“By its fruits one knows the tree.” – Brazilian proverb
It is important to talk about this tree. As visitors that came from far, it is inspiring to see Pallium India’s patients and families – it is not an overstatement to say how much your work brings them answers, respect, relief and orientation. In the storm of pain and disease there is a safe harbor.
We don’t need to know more than three words in Malayalam* to see that.
Pallium’s fruits speak for themselves.
The tree is growing, not only providing shelter to so many different patients and families but also welcoming those who want to learn and improve palliative care worldwide.
The nurses are in the roots, the body and branches of this tree. They go way beyond care and comfort and holding hands and bringing a smile.
In every shift, in every visit, you carry in your arms the responsibility of one of the most rewarding jobs in world, navigating the system and crossing the shadows of suffering.
We won’t talk about holding hands. The celebration goes to the arms. You hold hands but your arms are arms. Arms that fight for those who can’t fight for themselves. Arms that hold, relieve, change. Arms that tell, hear and prepare. Arms that learn, teach and grow. Not just the hands, the holding of hands.
You, nurses, are the engineers that balance art and science by the bedside of the patient. In a room or a ward. In a corridor or in a street. At a meeting or a conference.
We celebrate the nurses of yesterday and the nurses of tomorrow. The nurses that know and the nurses that learn. The nurses that do and the nurses that teach.
So raise your arms and keep your fight so inspiring.
*Important note: We know more than three words in Malayalam.
Ana (physician) and Tania (nurse) are volunteers who visited Pallium India in May 2017.
“What should I do after he passes away? I mean…the practicalities. How do I deal with the dead body at home?”
It was this question, put to me by the son of a patient whose home we were visiting in Hyderabad, India, that inspired me to write this article. The patient was an elderly gentleman with a terminal medical condition. We were there to offer the patient and the family, palliative care.
One of the services provided by palliative care, a medical specialty that deals with life-limiting and terminal illnesses, is to plan for a good death. This involves providing supportive care to the patient and relief from pain and other symptoms (at home or in the hospital, as per the patient’s choice), and also providing support to the family during the last days of the patient’s life and beyond death, to assist the family with the practical arrangements that need to be made and to provide bereavement care.
If a patient’s last wish is to die at home, then we want to support the family through that process with the necessary information and guidance.
As our palliative care service is based in Hyderabad, I can tell you how it works here. The first thing you need to do is to get a doctor that lives nearby (or call for one from a hospital nearby) to come and confirm the death. It would be a good idea to find this doctor beforehand and inform them that you have a dying relative at home. Request the doctor to provide you with a written record of the time and date of death (and probable cause if it is a known life-limiting illness like cancer, heart disease etc.) on their official letterhead. Next, you need to decide whether you are going to move the body right away or whether you need to wait for relatives to come. In the latter case, you can rent a freezer box to preserve the body at home till you are ready to transport it to the cremation or burial ground. This will cost around ₹3000 per day, and you can find the contact for dead body freezer box rentals on Google. You can also contact our palliative care society for details on freezer box and hearse services.
When you are ready to move the body from home, you need to make contact with the nearest cremation or burial ground, as per the religious beliefs of the deceased. For Hindus, there are Smashana Vatikas that will take care of cremation (electric or wooden) at a cost of around ₹4000. Additional puja services can cost between ₹10,000 to 20,000. For Muslims, contact the nearest Kabristan. The burial will cost around ₹4000, which is labor charge for the grave diggers. Christians will have church memberships that include right of burial on church grounds, and for those who don’t have such a membership, certain churches may allow for funeral services at a cost of around ₹3000. Call and inform the facility beforehand so arrangements can be made.
Carry the Aadhaar card or other identity proof of the deceased and the doctor’s death declaration with you and at the end of the funeral service collect a receipt of cremation or burial from the facility. This receipt, the doctor’s declaration, and copy of the identity proof of the deceased need to be submitted at the nearest Greater Hyderabad Municipal Corporation (GHMC) office. In addition, you will need to submit copies of your own Aadhaar card and of the electricity bill as address proof. In 2-3 weeks, the death certificate will be available on e-Seva online.
Dealing with the death of a loved one is something difficult that we all have to go through in life. This article describes the practicalities of how to deal with death at home in Hyderabad. It is reasonable to suppose that this protocol can be used in other cities and towns in India. For help with this and other aspects of care for a loved one at the end of life, contact your nearest palliative care service. If you are in Hyderabad, reach out to us: firstname.lastname@example.org or +91-9177238901.
The author is a palliative care physician employed by Two Worlds Cancer Collaboration, Canada, and working with the Pain Relief and Palliative Care Society (PRPCS) in Hyderabad. He can be contacted at email@example.com.
A short version of this article was published by Deccan Chronicle.
Now, in a new study published by The Economist Intelligence Unit on Global Access to Healthcare, India finds itself among the worst 10 in equity of access to health care.
This report looks into how healthcare systems across 60 countries are working to offer solutions to the most pressing healthcare needs of their populations.
The key findings are:
- Political will and a social compact are prerequisites for both access and sustainable health systems.
- Public investment underpins good access and demonstrates the commitment of governments to ensuring the health of their populations
- Universal coverage does not mean universal access, but extending universal health coverage (UHC) can be a crucial part of improving access.
Thank you, Katherine Pettus, for bringing this to our attention.
Hippocratic is a feature-length film exploring the life story of this acclaimed Indian pain & palliative care physician, Dr M. R. Rajagopal. This is a must-see documentary for all those interested in the power of the human spirit, human rights and social justice. It is essential viewing for anyone working in health care, medicine, nursing and public health.
Thank you, Mike Hill, Sue Collins and Moonshine Agency, for this wonderful tribute to our Founder-Chairman and for bringing the course of palliative care in India to the eyes of the world.