Dear Friends, 

In memorium: Dr Manmi Talukdar

On 25 September 2012, Dr Manmi Talukdar, a budding Palliative care physician from Assam, succumbed to Hodgkin lymphoma within 2 months of diagnosis.

She was inspiring and loved by all. As Dr Dinesh Chandra Goswami, the founder of the Guahati Pain and Palliative Care Society, writes, the palliative care scene in India “has been bereaved by the irreparable loss of this noble soul”.

May her soul rest in peace.

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Join us in Trivandrum for World Palliative Care Day: 13 October 2012

A number of people who are ordinarily confined to wheelchairs or to beds will have a day of outing to celebrate World Palliative Care Day on 13 October 2012 in Shankumugham beach at Trivandrum.

The location was their choice – many said they had not seen the sea in many many years, and one young lady said, she wanted to feel the sea on her feet just once more. Many volunteers are joining to make it all happen, and our physiotherapist Sunaj has been fully immersed in the work for quite some time. Magician Nath is going to perform for them. it is his donation to the cause.

Come, join them on a day of fun and enjoyment.

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Promising Developments on Access to Opioids in India

As the Ministries of Revenue and Health are gearing up for an amendment to the Narcotics and Psychotropic Substances Act of India to simplify it and to improve access to opioids for pain relief, there is mounting public awareness about the issue. The Times of India reports:

‘We want to make end of the terminally ill painless’

NEW DELHI: The availability of morphine — the cheapest and most effective painkiller — may soon be relaxed for medical use, helping reduce acute and chronic pain suffered by terminally ill cancer and HIV patients.

[…]

[Joint secretary Shakuntala Gamlin] added, “The Act needs to be relaxed and amended. We are studying international protocols to make the Act as patient friendly as possible.”

Dr M R Rajagopal, chairman of Pallium India and a part of the panel, says at least 20 lakh people need morphine but aren’t getting it.

“Paradoxically, India is supplying opium to the whole world but our own people are dying because of misapprehensions. Two most important barriers to availability of morphine are the complicated narcotic regulations and generations of doctors having no education or exposure to it,” Dr Rajagopal said.

Read more at The Times of India…

It is heartening that the media is supporting the issue and improving public awareness.

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Indian Academy of Pediatrics and Palliative Care

The Trivandrum branch of Indian Academy of Pediatrics initiated an annual oration award in memory of the late Professor Omana Mathew, a doyen of Pediatrics who was known for her sincerity, integrity and leadership.

The first “Dr Omana Mathew Oration” was delivered on 6 September 2012 by Dr M.R.Rajagopal, the chairman of Pallium India.

We are very happy to note that the joint palliative care clinic run by Departments of Pediatrics and Pediatric Neurology of Trivandrum Medical College in collaboration with Pallium India is nearing one year of active functioning. Pallium India thanks the Trivandrum branch of Indian Academy of Pediatrics for making Palliative Care the subject of the first oration named after Professor Omana Mathew.

We also thank Professor Lalitha Kailas, the Head of Pediatrics, Professor Mohammed Kunju, the head of Pediatric Neurology, Professor Elizabeth, the medical superintendent of S.A.T Hospital and Dr Kalpana and Dr Hariprasad of the departments of Pediatric Neurology and Pediatrics for their initiative and leadership in Pediatric Palliative Care. Pallium India’s palliative care team, with Dr Sithara Raman heading the medical services, Ms Dinu heading nursing services, Mr Babykutty leading the volunteers and Mr Sunaj, the physiotherapist doing exemplary work with children, deserve appreciation.

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Rotarians Discuss Palliative Care

The Rotary Club of Trivandrum Suburban had a discussion on another facet of palliative care, this time on “Caring for the ill in your own family” – what to say, what not to say, what to do and what not to do.

The club has been a staunch supporter of palliative care and Pallium India is very grateful to them. At the end of the session, twenty Rotarians gave in their pledges for Pallium India’s “Share to Care” program – offering to share something for the less privileged when they celebrate a birthday, an anniversary or another event or when they observe the death anniversary of a dear one.

Thank you Mr NRU Kartha, president of Rotary Club of Trivandrum Suburban, and all members of the Club for your kind gesture.

If any of our readers would care to join the “Care to Share program” please visit palliumindia.live-website.com/sharetocare

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Fellowship in Palliative Medicine at Christian Medical College, Vellore

Applications are invited for the Postgraduate Fellowship in Palliative Medicine offered by Christian Medical College, Vellore.

• It is a one year, stipendary, full time course for MBBS doctors; accommodation will be provided.
• The last date to download the application form is 20th October 2012
• Last date of submission of filled application form is 26th October 2012

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Dr Sushma Bhatnagar Receives IASP Excellence Award

Dr Sushma Bhatnagar, received the prestigious “IASP Award for Excellence in Pain Research and Management in Developing Countries” for her work in ‘Clinical Research or Practice and/or Policy Changes in Pain Management‘.

Dr Bhatnagar is Head of Anaesthesiology, Pain and Palliative Care at Institute-Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences (AIIMS), New Delhi.

The award was presented at the 14th World Congress on Pain in Milan, Italy, August 27-31,2012.

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LIFE Before Death Receives Another Award!

Moonshine Movies and Palliative Care Australia have received an Arts & Health Foundation Award – State Winner in the Australian Business Arts Foundation Awards for the “LIFE Before Death” movie.

Above: Yvonne Luxford, CEO, Palliative Care Australia; Deborah Mills, Director Policy & Strategy, Arts & Health Foundation; Sue Collins, Moonshine Movies; Mike Hill, Moonshine Movies.

Arts & Health Foundation Award is “For partnerships between healthcare organisations and businesses, and arts or cultural organisations that improve the health and wellbeing of individuals, groups or a community.”

This is the project’s 5th Award to date. Congratulations Mike and Sue!

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Excellent News from Trichy, Tamil Nadu

The National Rural Health Mission (NRHM) and the Government of Tamil Nadu join hands with Sudarshana Pain Relief and Palliative Care Service to survey the district, identify the needy patients and to provide palliative care to them.

Sudarshana Pain Relief and Palliative Care Service was founded by Dr Mohanasundaram who organized the national conference of the Indian Association of Palliative Care a few years back.

The NRHM has been very active in palliative care in Kerala for the last several years.

It is heartening to see that the movement is spreading far and wide elsewhere.

Hearty congratulations to the pioneer, Dr Mohanasundaram!

• Read more at The Hindu: Relief for terminally ill at doorstep

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Royalty Supports Palliative Care

Dr Ednin Hamza, CEO and medical director of Hospis Malaysia informs us about the visit to Hospis Malaysia by Royalty – the Duke and Duchess of Cambridge.

Media reports:

• Washington Post: Kate, stresses palliative care for children…
• The Telegraph: Duchess of Cambridge helps terminally-ill boy find smile again – Full speech
• Malaysia’a Star Online: It’s Prince Charming himself
• Watch the video produced by EACH, shown to the Duke & Duchess on our blog.

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Some Welcome Pharma News for India

In a recent case, The Delhi High Court held that Indian pharmaceutical company Cipla has not infringed upon the patent right of Swiss drug company F Hoffman La-Roche on a cancer drug.

Dr B Ekbal, former Vice chancellor of Kerala University, informs us about this welcome news which may have a significant and positive impact on our work:

The Delhi High Court took up the first patent case in India under the patent regime implemented from 2005 onwards. Roche was marketing the drug Tarceva for management of advanced or metastatic non small cell carcinoma of lung in India from 2007 onwards. The drug costs Rs 4800 per capsule and Rs.1, 44,000 for one month’s course of treatment. Tarceva is the brand name of Erlotinib which acts by inhibiting the epidermal growth factor for which Pfizer holds the original patent from US and European Union Patent Offices. Roche is licensed by Pfizer to market the drug in India and subsequently got the patent rights in India in 2007.

Meanwhile, Cipla announced that they are going to market the generic version of Erlotinib priced Rs 1600 per capsule i.e. Rs 48,000 for a month’s treatment. Roche then filed the case arguing that Cipla for violating the rule 48 of the Indian Patent Act which gives exclusive right to the patentee of a product to prevent any third party from non consensual usage of the product.

Cipla opposed Roche’s case by invoking rule 3(d) of the Indian Patent Act to argue that the Erlotinib is not a new drug at all and hence the patent given to the drug is not valid. This drug is only an improvement of the existing “prior art” as Quinazoline compound that inhibits growth factor. It is a derivative of a known compound and hence not patentable under section 3(d) of the Indian Patent Act. Cipla also pointed out that the patented product is a derivative of Gefitnib of Astra Seneca for which patent was refused in India on the ground that the compound was already in public domain.

The Delhi high court accepted Cipla’s arguments and gave a verdict against Roche. The Delhi High Court ruling in effect endorsed the validity of rule 3(d) and hence will have strong positive impact on the Novartis case on Gleevec – one that is waiting to be heard by the Supreme Court of India.

• Economic Times: Cipla’s patent win against Roche boosts hopes of generic drugmakers

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PARTING SHOT

Look up the “side effects of chemotherapy” on the web and you are likely to find anywhere between 15 to 30 of them listed – along with the treatment for each. But none of those words might describe what it “feels” like to go through the process.

In the most recent New York Times “Well” blog posting, Suleika Jaouad describes it day by day. Not only what she went through, but also what she felt she could do or would like to do. Like a hug to the girl whom she finds in the next bed.

When you include “feeling miserable” among the side effects, perhaps you could include “loving hugs as many times a day as possible” in the “treatment of side effects” column too.

Life, Interrupted: Five Days of Chemo

Day 1No matter what I do — skip breakfast, set multiple alarms or go to sleep early the night before — I always seem to arrive at the hospital exactly 30 minutes late for my appointments. Today is Monday, and it’s the first of five straight days I’ll go to the hospital to receive outpatient chemotherapy injections. Then I get three weeks off. Then another week of chemo. And so on. My doctors say this will be my routine for the next year.

My 30-minute lateness buffer has become so consistent, I’m almost proud of it. I am on time, but it’s my time. Maybe I’m secretly hoping that if I show up late enough I’ll just be let off the hook, told I can take the day off. I set out for the hospital by cab; it’s the only way I can travel, for now, because with my weak immune system, public transportation is still off limits.

“Your eyes look red,” Abby says when I finally arrive. She’s one of my favorite nurses.

I’m just tired, I begin to tell her, which is true. I haven’t been sleeping so well lately, a mix of restlessness and staying up late watching movies. Then all of a sudden I find myself tearing up. Then full-on crying.

The crying surprises me, but I’ve been feeling down ever since I learned I would need to start chemotherapy again. Even though my recent biopsy results show no cancerous cells, my doctors say new research shows that for patients with high-risk leukemia, preventive chemo may be beneficial after a bone marrow transplant.

An attendant comes to the room to tell me that they are ready for me in the infusion suite. “I’m sorry,” I tell Abby as I start to cry again. “I’m just really tired.”

Read the rest here…

• Read Suleika Jaouad’s full LIFE, INTERRUPTED series here…
• VIDEO – The First 100 Days

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Don’t forget to sign the Morphine Manifesto!