Hyderabad – Fellowship in Pediatric Palliative Care
It is a two-year integrated international pediatric palliative care fellowship program with the aim of increasing access to palliative care for children in India. A physician with a postgraduate qualification in pediatrics or the equivalent, a long-term commitment to palliative care and the potential to become an effective champion in the field will be identified for training.
MNJ Institute of Oncology and RCC
In July 2006 the American Cancer Society (ACS), INCTR and Pallium India collaborated to develop the first palliative care training center in the state of Andhra Pradesh (population 65 million) at Mehdi Nawaz Jung Institute of Oncology and Regional Cancer Centre (MNJ), Hyderabad. By the end of 2009 the team had carried out nearly 24,000 patient “visits”.
Current training programs include an intensive one month long certificate course that is held every two months for doctors, nurses, social workers and other medical professionals. MNJIO has become a training centre for other cities and states in India and for other countries, e.g. Nepal, Ethiopia and Somalia. The Center has prepared a Training Manual for Hospital and Community Based Palliative Care in India working with government of India and the World Health Organization. The institute has, in addition, been successful in working with state policy makers to change the drug regulatory policies and, thus, improve the availability of opioids for medical use.
Treatment of childhood cancers is one of the major successes of modern medicine. Today, a child diagnosed with cancer in a developed country has an 80% chance of being cured. Unfortunately, the same is not true for India where, of the 75,000 children with recorded cancer every year, less than 20% survive. Many more probably die before a diagnosis is made. Furthermore, among the estimated 2.5 million people in India living with HIV/AIDS, 70,000 are children under the age of 15 . These children, as well as many with others with life limiting diseases, need help and support to reduce their symptoms. It is estimated, however, that at present less than 1% of them have any access to palliative care .
As in other developing countries there are many barriers to the delivery of pediatric palliative care in India and lack of training among healthcare professionals in dealing with death and dying, including communication skills, and pain and symptom management is one of the most important barriers.
MNJIO Pain Relief and Palliative Care Program added pediatric palliative care to their service in November 2007 with referrals coming from MNJIO and a nearby 500-bed children’s hospital, Niloufer Hospital. Niloufer is the only pediatric hospital in Andhra Pradesh, and each year they refer around 400 children with cancer to MNJ for treatment. Unfortunately, the cure rate is less than 10% in spite of free chemotherapy medications and more than 80% will need some kind of pain relief or general palliative care support.
Since the pediatric program was established there has been a rapid increase in the number of children treated, from 69 patient visits in 2006 to 2922 in 2010. Most of the children have advanced cancer and are referred for end-of-life care, but around 30% come for symptomatic relief during curative therapy. The patients are seen primarily as outpatients but, like the adults, also as inpatient consultations and at home. Another important aspect of the work is educating general oncologists in the control of procedural pain in children.
The purpose and goal of the project is to identify and train a physician with a postgraduate qualification in pediatrics or the equivalent who has a long-term commitment to palliative care and will become an effective champion and trainer in this field.
The chosen candidate will undertake a two-year fellowship program to provide him/her with the skills required to be a good clinician and leader. One salient feature of the training will be to prepare the graduate to help integrate pediatric palliative care into comprehensive cancer control and HIV/AIDS programs in accordance with the World Health Organization’s recommendations, including the provision of home-based care in rural and urban communities. Such integration will not only directly benefit many children and their families but create a model for up-scaling population access in other regions.
On completion of the program, the graduate will receive a Fellowship in Palliative Medicine from MNJ Institute of Oncology and RCC, endorsed by INCTR and Pallium India.
Activities and Timeline
It will be a two years program. Most of the two-year training will be carried out at MNJ under the direction and supervision of Director of the INCTR PAX Program in India. In the second year, the fellow has the choice of go back to the parent organization and work towards developing a program under the supervision of MNJ and international collaboration. (What is the other choice? Needs to be specified). The MNJIO team will receive support from members of the international faculty of INCTR PAX who will make regular visits during the period of the fellowship. It is hoped the candidate will also spend approximately three months each year at the Institute of Palliative Medicine (IPM) at San Diego Hospice if funding allows and trainee space is available in their program.
At both training sites the fellow will be taught the skills, knowledge and attitudes required to practice palliative care, with particular emphasis on the treatment of children. Developing the leadership skills required to establish programs and increase access to palliative care for larger populations will be of prime importance.
International Network for Cancer Treatment and Research (INCTR)
The International Network for Cancer Treatment and Research (INCTR) is one of only a few non-profit groups exclusively dedicated to improving cancer control in resource-challenged countries. The organization works to build their capacity for cancer treatment and research through long-term collaborative projects with more technologically advanced countries, training and education, and the establishment of cooperative networks and partnerships. Additional information about the organization is available on their website www.inctr.org.
The INCTR Palliative Access Program (PAX) has been working with local groups in several countries to set up regional centers that provide specialist palliative care for patients, coupled with education for healthcare workers and the general public. Using this approach, as well as interaction with government agencies to improve pertinent healthcare policy and drug availability, it has been very successful in building sustainable programs in India, Brazil and Nepal. The INCTR PAX team provides consulting and advisory services to national and regional governments, WHO and IAEA.
Pallium India is a registered Indian charitable trust formed in 2003 to fulfill the need for a stable organization working at the national level to fight for the needs of the suffering millions in India who are in need of pain relief and palliative care (www.palliumindia.org). Most of the trustees are people who have done pioneering work in the field of palliative care in the country. Pallium India works with local organizations, supporting them as they develop palliative care facilities, expand existing facilities and start rehabilitation services for families of patients afflicted by cancer. It also undertakes activities at the national level to ensure availability of opioids, for which purpose it works closely with the WHO Collaborating Center at Madison-Wisconsin. Education and quality assurance in palliative care are other major goals of the organization. They will assist with development and accreditation of the fellowship training program.
The INCTR PAX and Pallium India will provide support and mentorship for the fellow during and after graduation from the program.
The candidate should have a M.B.B.S degree with permanent registration with Medical Council of India and MD or post graduate diploma in clinical specialty. Preference will be given for post graduate qualification in pediatrics. Preference will also be given to a candidate applying from the state of Andhra Pradesh. Rule of reservation does not apply Needs explanation.
The selection committee wil be chaired by the Director of MNJIO. The committee will select the candidate based on eligibility and requirement.
There will be a written examination and Viva Voce at the end of one year. There will be an external examiner for the evaluation. During the second year, a quarterly evaluation will be done by the internal and external (INCTR and Pallium India) examiners on the individual development plan. A certificate of Fellowship in Pediatric Palliative Medicine will be jointly issued by MNJIO, INCTR and Pallium India at the end of completion of two year.
Course coordinator, Department of Palliative care, MNJIO, Redhills, Hyderabad-500004
Phone: 040- 23397000, 23318424, 09177238901
- Nair MK, Varghese C, Swaminathan R. Cancer: current scenario, intervention strategies and projections for 2015. NCMH Background Papers. PDF available here.
- Rajagopal MR, Joranson DE. India: opioid availability – an update. J Pain Symptom Manage 2007;33(5);615-622.