Published on: January 2, 2025

DEMONSTRATE

“It is not given us to know who is lost in the darkness that surrounds us or even if our light is seen. We can only know that against even the smallest of lights, darkness cannot stand.”
— Kent Nerburn, Make Me an Instrument of Your Peace

Between January and December 2024, our clinical team cared for 5145 individual patients.

As part of our commitment to enhance healthcare access, we expanded our homecare services to operate seven days a week, starting from 5th May 2024.

Emotional and mental health require support in any illness journey, As of June, a team of psychiatrists led by Dr. Arya from SUT Hospital began volunteering their services to our patients, both in the facility and in their homes every fortnight.

Extensive spadework in 2024 led to the expansion of the Children’s Palliative Care Program – a new Children’s Palliative Care Outpatient Unit will launch at the Child Development Centre (CDC) on January 17, 2024. This unit will operate between 9:30 AM and noon on the first and third Wednesdays, to address the palliative care needs of children. The program aims to provide comprehensive medical care and emotional support through a dedicated team of a doctor, nurse, volunteer, psychologist, and social worker.

The Rithu initiative is a supportive community for parents of children receiving palliative care. Launched on March 24, 2024 at the Trivandrum Institute of Palliative Sciences (TIPS), Rithu provides parents much needed respite from caregiving duties, and an opportunity to express themselves, engage with other families navigating similar situations, participate in activities together and seek professional counselling services.

Community participation has been the keystone of palliative care delivery in Kerala. Over the last year, we collaborated with several groups – the Kerala Chapter of the Indian Association of Palliative Care, the APJ Abdul Kalam Technological University (KTU), the National Service Scheme (NSS), Institute for Palliative Medicine (IPM) Kozhikode and the Students Initiative in Palliative Care (SIPC) – to engage with over 200 universities and district administrators across Kerala and train over 300 community volunteers.

Recognising the importance of individual stories behind illness, the clinical team initiated a monthly Patient Story Discussion Program on 29^th May 2024 for the team to learn from real-life patient experiences, improve their understanding of patient care and approach care from a humanistic perspective.

In order to truly be a part of healthcare, it is important for palliative care to be integrated with other disciplines. We built momentum through awareness building programs with departments of Oncology, Neurology and with young physicians at the Trivandrum Government Medical college.

A new and important milestone was achieved by way of a partnership with the Military Hospital, Trivandrum. They opened a Pain and Palliative care OPD in August, marking the advent of specialised care for servicemen, veterans and their dependents.

Our Institutional Ethics Committee was re-registered with the Department of Health Research (DHR). It granted ethical clearance to five research proposals and is currently reviewing four.

In a bid to improve patient safety within our own services, we now have in place standard operating procedures for Adverse Incident Reporting, which will continue to be improved for better outcomes. We strive to build better work environments, to which end we had an all-staff orientation and training on Prevention of Sexual Harassment (PoSH), with a focus on Indian Laws and Prevention and Response to Sexual Exploitation, Abuse and Harassment (PRSEAH, with a focus on WHO regulations and requirements).

At Pallium India, we believe that our people are our greatest asset and it is an unrelenting endeavour to support our incredible team. Our commitment is not just to policies and processes but to empowering our employees and creating a workplace where they thrive. Empowerment is a cornerstone of our philosophy. We ensure that our employees have access to the resources, information, and support they need to make impactful decisions and take ownership of their work. We are proud to share that Pallium India has received the prestigious Great Place to Work certification. This recognition is a testament to our commitment to the overall wellbeing and experience of our employees.

One of our standout employee engagement initiatives is the introduction of a sports league. Understanding the wide-ranging benefits of physical activity, we launched a league featuring sports like badminton, chess, cricket, football, Carroms, and volleyball. This initiative was enthusiastically embraced by our team members, transcending barriers of age and gender. By bringing everyone together on the field, we’ve not only strengthened bonds but also celebrated the spirit of healthy competition and teamwork.

In keeping up with technological advancements, we created digital archives, implemented the Digital Personal Data Protection Act, 2023 and began the development of asset management systems.

We extend our heartfelt gratitude to our institutional donors: Azim Premji Foundation, Big Basket Foundation, Care & Share, Cipla Foundation, General Motors Technical Centre India, IQVIA, MRF Foundation, Pakhar Foundation, Pallium India Inc., Queens University, SADA India, South Indian Bank, and State Bank of India. Their generous contributions have been instrumental in sustaining Pallium India’s major projects.

We are also deeply thankful to our individual donors, whose unwavering support over the past two decades has enabled us to provide care for patients and their families.

EDUCATE

“Education is not the filling of a pail, but the lighting of a fire.” – W.B. Yeats

In 2024, the Global Fellowship Program kicked off its second batch, expanding to welcome 40 participants.

While regular foundation courses continued to be offered, we launched a new program called 5M Approach to Geriatrics in Palliative Care in formal collaboration with the Indian Association of Geriatrics (IAG) Kerala chapter. Additionally, we introduced a short course on Dry Needling with the expertise of Dr. Mary Abraham and Dr. Lakshmi Vas.

We conducted a special 5-day online course for healthcare professionals at Hakkim Sanaullah Hospital in Jammu and Kashmir.

This year marked the launch of EduPall, a dedicated Learning Management System (LMS). We held training batches for doctors and nurses from the Directorate of Health Services in Goa, along with the fourth cohort of a pain management program for oncologists in partnership with the National Cancer Grid.

Responding to the Indian Nursing Council’s recommendation to integrate palliative care into nursing education, a Faculty Development Program for nurses was initiated in collaboration with the Sikkim Nursing Council and ECHO India.

Notably, Kerala University of Health Sciences (KUHS) became the first health university in India to implement an undergraduate medical education program alongside TIPS, training 98 faculty members. Over the year, extensive training efforts led to the successful development of healthcare workers from six states through collaborations with ECHO India for the Cancer Mukt Bharat program, aiming to train Community Health Officers across India over the next three years.

In total, 421 doctors, 126 nurses, 103 allied healthcare workers, and 50 Community Health Officers were trained through online sessions, while additional in-person training reached 18 doctors and 16 nurses in Thiruvananthapuram, along with six Auxiliary nurses.

FACILITATE

“Our lives begin to end the day we become silent about things that matter.” – Martin Luther King Jr.

The Narcotic Drugs and Psychotropic Substances (NDPS) Act was amended in 2014 with a view to improve access to opioids for pain relief. However, a decade later, the implementation of the Rules across the country leaves much to be desired. We continue to engage in crucial deliberations with the Ministry of Finance and the Department of Revenue (DoR) to improve access to these essential medicines. In 2024 we collated and submitted 54 legal cases to the DoR, accompanied by multiple research papers published in collaboration with the Association for Socially Applicable Research in order to provide robust evidence to support our request. 

Our efforts in New Delhi led to a visit from Government representatives from the Central Bureau of Narcotics to TIPS. They observed the process of tracking and dispensing morphine in homecare, noting the effective measures in place to prevent diversion. The visit marked crucial support required for changes required in regulations to access and availability of essential narcotic medicines.

Visits to TIPS from the Health Minister of Himachal Pradesh and the Punjab Drugs Controller were significant milestones we achieved this year.

In 2024, our team travelled across 29 states & UTs and 72 cities, to build networks, catalyze new initiatives, and foster collaboration. Our national level outreach efforts resulted in 59974 new patients receiving palliative care through partner sites. We were able to support the establishment 69 new centers, and added 128 facilities to the national directory.

Key initiatives included 8 Opioid Accessibility Workshops and facilitating 24 new Recognized Medical Institutes (RMI) certifications across 12 states. Additionally, the team conducted a Hindi Volunteer Training Program for 240 participants from across India to engage volunteers in delivering palliative care to the patients in their community, hosted 27 awareness sessions, and facilitated a Foundation Course in Palliative Medicine and Nursing in Sopore, Kashmir.

With a focus to create access to palliative care services in the government institutes, the team collaborated with six NHMs (Haryana, Himachal, Uttarakhand, Sikkim, Nagaland and Goa) for training, facilitation and quality gap analysis.

This year, the outreach extended to remote regions, such as Ladakh, Daman, and Andaman & Nicobar Islands. Information on palliative care services from these places was added into our website directory for the first time.

These efforts underline the commitment to ensure that no region or patient is left behind.

Team members represented palliative care priorities in several high level events and conclaves across the country, including Manotsava Mental Health Festival in NIMHANS, the 8^th National Consultation on Non-Communicable Diseases, Actionable Solutions for Aging in India and others.

India has long ranked amongst the worst in terms of quality of death, as per studies conducted by the Economist Intelligence Unit in 2010, 2015 and 2021. Taking cognisance of this, we were one of the founding members of the national Advance Care Planning Taskforce that has undertaken improving death literacy across the country, with a special focus on Advance Medical Directives. Through this taskforce, we aim to engage with lay people, legislators, policy makers and the medical fraternity in order to reduce the immense suffering people are subjected to at the end of life.

Further away from home, members of our team delivered key note addresses at several events, including the Indonesia International Cancer Conference, the first Palliative Care Conference in the UAE, and the Palliative Care Congress of The Association for Palliative Medicine of Great Britain and Ireland (APM).

We are part of the WHO Working Group for Palliative care and remain engaged with international bodies, agencies and institutions to improve access to pain relief and palliative care for the global South.

Going into 2025, we extend our heartfelt gratitude to all our donors, the known and the anonymous, for all your contributions that have allowed us to complete 21 years of service. And to keep growing.

We acknowledge with love the support of all our friends and collaborators who encourage and motivate us. We remain steadfast because of you.

As we reflect on the distance travelled in the past year, we remember those for whom 2024 was the last year. We carry their light, their songs and their stories with us, so that all future encounters may be softened by them.

We wish you a year of ease, fulfilment and joy.

May compassion, truth and justice be with you.

(Prepared by Smriti Rana, Head – Strategic Programs and Partnerships, with inputs from all departments of Pallium India.)