Published on: June 30, 2012

Dear Friends,

Here is an invitation to join us at an inaugural event. This is not just another public function; we see it as another important phase in our relentless work to remove as much of disease-related pain and suffering in the country as possible.

Please join us at the inaugural function of  the WHO Collaborating Centre at Trivandrum Institute of Palliative Sciences (TIPS).

The centre which is to work with the World Health Organization on Policy and Training on Access to Pain Treatment, is being inaugurated by the Honorable Union Defence Minister, Shri A.K. Antony. Health Minister for Kerala, Shri V.S. Sivakumar will preside over the function at which many dignitaries will take part.

Do come if you can, and please be seated by 10.45 AM.

Pallium India-USA at Sevathon 2012 – July 15!

Spread the word among family & friends!

Come and enjoy delicious Indian food, live music & vibrant dance performances!

Sunday 15th July 2012 – 7.30am onwards

Baylands Park, Sunnyvale, CA


Download PDF flyer & register here:

  • Registration fees: $25 5K/10K, $40 Half Marathon.
  • If you are unable to participate in the walk or run, you can support Pallium India-USA’s work by donating here:

We look forward to seeing you at Sevathon 2012!

Morphine Manifesto Hits 3,000 Signatures!

In under five months, The Morphine Manifesto has reached the significant milestone of 3,000 signatures!

We’ve added a Spanish translation. Thanks to contributions from supporters around the World, this brings the total number of translations to NINE:  Ukrainian, Russian, Hindi, Gujarati, Assamese, Tamil, Telugu, French & Spanish. If you would like to contribute a translation, please contact us…

We’ve even had 40+ signatures via our custom Facebook application – which you can add to your Facebook profile or page!

You can read and download The Morphine Manifesto here…

Please ask your friends to sign up too.

Health Spending Around the World

Our grandmothers passed on to us the kitchen table wisdom “Health is wealth” – how did we get to forget it?

A recent Guardian report, “Healthcare spending around the world, country by country”, shows that the adage is particularly important for a resource-poor country like India, where people are the most important resource for the future.

How can we accept the Indian Government spending only 1.2% of GDP on Health? Here are the statistics.

  • 4.1% of GDP is spent on health (both Government and Private) or $132 per person
  • In India, Government spending on health is 29.2% of all health spending
  • Private is 70.8% of all health spending. How does private health break down?
    • 86.4% of health spending is ‘out of pocket’ expenses
    • 4.6% is in private health plans
  • How big is the medical system?
    • There are 757,377 doctors, which is 6.49 per 10,000 people.
    • For comparison, in the UK there are 27.43 doctors per 10,000 people.

See the Guardian Data Blog’s visualisation of the data: The health spending map of the world

(Data is sourced from the WHO 2010 statistics)

WHO Analgesic Ladder – can it be an escalator?

The pain team at Tata Cancer Hospital deserves congratulations on their several achievements – routine pain monitoring of postoperative patients and on their leadership in pain manangement activities.

On the 30th of July 2012, they started their two day pain education program under the leadership of Dr P.N.Jain, Dr Gehdoo and Dr Sumitra Bakshi. Pallium India was privileged to be part of this program.

“How rigid should be the ladder?” was a question that came up for discussion.

The group emphasized the need for flexibility in approach to the WHO analgesic ladder:

  • The concept should not prevent proper management of a patient with severe pain.
  • When someone is rolling in pain, it would be cruel to start him on step I of the ladder and gradually build the dose up over several days.
  • We may have to go straight to step III or resort to parenteral medication or interventions as appropriate.
  • “The ladder, when necessary, must become an escalator”, said Dr P.N. Jain.

Numerical Rating Scale for Pain

It should be the slave; not the master.

It’s true that most of us would like to have pain measured as the fifth vital sign. But, is there a down side to it?

Please see the article, What’s in a Number? (Medscape). It quotes the Hastings Center Report, giving a word of warning – that blind rating of pain may:

… sell short empathy, and thus, the very core of caregiving

Well, we in developing countries do not have to worry about this, do we?

Right now our problem is that pain is not seen as a problem at all and ignored.

When we do eventually get around to monitoring pain, then we need to remember that pain is not something to be measured mechanically like the room temperature, but to be explored sensitively, recognizing the suffering behind a number.

(full text is here for those without online journal access)

Dr Arunangshu Ghoshal: an important link in the history of Palliative Care in India

It happened! The MD course in Palliative Medicine started in Tata Cancer Hospital, Mumbai.

Dr Arunangshu Ghoshal (right) is the first doctor to join the three year course.

It was a pleasure to talk to him and to share his enthusiasm:

“No one knows about palliative care. Medical students must learn it.”, he said.

You have a heavy responsibility on your young shoulders, Dr Arunangshu!

Palliative Care team at Tata Cancer Hospital

Best wishes to Dr Arunangshu, and a hearty congratulations to Professor Maryann Muckaden and team, on this achievement!

Dr Rakesh Roy Receives ASCO IDEA Award

Dr Rakesh Roy from Thakurpukur, Kolkata was one of the recipients of this year’s American Society of Clinical Oncology‘s (ASCO) International Development and Education Award in Palliative Care (IDEA) award.

Congratulations, Dr Rakesh Roy. We are glad to see that you propose to engage the Government of West Bengal for promotion of Palliative Care.

West Bengal is one of the states which has not simplified its narcotic regulations yet. Opioid access is indeed a big problem and we hope we can work with you on this matter.

Ten Fellows Selected for 2012 International Pain Policy Fellowship

The Pain & Policy Studies Group (PPSG) / World Health Organization Collaborating Center has announced the selection of ten Fellows for its Cohort III International Pain Policy Fellowship (IPPF) program.

Built on the success of the previous two cohorts of this program in 2006 and 2008, LIVESTRONG (Lance Armstrong Foundation) and the Open Society Foundations (OSF) International Palliative Care Initiative are providing major funding to support these Fellows for a two-year project.

The purpose of the Fellowship is to assist low and middle income countries to improve patient access to pain medicines recommended by the World Health Organization (WHO) for pain of cancer, HIV/AIDS and other diseases. United Nations bodies, including the WHO and the International Narcotics Control Board, have expressed concern about the low consumption of controlled pain medicines in the world, especially in developing countries.

Fellows will train with the PPSG and other international experts in Madison, Wisconsin, USA during the week of 6-10 August 2012. They will develop action plans to improve opioid availability that they will implement during the next two years. Many Fellows will be accompanied to Madison by a government representative, demonstrating valuable high-level commitment to support efforts to improve opioid availability for pain management in their respective country.

This 2012 class involves ten Fellows from six countries, with a regional focus on South Asia (7) and Eastern Europe / Central Asia (3). The ten selected Fellows are:

  • Natalia Datsiuk, MPH – UKRAINE 
  • Rumana Dowla, MBBS, MPH, DipPallMed – BANGLADESH 
  • Kristo Huta, MD, PhD – ALBANIA 
  • Nadarajah Jeyakumaran, MD – SRI LANKA 
  • Farzana Khan, MBBS, MPH – BANGLADESH 
  • Priyadarshini Kulkarni, MD – INDIA 
  • Suraj Perera, MD – SRI LANKA 
  • Taalaigul Sabyrbekova, MD, PhD – KYRGYZSTAN
  • Shalini Vallabhan, PhD – INDIA
  • Nandini Vallath, MD – INDIA 

Congratulations to all the Fellows!

PARTING SHOT: When the Sufferer is a Part of You

Can you imagine a mother tying her three year old daughter to her own body with a pair of trousers every night so that the little girl would not be abused while the mother slept?

Can you imagine a mother and daughter going through life like that for more than a year, till they ran away to save the child?

We realise that this parting shot can be a little too painful. We shall spare you a lot of the hurtful details; but still feel we must share some of it – just to show how supportive some of our fellow-human beings can be and how much interaction between various professionals and volunteers can help.

A volunteer brought the young mother to us. It was obvious that her cancer was bringing her close to her end. She was in a lot of pain. We could take away some of the physical pain, but what could take away her fear for her eight-year-old daughter that those who should have been protecting her might abuse her? We had the feeling that all our morphine and symptom control were meaningless if we could not so something about the dreadful situation.

A volunteer lawyer (bless her!) came to our help. She did what few others would do. She dealt with the situation as if the sufferer was part of her own family. She advised us what to do; she went to the Child Welfare Council (a statutory body with enough authority) and did all the documentation that could protect the child on the mother’s death. The council’s representatives (bless them too!) did everything that was necessary.

Today, the mother is no more. Nevertheless we feel, could die in some peace. The child is sad; but safe. We do not want to name the volunteer, the lawyer or the humane representatives of the Child Welfare Council in these columns without their permission, but want them to know this: we see God in you.


Don’t forget to sign the Morphine Manifesto!

One response to “June 2012”

  1. Misah Paidi says:

    Well done…keep up the good job…May God bless all the people whose doing palliative care ministry…