Published on: July 25, 2024

In April 2024, Pallium India’s Regional Facilitator, Syed Askari, and Head of Facilitation, Shalini Arora Joseph, travelled to the highest point of habitation in India – the Union Territory of Ladakh. The objective of the visit was to explore the availability of palliative care services to this land where so many Indian wars have been fought.

Ladakh has a relatively small population of 2.7 lakh, with only two districts – Leh & Kargil. Medical services are provided primarily by two tertiary hospitals – The Sonam Nurboo Memorial Hospital (SNMH) in Leh, and the Kargil District Hospital.

Syed and Shalini met the Mission Director of National Health Mission (NHM) Ladakh – Dr. Motup Dorjey and discussed the possibilities of partnering with the government healthcare facilities to enhance palliative care services. As a result of this discussion, proposals have been submitted to NHM Ladakh for capacity building and service delivery. The visiting team also met the Principal Secretary, Mr. Pawan Kotwal, State Consultant Maternal & Child Health – Dr.Rinchen Angamo, Chief Medical Officer Leh, Dr. Diskit and discussed the current status and challenges of implementing palliative care services. Apart from officials, Syed & Shalini also met the palliative care team at SNMH in Leh. The hospital currently accounts for the majority of palliative care services in the region, and is the only source of oral morphine for patients.

The SNMH team began the process of procuring oral morphine after the opioid availability workshop (OAW) conducted by Pallium India in 2021. Mr. Mohd Bashir Banday, the then Drug Controller was instrumental in making the workshop happen, and we extend our gratitude to him for consistently guiding and supporting Shalini and Syed right through their visit to Ladakh.

The team also met the Assistant Drug Controller – Ms. Nasreen Bano. She is the acting Drug Controller of Ladakh currently. With her, they discussed the challenges and possibilities for making opioids available at other medical institutes. A remarkable discovery was the fact that prior to SNMH Hospital stocking and dispensing oral morphine, all patients were dependent on the military hospital in the region for getting this important pain relief medicine. Syed and Shalini took the opportunity to meet with The Commandant of the Leh Military Hospital – Col. P. Suresh.

Kargil District Hospital has two doctors trained in palliative care – Dr. Gulam and Dr. Asif. A meeting with them and the Chief Medical Officer (CMO), Dr. Kacho Liyaqat Khan revealed that the team hopes to initiate palliative care services at the hospital shortly.

All thanks to Dr. Akhtar from Community Health Center Chitkon-Kargil, it was a seamless visit to the region of Kargil and the team could meet all people related to palliative care. Dr. Akhtar learnt about palliative care from another legendary figure in the erstwhile state of J&K – Dr. Shaad Saleem, a senior and famous oncologist in Srinagar who is respected around for his work and contribution to the healthcare of the UTs of J&K and Ladakh.

The team also met the Drug inspector of Kargil district – Mr. Mumtaz and discussed arranging morphine tablets in Kargil district hospital as soon as possible.

Pallium India runs a directory of services available across the country. In person visits help us understand ground realities, along with barriers that may hinder service delivery. It is our endeavour to make communities aware of the services that exist in their region, and to provide support by way of cross pollinating ideas, connecting those who may be working in silos and if possible, to enhance cohesion.

This visit to Ladakh in equal parts stunned us with the beauty of the landscape and the commitment to improving access to pain relief and palliative care.