Published on: August 31, 2012

Dear Friends, Happy Onam!

We bring you greetings on the festive occasion of Onam, the harvest festival of Kerala. This is the festival that every Keralite takes part in irrespective of religion, caste or creed, a time of friendship, love and  happiness.

Pallium India’s Trivandrum Institute of Palliative Sciences (TIPS) celebrated it with a feast, the whole team taking part of it including patients, family members, volunteers and professionals. Lija (one of our patients) sang for everyone.

The audience was delighted not only because of the lovely melodies that flowed out of her blessed voicebox, but also because she had come walking without support, after being wheelchair-bound for 6 years.  She conveyed to us the essence of palliative care. Thank you Lija.

Supreme Court of India’s Ultimatum Regarding Morphine Availability

The Indian Supreme Court today warned the states that their Chief Secretaries would have to appear before it if they failed to comply with its directives to ensure easily availability of “Morphine” preparations for people in pain.

A bench of justices B S Chauhan and Swatanter Kumar granted 3 weeks time to defaulting states to comply with the directive by filing affidavits, failing which it said their Chief Secretaries would have to appear in person.

The apex court passed the order while dealing with a 2007 PIL filed by Indian Association of Palliative Care pleading for access for Morphine to patients in pain in the country.  

Reported in the Business Standard:

SC ultimatum to states on pain killer for cancer patients

The Supreme Court today warned the states that their Chief Secretaries would have to appear before it if they failed to comply with its directives to ensure easily availability of “Morphine” preparations, a pain kiler for terminally ill cancer patients.

A bench of justices B S Chauhan and Swatanter Kumar granted 3 weeks time to defaulting states to comply with the directive by filing affidavits, failing which it said their Chief Secretaries would have to appear in person.

The apex court passed the order while dealing with a 2007 PIL filed by an NGO Indian Association of Palliative Care pleading for easy access for Morphine to cancer patients in the country.

Because of its possible misuse by drug addicts, the availability of Morphine preparations is greatly restricted in India and the sale is governed by the Narcotics Drugs and Psychotropic Substances Act, 1985.

Needed: More Public Demand for Access to Pain Relief

The recent edition of India’s Economic Times had the front page news item captioned:

“Cancer, HIV patients suffer as morphine supplies are hobbled by excessive regulation”

The lack of access to pain relief in India is something that should be on our collective conscience.

Those in pain and suffering are too weak to fight for their right.

We need to be their collective conscience.

Thank you, Ms Divya Rajagopal of Economic Times, for bringing the issue into focus.

India’s Shameful Situation Figures in International Press

Dr Nagesh Simha, president of Indian Association of Palliative Care, brings our attention to an article in the French newspaper Le Monde, which talks about the serious lapse of Indian legal system which prevents access to pain relief for Indians with cancer, HIV/AIDS and other diseases which cause pain.

You can read the original French version here (img) and the English Google translation, below:

Palliative Care inaccessible in poor countries

Indifference or legal restrictions in the use of opium prevent in easing pain at the end of life. A “Human Right” for the NGO Human Rights Watch

Tens of millions of people around the world do not have access to medication against pain. This is because of the indifference of authorities with respect to this problem, or due to legal and administrative restrictions in the use of major analgesics such as opioids.

In a public report in June 2011, the Human Rights Watch (HRW) organization recalled that “60% of people who die each year in the low or meager income countries, or an impressive figure of 33 million, need palliative care”. The NGO calculated that “more than 3.5 million people with a terminal cancer or AIDS die every year without adequate analgesic treatment”

One of the explanations is the single convention on Narcotics, adopted in 1961 by the United Nations. It recognizes that “the medical use of narcotic drugs continues to be indispensable for pain relief” and that “the appropriate measures should be taken to ensure that narcotic drugs should be available for this purpose”

But it says, at the same time, that “addiction is a curse for the individual and constitutes an economic and social threat to humanity” against which we must fight. A dual obligation for the States, hence, to which the International Narcotics Control Board (INCB), based in Vienna (Austria), complies with.

Read more on our blog…

Is a Dream Being Shattered?

A palliative care pioneer, the celebrated Dr Derek Doyle laments about the current status of integration of palliative care into medical practice.

Please read his moving article in the IAHPC newsletter,

I Had A Dream!

Like the great Martin Luther King ‘I had a dream!’  In my case it was shared by hundreds of fellow countrymen in the UK and countless thousands worldwide. It was an exciting dream that I prayed would become a reality – dignity and compassionate care would be recognised as basic human rights, and the principles of palliative care would be adopted as integral components of all care worldwide.

I thought my dream was coming true. First there were palliative care units, then community services, then hospital teams. Degree courses in palliative care nursing became available country-wide. Every medical school introduced palliative medicine into the curriculum (though, it must be admitted, in much more depth in some than others) and every family doctor (GP) had to demonstrate knowledge of it. There are now more palliative medicine specialists in the UK than there are neurologists and oncologists combined. There is no denying that palliative care nursing and palliative medicine are respected and now attractive to increasing numbers of young nurses and doctors.

Read the full article here…

But we from low income countries look at what you and people like you have achieved at least in the high income countries, Derek. True, there is a long way to go, but you give us hope.

Thank you for your article.

Nominations Open for South Asian Palliative Care Award

Cancer Aid Society, an Indian NGO, calls for applications from palliative care activists for an award, carrying a purse of Rs. 100,000.

Application/ Nominations are invited from Doctors, Paramedical Staff and Social Workers  with “Demonstrative Leadership in the field of Palliative Care for the Cancer Patients” from India, Bangladesh, Bhutan, Nepal,  Pakistan, Afganistan and Sri Lanka.

Applications can be made online here…

Fill this form along with the references and verifiable evidences through media and pictures in order to identify the leadership of the applicants/ nominees. Last date of Application is 12pm (India Time) 30th November 2012.

The Rs100,000 award and plaque will be presented at IAPCON 2013, 20th International Conference of the Indian Association of Palliative Care, February 2013 in Bengaluru, India.

The 2011 award went to Dr Bishnu Dutta Paudel, Kathmandu, Nepal.

The Assisted Suicide Debate & Developing Countries

Is there anyone out there thinking on behalf of developing countries?

One more state in USA (Washington state) has followed Oregon in legalizing assisted suicide. In an article on its current status, the New York Times quotes Dr Ganzini, “Everybody thought this was going to be about pain. It turns out that pain is kind of irrelevant” – It was more about a desire to be in control and to die at home.

In Ill Doctor, a Surprise Reflection of Who Picks Assisted Suicide

SEATTLE — Dr. Richard Wesley has amyotrophic lateral sclerosis, the incurable disease that lays waste to muscles while leaving the mind intact. He lives with the knowledge that an untimely death is chasing him down, but takes solace in knowing that he can decide exactly when, where and how he will die.

Under Washington State’s Death With Dignity Act, his physician has given him a prescription for a lethal dose of barbiturates. He would prefer to die naturally, but if dying becomes protracted and difficult, he plans to take the drugs and die peacefully within minutes.

“It’s like the definition of pornography,” Dr. Wesley, 67, said at his home here in Seattle, with Mount Rainier in the distance. “I’ll know it’s time to go when I see it.”

Read the full article here…

We are not surprised. In a country where pain is generally treated, is it not natural that it is not the main concern?

But the situation is so very different in countries in which most people do not have access to pain relief.

This underlines Pallium India’s argument to anyone who wishes to talk about euthanasia in India: Let us first offer palliative care to the masses, and then discuss euthanasia. True; it is easier and cheaper to end life than to care; but do we want to be as savage as to say,

“Sorry, we do not care enough to offer you available inexpensive pain-relieving medicines, but walk into our parlor; we can end your life?”

Palliative Care and Standards on the Rights of Older Persons

The UN is hosting the “Open-ended Working Group on Ageing for the purpose of strengthening the protection of the human rights of older persons” this month. Blog: Protecting the Rights of Older People – 10 reasons why we need to act.

In Europe, the Americas and Africa, regional leaders are working on new human rights instruments to protect the rights of older people.

This is a good opportunity to try to get a right to palliative care specifically included. 

Would you like your organization to be a signatory? Please email Mr Diederik Lohman of Human Rights Watch


Palliative Care in India Gets Discussed in Boston

A group of Indians of American origin got together in Boston to discuss the needs and solution regarding palliative care in India – analyzing

  • the depth of the problem
  • clarifying myths regarding addiction
  • and seeking solutions

Pallium India was privileged to be a part of this event on 2 August 2012.

Thank you Dr Sudha Mehta and Mr Girish Mehta for organizing and hosting it and thank you everyone for the participation and the support. And thank you, Dr Jerina Kapoor, president of Pallium India USA, for catalyzing it.

The Killer is On the Loose

If you live in a town where smoking has been banned in public places, it may seem like the habit is on the decline. But the global numbers tell a much different story.

The largest ever study published in the Lancet estimating prevalence of smoking among 3 billion individuals worldwide, shows that the scourge is on the increase in most developing countries including India.

The Lancet: Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys

Despite the high global burden of diseases caused by tobacco, valid and comparable prevalence data for patterns of adult tobacco use and factors influencing use are absent for many low-income and middle-income countries. We assess these patterns through analysis of data from the Global Adult Tobacco Survey (GATS).

The World Health Organization recommends six major steps for harm reduction, proven to reduce smoking rates, including:

  • protecting people from tobacco smoke
  • offering help to quit
  • raising awareness about the dangers of tobacco through warning labels and public education campaigns
  • enforcing tobacco advertising bans
  • raising the price of tobacco products

CNN report: Largest-ever tobacco study finds ‘urgent need’ for policy change

Australian Update: The Fight Against Merchants of Death

Palliative care by definition, is not only treatment of suffering, but also prevention.

So palliative care enthusiasts are happy to hear of any action which will bring in fewer clients to them.

Please read the recent news about how Australia’s highest court has upheld a Government law that mandates the removal of logos and brand colors from cigarette packaging, requiring cigarettes to be sold in olive green packets, with graphic images warning of the consequences of smoking.


World Hospice & Palliative Care Day – 13 October 2012

Join the rest of the world to celebrate World Hospice and Palliative Care Day on 13th October 2012. The theme for  2012 is:

“Living to the end – palliative care for an ageing population”

The specific palliative care needs of older people are increasingly being recognized due to the burden of non-communicable diseases on older people as well as the ageing HIV pandemic in the era of anti-retroviral therapy. As the “Worldwide Hospice and Palliative Care Online” points out in their newsletter,

The palliative care needs of older people are complex and often neglected. The issue is globally applicable and incorporates older people living with life-limiting diseases as well as the issue of older people as carers of people with life-limiting illness, particularly HIV and AIDS, in developing countries.

India has included palliative care and elder care as important targets in its Non-Communicable Diseases strategy in the next five year plan. We are looking forward to significant progress in the coming years!

Join the rest of the world in Observing the day.

You can register your event on the World Hospice and Palliative Care Day website…

Don’t forget to sign the Morphine Manifesto!

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