How good is access to palliative care in Kerala?

2017 February 22
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What do you think? Poor? Good? Very good? Excellent?

Read the article in the Journal of Global Oncology, titled “Oral Morphine Use in South India: A Population-Based Study” by M.R. Rajagopal, Safiya Karim, and Christopher M. Booth.

Access to palliative care is notoriously difficult to measure. The world has accepted per capita morphine consumption as the index.

If you want the good news, access to pain relief in Kerala is at least four times better than the national average.

But wait, there is some bad news to follow. If we take UK and some West European countries as ideal (USA and Canada are not ideal as their high consumption is suspected to reflect some diversion of prescription drugs to illicit channels), 150-200mg of morphine (or its equivalent) per year would be optimal. Unfortunately, the consumption in Kerala is still only about one hundredth of that. And, only 1/4th of the global average.

You find it difficult to believe? Yet this is a fact despite the widespread recognition of the Kerala model. Why? The main reason is that hospitals do not use morphine for pain relief following operations, after accidents or even in cancer pain. The essential morphine is not available in majority of the hospitals.

Moreover, even in cancer, pain relief reaches too few, too late. There is almost unbelievably high variation in opioid access between various districts of Kerala.

We are glad that the Government of Kerala is considering palliative care as one of its focus areas. Things are bound to improve in the next few years.

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