Published on: October 31, 2016

Dear Friends,

Singing to ease pain


What a great musical extravaganza!

As a celebrated music composer and director, M. Jayachandran is not unknown to anyone in Kerala. For the third time in recent years, he conducted a musical show as a fund raiser – this time an event to raise funds jointly for Heart Care Foundation in Kochi and Pallium India. He and 14 singers volunteered their time and the audience loved every moment of it.

Thank you very much, M. Jayachandran and team!

Little Anavadya donates talent to Pallium India

anavadya-luluNine year old artist Anavadya was in the Central Hall of Lulu Mall at Kochi from 10 AM to 2 PM on 30 October 2016, to promote the musical evening to be held at 6 PM that day. Many lined up to have caricatures of themselves drawn by the little gifted artist.

Thank you and best wishes Anavadya.

A day with Dr Robert Twycross

robert-twycrossHere is an opportunity to listen to the celebrated Dr Robert Twycross, the teacher par excellence who mentored most of the first generation palliative care physicians in India.

  • IMA Kerala state branch
  • Consortium of Palliative Care Units of Ernakulam district and
  • Pallium India

join hands to conduct a refresher course in Palliative Medicine for doctors who are already trained in palliative care, as part of the state conference of IMA.

The program will be conducted at CIAL convention centre near Kochi International Airport on 12th November, 2016.

You can register on the spot.

Those who have registered for the IMA conference need to pay no registration fee. For the others, it will be ₹1000. Do take this opportunity. Click here to view the tentative program schedule.

Important message to Recognized Medical Institutions (RMIs) in India.

bookRMIs, please submit your morphine (or other essential narcotic drugs like Fentanyl) consumption data for the period from 1 November 2015 to 31 October 2016 to the drugs controller of your state by registered post, along with your estimated requirement for the coming year.

Please remember to keep a copy and evidence of posting in a separate file.

If you have any questions, please write to

WHO calls for balance in opioid policy

A new WHO document titled “The Preventable Pain Pandemic” points out examples from Mexico and India as places where progress has been made but where there is plenty of room for future work. It is 39 years now since the WHO placed morphine on its essential medicine list, and “considers it the gold standard in pain management and relief.” India also has this medicine on its essential list; yet less than 1% of the hospitals stock or use it.

It is high time the situation changed.

This WHO document calls for “balance in national policies”.

Guide for program managers from WHO

Belinda Loring and Marie-Charlotte Bouesseau from the World Health Organization write to inform that the WHO manual “Planning and implementing palliative care services: a guide for programme managers” has now been published. It is available online at this link:

We are sure that the document will be an excellent resource particularly for newly evolving palliative care programs.

Palliative care included in UN Human Rights Council resolution on the rights of older persons

From ehospice International edition:

The UN Human Rights Council has passed a resolution on The Human Rights of Older Persons ahead of the International day of Older Persons on 1 October.

Palliative care was specifically mentioned twice in this important document. The resolution also renewed the mandate of Ms Rosa Kornfeld-Matte, first Independent Expert on the enjoyment of all human rights by older persons.

Organisations and individuals working in hospice and palliative care and related fields at national and regional levels can draw on this resolution for their advocacy work.


International Congress at Montreal

Father Abraham Varghese

The biennial international congress held in Montreal is something of an institution. Initiated by the palliative care pioneer Dr Balfour Mount, it attracts wide international attendance every time. This year’s congress was held at Montreal convention centre from 18 to 21 October 2016.

Pallium India participated in 5 events. Our volunteer, Father Abraham Varghese (Abeyachan) presented a poster on spiritual care in Kerala and Dr M. R. Rajagopal gave the closing plenary talk ‘On caring – Today, Tomorrow’. Pallium India also participated in 3 different workshops; one on politics of programme development led by Dr Rajagopal, one on mentoring in palliative care led by Dr Eduardo Bruera and one on the relevance of Kerala’s community participation in western society by Dr Ann Broderick.

Pallium India’s days in Queen’s university, Kingston, Canada

Dr Christopher Booth outside his waterfront home in KingstonSince 2015, Pallium India has forged a strong tie with the department of medical oncology and epidemiology at Queen’s University in Kingston, one of the four most reputed universities in Canada. Dr Rajagopal was Visiting Professor at Queen’s university from 23rd to 25th October, 2016. During this time, he held teaching sessions separately for residents and for medical students. He also delivered the H. G. Kelly Memorial Annual Lecture on 25 October.

Pallium India has entered into an understanding with the university for continued, need-based research activities that will be helpful to our country.

We are very grateful to Dr Christopher Booth and team for making this relationship possible.


A day with the legendary Dr Michael Kearney


We are very proud of our collaborators at Tanda, Himachal Pradesh. The palliative care pioneers in the state, Professors Parveen Sharma, Rekha Sharma and Ms Rajani Arora got together to plan their first academic activity – a one day educational program for nurses.

The legendary Dr Michael Kearney, the Irish Physician who is the author of such well-known books like “Mortally Wounded”, blessed the event with his presence. (The picture shows Dr Michael Kearney and Dr Parveen Sharma).

Pallium India is proud to work with this team in initiating the first palliative care service in HP. Thank you Dorabji Tata Trust, for funding this program.

Students in Palliative Care

Students at work

Alpha Charitable Trust is one of the palliative care leaders in Kerala. Under the stewardship of the founder, Mr K M Noordeen, it achieves great heights. Recently, Pallium India had an opportunity to participate in an annual meeting of student volunteers in palliative care. We did expect a lot of participation; but the crowd was beyond our expectation. There were around 400 students in a large hall, actively participating in deliberations and contributing in numerous ways, declaring by their action that palliative care is as much someone’s responsibility as right.

We thank Alpha Charitable Trust for honouring Chairman of Pallium India, Dr M R Rajagopal, with their Alpha Excellence Award.

Remembering pain relief on World Anaesthesia Day

anaesthesia-dayThe Cochin Anaesthesia Research Society, a vibrant group of anesthetists based in and around Kochi, organized the World Anesthesia Day celebrations on 16th October 2016 with an emphasis on pain management. October 16th is a much remembered day on which William Thomas Green Morton demonstrated surgical anaesthesia successfully, and thus conquered surgical pain.

The humanist cardiac surgeon, Dr Jose Chakko Periyappuram, the founder of the Heart Care Foundation of Cochin was the chief guest. (This organization partnered with Pallium India to conduct the musical event by the noted music director M Jayachandran at Cochin on 30 October 2016.)

The event saw the honoring of the senior anaesthesiologist Dr T.A Mohanan with a lifetime achievement award. The audience was reminded of Dr Morton’s legacy and the fact that anaesthesiologists have a duty not only to make the person unconscious during surgery but also to keep them as pain-free and comfortable as possible in the perioperative period.

Misunderstandings Galore! Here is one more proof.

Despite all the news reports in the media, misunderstandings continue even among medical professionals. Despite all the declarations of the World Health Assembly and International Narcotics Control Board, pain continues to be untreated.

Please see this report: Too little, too late: Why palliative care is vastly inadequate in India

Is there not violation of our fundamental right to life with dignity when hospitals do not stock or use the essential medicine, morphine?

How can we justify medical and nursing curricula which do not include palliative care?

SC keeps out of debate on right to refuse treatment

The confusion in the public mind between euthanasia and withdrawal of life support seems to be getting deeper and deeper.

Please see the latest Supreme Court decision.

Let us hope the Parliament is not confused when the matter is placed before them.

The confusion gets confounded

How will we ever get out of the confusion? The average citizen of India continues to be confused between passive euthanasia and withholding or withdrawal of life support. The result: failure of formation of a strong public opinion.

In the month of October, we participated in 2 workshops in Kerala aimed at clearing the confusion. One was organized by Pain and Palliative Care Society, Thrissur. Led by many of the intelligentsia of Thrissur, this institution is one of the best palliative care centres in the state. Many dignitaries including the erudite education minister of Kerala state, Prof. C. Raveendranath, participated in the event.

The second was in Ernakulam organized by the palliative care department at General Hospital. This hospital has been famous for its exceptional quality of care and for public participation in health care delivery. The palliative care unit in this hospital certainly has achieved significant integration of palliative care into oncology practice. We hope these workshops and many like them that we make happen in Kerala clear the confusion in the public mind, at least upto a point.

Suicides in India: 2-day seminar in Hyderabad

A two day seminar on “Suicides in India: Tendencies, Prevention and Mitigation of the Social Crisis” was organized on 5th & 6th October, 2016 at Nizam College, Hyderabad, by the Department of Sociology, Nizam College, (Osmania University) in collaboration with Centre for Action Research and People’s Development (CARPED).

The seminar encompassed several serious deliberations on suicides and the delegates discussed on psychological, social and anthropological aspects of suicides. The topics included “Euthanasia, assisted suicide and the right to die” and “Suicides in advanced cancer”. It is a well known fact that advanced cancer patients have significant suicidal thoughts. There are methods that could be used to identify the psychiatric needs of such patients and treat them effectively with palliative care.

The seminar explored the role of community and creating awareness on palliative care in coping, preventing and mitigation of suicides.

Chittoor’s Euthanasia Seekers

The Hindu reports:
In this Andhra Pradesh district, parents unable to cough up the money needed for treatment are moving petitions seeking euthanasia for their ailing children.

For three generations Jalla Ramanappa’s family did not have a girl child. In a country where the premium on the male child knows no bounds, the Jalla family’s wish for a girl was unusual. But when his sister-in-law delivered the first baby girl followed by the arrival of his own bundle of joy, Gynana Sai, on October 10, 2015, celebrations erupted in the Jalla household.

“My brother had a son and a daughter and I and my wife yearned for a complete family like his. Our prayers were answered when Gynana was born, a year after my son Sai Teja’s birth,” says Ramanappa, a farm labourer-turned-salesman. He and his elder brother, Jalla Srinivasulu, a teacher in a private school, got married to two sisters, and live in a modest two-room house in a remote tiny village abutting the first railway station in the area that lent it the name RS Kothapalli in Chittoor district of Andhra Pradesh.


For dignified death, Jaipur needs palliative care units

Times of India reports:

Two years ago, a 40-year-old patient undergoing treatment for blood cancer committed suicide by jumping from the third floor of a city-based hospital. The incident brought to light the importance of providing palliative care for such patients and give them a dignified, pain-free and good quality of life. But, the state has fallen woefully short in creating such facilities and providing universal access to palliative care. Only a few hospitals have palliative care units in the state.

The strict norms of narcotics department for using and storing morphine, used in palliative care, is one of the major reasons hampering the setting up of palliative care units.


Kerala University of Health Sciences to brush up soft skills of doctors

Times of India reports:

Recognizing that the lack of proper communication skills is one of the main reasons for increasing conflicts between doctors and patient’s relatives, Kerala University of Health Sciences (KUHS) is focusing on developing communication skills of future doctors.

“We plan to teach communication skills to all MBBS students before internship as part of curriculum. What is happening now is that though treatment is perfect, problem starts when there is no proper communication. Properly communicating the treatment course to the patient and family is part of the treatment process. Often doctors tend to ignore it stating that they are overloaded,” said KUHS governing council member Dr K Mohanan.

Students will also be taught medical ethics and basics in palliative care before internship.


Here is a new book to read: “Two Journeys” by Usha Jesudasan.

two-journeys-usha-jesudasanYou don’t know Usha Jesudasan?

It would be a treat to get to know her. Her first work that we came across was “I will lie down in peace” in which she shared with us the agonies that her husband Dr Jesudasan went through in the last year of his life. And the agonies that she and their children went through as the medical system failed to relieve his pain and suffering.

Here in Two Journeys, Usha shares with us more of herself. The journey of her mother who lost her life to cancer and Usha’s own cancer story.

Watch this short video on Youtube; you will not regret it. And dont miss the book.

Purchase it here:

Mom is not suffering any more

A father-daughter duo recalls their personal trauma over the tragedy of losing their closest person to terminal cancer and struggling to help her cope with the pain. A case for respecting end of life choices of a patient and access to Palliative Care.

Jayanta Sinha writes in

She is my wife, my child’s mother – the most beloved one – who passed away at the age of 49 years after a painful journey of seven long months.

Smriti Kana was always a good student and aspired to be a doctor to help the poor and the needy. But her conservative parents did not extend to her much freedom and she was even prevented from taking up the job of a nurse in the Indian Army. We got married when she was 26. We quarrelled with each other, blamed each other on different occasions but never even imagined parting ways. She was my friend. We did everything after discussing, even for minor issues.


Two more stories of intensive torture

It is happening all around us, every day. It is happening to our near ones. We suffer with them and feel helpless.

Read two heartrending stories published recently in PatientsEngage and the Journal of Pain and Palliative Care Pharmacotherapy.

In the first, “The medical system failed us“, Usha Ravi, an intensive care nurse working in Australia, narrates her mother’s harrowing experience in the ICU. Eventually the author saves her from the torture chamber and takes her home only to find that she has to move heaven and earth to obtain some pain medicine.

In the second, “When Pain is Medicine“, Sindhu S. writes about the horrendous suffering that her father had to go through. This narrative also describes the feeling of helplessness. “I didn’t want to infuriate the doctors in whose hands we had surrendered his body, and who had broken down his body into isolated segments only they could put back together again, if at all,” she writes. Eventually, she hears about palliative care and decides to move him out. But the father dies that morning.

We thank the authors for sharing their story with the world. Both Usha and Sindhu must have died a thousand deaths as they relived the agony of those days, in the process of writing down their experience. Yet they did it, so that others could learn from it. How many thousands of such stories will be necessary to wake the medical world up and to infuse a bit of compassion into health care?

Life Asked Death: Palliative Care in Asia


Life Asked Death’ is a film that focuses on the suffering experienced by patients with cancer, and difficulty in morphine availability, accessibility and affordability. Produced by Moonshine Movies, ‘Life Asked Death’ highlights the scale of pain and suffering that needs to be urgently addressed in Asia, and offers insights into the positive outcomes that can be achieved even in resource-limited countries. The documentary brings viewers to Bangladesh, Myanmar and Sri Lanka to witness how Lien Collaborative’s specialist volunteers bring palliative care and training to these countries. When international experts and local stakeholders work together to develop palliative care capacity in the government-run health systems, the barriers to pain relief and humane care can be removed.

Watch ‘Life Asked Death’ now; you will enjoy it.

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Ashla Rani


“I am a quadriplegic. I came to Pallium India as a patient; now I am a full-time volunteer. I work as the chairman’s executive assistant. I also work with and help people with paraplegia and bereaved children.”

These are the words of Ashla Rani, Pallium India’a volunteer, as she addressed a thousand-odd gathering at the musical evening at Kochi on 30 October 2016.

“If given a choice, it is true, I would like to get up and walk. But it is also true that compared to my life till I was 27 and had the accident, my life has been so much more meaningful in the last few years.”

The audience broke into applause at this. Ashla continued:

“Help us. Just go to and click on the Donate button. If you give us what your family would spend dining out once a month, one person will live pain-free for a month. If you share a fraction of what you spend celebrating a birthday, a child will go to school for a whole year”.

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