The episode was broadcast as planned last week. Watch the section of the show here:

Some media comment on the broadcast:

• The Telegraph: Why the BBC was right to air footage of a dying man
• The Independent: Television is not how to witness the passing of a life
• The Daily Mirror: Gerald becomes first person in Britain to die on national television

And, from The Guardian TV review:

It is not the kind of thing I would choose to watch every night, but the film was a genuinely moving, unsentimental portrait of an intimate moment and, compared with the daily dose of violent death we get on the news, it did more to make death seem less scary than any theologian has ever done. I can’t say I would choose to have my death filmed, but it was Gerald’s death and Gerald’s choice.

What do you think? Please leave your comments here…

Bringing hope to elderly and terminally ill Indians

By Sanjoy Majumder – BBC News, Kerala

Pain and suffering

Only the rich or privileged have access to proper health care – the rest are increasingly forced to battle alone.

But 2,000km (1,242 miles) away, in Kerala, there is a ray of hope.

At the Institute of Palliative Medicine in Calicut, Dr Suresh Kumar checks on a patient, a poor fisherman who is suffering from lung cancer.

Moved by the pain and suffering of terminally ill patients, the doctor gave up his job as an anaesthetist to set up a ground-breaking palliative care system that has now spread across the state.

“Most of the problems faced by elderly people are not medical. A lot of the issues are social, emotional, issues of loneliness and a lack of money,” he explains.

Read the full article at BBC News…

Thanks to the BBC, Sanjoy Majumder and Linda Pressly for sharing palliative care with the World!

• If you missed Linda Pressly’s January 2011 interview in Trivandrum, listen to it here…

Maybe it can, but as things stand now, even the mention of death makes some people angry. Then what reaction would the filming of a dying process elicit?

The second episode of the BBC’s new series, Inside the Human Body, will show the final breaths of an 84-year-old man dying from cancer. The Guardian reports on the controversy:

BBC defends filming cancer patient’s death

The BBC has braced for criticism after filming the dying moments of a terminally-ill man whose family agreed for the death to be captured on camera.

A BBC science series, Inside the Human Body, will show the final breath of 84-year-old Gerald as he dies at home surrounded by his family. The producers recognised the second episode of the series, which includes footage of the death, would anger some people, but said they wanted to tackle the difficult subject.

Presenter Michael Mosely told the Radio Times he believed the programme was justified and that it was important not to avoid “talking about death and, when it’s warranted, showing it”.

“There are those who feel that showing a human death on television is wrong, whatever the circumstances,” he said. “Although I respect this point of view I think there is a case to be made for filming a peaceful, natural death – a view shared by many who work closely with the dying.”

It would not be the first time the BBC has faced criticism for showing death on screen. Early this month it was accused of being a “cheerleader for assisted suicide” after filming the last moment of a man at a Dignitas clinic in Switzerland for a Terry Pratchett documentary. The programme, due to be broadcast on BBC 2 this summer, follows a 71-year-old man in the late stages of motor neurone disease. The fantasy novelist, a vocal supporter of euthanasia, stays at his bedside until he dies from a mixture of drugs taken to end his life.

Inside the Human Body will track the development of a life – from conception to the grave – and will feature the moment of conception, a baby’s first breath, the body’s development to adulthood, and the body’s defence mechanisms.

The second episode, which features Gerard’s death, will also look at a woman who has survived for 10 years eating nothing but crisps, a man who can hold his breath for nine minutes, and another who can swim in water so cold it would normally kill. The final part will examine what happens when the body gives up its fight for survival.

“We met many wonderful people while making the series, but Gerald was special. We were privileged to share, with his family, his last few weeks and the moment of his final breath,” said Moseley.

After approaching several hospices asking for permission to film, A hospice in Pembur, Kent, had put the programme makers in touch with Gerald because they felt it was “important that life-threatening illness and death is discussed and understood more in our society”.

Gerald, who had cancer, said he hoped filming his death would help others. “I don’t want to die, but pretty evidently unless some miracle happens, I ain’t gonna be here very long … I’m not frightened,” he said.

“I don’t believe that it’ll be just like cutting off some tape with some scissors, though it might be. But either way I have blind trust that I shall not disappear completely,” he said. He vowed to see the start of 2011, and died on 1 January, surrounded by family.

Mosley said: “The death of a loved one is a hugely significant moment in all our lives, but not something to be feared. I watched my own father die. Just before the end he decided to start singing. He sang for several minutes and then he stopped and he was gone. I’m so glad I was there and the time I spent with him before his death are among the many memories that I treasure.”

UK readers can see this episode of Inside the Human Body on BBC One: Thursday May 12, 2011 at 9pm.

• Update: Watch the scene here…

Medical Council of India Approves MD Palliative Medicine!

Till now, Palliative Medicine was not approved as a medical specialty by the Medical Council of India (the statutory body with the authority to do so). Palliative care workers have been trying hard to get this done.

In 2009, the then acting president of the Medical Council of India, Dr Kesavan Kutty Nair, had responded very positively to our request and arranged for us to meet the then-chairman of the postgraduate board of Medical Council of India, who had agreed to do the needful.

In the Public Interest Litigation filed by the Indian Association of Palliative Care before the Supreme Court of India, this was a major prayer. At a hearing of the case on 12 November 2010, the Medical Council of India was represented by counsel and was asked by the Court to file an affidavit. Thanks to the initiative of Dr Nandini, a few of us had met one member of the MCI board, Dr Devi Shetty, who had wholeheartedly agreed with the cause and had promised to do what he can. We are sure many others in the country must also have been making similar efforts.

Professor Reena George of Christian Medical College, Vellore has just found out that the MCI has approved Palliative Medicine as a specialty and even announced an MD course (the standard post-graduate medical degree in India) in Palliative Medicine.

A giant step forward indeed! All palliative care workers in India, I am sure, would be very thankful to the numerous individuals and organizations all over the world who supported us and helped us to reach this major achievement.

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BBC Radio Visits Pallium India

When Linda Pressly from BBC Radio walked into Pallium India’s Palliative Care Unit at Trivandrum Institute of Palliative Sciences in S.U.T Hospital, she met up with Radha Bai and her husband. They were more than happy to be interviewed.

Listen to “Crossing Continents: Palliative Care in India” on our website…

They explained how she seemed to be dying from subacute intestinal obstruction a year back (she has an active malignancy) and how palliative care made her well enough go home, functioning normally. A year later, now she is still on oral morphine and other medications, and is able to cook, look after her grand children and even attend parties!

The message is important because too often palliative care is associated with the dying process. Though available evidence shows that palliative care substantially prolongs life, this is not generally known.

Linda’s program will remove some of these myths from many minds.

The program presents the lack of access to palliative care in most of India and compares it with the situation in Kerala where a network of palliative care centers offer care to patients.

From BBC:

It’s estimated that nearly one million Indians with conditions like cancer die in acute, unnecessary pain because of the lack of palliative care. Restrictions on morphine prescription are being lifted, but too slowly.

One of the most sophisticated systems of palliative care in the developing world has been established in the Indian state of Kerala. The grassroots movement to create a much-valued and effective palliative care system in Kerala has been called a silent revolution. Every week, thousands of volunteers across the state give up their time to go and tend to those who are dying. They may cook food, help with chores, or simply provide a listening ear. Hundreds of thousands more people in Kerala belong to Palliative Care Societies. They donate money regularly – even just a few rupees – to help support this kind of outreach. The hope is that people will not die alone, and in pain, without any support.

Linda Pressly travels to Kerala, which has more palliative care centres than the rest of the country put together, and ask whether this is a model to treat the dying that could be rolled out in other nations, as well as other parts of India.

• Listen on our website…
• Also on BBC World Service, Thu 20/1/2011.

• Linda has a related story on the BBC News website about morphine availability in Rajasthan: Rajasthan patients’ severe pain due to lack of morphine…

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Palliative Care at the Third International Congress on Kerala Studies

Suma’s story was part of the discussion at the Third International Congress on Kerala Studies, organised by the AKG Study and Research Centre at University College, Trivandrum, from January 1 to 3, 2011.

There was one whole session dedicated to palliative care and Suma’s tragic story came up for discussion.

The audience strongly felt that both the Community and the Government have a responsibility to make sure that such needless suffering is prevented.

The meeting particularly discussed the problems of the elderly. Mr. A.K.D Pillai, Secretary of the Central Government Pensioners’ Association and Secretary of the Senior Citizens’ Friends’ Association, submitted a detailed proposal to the Congress, pragmatically listing out the possible measures that can be undertaken by the Government in association with Non-Government Organizations.

Let us hope some of these discussions will be translated to action.

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Letter from our Edinburgh Medical Student

Amanda Rodger is a medical student from Edinburgh, who did a two-month elective with us at Trivandrum Institute of Palliative Sciences (TIPS). She helped us by doing a formal evaluation of our six weeks course in Palliative Medicine for doctors, so that we could use the information to improve future courses.

Here is the letter that she sent at the time of leaving us:

TO EVERYONE AT PALLIUM INDIA:

I just wanted to say a massive THANK YOU! to you all for welcoming me into your team. It has been lovely coming in every morning to be greeted by smiles all round.

I have enjoyed my time here and it has been a very valuable elective experience. I have learnt a lot about palliative care and India, and most importantly, I will return to UK with fond memories.

You are an inspiring group of people, who I have much admiration for. I can only hope that I show as much compassion and care as you all do to my patients of the future.

Keep up the good work.

All the Best,
Amanda.

Thank you for the visit and for so easily merging into the team, Amanda. It was good to have you with us.

Hope you will come back some day to work with us!

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Report: Excellence in Oncology 2010

Miss Aneeja Mariam Joseph (right), a Medical Social Worker from Pallium India, attended the international conference Excellence in Oncology 2010, held at Kolkata’s Cancer Centre Welfare Home and Research Institute from 10-12th December 2010.

The conference included hands-on workshop in Palliative Care for doctors, nurses, social workers and volunteers.

One of the delegates, a cancer survivor working with HITAISHINI, a voluntary group for breast cancer survivors, told after Aneeja’s session with them,

It was truly a great joy to see and meet people who are interested in palliative care.

I believe this means people are beginning to understand and accept the need for palliative care.

It’s about time things changed.

The workshop has been organized by the Department of Palliative Care, CCWHRI in collaboration with Royal Sussex County Hospital, UK, the Indo American Cancer Association and UICC.

Dr. Rakesh Roy and Dr. Sanghamitra Bora (both had undergone the six-weeks’ certificate courses in palliative care at TIPS in the years 2008-2009, and we still consider them part of the TIPS team!) were the chief organizers of the program under Dr Arnab Gupta’s leadership.

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Hope Soars: There is Life After Cancer

What is it like, to be told that one has cancer?

Find out from some people who know. About three dozen of them.

In “Hope Soars” (Vitasta Publishing, 2010) Jyotsna Govil of Cancer Sahyog has edited a compilation of experiences from people who went through the cancer journey.

One recurring theme that appears in these stories is one of emotional isolation – how some of them felt isolated even while amidst loving friends and family. The family members love; but they do not understand how you feel. But others who have gone through the cancer journey understand and support.

The stories underscore the value of support groups.

• Read an excerpt: A Survivor Maps Life After Cancer
• Hope Soars is available online from Vitasta Publishing for Rs.395…
• Proceeds from sales will go to the Indian Cancer Society!

Hope Soars narrates such heart rending stories of those brave men and women, patients and caregivers, who faced the onslaught of cancer with rare and unbridled courage. This book intends to create awareness about the disease and how to adjust to life with and after Cancer.

A chill runs down one’s spine with the discovery that one is diagnosed with cancer. The dream of a beautiful life ahead and the desire to have the whole world at one’s feet suddenly comes crashing down. Hope Soars narrates heart-rending stories of those brave men and women, patients and caregivers, who faced the onslaught of cancer with rare and unbridled courage.

Some of these stories will take you through the lives of a professor who shuffled her lectures, her appointments with the doctor and chemotherapy sessions, and it was all in a day’s work for her; a mother who lost her little one at a very tender age when he was just beginning to dream big; a young girl who had the entire life ahead of her when she found the malignant tumour in her body; and, a beautiful woman who could not bear to look at herself in the mirror after her mastectomy. But they all emerged winners in the end. These are their stories of triumph over cancer.

Hope is the common link uniting these thirty-four unique and fascinating stories. Readers will be caught unaware saying along with those who have suffered that “Yes, we CAN.” And this is the spirit that the book seeks to promote—the true mission of Indian Cancer Society.

Buy Online – proceeds go to Indian Cancer Society!

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In Closing…

“In all 40 years of my experience as a surgeon, I have not come across subcutaneous saline infusion as a management scheme in adults. Never”, said the senior surgeon.

He was angry. His relative was a patient who died after being referred to palliative care only two days back.

The patient had received a subcutaneous infusion of saline on the last day of his life. The surgeon was angry at what he perceived as quackery that his relative was subjected to.

Subcutaneous infusion came back as a therapeutic tool in adults at least two decades back. It is recommended by authorities as strong as Oxford Textbook of Palliative Medicine and is evidence based.

Yet, it has not yet become known to the medical fraternity at large. We come across the same anger about oral morphine and many other essential humane options of treatment.

How long is it going to take for us to reach our colleagues?

How can we improve palliative care advocacy among our fellow-professionals?

Listen to “Crossing Continents: Palliative Care in India”:

They explained how she seemed to be dying from subacute intestinal obstruction a year back (she has an active malignancy) and how palliative care made her well enough go home, functioning normally. A year later, now she is still on oral morphine and other medications, and is able to cook, look after her grand children and even attend parties!

The message is important because too often palliative care is associated with the dying process. Though available evidence shows that palliative care substantially prolongs life, this is not generally known.

Linda’s program will remove some of these myths from many minds.

The program presents the lack of access to palliative care in most of India and compares it with the situation in Kerala where a network of palliative care centers offer care to patients.

From BBC:

Crossing Continents

It’s estimated that nearly one million Indians with conditions like cancer die in acute, unnecessary pain because of the lack of palliative care. Restrictions on morphine prescription are being lifted, but too slowly.

One of the most sophisticated systems of palliative care in the developing world has been established in the Indian state of Kerala. The grassroots movement to create a much-valued and effective palliative care system in Kerala has been called a silent revolution. Every week, thousands of volunteers across the state give up their time to go and tend to those who are dying. They may cook food, help with chores, or simply provide a listening ear. Hundreds of thousands more people in Kerala belong to Palliative Care Societies. They donate money regularly – even just a few rupees – to help support this kind of outreach. The hope is that people will not die alone, and in pain, without any support.

Linda Pressly travels to Kerala, which has more palliative care centres than the rest of the country put together, and ask whether this is a model to treat the dying that could be rolled out in other nations, as well as other parts of India.

• Download the mp3 podcast… (.mp3, 13mb) or listen above.
• Also on BBC World Service, Thu 20/1/2011.

• Linda has a related story on the BBC News website about morphine availability in Rajasthan: Rajasthan patients’ severe pain due to lack of morphine…

Aruna Shanbaug, a nurse in Mumbai, has been paralysed and considered “brain-dead” since she was attacked by a rapist in November 1973.

Pinki Virani, a journalist who has authored a book on Aruna, has filed a case before the Supreme Court of India asking for permission to end Aruna‟s life.

The BBC report goes on to say that “The court will examine if the plea is “akin to euthanasia”.

The medical communities, and particularly palliative care experts, have a responsibility to clear the confusion.

Please read about it at http://news.bbc.co.uk/2/hi/south_asia/8417549.stm

Thank you Dr Charu Singh, for bringing this to our attention.