April 2019 Newsletter

2019 April 1

Medical Council of India includes palliative care in undergraduate medical education

The Medical Council of India (MCI) has now added the missing link. It has included palliative care in undergraduate medical curriculum as part of its new AETCOM (Attitude, Ethics and Communication) module. Please see https://old.mciindia.org/UG-Curriculum/AETCOM_book.pdf

We call it the missing link for a reason.

Though the Government of India had created the National Program for Palliative Care (NPPC) in 2012 and though the Indian Parliament amended the draconian NDPS Act in 2014, all that had little impact because medical students were still not learning palliative care and were qualifying without seeing or learning pain management, leave alone all aspects of palliation.


Now we can fly!

And fly, we will.

Thank you, Professor Naveen Salins, head of Palliative Medicine of Manipal Academy of Higher Education (MAHE), for gifting us your analysis of the AETCOM module, indicating which disciplines the various aspects of palliative care will be taught in. Precious work! As usual, you combine brain power with sheer painstaking hard work. Your work is a great gift to our country.

Palliative sedation

This is certainly not about euthanasia: this is about treating suffering.

Every palliative care worker has come across this situation: The patient is in intolerable pain (or breathlessness or agitation) and despite all you do, continues to be so. You look up Oxford Textbook of Palliative Medicine; you google all over the cyber world; yet there is no solution in sight. The patient is in agony; the family is in agony.

Yes; this happens. Palliative care professionals are only human beings. They can get rid of much of the suffering; but not all the time.

When everything fails (refractory symptoms, if you want to get technical) and the patient is near the end of life, we discuss within the team; we discuss with the patient if he is competent to understand and take decisions, we discuss with the family, and with consensus, provide deep sedation to relieve the “intolerable suffering”.

The objective is to relieve symptoms, not to cause death. And this is not something that a palliative care team does every day; this is an exceptional situation.

Read the article titled Reflections on Palliative Sedation by the master, Dr Robert Twycross, on the latest on this ethical dilemma/imperative.

Urgent need for guidelines to communicate with children about life threatening conditions

eHospice

On 14 March 2019, The Lancet published two groundbreaking papers collating evidence and global expertise to derive core communication principles to assist healthcare professionals in communicating with children about their own life threatening condition, or that of a parent.

These papers, led by a team at the University of Oxford, highlight the importance of communicating with families about life threatening conditions in ways that can make a real difference to the traumatic circumstances in which families find themselves.

Read more: https://ehospice.com/inter_childrens_posts/urgent-need-for-guidelines-to-communicate-with-children-about-life-threatening-conditions/

Setting a trend in relieving terminally-ill of their suffering

The Hindu

Director, Care Response International and founder-director, CRI U.K. Gilly Burn has travelled the length and breadth of India, introducing palliative care, finding pioneers, getting them trained and empowering them for palliative care for over three decades. Ms. Burn visited India in 1989 to submit a report for World Health Organisation based on her assessment and recommendation on palliative care. “I am happy that my visit to the hospital in Mangalore. The suffering of the patients brought change in my life which subsequently led to founding of CRI. The aim is to relieve of pain to a large extend among terminally ill patients,” she told The Hindu.

Read more: https://www.thehindu.com/news/cities/Visakhapatnam/setting-a-trend-in-relieving-terminally-ill-of-their-suffering/article26490186.ece

Dr Sunil Kumar of Pallium India at AAHPM annual assembly, Orlando, USA

A Fulbright Specialist from USA, Professor Marcia Glass writes:

Dr. Sunil Kumar from Pallium India gave an engaging talk at the American Academy of Hospice and Palliative Medicine on March 14, 2019. Dr. Sunil was visiting after being awarded a competitive international scholar fellowship through AAHPM.

He spoke about the burgeoning field of Indian palliative care and the challenges his country has faced in this arena. He described the inspiring work of his colleagues in Pallium India and the overall structure of their program. During the Q and A session, he fielded questions about Pallium’s innovative volunteer program and their inpatient unit’s experience with ketamine (a novel drug in America that is only recently gaining traction in the U.S.). Dr Sunil did a wonderful job representing his organization and his country.

Palliative Care – Everyone’s Business

A truly inspiring and interactive session on Palliative Care at DAV (PG) College, Dehradun was co-ordinated by Pallium – Ganga Prem Project Manager, Ms. Shareena Bhaya, and conducted by Dr. Jyotsna Seth of Seema Dental College on 16th March 2019.

It was heartwarming to experience the positive / creative involvement of young students – various questions were posed by the students on whether palliative care can lead to reversal of illness, what is the success rate, do we need to stay away from cancer patients?

The faculty are also very enthusiastic to get involved long term, the college is in the process of signing a MOU with Ganga Prem Hospice towards promoting and supporting palliative care.

Memorandum of Understanding (MoU) to be signed between Ganga Prem Hospice, Rishikesh and DAV (PG) College, Dehradun in the interest of the students and the need of higher education with following areas of common interest :

  1. Creating awareness about palliative care by organizing sensitization talks in the college, on dates and venue, as per the convenience of both parties.
  2. The college will provide a platform for intimating the students, and developing compassion towards the noble works of Ganga Prem Hospice (GPH), devoted to provide palliative care to terminally ill patients.
  3. The students of the college selected as volunteers will escort the patients to GPH, besides providing a healing balm to them through their sensitive understanding of the problems of terminally ill patients.
  4. The student volunteers will help the GPH team members in homecare visits within the city of Dehradun.

The Economist’s event in Singapore

Pallium India took part in a panel discussion on palliative care as part of The Economist’s War on Cancer event at Singapore on 29 March 2019.

Kudos to the Economist Events team for ensuring the strong presence of cancer survivors. That truly acknowledges the value of the recommendation by Astana declaration on Universal Health Coverage that “Healthcare for all has to be healthcare with all”.

Actress Gautami Tadimalla was a strong presence, sharing her personal experience with cancer. It was truly heartwarming to see how she made a lot of good to come out of her cancer experience by forming Life Again Foundation.

* Image courtesy: https://events.economist.com/events-conferences/asia/war-on-cancer-asia

Stanford acquires archive of Elisabeth Kübler-Ross

The family of Elisabeth Kübler-Ross, M.D. has donated the official archive collection of the late iconic psychiatrist, author and hospice pioneer to Stanford Libraries’ Department of Special Collections. Dr. Kübler-Ross is the legendary author of 24 books including the groundbreaking bestseller On Death and Dying, which is being published in its 50th anniversary edition.

Please read: Stanford acquires archive of palliative care pioneer Elisabeth Kübler-Ross

Some time back, Elisabeth Kubler-Ross foundation had donated a large collection of EKR’s books to Pallium India’s Elisabeth Kubler-Ross library at Trivandrum Institute of Palliative Sciences.

Thank you, Ken Ross and all at EKR foundation.

Disability Inclusive Disaster Risk Reduction and Potential Recovery Strategies in the Kerala Flood and Landslides 2018

It was Pallium India’s privilege to take part in MITRA, a 1-day workshop on Inclusive Disaster Management jointly organized by KSDMA and Care India.

Pallium India’s project officer Vyshnavi presented to the audience the efforts that Pallium India undertook to assess the health-related suffering in some disaster-affected areas and the interventions undertaken.

We hope the deliberations will make us prepared to face any future calamity optimally.

Vacancy: Junior / Senior Resident at GCRI, Ahmedabad

Gujarat Cancer & Research Institute, Ahmedabad, Gujarat invites applications to the posts of Junior Resident & Senior Resident.

No. of vacancies: 1 each

Nature of Job: Full time Residency

Qualification: MBBS or Diploma in Clinical branch for Junior Resident, MD in Clinical branch for Senior Resident

Place of Job: Dept of Palliative Medicine, Gujarat Cancer & Research Institute, Ahmedabad

Experience: As per prevailing rules of MCI.

How to apply

Interested candidates can send detailed and updated CV to drpritisanghavi@gmail.com  with email subject as “Application for the post of Junior Resident / Senior Resident”.

For more details Contact: Dr Priti Sanghavi, drpritisanghavi@gmail.com / 9825420656

Video of the month:

 

Psychological Aspects of Pain

 

Click here to watch the video: https://youtu.be/n3P6COSDMhk

(Video by Mike Hill, Moonshine Agency)

Kerala a Role Model in Making Tourism Disabled-friendly: Minister

NewsExperts.in

Kerala is the first state in the country to create basic infrastructure and amenities for the disabled in tourism centres, thereby setting itself as a role model for others, said Minister for Tourism, Kadakampally Surendran, on Saturday.

Speaking after unveiling the new initiatives of Thenmala Ecotourism Promotion Society (T.E.P.S) at a function here, the Minister unveiled a Braille Brochure on the attractive spots at Thenmala and a video brochure in sign language.

Read more: https://www.newsexperts.in/kerala-role-model-making-tourism-disabled-friendly-minister/

Opinion: The Problem With The Phrase ‘Beat Cancer’

Huffington Post

The idea that you can “beat” something as insidious as cancer perpetuates the myth that the patient is wholly responsible for their recovery, not a human caught up in an endless cycle of surgeries, chemotherapy, radiation and relapses. And if they don’t beat it? That’s failure.

Read more: https://www.huffingtonpost.in/entry/beat-cancer-phrase_l_5c7479e3e4b03a10c230c8a7

Donate to Pallium India

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:

http://palliumindia.org/donate/ (India)

http://palliumindiausa.org/ (USA)

Write to us: info@palliumindia.org

Call us: +91-9746745497 (India) / +1-718-273-8597 (USA)

All donations to Pallium India are tax deductible.

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Find out more about our courses at: http://palliumindia.org/courses/

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image06Palliative Care Information Centre

Contact Pallium India’s Information Centre (9 am to 5 p.m., except on Sundays and National holidays) for information related to palliative care and about establishments where such facilities are available in India.

Telephone: +91-9746745497
or E-mail: info@palliumindia.org
Address: Pallium India Trust, VP 80/13, Golden Hills, Venkode P.O., Vattappara, Thiruvananthapuram 695028

For more details, please visit: http://palliumindia.org/info-centre/

PARTING SHOT

The Healing Garden

Krishnaraj Nambiar, Volunteer at Pallium India, writes:

What does it take to transform a barren land into a beautiful garden? And to infuse life into the monotony of existence of people with major health issues?

Ian Wallace and his wife Dr. Anne Wallace from New Zealand showed that it could be done not with a lot of money but with a vision, a lot of grit and determination, the ability to mobilise and motivate people to lend a hand, and the use of recyclable materials that would otherwise have been wasted.

The Wallaces recently spent a month in Trivandrum where Dr. Anne was working on a project for Pallium India. She was joined by her husband Ian, a Forester. Ian was saddened by the sight of the hardened waste land lying at the far end of Pallium India’s premises. He visualised that it could be converted into a beautiful garden that would enhance the quality of lives of our in-patients. He soon set about buying the basic gardening tools of a shovel, pick axe, wheel barrow etc and working throughout the day to dig up the ground, clear it of weeds, rubble and waste. He used discarded wooden sleepers to build a compost bin (to produce vermi compost), dug and prepared pits and planted banana plants. He helped with preparing beds to grow spinach and planting seedlings of tomato, bitter gourd, egg plant, okra, mint, coriander, chilly, Roses, Lily, Bougainvilleas etc. His untiring efforts inspired a few caregivers to lend him a hand. Dr. Anne too found time to help out.

The Wallaces also raised funds for the venture from their friends in New Zealand and elsewhere, to give us a beautiful garden entirely free. We learnt many a lesson from their initiative and applaud them for such a noble gesture. Some of the plants have started yielding vegetables and are being used in our half way home and the surplus sold to staff. All proceeds from the sale go to the care of Pallium India’s patients.

Ian has aptly named the garden “The Healing Garden”.

We saw the garden truly healing people. Our lives acquired new meaning when a young woman with only three more days to live, hooked up to a syringe pump to ward off her incessant vomiting, was wheeled out to the garden and when a smile lit up her face for the first time in several days.

It was heart-warming when a gentleman with paraplegia, till then a “patient”, became a member of the healing team by untiringly engaging in painting the flower-pots. And when Ashla, our chairman’s executive assistant on her wheelchair, made a shaded area in the garden her office one day.

Read more about what the Healing Garden means to the people in our care: https://palliumindia.org/2019/01/love-made-visible/

This article wouldn’t be complete without recognising the untiring effort put in by Shriya Singh, an intern from IIM Kolkatta, Ramakrishnan the caregiver and Shambhu the volunteer consultant.

The Wallaces were filled with emotion when bidding good bye to their garden and to Pallium India. They have since been in frequent touch with us from New Zealand enquiring about the welfare of The Healing Garden.

We look forward to the day when the garden will beckon the Wallaces to make another trip to their creation.

 

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