bleeding,,particularly in older persons taking anticoagulants and with platelet dysfunction..
  • Although low dose aspirin is cardioprotective, NSAIDs as a class can worsen congestive heart failure and increase blood pressure.
  • They can lead to bleeding problems and renal failure in persons with cirrhotic liver disease.
  • Asthma may be induced or aggravated.
  • It is to be avoided in the last 6-8 months of pregnancy.
  • There will always be patients with pain conditions relieved only by NSAIDs. There is need to focus on balance between risk and benefit before NSAID therapy As supplements to analgesic therapy, nonpharmacologic treatment such as physiotherapy and physical exercise may be considered.
    Read the full article at American Family Physician…

Anaesthesia During Cesarean Delivery

“Childbirth is an emotion-filled event and the mother needs to bond with her newborn baby as early as possible,” writes Anthony A. Bamigboye, from University of Witwatersrand in Nelspruit, South Africa, and G. Justus Hofmeyr, from University of Fort Hare, Eastern Cape Department of Health in East London, South Africa. “Any intervention that leads to improvement in pain relief is worthy of investigation. Local anaesthetics, either on their own or in combination with opioids or nonsteroidal antiinflammatory drugs, have been employed as an adjunct to other postoperative pain relief strategies.”

“A pharmacokinetic study of local anaesthetic absorption following wound and peritoneal infiltration is necessary,” the review authors conclude. “Ultrasound guided direct block of anterior abdominal wall nerves in caesarean section should be explored. An important research agenda will also be the effect of the intervention on chronic pelvic pain.”

Read the full review here…

Weighing Medical Costs of End-Of-Life Care: There is No End to the Debate.

If this is the reality for USA, how would such aggressive treatment add to suffering in resource-poor countries like India?:

How far should doctors go to try to save a patient’s life? “If you come into this hospital, we’re not going to let you die”, says Dr David T Feinberg, the chief executive of the Ronald Reagan UCLA Medical Center. According to data compiled at Dartmouth, Medicare pays about $50000 during a patient’s last 6 months of care at UCLA whereas Mayo Clinic in Rochester, Minn. incurs about $25000.The cost of treatment of a patient awaiting a heart transplant reached $300000 before he died after 5 weeks in the ICU. The moot point is, what is the cost-benefit ratio?

The current payment system encourages additional tests and procedures. As one doctor said,” The more tubes you put in, the more you get paid.” But, difficult family dynamics are also involved. Family members don’t want to let go. And, doctors too have trouble letting go. Doctors and nurses should talk to the patient and their families about their choices, educate them about the realistic chances of recovery; of the kind of life that awaits the patient even after the expensive treatment. A patient waiting for a liver transplant is seldom told about the severe repercussions of rejection; that he would have to live with a ventilator and dialysis for the rest of his life. If he was told, maybe he would opt for hospice care. Until recently, palliative care especially at end of life was an afterthought at such medical institutions.

Read more at the New York Times… & listen to the audio slideshow

Dark Humour?

Mr Innocent is a popular comedian of the silver screen in Kerala, India and a palliative care enthusiast.

He was to receive an award at a public ceremony and a tobacco company was one of the sponsors. They asked him to say a few good words about their brand of cigarette.

During his speech, Mr Innocent advised all the women in the crowd to persuade their husbands to smoke this particular brand more and more. He also advised them to get their children to start smoking as early as possible. And he had some innovative suggestions to them to make even snacks out of cigarettes.

The satire hit its target, bang on. The company withdrew from sponsorship of the award from the next year.

The anecdote though funny, is thought provoking, and the scenario lurking in the back drop very worrisome. Smoking among young people is increasing at an alarming rate. Recently,an Indian Health Minister bewailed that though his ministry was trying hard to ban smoking in public places, there were seven other ministries – Finance, Labor, Agriculture and several others – working in favor of tobacco.

As one palliative care worker wryly commented, smoking is good for the palliative care business too!

Finally, a Sweet Message for Valentine’s Day

Pallium India got a sweet message from Ms Meera Mohan on Valentine’s day – a poem, it concludes with the prayer:

On this Valentine’s Day,
I do sincerely pray
That all the tears YOU’ve wiped away
Will become guardian angels to protect YOU
And, help YOU in your mission, all your life through!

Read the whole poem on our Blog…

Thank you, Meera!

Please send us feedback about the newsletter here…

Editorial Board: K Govindan Kutty, A Salahuddin Kunju, C Mohanan & M R Rajagopal.

PALLIUM INDIA (REGISTERED CHARITABLE TRUST)

Address: II Floor, S.U.T. Speciality Hospital. Plamood, Trivandrum 695004, Kerala, India

Phone: 91 471 244 0306 (office) & 91 938 729 6889 (mobile)

Fax: 91 471 244 0306

Email: info@palliumindia.org

Web: http://www.palliumindia.org

One Response
  1. N.Sridhar rao permalink
    May 30, 2010

    im 36 m from andhra pradesh, kadapa.im suffering from cirrohsis liver from 2 years, im very depressed with my health condition financially, if any one/ any charitble trust donate some financial help for liver transplantation , im very thankful to them to and i can assure u that i can give hands to anyone to help if i get cured of this chronic liver diease.please save me.

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