WHO Includes Palliative Care as Indicator of Control of Non-Communicable Diseases
The World Health Organization is evolving global strategy for control of non-communicable diseases. Several international organizations have been working together to include access to palliative care as an important component of the program.
I am glad to report that Pallium India has had its share in persuading the Government of India to support the move, particularly with advocacy by the Pallium India trustee Dr Shalini Vallabhan.
Within the WHO’s recently published consultation document, “A Comprehensive Global Monitoring Framework Including Indicators and a Set of Voluntary Global Targets for The Prevention and Control of Noncommunicabale Diseases,” the following statement appears on page 10 (PDF):
- Table 2: Core indicators for NCD surveillance
- National Health Systems Response
- Access to palliative care assessed by morphine-equivalent consumption of strong opioid analgesics (excluding methadone) per death from cancer
We all know that this statement is not perfect.
- For one thing, morphine consumption is an imperfect indicator of access to palliative care; but we also realize that there is no totally satisfactory indicator.
- We are particularly unhappy that the access to palliative care has been needlessly linked to cancer. We worry that with this sentence, the WHO may be unintentionally conveying to member countries that palliative care is meant only for cancer.
However, we also realize that it has been a huge achievement to have gone thus far and any change in that wording at this stage will be almost impossible.
WHO asks all member countries to respond to this with their comments by April 19:
Member States and UN agencies are invited to submit their comments on the second WHO Discussion Paper by sending an email to ncdmonitoring@who.int by 19 April 2012. Relevant NGOs and selected private sector are invited to submit their views to the same email address.
There will be a certain maximum number of indicators and it will need several countries’ support to ensure that the current recommendation will stay in the final form of the document.
This is the time when we must use all our contacts with the Department of Health to persuade them to strongly argue to keep the recommendation in.
Pallium India-USA plans to join thousands of Americans across the country for National Healthcare Decisions Day on April 16 2012, which brings to the forefront the need to make one’s future healthcare decisions known to family, friends and healthcare providers.
The group will give a formal presentation about how to develop an Advance Healthcare Directive on April 22 at the India Community Center in Milpitas, CA – Learn more and register here.
Advance Healthcare Directives are instructions for your medical decisions if you are not able to speak for yourself. The program is meant to inspire, educate, and empower the community to take charge of its medical care at a crucial time in one’s life.
The San Jose Mercury News coverage of the issue is well worth a read, part of a larger series on the “Cost of Dying,” from reporter Lisa M. Krieger. This piece gets to the heart of why an Advance Healthcare Directive is such an important document:
Cost of Dying: planning for a good death, from advance directive to talking with your family
(Dai Sugano/Staff)
Bill Newman has seen his share of hospitals. That’s why he plans to never go back.‘If I fall over, just let me go. No 911 guys with paddles. No bells and whistles,’ said the 87-year-old retired high school teacher and double bypass survivor.
[…] Modern medicine prolongs our lives in ways once thought unimaginable. But increasingly, we dwindle into frailty, disease and dementia, ill-prepared for the day when treatment fails us. We can do better, if we make a conscious choice.”
Pallium India-USA’s mission includes educating the community about the crucial need to put one’s wishes on paper so as to ensure the best quality end of life care.
“Nothing that I did in medical school prepared me for what I do now, at least in terms of Palliative Medicine.”
So writes Donal Kevin Gordon MD in “What I Do and Why I Do It: A Palliative Perspective”, published in the Journal of Palliative Medicine blog.
Donal Kevin Gordon MD
He describes his work in ways that are both heartening and heart rending – highlighting the emotional challenges and sometimes intense family dynamics he encounters. At the end of the day, he often needs an hour sitting in silence in his living room.
His own personal story is striking as well.
He became a doctor late in life, not entering medical school until the age of 49. Prior to that, he was a professional writer, penning books for major publishers.
Why did he become a doctor? And why palliative medicine?
“Life, in fact, was my only preparation for both,
My mother, dead at 49 of breast cancer; my father, dead at 66, himself of pancreatic cancer; me, my bride, then of only months, then suddenly helping me to raise my 11-year-old brother.
And don’t ask me to tell you about my father’s brothers, lost in their 20s, accidents both;
his mother, dead of cancer in her 40s;
her own mother, killed even younger;
yes, by cancer.”
We come to this work for many different reasons, and even–such as in this case–at different points in our lives.
But as he puts it, the doing of the work is:
“… always good… Always rewarding.
And always, considering with whom I work, in good, very good, company.”
BUY the DVD!
Short Film 45 of 50 in the LIFE Before Death documentary series about the global crisis in untreated pain and the dramatic life changing affect palliative care services can deliver to patients and their families around the world.
In “Share The Wealth” we discover how essential palliative medicine skills and knowledge are being transferred between San Diego and Tbilisi, Georgia.
“My interest has been in developing palliative care capacity around the world,” states Dr Frank Ferris (USA). “When I start thinking about coming to teach in a particular country, there has to be a champion. Fortunately when we came to Georgia we were really invited by the champions.”
“We realized how important it was to develop palliative care as part of the national health system,” reflects Dr Dimitri Kordzaya (Georgia).
“Five or six years ago it was impossible to access these services in Georgia,” recollects Professor Rema Gvamichava (Georgia). “Now it is possible in Tbilisi and many other big cities in Georgia. We want everybody in Georgia to have access to these kinds of services.”
“Palliative care represents a main subject of concern for the country,” states elected official Dr Otar Toidze (Georgia).
“They’ve made great progress in ten years,” attests Mary Callaway (USA). “In talking to the experts in this country they all say that education (is the most important element). So we’re trying to explore different ways that we can try to help the physicians and nurses in the country.”
Featuring: Dr Frank Ferris (USA), Dr Gary Buckholtz (USA), Dr Tamari Rukhadze (Georgia), Dr Dimitri Kordzaya (Georgia), Professor Rema Gvamichava (Georgia), Dr Otar Toidze (Georgia), Mary Callaway (USA), Dr Manon Turkadze (Georgia), Mary (Georgia).
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If you’ve missed previous episodes, catch up on the LIFE Before Death website…
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The LIFE Before Death feature film was premiered on 1 February 2012 in Singapore.
Why not organise a screening in your community? GET MORE INFORMATION HERE…
A few simple words–or even just a silent, supportive presence – can do so much to bring peace to the seriously ill and dying.
This was the essential message of the “Compassion in Action” Conference, held at Santa Clara University in Santa Clara, California, USA on March 30, 2012. The theme of the one-day event was “Providing ‘The Best Care Possible’ Through the End of Life.”
Organized by Hospice of the Valley and Santa Clara University Department of Counseling Psychology, it featured top tier speakers and drew a sold out crowd of professionals and volunteers from the palliative care and hospice fields.
Pallium India-USA, which was a sponsor of the event, provided information to participants about culturally sensitive hospice volunteering, advance care planning, and the situation in India.
Kersi Daruwalla, a longtime hospice volunteer who has recently joined Pallium India-USA, was a stalwart at the table, as were volunteers Zarina Kaji and Sunshine Mugrabi. Kersi had this to say:
This is a type of conference I recommend all of us can attend from time to time. It revitalizes every cell in your body, and helps you understand how simple life and relationships can be. Yet, it is up to us to make this happen.
I can sum this experience up in the following words: It feels good to be a human, caring for another human.
Here are some highlights from the speaker line-up:
Providing “The Best Care Possible” Through the End of Life – Ira Byock, MD, Director of Palliative Medicine, Dartmouth-Hitchcock Medical Center; Professor, Dartmouth Medical School. A world-renowned writer and speaker on palliative care issues, Dr. Byock gave a gripping and impassioned speech about the crucial need for a major rethink on how we take care of our elderly and dying in America. Giving examples from his own practice and personal life, he laid out a path for medicine, families, and US society as a whole to ensure the best care possible for those who are in the last stages of life.
Family Meanings and the Death of a Loved One: Understanding and Helping – Janice Nadeau, RN, PhD, Minnesota Human Development Consultants. Family dynamics are an inherent part of the grieving process. Dr. Nadeau, a family therapist, used an unusual prop–a literal “family mobile”–to demonstrate the importance of understanding and recognize these unconscious interactions when working with families of dying patients.
The Challenge of Caring: Putting Your Empathy to Work Without Burning Out – Dale G. Larson, PhD, Professor of Counseling Psychology, Coordinator, Health Psychology Emphasis. Dr. Larson shared his immense wealth of experience in how to stay balanced in the end-of-life care field. Laced with humor and warmth, the talk inspired many in the audience to nod in recognition over and over again. His list of the “top 10 signs of burnout” were as laugh-out-loud funny as anything on late night TV.
Wounded Warriors: Their Last Battle – Deborah Grassman, NP, Bay Pines Veterans Administration Medical Center. Grassman’s hard hitting and emotionally intense talk brought tears to the eyes of many in the audience. She demonstrated with story after story that the healing of our veterans at the end of life is and can be a healing for the entire nation.- Read the 2007 article from Home Healthcare Nurse, Wounded Warriors: Their Last Battle (pdf)
Where is Santa Clara ?
