December 2017 Newsletter
Thanks to Ms Phuntsho Om and Ms Tara Devi, who took the initiative to find us and to come to us for a six weeks course in Trivandrum in 2016, palliative care is growing roots in Bhutan. Not only did they start a palliative care service after their return to Thimphu; they got the support of the administration leading to training of several more professionals.
Thank you, American Society of Clinical Oncology (ASCO), for organising a three-day workshop on palliative care on 15-17 November 2017 and for the opportunity given to Pallium India to be part of it. Congratulations Vanessa Eaton and Vanessa Sarchet for the excellent organization, and Anna Antonowich, Dr Habib Ghaddar, Dr Cynthia Goh and Dr Pendharkar and others who joined the faculty to provide an academic feast.
Last but not least, let us express our admiration for the exceptional audience. The organisers had hoped for about 60 participants; but more than 85 turned up. The enthusiasm was palpable and the whole program, very interactive.
Dear friends in Bhutan, we look forward to working with you to make sure that palliative care service reaches all who need it.
Some revolutions creep up on you without you realising that it has happened already. Such an event happened in Bengaluru initiated by Dr Roop Gursahani, the neurologist from Indian Academy of Neurology, Mumbai in collaboration with Karunashraya hospice, Bengaluru on 10, 11, 12 November 2017.
The Radisson Blu Atria witnessed about 35 neurologists from all over India, many of them very senior and well-known members of the profession, getting together for three days of discussion on palliative care in neurology. Those who have gone through the early years of palliative care development in the country, the struggles and the conflicts, would find it hard to believe that this initiative came from the neurology fraternity which felt the need.
Can you blame us for being optimistic, very optimistic, about the future?
Dr Roop Gursahani, Pallium India thanks you for the opportunity to be part of this historic and very worthwhile event.
Read the article in the Huffington Post by Dr Katherine Pettus PhD, Political Theorist, Advocate for Improved Access to Internationally Controlled Medicines and for Rights of Older Persons: Religionless Palliative Care and the new WHO Draft Program of Work
What a tireless advocate! Thank you Katherine, for giving Pallium India the opportunity to work with you.
Do you remember the joy of sending and receiving Christmas and New year cards?
The staff, volunteers and patients of Pallium India have put in their sincere effort, with love to bring out beautiful handmade Christmas & New year greeting cards, as part of our Vocational Rehabilitation Training Program.
So, what are you waiting for? Take a pen and write affectionate messages and sign on these cards – and relive those days!
To purchase these lovely greeting cards, please contact Reshma, MSW, at 9745066002. E-mail: email@example.com
“Ashla Rani, a paraplegic, lives a productive, fulfilled life, with a job, friends and family,” writes Athira M, in the Hindu dated November 27, 2017. In an article titled “Always look on the bright side of life”, Athira describes Ashla’s journey from being a software engineer working at Chennai to Pallium India, Trivandrum.
Mike Hill and Sue Collins of Moonshine Agency have done us a huge favour by creating the film Hippocratic, the story of palliative care in India, highlighting the need and possible solutions to the current situation. The producers of the movie and Pallium India seek volunteers willing to translate the script of the narration from English to Hindi, Bangla and possibly other regional languages, for subtitles / voice-over, so that the message of the movie can reach more people.
Anyone with the necessary language skills and computer access, who are interested to volunteer, please contact us: firstname.lastname@example.org.
Recognising the huge need for palliative care education of medical and allied professionals in the country, Pallium India’s Trivandrum Institute of Palliative Sciences (WHO Collaborating Centre for Training and Policy on Access to Pain Relief) announces online educational program to introduce pain and palliative care concepts to doctors (MBBS /BDS). This enhances skills for better pain and symptom management through patient and family oriented comprehensive approach.
Eligibility: MBBS /BDS (registered).
- Laptop/tablet/smart phone with internet connectivity. If using a desktop, it needs to be connected to webcam and microphone-speaker.
- All lessons will be imparted on the ECHO platform using Zoom, which is free of cost
- Case presentations
- Video demonstrations of procedures
- Reading materials
- Evaluation Criteria:
- Completed Assignments
- Scores in final exam
- Upon completion of the course, e-certificates will be provided to doctors who have attended all the session and fulfilled the evaluation criteria
- Course Fees: Rs.5000/-
- Date of start of the course: 20th December 2017
- Last date of registration: 12th December 2017
Cankids is looking for a full time physician for the country’s only stand-alone pediatric palliative care center in close proximity to two leading government hospitals in New Delhi.
The center has inpatient / outpatient and ambulatory care services and runs a special palliative care and social support OPD.
- Qualification: a fully qualified palliative care physician / MD pediatrics.
- Contact: email@example.com
The World Medical Association (WMA), on the 14th of October 2017, published a revised Declaration of Geneva, the modern version of the 2500-year-old Hippocratic oath which laid down the fundamental principles of medical ethics that any physician should follow. The document which was decided on by an international working group over a period of two years, has several differences in wording from the previous version, but to us, the following three changes appear to be the most significant.
- Respect to autonomy and dignity have been brought in. (It is surprising that it was not there in the previous version, despite autonomy being widely accepted as the over-riding principle of medical ethics!).
- While traditionally doctors have been advised to respect teachers and colleagues, the new version has gone one essential step further to include reciprocity in relationships. It says, “I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due”. Indeed! Is it not obvious that mutual respect should underpin all human relationships and would cement the right teacher-student relationship and hence facilitate learning?
- It has brought in self-care as an essential obligation of the doctor. The new version reads, “I WILL ATTEND TO my own health, well-being and abilities in order to provide care of the highest standard.”
To read a report in the Journal of American Medical Association, see
Parsa-Parsi R W; JAMA. Published online October 14, 2017. doi:10.1001/jama.2017.16230
Pallium India is very pleased to report that our colleague Dr Geeta Joshi, who recently retired as Prof and Head of Department of Palliative Medicine as well as Deputy Director of Gujarat Cancer Research Institute, Ahmedabad, is the winner of this year’s SAARC award for Excellence & Leadership in Palliative Care instituted by Cancer Aid Society.
Dr Geeta Joshi is one of the most active champions of palliative care in the country. Pallium India had the privilege of working with her to establish a palliative care training center in her Institute. She continues to work for Palliative Care as CEO of Community Oncology Center.
We are proud to be your fellow traveler, Dr Geeta Joshi. And thank you, Dr Piyush Gupta, CEO of Cancer Aid Society, for establishing this prestigious award which carries a purse of ₹1,00,000.
Dr M R Rajagopal was named one of the 30 most influential leaders in hospice and palliative medicine by American Academy of Hospice and Palliative Medicine.
In celebration of 30 years serving the profession, the American Academy of Hospice and Palliative Medicine (AAHPM) asked its 5,000 members to nominate whom they think are the leaders – or Visionaries – in the field. They then asked members to vote for the top 10 among the 142 nominated.
Dr Rajagopal is one of 30 physicians, nurses and researchers recognized by peers for the important role he or she played in advancing the medical specialty of Hospice and Palliative Medicine.
“This program recognizes key individuals who have been critical in building and shaping our field over the past 30 years,” noted Steve R. Smith, AAHPM CEO. “These individuals represent thousands of other healthcare professionals in this country who provide quality medical care and support for those living with serious illness — each and every day.”
Pallium India was awarded Sat Paul Mittal Award of appreciation in Ludhiana on Nov 13. Mr Ashok Chitale, Pallium India’s trustee, received the award from Health and Family Welfare Minister of Punjab, Brahm Mahindra and Mr. Rakesh Mittal, the President of Nehru Sidant Kender Trust and Airtel chief.
Mr. Chitale gave an informative talk on palliative care and availability of morphine. He urged the Health Minister to act for the cause of suffering patients and also to bring controlled accessibility of morphine for medical use. Dr. Rakesh Mittal appreciated the work Pallium India has been doing.
Sat Paul Mittal National Award was instituted by Nehru Sidhant Kender Trust for outstanding services to humanity. The Trust was founded by the late Congress MP Sat Paul Mittal in 1983 to propagate the ideologies of Pandit Jawaharlal Nehru.
Six states in the USA “have taken the unusual step of using their legal authority to declare their opioid overdose situation an emergency”. See the article Emergency Legal Authority and the Opioid Crisis by Lainie Rutkow in the New England Journal of Medicine, November 15, 2017.
This declaration gives the authority to state government to take the required steps to combat the emergency.
Let us hope that the steps taken will not be knee-jerk reactions and would see the other side of the coin too.
Opioid overdose deaths could well be the current major problem in the USA; but the world over there are two kinds of opioid crisis. And globally, the bigger crisis is the pain burden and serious health-related suffering caused by lack of access to opioids to treat pain.
Let us remember the principle of balance: we have a duty to contain the current problem of non-medical use of opioids; just as we have a duty to make opioids available for those who need them desperately. Like this man.
“In our country, we are all the time talking theoretically about whether there is a right to live or die, whether euthanasia should be allowed, is it socially acceptable, is it right by the person. We are not touching the core issue, which is, how to care for those people who are facing incurable or terminal illnesses.” These are the words of Dr Raj Kumar Mani, CEO (Medical) Nayati Healthcare and Chairman, Critical Care & Pulmonology. Dr Mani was the author of the first ethical guidelines on End of Life Care in India, prepared on behalf of the Indian Society of Critical Care Medicine in 2005.
In an article titled It’s Our Dignity-in-Death Moment, published in the Open Magazine on November 10, 2017, Madhavankutty Pillai explains why India must legalise Living Wills and remove the confusion over euthanasia and End Of Life Care.
At present, a five-judge bench of the Supreme Court is hearing a public interest litigation filed by the NGO Common Cause on legalising Living Wills – advance directives by a person on what to do about pulling the plug should he be kept alive on artificial support and unable to communicate his desire to die. The Constitution Bench is also going to clarify the legal position on the right to die. In court, the Government argued that it had a draft bill on passive euthanasia ready but it was still not okay with Living Wills.
This informative article throws light on many sides of the issue. Please read: http://www.openthemagazine.com/article/society/its-our-dignity-in-death-moment
(Photo by Ruth Fremson)
There is a huge dichotomy between “the internal view” (as Amartya Sen calls it) of the healthcare system and the external view of the man on the street about what the purpose of healthcare is. Is it to consider health as a commodity, generating as much profit out of healthcare as possible, concentrating on prolongation of the heart-beat and not caring about the suffering associated with health issues? Surprisingly, many health professionals and many laymen believe so. The man on the street is totally confused and suspicious.
And everyone looks for easy solutions.
It is time we choose to look at the problem in all its complexity, identify solutions even if difficult and to address them. The solutions include:
- A discussion involving medical ethicists, health care managers, and social activists about the duty of the medical profession being not only to cure diseases but also to treat serious health-related suffering (SHS).
- A clear enunciation by statutory bodies like Medical Council of India and Indian Council of Medical Research that the duty of the medical profession is not only to cure; but rather, as the 14th century aphorism taught us, “to cure sometimes, relieve often and comfort always”.
- Rational re-drafting and enactment of the end of life care law that has been pending with the Government of India since mid-2016.
- Inclusion of palliative care as an essential part of health care and education as envisaged in the new health care policy of India and in the world health assembly resolution of 2104.
True; it will take time and effort, but if we do not start the process now, the current abysmal situation can deteriorate even further.
Palliative secondary-level care services will be extended to all community health centres (CHCs) in Kerala, Health Minister K. K. Shylaja has said.
At the secondary level, palliative care units are functioning in district and taluk hospitals with the help of the National Health Mission (NHM). A separate staff nurse, a doctor and physiotherapist have been appointed by the NHM for the same. The services offered include inpatient care, tracheostomy care, colostomy care and physiotherapy.
Every child with special needs will now get free education upto the age of 18, according to new orders by the Centre. The states have been asked by the Human Resource Development (HRD) ministry to make suitable modifications in the curriculum and examination system to meet the needs of such students.
This is the heart-warming moment when ambulance workers took a palliative care patient to the beach, while still in her hospital bed, to fulfil her dying wish.
The Queensland Ambulance Service posted a photo of a paramedic called Graeme standing beside a woman in a hospital bed overlooking the water at Hervey Bay, a coastal city in Queensland. Hervey Bay Officer in Charge Helen Donaldson said the woman’s dying wish was to visit the beach again.
Dr Rajagopal, Chairman of Pallium India, writes:
This is Gabriel Hebb from Woodend, near Melbourne. His chicken farm has eleven hens.
He collects their eggs and does a biweekly round in the neighbourhood, selling them. He is quite an impressive salesman.
We were in his home when two guests dropped in. He said hello to them and asked “Don’t you need eggs?” A few minutes later, the visitors walked away with their purchase.
Gabriel is not only a salesman but also a liberal donor. He generously and spontaneously donated his earnings to Pallium India.
Thank you, Gab!
Our heartfelt gratitude to Sharing Care, a non-governmental, not for profit, charitable organisation based in Ireland, for their support to Pallium India’s educational program. Sharing Care has made a significant donation to support the education of 50 students whose family members receive palliative care.
Sharing Care envisions a world where all have access to good quality education and health care system; a world where all enjoy a decent standard of living. Sharing Care is dedicated to support people living in extreme poverty to achieve major improvements in their lives.
The 25th Annual Conference of the Indian Association of Palliative Care (IAPCON 2018) will be held from 23rd to 25th February, 2018, at Jawaharlal Auditorium, AIIMS, New Delhi.
The theme of the conference is Create, Collaborate and Communicate.
For more details on the Conference, please download the brochure.
Visit the conference homepage: http://www.iapcon2018.com/
Currently, more than 15 million adults provide care to relatives, saving the formal health care system billions of dollars annually. Provision of care to a loved one can be overwhelming and often times the caregiver’s own needs fall by the wayside.
The majority of those providing care are the middle-aged adult, children and older spouses who support a parent or spouse with functional limitations. Studies have shown that caregivers are less likely to engage in preventive health behaviors due to their caregiving requirements.
The department of Palliative Care of BMCHRC, Jaipur, conducted several palliative care awareness training programmes in October, in keeping with the theme of this year’s World Palliative Care Day: “Palliative Care and Universal Health Coverage – Don’t leave those suffering behind”.
Dr. Vinita Jain, Dr. Manisha Hemrajani & Ms. Arati Hota educated the nurses in BMCHRC hospital on the basics of pain management, basics of palliative care and communication skills. Around 300 postgraduate students from diverse backgrounds were introduced to the concepts of palliative care and the role of community in palliative care. On World Palliative Care day, 14th of October, families of patients in outpatient and inpatient wards were addressed by senior nurses, to help them to understand “What is palliative care?” and “How I can help my loved one”.
The Palliative Care Department organized the screening of the movie “Hippocratic: 18 Experiments in Gently Shaking the World” on the 28th of October for volunteers, doctors, staff and nursing students of BMCHRC College of Nursing. The palliative care team of BMCHRC also participated in different TV & Radio channels to spread the message of palliative care.
Our congratulations to BMCHRC, Jaipur, for their efforts in improving awareness on pain relief and palliative care among the community.
Dr Brenda Wards writes in eHospice International:
In order to raise awareness of the hospice, a very new concept in North India, locals from the surrounding villages connected to the hospice were invited, with their children, to share the occasion with current inpatient Reshu, only 15 years old.
Please see the personal testimony from Akkineni Nagarjuna, the Indian film actor, producer and entrepreneur, who is generally loved as a super star. He describes his personal experience, both the pain of lack of access to palliative care, and the relief that his family got with palliative care.
Mr Nagarjuna, thank you for your compassion, and for acceding to our request to create this video (at your own cost!) so that the message can reach a lot of people in India.
Sasha K. Shillcutt
As a cardiac anesthesiologist, there are times I care for patients who are faced with a tough decision: to take their chance on a very high-risk surgery, or let nature take its course. It is in these times I feel most humble and most human, as I may be the last one to hear the last words they speak.
They hold my hand and look into my eyes. Often times they squeeze my hand, and I squeeze back. There is a lot that transpires between us, silently. What they are saying is this: please take care of me. Please return me safely to these people who are in this room with me. Someone loves me. Please care for them by caring for me.
The money you give will pay for essential free medicines for the poor, for their travel to the clinic or for schooling of their children, or other forms of care. Please give whatever you can. No amount is too small.
To donate, please visit: palliumindia.org/donate
Write to us: firstname.lastname@example.org / 9746745497
- Dec 3, 2017: World Disability Day – Get together at Halfway Home, Pallium India
- Dec 5, 2017: International Volunteers’ Day
- Dec 8, 2017: Extension for Community Health Outcome (ECHO) Season 2. Topic: “Interventional Pain Management: Musculoskeletal pains.” ECHO is an online learning platform through knowledge and experience can be shared. For details and to register, visit: http://palliumindia.org/courses/echo/ Contact: email@example.com
- Dec 9, 2017: 6th anniversary of Pratheeksha Palliative Clinic at Trivandrum. Get-together of the children and their families.
- Dec 18, 2017: Certificate Program in Palliative Auxiliary Nursing (CPPAN) at Trivandrum, Kerala. Contact: firstname.lastname@example.org
- Dec 22, 2017: Extension for Community Health Outcome (ECHO) Season 2. Topic: “Interventional Pain Management: Carcinoma cervix.” ECHO is an online learning platform through knowledge and experience can be shared. For details and to register, visit: http://palliumindia.org/courses/echo/ Contact: email@example.com
- Jan 15, 2018: Kerala Palliative Care Day
- Feb 23, 2018: IAPCON 2018, Jawaharlal Auditorium, AIIMS, New Delhi. Visit: http://www.iapcon2018.com/
- Feb 24, 2018: 8th Congress on PAIN – South Asian Regional Pain Society. Last date to register: 1 January, 2018. Contact: firstname.lastname@example.org Website: www.bsspbd.com
- Mar 5, 2018: 6 weeks certificate course in palliative medicine and nursing (CCPPM, CCPN) at Trivandrum. Register: http://palliumindia.org/courses/ Contact: email@example.com / 8589998760
- May 30, 2018: 3rd ICPCN Conference, Durban, South Africa. Visit: http://www.icpcnconference.org/
Pallium India’s Facebook page has over 7500 Likes.
We regularly post articles related to palliative care from around the world.
We’re also on Twitter: @palliumindia
Contact Pallium India’s Information Centre (9 am to 12 noon) for information related to palliative care and about establishments where such facilities are available in India.
Telephone: +91-9746745497 or E-mail: firstname.lastname@example.org
Address: Pallium India, Arumana Hospital, Perunthanni, Trivandrum
For more details, please visit: http://palliumindia.org/info-centre/
Meet Pema Shering in Thimphu, Bhutan.
He is an artist and paints with his feet. His creations adorn palaces and art galleries.
See http://www.simplybhutan.bt/tshering.php to read about his carvings and this triumph of the human spirit!
posted by palliumindia in Newsletter