Dates: March 17 – 18, 2012

The proposed venue will be CanKids‘ Training Center at J-161 A, Gautam Nagar, Near Green Park Metro Station, New Delhi.

It is intended for practicing palliative care physicians for updating their knowledge and skills with stress on recent developments in this field.

The areas that would be covered during this course include,

• discussions on difficult pain management
• difficult clinical situations like delirium
• role and scope of palliative sedation
• dealing with our limitations

Other issues and areas that will be covered: organizing palliative care units, media advocacy and self learning thru e-resources.

Faculty includes Dr Odette Spruyt, Dr Sushma Bhatnagar, Dr V Nandini , Dr Anjum Khan Joad, Dr Charu Singh and Dr M.R.Rajagopal.

The proposed venue will be CanKids‘ Training Center at J-161 A, Gautam Nagar, Near Green Park Metro Station, New Delhi.

Registration fee for the Course is Rs.1,000. (Registration is free for centers funded by JDF and IACA and for centers supported by Pallium India.)

Those interested may apply with a draft made out to “Pallium India” payable at Trivandrum and sent to:

Mr V.Jayprakashan
CEO, Pallium India
S10, Vrindavan Housing Colony,
Opposite Traffic Police Station,
Pattom, Trivandrum – 695 004
Kerala, India
Email: info@palliumindia.org

The proposed venue will be CanKids‘ Training Center at J-161 A, Gautam Nagar, Near Green Park Metro Station, New Delhi.

Dr E Divakaran, Director, Institute of Palliative Care, Thrissur proposes to present various palliative care training programs in the country at the forthcoming annual conference of Indian Association of Palliative Care at Kolkata on 10-12 February, 2012.

He requests information on all training programs in India.

Please oblige by submitting details using the online form – Deadline: 31 December 2011

SUBMIT NOW »

It will help your institution by attracting candidates and more importantly, it will help candidates seeking training.

The goal of training is to change practice; not simply acquire knowledge yet too often curriculums and assessment focus on knowledge and skills.

Dr Mhoira Leng

A quote from Dr Mhoira Leng‘s paper, Networking and training in palliative care – Challenging values and changing practice, for the Indian Journal of Palliative Medicine.

To illustrate this point, she quotes the following responses from participants of palliative care training programs:

• ‘I will be a better doctor now’
• ‘This palliative care course has reminded me why I came into Medicine in the first place.’
• ‘I feel better equipped to help people and their families.’
• ‘This will help my practice from tomorrow.’
• ‘I have learned to listen.’
• ‘I now understand what palliative care means and there will be a palliative care team in my hospital from this year’.

No doubt, a change in attitude is as important as knowledge and skills!

You can read the full article (free access) on the IJPC website (Vol 17, issue 4, pages 33-35):

“Networking and training in palliative care – Challenging values and changing practice.”

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You can also read about Mhoira’s recent “Whirlwind Tour” of India on her blog.

SPOTLIGHT…

Being a senior doctor and medical Professor, everyone treated me well and with deference during my cancer treatment.

But I still did not get relief from pain. My bone pain induced by radiation was agonizing. I cannot think of a worse experience.

It was as if someone was driving a nail into my leg. Not a small nail either. It simply went on and on. I was told that no relief was possible!

If I, a privileged doctor-patient had this sort of experience, what would be the fate of those patients who are not so fortunate to have such privileges?

This was narrated by one among the 15 lady doctors, all retired Professors from Trivandrum Medical College, who get together every month for a re-union. They call themselves, Aging Gracefully Women’s Group (AGWG).

Thanks to the initiative of our well-wisher, Professor Sara Varghese, Pallium India had the privilege of addressing the group on 10 July 2010, during their get-together at the residence of Dr G Santhakumari, former Director of Medical Education of Kerala. They discussed palliative care and shared their experiences. We left them in an introspective mood, asking themselves an important question, “What can we do to help; to make a difference?”

Some of them are already donors of Pallium India. Thank you for the support and for your interest, AGWG!

STAFF CLUB…

Probuphine Patent for the Treatment of Opiate Addiction

United States Patent and Trademark Organization (USPTO) has granted a patent for a method for treating opiate addiction with a subcutaneously implanted device comprising of buprenorphine and ethylene vinyl acetate, a biocompatible copolymer that releases buprenorphine continuously for extended periods of time (PBR 17/6/10).

Probuphine is designed to deliver six months of continuous, therapeutic levels of buprenorphine following a single treatment.

Every new discovery should excite us; but actually many of us from the developing world are scared of each and every new one. Is this another possibly expensive treatment modality to burden our poor people? Please allow us to keep praying for methadone.

Access CINAHL with IAHPC Membership

Liliana De Lima, Executive Director of International Association for Hospice and Palliative Care (IAHPC) sent us this notice about an invaluable benefit of IAHPC membership, access to the Cumulative Index to Nursing and Allied Health Literature:

We are happy to inform you that IAHPC has acquired from EBSCO the right to access the CINAHL database for our members.

The CINAHL database offers online access to hundreds of citations and also full text access to several palliative care journals.

To become a member of IAHPC, please visit www.hospicecare.com

Quality of Death: Ranking End-of-Life Care Across the World

The Economic Intelligence Unit of the “Economist” and Lien Foundation in Singapore joined hands to produce a white paper on Quality of Death that was published on 14 July 2010. A poor quality of death means intense suffering for the dying person and his family and the situation can improve only with improved access to palliative care services.

The white paper lists 40 countries and ranks them according to Quality of Death. UK ranks first, and sadly, India comes at the very bottom as the 40th, next to Uganda. As a redeeming feature, the exceptional performance of Kerala in this field is highlighted in the paper.
For the entire report, please visit our blog…

RESPONSES…

A Voice from the Kyrgyz Republic

It was deeply satisfying to come across Dr Nargiza Dadahanova‘s kind words of appreciation in our blog, about the work we are doing.

She has shared with us her experiences in the area of cancer treatment in her country. We would like our readers to have an inside view of the state of affairs in palliative care and treatment in a resource poor country like hers, the Kyrgyz Republic. We invite you to our blog to read about her experiences….

Nargiza, we are glad that our blog reached you and inspired you to share your experience with us. Thank you!

We invite our readers in similar circumstances to use this as a platform for showcasing their problems and solutions so that every one can benefit from the fount of collective experience. Contact us via the website…

EVENTS & EXPERIENCES…

Pallium India-USA  Event: Sevathon

Pallium India-USA took part in the Sevathon: the largest community-wide walkathon and awareness platform dedicated to “Seva” or “Service” and to local non-profits who share this principle.

Pallium India-USA envisions an India where every citizen will receive palliative care services. Pallium India-USA seeks to support the work of Pallium India to achieve the Vision by:

• Creating awareness of the serious absence of these services in India in the Asian Indian population in USA, many of whom have family members residing in India.
• By building a community of people to support the work of Pallium India.
• Educate the Asian Indian population about Advance Care Planning, and decisions that they might need to make for themselves and their families here in USA when they are unable to speak for themselves.

We appreciate the efforts of Dr Jerina Kapoor who has initiated this venture and our well-wishers in the USA. For more details, visit our website.

Emmanuel Hospital Association Starts Palliative Care Activity

Dr Ann Thyle, who directs Emmanuel Hospital Association’s palliative care program writes to say that EHA has formally started its activities at Lalitpur.

Operating since mid-March, the project is run by Leela Pradhan, an experienced community nurse, as Home Care Coordinator and Carol Motuz as Administration and Training Coordinator.

Lalitpur is in Uttar Pradesh, the most populous state in India. It houses 2.9% of the world’s population (16% of India’s population). It has negligible palliative care.

We are glad to report that Pallium India’s collaborative project with SGPGIMS in Lucknow- Pallcare Project, has taken off recently.

It is indeed heartening to see the progress in the state. Congratulations and best wishes, Dr Ann Thyle and team!

Palliative Care Updates from Rishikesh

“Train me well, I have important work to do when I get back to Rishikesh” – Sicily Sebastian, when she joined TIPS for the six week Certificate Course in Palliative Nursing (CCPN)

We were touched by her commitment and enthusiasm.

Sicily Sebastian comes from Rishikesh in Uttarakhand, a state having very little palliative care. Ganga Prem Hospice, a new venture, promises some hope of solace to the suffering.

Currently, the Medical Director Dr A.K.Dewan, an oncologist from the Rajiv Gandhi Cancer Institute in New Delhi, travels to Rishikesh, 227 kms away, every month, to help with the efforts. Indian American Cancer Association (IACA) is supporting this venture – one of the several projects that IACA is undertaking in India.

Best wishes, Sicily, Dr Dewan, every one at Ganga Prem Hospice and IACA. Pallium India is proud to be associated with you!

Toolkit Training Programme at Lucknow

A Palliative Care Toolkit Training Programme was conducted at the Sanjay Gandhi Post Graduate Institute of Medical Sciences between 21st and 25th June 2010.

It was led by Dr Mhoira Leng, the director of the international organisation Cairdeas International and the palliative care team at SGPGI consisting of Dr Shakeel Ahmad, Dr Sanjay Dhiraaj and palliative care nurse Alice among others. The group also had interactive sessions with medical personnel from nearby medical colleges.

Around 20 people were trained in 5 days and more than 40 were sensitised to the compelling need for palliative care services in the region. Significant coverage in the media ensured that more and more people who need such services but had no prior knowledge of this form of treatment will now be able to access it.

We are also happy that the team has been able to increase their home care services in the last few months.

Dr Mhoira Leng’s Experiences in Mizoram

As a continuation of Pallium India‘s Pallcare Project in Lucknow, Dr Mhoira Leng, the director of the international organization called Cairdeas International has been supporting us by mentoring in Mizoram and Lucknow.

Dr Leng shares her new and exciting experiences in Mizoram which you can read at our blog…

Dr Shashi Tharoor Visits TIPS

Former Under-Secretary General of United Nations, author and Member of Indian Parliament Mr Shashi Tharoor visited TIPS on the 24th of May 2010.

He took keen interest in the activities of Pallium India and visited patients under treatment and families. He has promised his support to the Palliative Care movement in India.

Starry-eyed fans of Shashi Tharoor can get an exciting account of his visit to Trivandrum from his blog, “After the Storm.”

Kollam Rotary Club Takes on Palliative Care

Kollam West-End Rotary Club’s new president, Dr Riyaz Ahammed assumed chair on 3 July 2010 with an announcement that his club would be taking up palliative care as its major social responsibility this year.

Congratulations, Dr Riyaz and members of Kollam West End Rotary, and thank you for your support to Pallium India.

By the way, Kollam (nicknamed Quilon by the British) is an attractive tourist spot with its beautiful backwaters, about 70 Kilometers north of Trivandrum, the capital of Kerala.

Trivandrum Exhibition by Palliative Care Patients

A wonderful event for those who can get to Trivandrum YMCA on Saturday 24th July:

On Saturday 24th July 2010, you MUST drop in at YMCA (Behind Govt Secretariat) between 9AM and 6PM to see what a group of special people – palliative care patients who are bed-bound or wheel-chair-bound, have created – paintings, dolls, utility items for the home and many things more!

Come and see the exhibits. Your presence itself will be an encouragement to the remarkable people who have created them. If you do want to buy something and take it home, we shall certainly not object!

Our congratulations to Dr Shibu ,our volunteer Physical Medicine specialist (who also thought up the idea) and Mr Sunaj, our physiotherapist, for making this happen and for encouraging the creativity of these people. See you on the 24th!

World News…

Vatican: “Nearly 2 billion people without access to basic medicine”

Archbishop Silvano M. Tomasi, Permanent Observer of the Holy See to the Office of the United Nations and Other International Organizations in Geneva, presented a speech at the UN Human Rights Council.

He focused largely on the need to ensure universal access to medicines.  He highlighted the role of poverty in developing countries, and noted that children are particularly deprived of access to medicines.

The Catholic Church provides a major contribution to health care in all parts of the world – through local churches, religious institutions and private initiatives, which act on their own responsibility and in the respect of the law of each country – including the promotion of 5,378 hospitals, 18,088 dispensaries and clinics, 521 leprosaria, and 15,448 homes for the aged, the chronically ill, or disabled people.

Read more at Fides.org…

Morphine Remains Scarce for Pain Sufferers World Wide

Martha Ann Overland reports for Time Magazine from Hanoi:

After the hospital sent Nguyen Van Dung home to die, his family watched helplessly as he wasted away from complications due to AIDS. And he did not go gently. “He was in such pain,” says Dung’s 73-year-old mother. “It was like seeing him on fire.”

Haunted by his screams, Dung’s sister bought him heroin to ease his pain. Street-grade heroin is hardly an ideal medical choice; it is also illegal. Last month, shortly after Dung’s death, a judge in Nha Trang sentenced his sister to three years in prison. Drug possession — “for any reason,” explained the judge — is against the law.

Whether you will have access to pain treatment depends largely upon where you live. Africa, which has most of the world’s AIDS victims, is a painkiller wasteland. In India, more than a million cancer and AIDS sufferers die each year in extreme pain as cumbersome regulations and paperwork make it nearly impossible to get prescription painkillers. (India produces much of the world’s legal opium, yet nearly all of it is exported to Western pharmaceutical companies.)

Read the rest of this excellent article at Time.com…

STUDENT’S CORNER…

The Palliative Care Training Center at MNJ Institute of Oncology (MNJIO) which was started in 2006 as a joint project between Pallium India, MNJIO and Canada’s International Network of Cancer Treatment & Research (INCTR).

They will be holding a “One Month Certificate Course in Pain & Palliative Care for Doctors, Nurses, Social Workers & Volunteers“. Internationally renowned faculty like Dr Stuart Brown, Director, PAX Program for INCTR will be the external faculty for the course. The course will held in Hyderabad at MNJIO, starting on August 2nd and finish on August 28th, 2010.

All details of  the course including Objectives, Learning Process, Schedule, Fees and Application Form are available in PDF .pdf or Word .doc

For details of Pallium India’s other courses, please visit: palliumindia.org/courses

PARTING SHOT…

Dr B is an Indian doctor working abroad. He has been supporting Pallium India in numerous ways, including reimbursing the salary of two nurses for quite some time now. He rang up recently and informed us of his wish to provide for the salary of one more nurse, so that our service could improve. We asked him if we might acknowledge his contribution in this newsletter. He declined; he wished to stay anonymous. He went on to add,

“My greatest pleasure is the undeterred effort that you have proven capable of, and if one hopeless soul smiles when you come on the horizon, the job is done. Help me find more opportunities for commitment so that I can contribute what little I can towards your vision!!”

You touch our hearts, Dr B. Thank you.

He would be starting a palliative care service soon as part of a Pallium India-PPSG-USCPRC project – in a state which till now had no effective palliative care facility.

But in the meantime, he was confronted with this situation – a five year old boy with a rhabdomyosarcoma in an upper limb, in excruciating pain. The child also had severe lymphoedema and extensive blisters and some abscesses. The child was receiving an NSAID, but it had not helped much. What could the doctor do?

No, they do not have oral morphine yet. No, they do not have injectable morphine either. Nor even injectable pethidine. They do have injectable fentanyl, though.

God, why is it that hospitals in our poor country have only the most expensive medications? Even if it were affordable, how would this child get pain relief round the clock with such a short-acting drug? Would someone study this international phenomenon which affects the 80% of the globe that forms the developing world? Fentanyl and morphine are controlled by the same narcotic regulations; but you cannot get hold of morphine!

Dear doctor, we sense your patient‟s pain and your distress. We will work with you and fight with you till you have access to morphine.