June 2014 Newsletter
On 2nd June, 2014, newspapers across Kerala carried a report that a family of three was found dead in a hospital in Kanhangad. As per these reports, the parents first killed their nine-year-old son who had been admitted to the hospital, before taking their own lives. A suicide note found in the room said that they were driven to this extreme step because they were unable to tolerate their son’s unbearable, unrelieved pain.
The news points to a huge violation of human rights that exists in our healthcare system. Valuable lives were lost only because there was failure of medical aid in the form of palliative care. Palliative care involves, very often, prescription of morphine, an opioid medication. It is included in the National List of Essential Medicines. And yet, the sad truth is that majority of hospitals in Kerala do not have morphine, do not have doctors trained in palliative care and patients are denied pain relief.
Pallium India has filed a petition with the Kerala Human Rights Commission to bring attention to this issue. A copy of the petition can be seen here. We are hopeful that the Human Rights Commission will take action on this by giving instructions to all medical institutions in the state to provide palliative care with adequate stock of morphine and allied opioids.
A few days ago, we had blogged about an important resolution adopted by the World Health Assembly at Geneva. This resolution is now available as a PDF on the website of World Health Organization (WHO), and can be accessed here.
Kerala’s flag flew high during a workshop on “Innovative practices in the health sector” organized at Bhubaneshwar, Odisha on 23-24 June 2014. About 80 senior officials from all over Odisha attended the workshop where 14 innovators in health care from various parts of the country got together to listen, discuss and learn. The program was organized by the Centre for Innovations in Public Systems (CIPS).
Two innovations from Kerala found their way into the list of 14. One was the palliative care movement of Kerala, presented by the Chairman of Pallium India, Dr M. R.Rajagopal, and the other, the journey towards quality by Dr Haneesh Meerasa of Government General Hospital, Ernakulam, the latter describing the growth of a government hospital to an NABH accredited institution. Incidentally, the palliative care unit at that hospital is a very successful example for the whole country, and we congratulate Dr Mathews Numpeli as well as the doctors in the hospital for making that happen.
What will this workshop achieve? Will it help to reduce the disease-related suffering in the country?
We think, yes, because a critical mass of health activists have now been sensitized. Several people from the faculty and participants expressed interest in starting palliative care in their respective states.
Some of our readers may remember Rahmath, an exceptional patient under our treatment, who smilingly went through agonising pain and eventually succumbed to the disease while spreading light and sweetness around her. (We had written about her here and here) She and her family were in dire economic situation, but still she could give a lot. Now that she is gone, her daughter Sunitha continues to live a difficult life and tries hard to sustain her mother’s tradition.
When Rahmath died, the daughter had insisted on donating part of her meagre inheritance to Pallium India. When we protested saying that she could ill afford it, she replied, “I have no choice. I have to do it for my mother.” Eking out a precarious living with a low paid job, she continued to send money on every single death anniversary of her mother.
Recently, tragedy struck again. Her husband had an accident and died a sudden death from head injury, leaving her to fend for three of her children, 15, 12 and 10 years old. Just as the rituals following the death were going on, she called us. She was making an urgent transfer of some money to us and wanted to ensure that on the very same day, our patients in our inpatient facility and their families should be given a meal in memory of the departed.
Sunitha, you are a lesson in giving. We bow before your mother’s memory and bow in respect of your essential humanity.
(In the picture, the late Rahmath, daughter Sunitha and two of Sunitha’s children).
East India Palliative Care presents “A Musical Evening with a Difference: Music, life, death and palliative care” on Monday 7 July 2014 (6.15 pm – 8.15 pm) at The Nehru Centre, London.
The events include Welcome by Sangeeta Bahadur, Minister of Culture, followed by an Introduction by David Oliviere, Former Director of Education and Training, St Christopher’s Hospice, London.
Viola da Cunha, a mezzo soprano, accompanied by Yuki Osedo (piano), will lead the evening of music. She will include a song cycle using poems written by a patient during her last days in a London hospice. A short presentation by Dr Sankha Mitra, Chairman of the EIPC Project, will be concluded by Rabindra Sangeet performer, Dr Susmita Ghosh Mitra from Kolkata.
Pallium India is proud to be EIPC’s partner in advancing palliative care in East and North-east India.
Asia Pacific Hospice Network (APHN) had its council meetings over three days – 12, 13 and 14 June, 2014, at Hong Kong. We are glad to report about some welcome development in the region. Assisted by the Lien foundation, APHN has started a program called The Lien Collaborative which is successfully moving ahead with initiating palliative care programs in Bangladesh, Myanmar and Srilanka. We are so glad to hear of the welcome development among our neighbors!.
Kudos to Dr Cynthia Goh and Mr Weng Wai of APHN and to Mr Lee Poh Wah of Lien Foundation.
Like last year, our friends Care and Share USA and Seattle Saptaswara organized yet another successful fund raiser among Malayali crowd in Seattle, Washington. The musical event, Ganolsavam, raised $17,000 to support Pallium India’s rehabilitation programs.
Ashley from Care & Share writes to us about the event:
Seattle Saptaswara is a non-profit troupe founded in 2009 with the mission to raise funds for deserving causes through musical events. Ganolsavam is their annual event to support Care & Share’s projects in Kerala. Around 40 people, including musicians and volunteers, worked close to 4 months in planning, practising and marketing for the grand success of Ganolsavam 2014. Combined, its an effort of more than 2000 hours! Being a huge supporter of quality palliative care, Care & Share has decided to spend all the funds raised to support Pallium India’s rehabilitation projects. Kudos to Saptaswara and Seattle crowd, your support and efforts will bring hope and comfort to a number of families. For more details please visit here.
A big Thank You to Care and Share, to Seattle Saptaswara and to the Seattle Malayali community!
Udhavum Ullangal is a very successful non-government organization in Tamil Nadu, working mainly in the areas of cancer awareness and early detection. Once cancer is detected, they support the patient through treatment.
It is indeed lucky for people in Tamil Nadu that Udhavum Ullangal is now venturing into the field of palliative care in Tirunelveli. On 22 June 2014, Pallium India was privileged to join the team at Tirunelveli during the inauguration of their day care centre and new early detection unit. Their volunteers already have gone through training in palliative care at Pallium India and shortly they hope to launch a full-fledged palliative care service.
Best Wishes to Mr Sankar Mahadevan and all at Udhavum Ullangal on this new enterprise; and thank you for allowing Pallium India to be part of it.
The International Narcotics Control Board (INCB) has the huge task of controlling abuse of opioids. But the board believes in and promotes the principle of balance – that is, while abuse must be curtailed, access to pain relief has to be maintained.
Dr Liz Gwyther writes in ehospice about a meeting with Dr Lochan Naidoo, the President of the International Narcotics Control Board. Dr Naidoo is an internationally recognized addiction medicine professional. He is planning a high level review and an update of the report on opioid availability for the United Nations General Assembly meeting in 2016.
Dr Gwyther’s report also mentions Pallium India’s request for focus on the availability of low cost opioids and formulations in developing countries. Dr Naidoo noted this matter, Dr Liz Gwyther reports. She goes on to add, “Dr Raj also reminded us of the palliumindia.org/manifesto signed by 60 launch partners – including HPCA – across the world.”
Thank you, Dr Liz Gwyther and Dr Zodwa Sithole, for bringing attention to the lamentable lack of access to opioids around the world. Thank you, Dr Naidoo. Your word counts globally. We are very grateful to you.
“People only die once,” says Dr Taranjit Singh in his article “Improving quality of life of dying patients” in the Tribune dated 26 June 2014. “They (and their families) don’t always know what is available, and can’t always express preferences. Who will speak for their needs and preferences at the end days of life? Will it take another 19 years to secure funding to implement the Pain and Palliative Care policy?”
Dr Taranjit Singh is referring to the 19 years of work that it took to achieve amendment of the Narcotic Drugs and Psychotropic Substances Act of India. He is also referring to the National Program for Palliative Care (NPPC) created by the Government of India in 2012, which had its teeth extracted at the last minute, when the proposed budget allocation did not materialise.
Thank you, Dr Taranjit Singh, for your article highlighting the need for palliative care.
“India produces a third of the world’s opium, but until recently, the legislation to provide that medication was so difficult that many hospitals refused to actually stock opioids,” said Joan Marston, CEO of the International Children’s Palliative Care Network (ICPCN), in an interview with South African Broadcasting Corporation(SABC).
She also spoke about 67th World Health Assembly (WHA) at Geneva and the landmark resolution on palliative care that was passed at the event, which asks that palliative care be integrated into the health system of all participating countries as part of comprehensive care and across the life course of a person. “So it means that from the tiny little newborn baby right up to the oldest of the elderly should receive palliative care.”
You can the watch the complete interview here…
We are proud to announce that the Chairman of Pallium India, Dr M R Rajagopal, has been invited to the Governing Council of the Kerala University of Health Sciences as a nominee of the Chancellor.
The Kerala University of Health Sciences (KUHS) currently has 249 colleges affiliated to it and nearly 70,000 students enrolled in it, and has jurisdiction all over Kerala. This University has the mandate to stream line health professional education in the State, enhance and uphold its academic standards, and promote research.
We are grateful to Dr Mohandas and Kerala University of Health Sciences for this honor.
“The doctors in Senegal’s second city of Touba have long since given up trying to prescribe the drug that stops the pain of cancer. There aren’t any morphine tablets in the city. The only place it can sometimes be found is in the capital, Dakar, four hours away – but government regulations prevent them from writing prescriptions for it anyway.”
In this article titled “The African cancer patients dying in unnecessary pain” Krishnan Guru-Murthy of the Guardian writes about the unnecessary pain that patients with advanced cancer have to endure because of the lack of basic pain medication. In the absence of morphine, doctors are forced to prescribe paracetamol, and when the pain gets worse, Tramadol also.
“The World Health Organisation estimates that 80% of the world faces shortages of morphine and the vast majority of the global supply is consumed by just six countries. As Africa develops the crisis will intensify as cancer rates and populations grow.” What kind of health care systems have we created for ourselves! As J Hinton said, “We emerge deserving of little credit; we who are capable of ignoring the conditions which make muted people suffer”.
The next six weeks course for doctors and nurses will start on August 4, 2014. For more details on this course, please visit: http://palliumindia.org/courses/ccppm/
Contact: email@example.com, (+91)9746746530
At our associate centre in MNJ Institute of Oncology in Hyderabad, the next four weeks course will begin on 7 July, 2014 and end on 2 Aug 2014. For more details on this course, visit: http://palliumindia.org/courses/hyd_ccppm/
Contact: Ms. Vineela Rapelli – Program Coordinator, firstname.lastname@example.org, (+91)91772 38901
Details on all these courses are available at http://palliumindia.org/courses/
For more information about any of our courses, please write to us: email@example.com or call us: (+91)471-2440306
Pallium India’s 2-day Volunteers’ Training Program is scheduled for 17 and 19 July, 2014. Write to firstname.lastname@example.org or call +91-471-2440306 to register. If you are unable to attend this training, you could register for one of the subsequent sessions on August 21 & 23 or September 18 & 20.
For more information on the different courses we offer, please visit:http://palliumindia.org/courses/
Doctors, Nurses and Data entry operators wanted at RK Birla Cancer Center, Sawai Mansingh Medical College Hospital, Jaipur and Sampurnananda Medical College, Jodhpur.
- Medical Officer for Palliative Care
Qualifications: MBBS/MD/MS; RMC registered doctor is preferred. MBBS from MCI recognized medical college with more than 5 years, RMC registered doctors can also apply.
- Palliative Care Nurse
Qualifications: B.Sc. Nursing from NCI recognized nursing college, RNC registered, is preferred. GNM nurse with more than 5 years of experience can also apply.
- Data Manager cum Counsellor for Palliative Care
Qualifications: MSW with training in computer applications is preferred. Minimum BCA or RSCIT or ‘O’ level (or higher) training in computer applications can also apply.
For more details and to apply, please visit: http://palliumindia.org/2014/06/vacancies-in-rajasthan-jaipur-and-jodhpur/
What crime did the child do to be deprived of any care?
It was a pleasure and privilege to meet Mr K. R. Raja during the inauguration of a day care centre and early detection centre for cancer at Thirunelveli. Mr Raja is on crutches, because he had poliomyelitis as a child and inappropriate intramuscular injections ensured his lower limb weakness. He is a medical and psychiatric social worker, working in Palayamkottai Central Prison. He heard about the event organized by Udhavum Ullangal (Helping Souls) and attended a palliative care awareness program.
Working with prisoners, he has an observation to make. He finds a significantly large number of men in prison who have killed their wives, possibly in a fit of anger. Raja asks, “Okay, he has killed. He is assured of at least three meals a day in prison. What crime did his child do to be deprived of any care or even to starve?”
Those children are a part of the neglected members of our society whom you and I find convenient not to see. Raja does not. He has a program to support them.
There is so much of sadness in the society; but also so much of goodness. Saddening, and heart-warming.
posted by palliumindia in Newsletter