Published on: December 13, 2011

Dear Friends,

We bring you good news! Palliative care reaches yet another virgin state in India.

Under the dynamic leadership of Dr Gautam Majumdar in Agartala in the state of Tripura, the Regional Cancer Center now has palliative care.

It is one of the eight palliative care centers that Pallium India has had the privilege of catalyzing in the last few years in eight different North and North-East Indian states.

Agartala is one of the projects funded jointly by Savitri Waney Trust, Farida and Yusuf Hamied Foundation and Bruce Davis Trust.

A doctor-nurse team, Ms Rita Saha (nurse) and Dr Batan Janapathy underwent Six Weeks’ Certificate Course at TIPS, Trivandrum. Within one month of finishing the training program, they have already started home visits!

Congratulations, Dr Majumdar, Dr Janapthy and Ms Saha.

Major Step Forward for Pediatric Palliative Care

Thursday, the 8th of December 2012 was a special day for Trivandrum Institute of Palliative Sciences (TIPS), the flagship of Pallium India.

In collaboration with the Department of Pediatrics in S.A.T Hospital at the Government Medical College, Trivandrum, and the Indian Academy of Pediatrics (Trivandrum branch), we started a trial run of a weekly Pediatric Palliative Care Clinic based at S.A.T Hospital.

Dr Lalitha Kailas (Head of Pediatrics), Dr Elizabeth (Superintendent of S.A.T Hospital), Dr Mohammed Kunju, (Head of Pediatric Neurology and President of Indian Academy of Pediatrics) give leadership to the program, while Dr Kalpana and Dr Hariprasad will be directly in charge of patient care from the part of the Government Institution.

The Pallium India team will be led by Dr Sithara Raman, the pediatrician in the Pallium India team.

It is a privilege to work with children. We are glad we have the opportunity.

International Journal of Palliative Nursing Awards 2012

International Journal of Palliative Nursing and MacMillan Cancer Support, are delighted to announce The International Journal of Palliative Nursing Awards 2012, one of the most prestigious events for nurses and allied health professionals working in the field of palliative care.

These awards, now in their seventh successive year, are organised by MA Healthcare, in association with the International Journal of Palliative Nursing and recognise the individual commitment and achievements of palliative nursing professionals.

Entries are invited from individuals, members of a team or you may nominate a colleague to enter one of the seven major categories.

The finalists of each category will be invited to an evening gala dinner and awards ceremony at a prestigious London venue on 29 March 2012.

Further information which includes the criteria and details of the categories are available on our website at where you can submit your applications online.

Closing date for entries is 16th December 2011.

Conquer Cancer Foundation Fellowship 2012 – APPLY NOW!

Mary Callaway at Open Society Foundation informs us of an interesting long-term fellowship opportunity:

Dear Colleagues

This may be an excellent opportunity for our palliative care oncologists to get additional training.  Although it doesn’t mention palliative care per se, it doesn’t exclude it so it may be worth responding to.

If nothing else, applications from our colleagues will draw attention to palliative care for cancer patients. I urge you to forward this announcement to our palliative care oncologists working in oncology hospitals in your countries.

Many thanks, Mary

Long-term International Fellowship (LIFe)

The one or two year Long-term International Fellowship (LIFe) provides early-career oncologists from low and middle income countries the opportunity to advance their medical education by:

  • Observing a clinical oncology practice in an academic center
  • Participating in clinical training and research opportunities with their mentor
  • Attending the 2012 American Society of Clinical Oncology (ASCO) Annual Meeting

APPLY NOW: Full details and application form available at Conquer Cancer Foundation…

IASP Developing Countries Project

An Initiative for Improving Pain Education

Apply now for grant applications for the IASP Developing Countries Project: Initiative for Improving Pain Education.

These educational support grants address the need for essential and improved education about pain and its treatment in developing countries, for members of all health-care disciplines, taking into account specific local needs. Multiple grants are available, each for up to US$10,000.

Who is Eligible?

Application Deadline: February 15, 2012

Find complete award information, eligibility requirements, and application instructions on the IASP website:

14th World Congress on Pain, Milan 2012: Call for Abstracts!

The International Association for the Study of Pain (IASP) is now accepting poster abstracts to be considered for presentation at the 14th World Congress on Pain to be held at the Milan Convention Centre, August 27-31, 2012.

Individuals can access the Call for Abstracts and submission guidelines on the Congress website:

To be considered, each abstract must be:

  • sponsored by an IASP member,
  • presented in English – the official language of the Congress, and
  • submitted via our online submission system.

Deadline for submission: February 6, 2012

Financial Aid Available!

Financial aid is available to applicants from developing or currency-restricted countries and trainees from developed countries. IASP strongly encourage applicants to submit an abstract to the Congress.

Visit the website for full information, financial aid guidelines and to submit your online application:

Awarding-winning LIFE Before Death Series continues…

The “Life Before Death” series of short movies continue to be released, one every week. They are not only very informative to the public; but also make powerful advocacy material for the palliative care community.

Here are the 3 films released in November & December:

Thank you, Mike Hill and team of Moonshine Movies and thank you, Lien foundation,International Association for the Study of Pain, The Mayday Fund, the Union for International Cancer Control and The Institute for Palliative Medicine at San Diego Hospice International Programs.

For more information and to view the entire series, visit the Life Before Death website…

Organize Your Own “LIFE Before Death” Screening!


Mike Hill and Sue Collins of Moonshine Agencies, who produced the 50 LIFE Before Death short films, will be releasing a feature film (81 minutes) next year.

The World Premiere will be in Singapore on 2 February 2012.

Palliative care enthusiasts in most countries are organizing screening of the film for the public between that day and February 4th, which is World Cancer Day.

In Trivandrum, Pallium India plan to host a screening on February 3rd at the Museum Hall in the heart of Trivandrum.

We strongly urge you to take this opportunity for advocacy and possibly for fund-raising, by arranging a screening of the film in your locality.

Moonshine Agencies offer to provide you with the DVD, find full details about hosting a screening on their website…

To Tell or Not to Tell, That is the Question

I'm lyingIt is a very frequent occurrence for any palliative service in India to come across patients who come with no clear idea of prognosis and at times, even of diagnosis. Often even dying patients are told,

.. we shall resume chemotherapy when you are stronger.

Palliative care teams then have the difficult task not only of disclosing the prognosis, but also of helping them to cope with the feeling of rejection.

But what would really be the better choice – a patient informed of imminent death, or someone blissfully unaware of it?

A report based on a study conducted in Sweden and published in “Journal of Clinical Oncology” – comprising 1091 patients, each in informed and uninformed groups – showed that

“providing information of imminent death to a patient with cancer at the end of life does not seem to increase pain or anxiety, but it does seem to be associated with improved care and to increase the likelihood of fulfilling the principles of a good death.”

Read the report here: Information of Imminent Death or Not: Does It Make a Difference?

Neuropathic Pain Redefined

The International Association for Study of Pain, the most authoritative organization in the filed of pain management, has revised the definition of Neuropathic pain. The new definition is:

Pain caused by a lesion or disease of the somatosensory system.

IASP offers the following footnote to the definition:

Neuropathic pain is a clinical description (and not a diagnosis) which requires a demonstrable lesion or a disease that satisfies established neurological diagnostic criteria.

The term lesion is commonly used when diagnostic investigations (e.g. imaging, neurophysiology, biopsies, lab tests) reveal an abnormality or when there was obvious trauma.

The term disease is commonly used when the underlying cause of the lesion is known (e.g. stroke, vasculitis, diabetes mellitus, genetic abnormality).

Somatosensory refers to information about the body per se including visceral organs, rather than information about the external world (e.g., vision, hearing, or olfaction).

The presence of symptoms or signs (e.g., touch-evoked pain) alone does not justify the use of the term neuropathic. Some disease entities, such as trigeminal neuralgia, are currently defined by their clinical presentation rather than by objective diagnostic testing.

Other diagnoses such as postherpetic neuralgia are normally based upon the history.

It is common when investigating neuropathic pain that diagnostic testing may yield inconclusive or even inconsistent data.

In such instances, clinical judgment is required to reduce the totality of findings in a patient into one putative diagnosis or concise group of diagnoses.

The previous definition by IASP (1994) had read:

Pain initiated or caused by a primary lesion, dysfunction or transitory perturbation of the peripheral or central nervous system.

The new definition takes away the word “dysfunction”.

In their editorial commentary, “A new definition of neuropathic pain” in Pain, 152 (2011) 2204-2205, Dr Troels S Jensen and colleagues explain why…

“Clinicians with neurological training and background have found it difficult to accept conditions in which symptoms and signs were not reflected in abnormal neuropathophysiology”

The new definition also specifies “somatosensory system” instead of the earlier more vague “nervous system”.

Vitamin Supplements Associated with Increased Risk for Death

Dr M Narendranathan, Gastroenterologist, writes:

Doc gave me a cocktail of vitamins and minerals to take each morningVitamin supplements associated with increased risk for death.

New findings from Iowa Women’s Health Study, published in October 2011, showed very few benefits if any of vitamin or mineral supplements. In fact, there was a suggestion of some risk associated with several of them.

The study followed more than 38,000 women, with an average age of 62, for up to 22 years. There were more than 15,000 deaths during the follow-up period. Vitamin B6, folic acid, iron, magnesium, and zinc were associated with about a 3%-6% increased risk for death, whereas copper was associated with an 18.0% increased risk for total mortality when compared with corresponding nonuse. In contrast, use of calcium was inversely related to risk for death

In her commentary on this study, Jo-Ann Manson, MD, said,

“This report serves as a cautionary tale about the potential risks related to dietary supplements and makes the point that more is not necessarily better. In the United States, about 50% of adults are currently taking 1 or more dietary supplements, and it is a $20-plus billion annual industry. But are consumers really getting value for the money spent?” 

Arch Intern Med. 2011;171:1625-1633,1633-1634.

Nominations for IAHPC Board of Directors – DEADLINE EXTENDED

A message from Liliana De Lima at IAHPC:

The International Association for Hospice & Palliative Care (IAHPC) is proud to announce a public call for nominations to 6 seats in the IAHPC Board of Directors.

IAHPC members are invited to nominate health professionals actively working in hospice and palliative care with demonstrated interest in the development of international palliative care initiatives and issues.

Criteria for nominees

Nominees may be located in any country, have academic backgrounds and must fulfill the following criteria:

  1. Have been active members of IAHPC for at least 3 (three) consecutive years at the time of nomination.
  2. Have demonstrated work and commitment in palliative/hospice care in his/her field.
  3. Currently holding or having held a position within a teaching hospital, university or palliative care organization.
  4. Have demonstrated willingness to participate and work in the board activities including working groups and task forces.
  5. Have demonstrated interest in international palliative and hospice care issues
  6. Be able to communicate effectively in English.
  7. Candidates must have access to the Internet and hold an active e-mail account.

Criteria for nominators

  1. Be an active member of IAHPC at the time of nomination

Nomination rules

  1. Nominators may nominate one candidate only.
  2. Nominations have to be done by submitting a nomination form. To request a form contact Ms. Ana Restrepo at
  3. Please submit a copy of a current CV of the nominee
  4. Deadline for nominations is November 30, 2011 December 15, 2011

We invite members to participate in this important process by nominating a candidate. Individuals who are not members and wish to also participate, may join through our website by clicking here.

After the nomination, candidates may be contacted by the governance committee for additional information.

The term of the new members will begin on January 1, 2012 and will end December 31, 2014. The new directors will be elected by a vote of the current Directors and will be announced in December 2011.

We look forward to your participation in this process and to the nomination of candidates.

Governance Committee, IAHPC Board of Directors
(Original announcement)

November 2011 Issue of Sahayatra Malayalam Newsletter

We are happy to announce that the November 2011 issue of SAHAYATRA, our monthly Malayalam newsletter, is now available for download here…

Things are Not Very Different Between Kota Kinabalu and India!

The woman lay semiconscious with brain cancer.

The husband hovered over her – jobless now because he has to stay home to care for the wife.

The teenage daughter looked a bit lost – she works long hours in a restaurant, and really looked tired.

The crowded room with appliances, like a commode and a wheel chair, did not seem to fit in at all with any ordinary pattern of life – all seemed so familiar.

The care team – nurse Jess was in charge of this patient – did such precious work, ensuring her comfort, answering questions and reassuring the family.

The scene could so well have been from India – the ramshackle tin cottage, the ugliness of disease-induced poverty in sharp contrast with the scenic natural beauty, the care and love provided by the palliative care team – everything.

Pallium India was participating in a two day workshop in Kota Kinabalu, Malaysia – a combination of an introductory course for new doctors coming into the field, and refresher for the veterans.

It was organized by Palliative Care Association Kota Kinabalu under the leadership of Dr Ranjit Mathew Oommen and Dr Molly. It gave us the opportunity to see the Palliative Care Unit in the Government hospital headed by Dr Chitra Rajendran and to join the team on home visits led by Dr Joseph Ninan.

Congratulations on what you have achieved, Palliative Care Association!

The impact that your work makes was obvious in people’s faces, in the enthusiasm of the team, in the nature of the press reports and in what we heard of your advocacy efforts and of your fund-raising programs with participation of celebrities!

Submit Your Palliative Care Training Program

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


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


RN Diane Lebeau, from Canada, says in the 29th Life Before Death video, “End of LIfe Nursing”:

“The nurse is always carrying the plan.

For sure, the physician and the team look at the plan together, but the nurse carries it.

She brings it at the bedside,”

Indeed. That is the way it should be. 

And that is something that we in India (and in many developing countries) need to think deeply about.

Is Palliative Care Nursing adequately developed? Or at least enough to keep pace with the doctors in Palliative Care?

Some time back, when we organized a refresher course for doctors, Ms Harmala Gupta questioned it, she asked:

“Why only for doctors?” 

Why indeed? We continue to do it only for doctors too often.

Perhaps the real reason is that we are comfortable with doing it for doctors and do not have the capacity to do it adequately for nurses – despite all that Gilly Burn, the late Val Hunkin, Raelee Jensen and many others did in this country.

This is certainly food for thought. What all do we need to do to develop Palliative Care Nursing adequately?

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