Published on: October 31, 2013

Dear Friends,

Who said it has to be easy?

Most things that are worth doing in life do not come easy. We know it is going to be a tough call to ensure amendment of the Narcotics Act through the Parliament, but we are determined to do our best. During the last fortnight, three of our team – Dr Nandini Vallath, Mr Binod Hariharan and Dr Shalini Vallabhan, all spent about 4-8 days each in New Delhi on advocacy. Pallium India’s vice chairman, Ms Poonam Bagai who lives in Delhi, is also at it constantly.

We know that many others – Ms Harmala Gupta, Dr Nagesh Simha and Mr Devesh Malladi are three names that come to mind first – are doing their best too. We hear that the Parliament is reconvening only on or after the 4th of December.

We shall keep you informed!

–

Annual conference at Hyderabad

If you are one of those people who want to make plans early, do please note: The 22nd International Conference of Indian Association of Palliative Care is going to be held at Hyderabad from 13 to 15 February 2015.

We are all rather proud of the success of the Hyderabad center. Started in 2006 as a joint project of INCTR and Pallium India working with the MNJ Institute of Oncology, the unit has gone from strength to strength, expanding its activities beyond the confines of that Regional Cancer Center, developing training programs, pioneering the development of an excellent pediatric palliative care service and now running a hospice too.

For details about the conference, please email mnj.palliative@gmail.com

–

New palliative care training centre at Jaipur

Pallium India is very happy to announce a major step forward. The Department of Palliative Medicine at Bhagwan Mahaveer Cancer Hospital and Research in Jaipur, Rajasthan, is announcing the starting of its new Training Centre in collaboration with Pallium India. Please join us in congratulating Dr Anjum Joad Khan and team on the achievement.

The first 6 week course for doctors and nurses starts on 25 November 2013. Please contact Dr Anjum Khan Joad – anjumjoad@gmail.com

–

We celebrated world palliative care day

Most of us would never know how it feels to experience the waves brushing against your feet, when you are paralyzed from the waist down and have altered sensations. “It is bliss!” was what Sindhu said. 12 october 2013 was the one day in the year for most of them, in which they had the luxury of getting out of the four walls that ordinarily confined them.

The palliative care team at Trivandrum Institute of Palliative Sciences led by 109 patients, many of them wheel-chair-bound, celebrated World Palliative Care Day at the seaside palliative care facility at Fathima Hospital, Thumpa.  The event was jointly organized by Pallium India and Fathima Hospital, Thumpa. Volunteer students from Malankara Catholic College, Mar Ivanios College and Mar Baselios Engineering College helped to transport the patients and to look after them.

The well-known mimicry artiste Kalabhavan George Eloor and cine artist Mr. Krishna Balakrishna entertained the audience.

–

2 day Refresher Course in Pain and Palliative Medicine at Trivandrum

Pallium India’s Trivandrum Institue of Palliative Sciences (TIPS) and Pain Clinic, Sree Chitra Thirunal Institute for Medical Sciences and Technology (SCTIMST) Trivandrum welcome you to a 2 day Refresher Course in Pain and Palliative Medicine at Trivandrum.

The objective is to update knowledge and skills in Palliative Medicine, to exchange experiences with peers, to keep abreast of the latest advances in the subjects and to create the culture of learning and self development. (Considering the feedbacks from our Delhi course in 2012, we have included more practical sessions this time.)

Date : 7-8 December, 2013

Venue : Auditorium 2, SCTIMST, Medical College Campus, Trivandrum-11.

Eligibility : Doctors who have had a minimum of 10 days’ practical hands-on training in Palliative medicine are invited.

Faculty :

• Dr. Odette Spruyt, Melbourne
• Dr. M.R. Rajagopal, Trivandrum
• Dr. Rajashree Suresh, Calicut
• Dr. Charu Singh, Cochin
• Dr. Ajmal, Thalassery

How to apply : Please click on the following link to go to the application page. Before applying keep a Cheque /DD of Rs. 1,000/- (registration fee) in favour of “Pallium India” payable at Trivandrum ready. You will be asked to enter the details of Cheque/DD to complete the application process.

Application Form

Registration fee : Rs. 1,000/-

Last date for Application : October 31, 2013

Contact : Dr. Abu Laize C.B, 9746745499, apm@palliumindia.live-website.com

Number of seats : To encourage interaction, we are forced to limit the number of participants to 30.

Welcome and Happy Learning – Organising Committee

–

Soorya festival dedicates Ms. Shobana’s dance recital to palliative care

Soorya festival is the longest and one of the most prestigious cultural events in India – conducted annually and now lasting for more than a hundred days in which the finest and most accomplished artists in Indian classical dances and music participate.

This year’s festival concluded on 10 October, with a dance recital by the famous film and classical dance personality Ms Shobana. In connection with the World Palliative Care Day, that day’s program was dedicated to Palliative Care. Speaking on behalf of Pallium India, Dr Baburaj Chakrapani introduced palliative care to the audience with a video and slide show. The audience listened, spell-bound.

Pallium India thanks Mr Soorya Krishnamoorthy, the founder of Soorya Festival and Ms Shobana, for giving visibility to palliative care and Pallium India.You can watch Ms Shobana’s dance performance here.

–

Medicos’ training: we are jubilant!

We are very pleased with the success of the “Palliative Medicos Training” that we held at Trivandrum in association with World Palliative Care Day. The three day program was held on the 8th,9th and 10th of October 2013. All 30 seats that we offered were taken up by budding doctors who had just completed their MBBS course successfully and were about to start on their one-year rotating house-surgeoncy.  Pallium India and the Department of Community Medicine at Medical College, Trivandrum had jointly organized the program. We thought that this would be a good initiation for the young doctors into practice of clinical medicine.

Here are some of the feedback from them:

• It reminded me that the patient is a person. I shall never again refer to the patient as a case.
• I think that this course has refined me. I will be a better person.
• I have learnt to respect the wishes of the patient.
• I understood why I must be a doctor with a “heart”, I have learnt the importance of compassion.
• I think I will become a doctor with a head, hands and heart.
• I learnt things that are really important in the practice of medicine; things that are not mentioned in the textbooks that I had studied.
• I learnt how to relieve pain; how to use analgesics.
• I can now support dying patients.
• I think this was a great start for my house-surgeoncy.

Thank you, dear friends, for participating in the program. Welcome to the club of doctors with a heart. Congratulations, Dr Ambu and team for making this happen.

–

Street play for public awareness

October the 2nd is a sacred day for Indians – the birthday of India’s beloved father of the nation, Mahatma Gandhi. In 2007, the United Nations General Assembly passed a resolution declaring it the International Day for Non-Violence.

On 02 October 2013, Pallium India’s volunteers and staff were joined by students from Mahatma Gandhi College and Mar Baselios Engineering College to clean Trivandrum’s popular evening get-away – the beach at Shankumugham. The Worshipful Mayor of Trivandrum Ms Chandrika herself joined the team in the cleaning campaign.

Following this, Pallium India team performed a street play to improve public awareness.  In the photograph you see Sreelekshmi, our Assistant HR manager playing the role of a patient’s wife.
The street play attracted a lot of public attention and was a great awareness tool. Pallium India’s Trivandrum team think they would be doing this more often.

–

Rotary award to Pallium India

Pallium India was the proud recipient of  Vocational  Excellence Award from the “Rotary Club of Trivandrum Suburban” on 26 October 2013.  Mr. Binod Hariharan, trustee of Pallium India received the award.

Thank you very much Rotary Club of Trivandrum Suburban.  You have always been supportive to Pallium India. We value your support greatly.

–

Asia Pacific Hospice Conference – Bangkok, 11-13 October 2013

The annual conference of the Asia Pacific Hospice Network (APHN) was held in Bangkok, Thailand from 11-13 October 2013. By getting together palliative care enthusiasts from the region, it served as an excellent resource for interaction and transmission of information.

The conference presented among other things, the success of the Lien Collaborative for Palliative Care, jointly developed by APHN and the Lien foundation (a  philanthropic house in Singapore which works in the areas of sustainable development, early childhood education as well as aging and palliative care).  The program draws on philanthropy, tertiary educational institutions, palliative care service providers and individuals to collaborate on a project designed to strengthen Palliative Care capacity and leadership. The program has been successfully launched in Bangladesh and Myanmar
The Asia Pacific Hospice Network (APHN) elected the following as office bearers.

Chairman: Dr Cynthia Goh, Singapore
Vice-Chairmen: Prof Kashiwagi, Japan; Dr M.R.Rajagopal, India
Hon Secretary: Dr Ednin Hamza, Malayasia
Asst Secretary: Dr Akhileshwaran, Singapore
Hon Treasurer: Ms Dorothy Wong, Hongkong
Asst Treasurer: Dr Ghauri Aggarwal, Australia

–

Discussion on core competencies at APHC

What competencies must a palliative care professional acquire? Just a treasure of knowledge and skills?  Or also the attitude – respect, compassion and empathy?

This was one of the matters that came up for discussion at the annual meeting of the Asia Pacific Hospice Conference in Bangkok from 11-13, 2103.
Ms Amy Lee, a hospice nurse from Singapore who had won the 2010 Humanity award for “Angelic Deeds” summed it up: “We have carelessly allowed much of our heads to take up our hearts. Being sensitive to the feeling of our patients is he very core essence of palliative care.”

–

IPPF and LDI – two major global developments

Dr Rajagopal, chairman of Pallium India writes:

The International Pain Policy Fellowship (IPPF) and the Leadership Development Initiative (LDI) have been two major developments in the global palliative care scene in the recent years.

As one of the mentors at both programs, I can say without any hesitation that these two are going to have long-terms positive impacts – they would surely lessen the burden of disease-related suffering in the world.

IPPF was the brain-child of Mr David Joranson, the founder of the Pain and Policy Studies Group (PPSG). Currently, it is directed by Dr Jim Cleary. IPPF is about to complete training of it’s third cohort of fellows. Recognizing that barriers related to legal and other issues is a common impediment to pain relief, this imaginative program brings together palliative care pioneers and government officials from various countries for a series of meetings and electronic exchanges with far-reaching effects. The third cohort just finished their two-year training with a final meeting at Bangkok, Thailand from 7-9 October 2013. From India, Dr Priya Kulkarni, Dr Nandini Vallath and Dr Shalini Vallabhan are part of the current (3rd) cohort of fellows.

The leadership Development Initiative (LDI) is directed by Dr Frank Ferris and team. The majority of palliative care pioneers around the world have been medical professionals. They would ordinarily have had no schooling at all in leadership skills – skills that would ordinarily be taught to any management professional. Recognising this, LDI selects palliative care pioneers from developing countries and brings them together for a couple of years of interaction and learning. The second cohort finished their third and final meeting at Columbus, Ohio from 12-19 October 2013. Dr Anjum Joad Khan from Rajasthan, Dr Chitra Venkateswaran from Kerala, Dr Dinesh Goswami from Assam and Dr Shoba Nair from Karnataka formed the Indian contingent.

It was a privilege to be part of two such significant programs.  The brains behind the programs have blended together compassion, imagination and expertise to change people in leadership roles and empower them to be better and more effective agents of change.

–

Meet a palliative care professional

Meet Lyden, a palliative care professional working at Kobacker house, Columbus, Ohio, USA.

He works from morning to evening, spending time with inpatients and offering companionship. If you think he looks a bit somber, well, it is just his bedside manner. He has a home which he shares with one of his human colleagues, and once he gets out of his blue uniform he transforms himself to a playful dog, full of life.

We may not really make this happen in India yet, but many palliative care facilities have a lesson to learn from the thought.  It is not just enough to offer patients a home and symptom control; they need whole-person care. And some companionship and warmth can never be provided by the best of medicines.

Mentors and participants at the Leadership Development Initiative organized by Dr Frank Ferris and colleagues had the opportunity of visiting Kobacker house and of course, of meeting Lyden. Beautiful facility!

–

IAHPC needs Advocacy officer based in Geneva.

IAHPC seeks a part-time expert to join as a Palliative Care Advocacy Officer to be based in Geneva. This Advocacy Officer will lead and further develop IAHPC’s and its members’ engagement with UN’s human rights and health mechanisms to advance the legal recognition of palliative care and pain treatment as human rights.

The Advocacy Officer will work closely with IAHPC’s Executive Director and with members of the Board of Directors. The Advocacy Officer will report directly to the Executive Director, who will provide guidance and monitoring from IAHPC’s office through email, Skype, and regular visits. The Executive Director will be supported in this supervision by an advisory committee of experts, including representatives of regional palliative care associations and international human rights organizations.

During the first few months of the project, the Advocacy Officer will receive training in basic concepts of palliative care and service provision, learning about different models of care in low, middle, and high resource countries. In addition to visiting local palliative care projects in Switzerland, a week of residential training will be arranged in palliative care settings (TBD). The Advocacy Officer will also accompany a representative from Human Rights Watch in his field work documenting reports and conducting advocacy on palliative care as a human right.

Main Responsibilities

The Advocacy Officer will work with IAHPC and member organizations to coordinate human rights advocacy on palliative care and pain treatment. This will entail participating in UN meetings, visiting country missions, helping develop shadow reports, collaborating with country delegations, etc.

Following this orientation period, the Advocacy Officer’s work will initially focus on developing a strategy for engagement with human rights and health mechanisms and laying the groundwork for effective advocacy. This will include the following activities:

• Analysis of existing standards to set benchmarks: This will entail examining treaties, resolutions, statements, jurisprudence, and treaty body interpretations to assess opportunities to address gaps in the international recognition of palliative care and access to pain treatment as a human right.
• Identification of target mechanisms: This work will focus on identifying monitoring bodies that are particularly poised to recognize palliative care and build on previous advocacy with them. These will most likely include the World Health Assembly, the Committee on Economic, Social and Cultural Rights; the Committee on the Rights of the Child and the Human Rights Council.
• Engagement of target mechanisms: The Advocacy Officer will invest in building relationships with relevant members, secretariats, mission representatives, and stakeholders. A mapping of partners will also be developed and shared with IAHPC members to enhance their advocacy efforts.
• Capacity building of IAHPC and its member organizations: This will entail working with IAHPC and its members to develop reports highlighting palliative care needs and government obligations, as well as supporting IAHPC members on effective follow-up advocacy with monitoring bodies and their national governments.
• Development of core advocacy arguments: Primers with core advocacy arguments to use with the various mechanisms will be developed for national partners and the relevant mechanisms.

Qualifications

Education

• Postgraduate qualification in international law and/or human rights.

Knowledge

• Sound understanding of the international conventions on human rights, the member states’ obligations and the mechanisms of enforcement.
• Basic knowledge of global public health.
• An understanding of current debates and directions in health and human rights and an ability to leverage these to drive outcome focused results for the palliative care population.

Experience

• Advocacy, research, and policy experience in an international setting.
• Human rights experience, preferably on health and human rights issues.
• Experience working in coalitions or networks.
• Work experience in a developing country is highly desirable.

Skills

• Strong verbal communication skills.  Public speaking experience is strongly preferred.
• Ability to write clearly and succinctly for a range of audiences, from formal submissions to short articles for social media or blogs.
• Working fluency in a relevant second language is highly desirable (e.g. Arabic, French, Russian or Spanish).
• Well organized and able to manage multiple tasks.
• Ability to respond flexibly to changing priorities and to set and work to deadlines.
• Ability to manage a budget (track expenditure / basic use of Excel etc).
• Excellent computer literacy (Word, Excel, PP or similar).

Attributes

• Self-motivated with a personal commitment to advocating for human rights and access to palliative care.
• Ability to learn quickly about new issues or advocacy targets.
• Willingness and ability to travel.
• Successful applicants will be asked to show proof that they can legally work in the USA and in Switzerland. Compensation will be done in the USA.

Recruitment Process

Please apply by sending a CV (maximum length 3 pages) and cover letter (maximum 2 pages) to advocacy@iahpc.com. Your cover letter should show why you are interested in this position and how you meet the qualifications. We will only be able to contact shortlisted candidates.

Terms and Conditions

Salary
Between $30,000 and $35,000 per year depending on experience. Salary reviews and performance appraisals are done in January every year.

Work Hours
This post requires a working week of 25 hours (excluding breaks). These hours will be worked as agreed with the Executive Director but some flexibility may be required to meet the needs of the job. There is no paid overtime.

Holidays
Holidays are 20 days per year plus bank holidays.

Length of term
Twelve months with likely renewal based on the project’s success.

Probationary Period and Notice Period
There is no probationary period for this role. The job may be terminated by IAHPC for any reason with a 30 day notice.

Location
The post is based in Geneva, Switzerland. Overseas travel will be required.

–

Dr M.R. Rajagopal Inspires Packed Crowd

Ms Sunshine Mugrabi, Pallium India’s volunteer in USA, writes:

Dr M.R. Rajagopal, Pallium India Chairman gave an impassioned and inspiring talk to a standing room only crowd on October 24, 2013. Hosted by Dr. Jyoti Lulla and Dr. Jerina Kapoor of Pallium India-USA, the evening event was held at Kaiser in Santa Clara, California.Dr. Rajagopal spoke of the urgent need to bring pain relief and appropriate palliative care to the suffering millions in India. He also shed light on the ongoing struggle for a palliative care policy by the government of India, which is progressing but has also encountered frustrating roadblocks.

In his talk he recounted the stories of two women in India who embodied the two extremes of end-of-life care. This dramatically illustrated the need for appropriate palliative care in the country. First, the story of a woman who was subjected to a kind of “high tech medical torture” in a prominent, well-known hospital in India, where she lay dying in the ICU with bright lights and unnecessary machines attached to her. The doctors there were deaf to the pleas of her daughter–who happens to be a palliative care physician in USA–for a more humane last few weeks of life. Her wishes were not honored.

“Unfortunately advance care directives tend to be ignored in Indian hospitals,” said Dr. Rajagopal, who lauded Pallium India-USA’s work in bringing the issue of Advance Healthcare Directives to the Indian community in the USA, where such documents tend to be respected and honored.

Next, he told the story of a young woman who came to him writhing in pain from advanced pancreatic cancer. Pallium India’s doctors treated her pain with morphine, which is available in the organization’s home state of Kerala at a relatively low cost.

As Dr. Rajagopal explained, relieving her pain was the easy part–as it turned out, the patient was afraid to die in peace because of fear that her 8-year-old daughter would be returned to the father who had tried to molest her. Pallium India then stepped in and helped provide legal protections for the daughter, so the woman could leave this world without fear. The happy result is that the young girl is living with an aunt and grandmother and the father is not allowed near her.

As always, Dr. Rajagopal’s quiet yet insistent tone resonated with many in the room, who shared their own stories and concerns about the need for palliative care in India, and indeed throughout the developing world. Pallium India-USA’s contributions have enabled development of a palliative care facility in Jamnagar in Gujarat, with plans for development of two  training centers, one each in Gujarat and Rajasthan.

The event was hosted by Pallium India-USA, with the generous use of Kaiser by member Dr. Jyoti Lulla, with a delicious dinner prepared by women in the group. Also in attendance was Dr. Evaleen Jones, founder of Child Family Health International, which partners with Pallium India to raise funds and awareness of the organization.In all, an inspiring, well-attended event. Click here for pictures of the event.

–

“The Hindu” highlights poor morphine consumption in Tamilnadu.

Consumption of medical morphine in Tamilnadu is second only to Kerala among Indian states. But that is really not cause for celebration because even now morphine reaches only a tiny minority of the needy.

Please see the article in The Hindu in which, among others, Pallium India’s trustee, Dr Mallika Tiruvadanan is quoted.

–

PARTING SHOT

Health tourism in India – why no pain relief?

Dr Esther Munyoro from Kenya writes to ask:

I am a Palliative Care Doctor in Kenya who is involved in caring for patients who have had treatment in India and I have also escorted Patients to hospitals in India. My concern is that even in a country with such advanced medical care patients do not have physical pain adequately addressed. When opioids are prescribed it is usually too little too late. In country that has a robust medical healthcare system with evidence-based practice why is pain not adequately dealt with?

Why indeed?  Why not relieve suffering?  Will corporate hospitals in India take note of the fact that Indian hospitals are steadily achieving a bad reputation abroad for not relieving pain?