Tramadol has been brought under Schedule H1 of the Drugs and Cosmetics Rules, 1945. It is the same list that has buprenorphine. It also has other drugs like Alprazolam, Zolpidem (which are in the NDPS Act).
The peculiar problem with Buprenorphine tablets is the condition imposed by the Drugs Controller General of India that it should only be available in select deaddiction centres. If a similar condition is imposed on Tramadol (like only select hospitals or pain centres), its availability can become a huge problem.
Even otherwise, bringing Tramadol under the NDPS Act is likely to have a chilling effect on its medical use.
Dr M. R. Rajagopal writes:
Our dear friend Bruce Davis MBE is no more.
Many palliative care activists like me, who have considered him a dear friend and benefactor, feel the pain of having a part of our very being taken away. Millions of people who have never known him have lost a friend whom they never knew.
Wilfrid Bruce Davis was born in England in 1925 into a family of businessmen and had to live with the suffering of several people with cancer in his family. On retirement, out of all his personal suffering, he made something beautiful happen. The trust that he founded, Wilfrid Bruce Davis Trust, started helping people who needed palliative care. His charitable arms extended across the length and breadth of India, from Guwahati Pain and Palliative Care Society in Assam in the North-East, to Kerala in the South-West. He funded educational efforts all over the country through the late Ms Val Hunkin and in many other ways, and helped palliative care organisations to build and grow in quantity as well as in quality.
When we had secured land from the Government of Kerala to build the Institute of Palliative Medicine at Calicut, he took it on himself to fund the whole project. An almost-shy person, he never liked the limelight. It was a matter of profound joy for us when he took part in the opening of the Institute of Palliative Medicine in January 2003. When later, some of us got together to create Pallium India for nationwide activities, he continued to support us.
His loving wife Dodo and he loved sailing. When they eventually sold their sailing boat which they had had for 32 years, the proceeds came to us to establish Pallium India’s Bruce Davis Training Centre. Since then, whenever I welcomed the participants of any course, I always started by introducing Bruce Davis to them. Both his picture and the picture of that sailing boat will continue to adorn the wall of our classroom.
Dear Dodo and family, a lot of us, his friends on the other side of the globe, share your pain and wish you strength to cope with the loss. And we shall continue our mission which we know was close to his heart.
In 2017, Pallium India entered into a partnership with Age care foundation in Vizag to initiate a statewide activity in Andhra Pradesh to promote access to palliative care, Dr N S Raju and Dr Vidya Vishwanath taking the lead.
They report of recent progress:
“Akshaya Trithiya on the 18th of April 2018 shone brightly for palliative care in Visakhapatnam! Sneha Sandhya Age Care Foundation and Two Worlds Cancer Collaborative supported by Pain and Palliative Care Services (Hyderabad) came together for a dedicated palliative care home care service with Dr Gayatri Palat making her third visit to the city. Incidentally, her first visit was to inaugurate the first hospice in the city, the second was to initiate the first IAPC Training in the State and her third was to participate in this Home Care Service inauguration of which was done by Dr Jitendra Sharma MDc and CEO of AP MedTec also known as the Med Tech Man of India. He is the architect for Universal Health Coverage for the State of Andhra Pradesh and the Adviser for Health to the Government of Andhra Pradesh.
A lively and very positive interaction followed regarding the need and urgency for a state policy in palliative care. The policy draft sent by Pallium India had been sent to him and there was a discussion about Private – Public Partnership and the need to involve NGOs for the implementation. Dr Gayatri said, “I wondered if I was travelling this far to inaugurate a van; but now I see this as a milestone and am proud to be part of this movement in Visakhapatnam!”
And may we add that our energy and enthusiasm are sustained because the catalysts and the driving force for the palliative care movement in Visakhapatnam are the stalwarts in medical oncology and palliative care, Dr D Raghunadharao and Pallium India! We are so very grateful for all this support.”
(Photo: Dr Jitendar Sharma explaining the Government’s plans to launch Palliative care services in all districts of AP)
Care and Share in Seattle joins “Saptaswara” to organise a musical event every year. This year the event was held at Kirkland performance Centre on 07 April, 2018.
It is many years since, thanks to an introduction by Dr Philomina Thuruthumaly, Pallium India has had this association with Mr Tony Devassy and Mr Ashley Elenjikkal of Care and Share, a non-profit organisation based in Seattle, USA. And they have continued to support us through the years.
For the first time, representatives of Pallium India were fortunate to attend the Ganolsavam this year. What energy! What enthusiasm! Indeed it was a privilege!
We cannot possibly thank each person enough for the warm hospitality and for the compassion.
The proceeds from the musical event will come to the famous charitable organisation Solace and also to Pallium India.
Hippocratic: 18 Experiments in gently shaking the world was screened in many North American cities during the months of March and April 2018 – Toronto, Kingston, Ottawa, Victoria and Vancouver in Canada and in New York, New Jersey, Washington DC, Boston, Columbus (Ohio), San Jose, San Francisco, San Diego, Houston (Texas) and Atlanta in USA.
Mike Hill and Sue Collins, the producers of the movie, attended the screenings in California. We are glad that they were able to be there on that leg of the journey to see how warmly the movie was received. We were unable to count the faces with tears rolling down their eyes, or the number of people who came and said how inspiring the movie was. Indeed, “life-changing experience” was the phrase used by several.
We are full of gratitude for the numerous palliative care teams in all the cities for welcoming the Hippocratic group and making us part of you.
And dear Mike Hill and Sue Collins, we cannot congratulate you enough or thank you enough.
To see the film, visit this page: http://hippocraticfilm.com/see-the-film/
Pallium India’s friend Sara Schear took the initiative to start a crowdfunding campaign to organise Ashla Rani’s travel to California so that she could meet and interact with luminaries like B J Miller and Dr. Grace Dammann.
We were indeed overcome by the warmth with which the world received the crowd-funding request. How can we thank the numerous individuals who came forward to help us in this fashion! Mary Gauwitz certainly heads the list with her generosity! How can we forget the frenetic enthusiasm and contribution of Dr Jan Stjernsward, former chief of cancer and palliative care at World Health Organisation and the immediate and warm reaction and contribution of Dr Yusuf Hamied!
No; these words are not enough. Everyone who helped, please forgive us for not mentioning each by name. But many of us have a thankful prayer for each of you in our hearts.
Dr M. R. Rajagopal writes in IndiaWest.com:
Recently, I spent an hour with a group of resident doctors and public health graduates. With World Health Day on April 7, our discussion naturally centered around health.
The conclusion: The world’s healthcare system does not provide true healthcare. Or teach it. It provides disease-focused treatment, diagnosis and cure. A bit of disease prevention on the side. And if cure is not possible, patients are told, “Sorry; there is nothing more we can do; go home.” In such a situation, going home often means receiving no support at all from the medical system, except in the form of half-hearted prescriptions for medications.
When a bed-bound, poor patient is sent away from curative treatment, how much effort goes into teaching the patient and family about preventing of suffering? Pressure sores can kill, through a slow, painful process. Constipation and urinary infections can cause untold suffering.
I told the young doctors why we provide this almost-irrational system of care which focuses only on diagnosis and cure: It is convenient for the medical system. We have the technology to delve deep into human bodies and diagnose and destroy diseases. Yes, in many cases, that is an incredible gift. But what about the consequences for the person as a whole?
Some people and some initiatives bring you strength, when you need it most. Under Dr Suresh Reddy’s leadership, Indo-American Cancer Association (IACA) took it on themselves to support educational initiatives in palliative care in India. They worked on the curriculum, made it more robust, particularly strengthening the evaluation, and raised funds to support scholarships for palliative care champions from all over the country to participate in educational programs in several locations in India. The poster reporting it won an award at the annual conference of the American Academy of Hospice and Palliative Medicine (AAHPM) in Boston, on March 17, 2018.
Congratulations, Dr Suresh Reddy and team. Pallium India is proud to partner with you.
A joint initiative of Pallium India and Prathidhwani
As a fund-raising exercise for Kuttikoottam 2018 (summer camp for children who are provided educational support by Pallium India) held from April 19 to 21, Pallium India organized a food festival at “Bhavani” in Technopark, Trivandrum. This was supported by “Prathidhwani”, the social service club of employees of various organizations in Technopark. This was an initiative by volunteers of Pallium India who prepared the food in their homes and also catered the same at the venue.
The festival opened at 10 a.m. with a trickle of visitors that kept increasing and peaked at 1 p.m. On display were 18 mouth-watering meal items, 9 snacks items, 5 juice items and 4 payasams that delighted not only Malayalis but also non-Malayalis. Our only regret is that our limitations on sourcing larger volumes of food left a few of our visitors disappointed. To them, our sincere apologies.
The festival ended at 2 p.m. and was a grand success. Thanks to the sensitized crowd of young techies who came in droves to help this great cause, we raised ₹65,000. We would also like to thank Prathidhwani, without whose support this event would not have taken place.
In an event held at the Rashtrapati Bhavan on April 2, Dr M. R. Rajagopal, Chairman of Pallium India, received the Padma Shri award from the Honorable President of India, Ram Nath Kovind.
Dancing, Singing and Learning at the Summer Camp for Children
Kuttikkoottam summer camp for children was conducted at Mitra Niketan City Centre, Trivandrum, from 19 to 21 April, 2018. The program was inaugurated by Dr. Mohammed Asheel, Executive Director of Kerala Social Security Mission.
The three-day camp focussed on providing knowledge interspersed with fun. The participants got the opportunity to meet several interesting people from different walks of life, who shared their own experiences and learning. The children learned art and craft, danced, sang and watched movies together. They went for a short half-day picnic. They also attended a career guidance program aimed at helping them choose their path forward. At the end of the camp, the children parted ways, promising to meet again soon, for “parting is such sweet sorrow”…
Children’s Educational Support Program: Pallium India currently supports the education of over 350 children. Many of them had been on the verge of dropping out of school, after their families were ravaged by illness or death, and they were financially destroyed. Thanks to constant support from our well-wishers, Pallium India has been able to keep their education uninterrupted, as much as possible. If you wish to help, please donate to us: http://palliumindia.org/donate/
Sherin Wilfred, Medical Social Worker at Pallium India, writes:
On 24 March 2018, during our home visit to Murukkumpuzha, we visited Mr Purushothaman (75 years), who has old age issues. He has weakness in his lower limbs, is unable to walk and needs help for his daily needs.
Our team noticed that the patient was left alone in the house. One of his daughters visits him in the morning and provides food for him. When we reached his home around 10:30 a.m., he was lying on the floor on a mat, and was soaked in urine. There were ants crawling around him and he had wounds between his toes from ant-bite. We cleaned the patient and swept the floor, and cleaned his wounds. A soft mattress was provided for him.
Meanwhile, we tried to get help from the neighbors. We informed Mr. Francis Ernest (community volunteer) regarding the patient’s condition. As part of the intervention, he contacted the Ezhava community group. With the help of the group members, the patient was transferred from Trivandrum to Bangalore to be with his eldest daughter.
I believe this was a great teamwork in improving the quality of life of this patient. This was possible with the strongest support of our volunteers and the palliative care team – Dr. Sathyasheelan, Sr Seena, Mr. Sujin (volunteer), Mr. Rajeev and myself.
Yes, indeed, we were able to make this year very special for Geetha. Geetha’s news was published on our website on New Year’s eve, seeking support. Now, 57-year old Geetha is living in a modified house which is wheelchair-friendly. She has a motorized wheelchair to move around. The housewarming function was attended by her relatives and friends as well as Pallium India team.
We owe the entire credit of her smiling face to MaChaNi group of friends from Seattle, Kerala Association of Washington, well-wishers who donated for the cause and volunteers. Thank you, everyone who came forward to support.
The Better India: Pallium India – A positive story
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- May 30, 2018: 3rd ICPCN Conference, Durban, South Africa. Visit: http://www.icpcnconference.org/
- Jun 4, 2018: 6 weeks certificate course in palliative medicine and nursing (CCPPM, CCPN) at Trivandrum. Register: http://palliumindia.org/courses/ Contact: firstname.lastname@example.org / 8589998760. Last date to apply: May 22
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- Aug 8, 2018: 10-day Foundation course for doctors at Trivandrum. Contact: firstname.lastname@example.org / 8589998760. Last date to apply: Jul 26
- Sep 3, 2018: 6 weeks certificate course in palliative medicine and nursing (CCPPM, CCPN) at Trivandrum. Register: http://palliumindia.org/courses/ Contact: email@example.com / 8589998760. Last date to apply: Aug 21
- Nov 5, 2018: 6 weeks certificate course in palliative medicine and nursing (CCPPM, CCPN) at Trivandrum. Register: http://palliumindia.org/courses/ Contact: firstname.lastname@example.org / 8589998760. Last date to apply: Oct 23
- Dec 7-8, 2018: 14th World Congress of Bioethics and 7th National Bioethics Conference. Venue: St. John’s National Academy of Health Sciences, Bengaluru, Karnataka 560034. Last date to submit abstracts: Sunday, April 8, 2018. Pre-conference workshop on December 3-4, 2018.
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This robot is a member of the staff of a pharmacy in MD Anderson Cancer Centre, Houston, Texas.
He (or she?) delivers medicines from ward to ward, can operate the elevator and can negotiate through crowded corridors.
Why do we post this here? Because there is food for thought: most of us are unable even to imagine the way technology will develop in another five or ten years. In many ways, technology will improve our efficiency. It may also potentially threaten the human element in medicine.
Let us brace ourselves, and think hard on how we can optimise the positives of technology, while minimising the negatives.