At this moment, over a million people in India are in unimaginable pain. We refuse to look the other way. We choose to hear the cry, and to do what we can.
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India’s healthcare is among the most unsatisfactory in the world: study

2018 May 30

(Photo by Ruth Fremson)

India’s healthcare is among the most unsatisfactory in the world – 145th among 195 countries – both in terms of quality and accessibility of health care, behind most of our neighbors like China, Bangladesh, Sri Lanka and Bhutan, according to a study published in the Lancet, Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015

The five countries that topped the list are Iceland (scoring 97.1), Norway, the Netherlands, Luxembourg and Finland and Australia. India’s score is an abysmal 41.2. in particular, India is reported to have done poorly in the areas of tuberculosis, rheumatic heart disease, ischemic heart disease, stroke, testicular and colon cancers and chronic renal disease.

On the positive side, India’s score improved from 24.7 in 1990 to 41.2 in 2016. But at the same time, the inequities have grown too, with a widening gap between the highest and lowest scores. Goa and Kerala do the best with more than 60 points, while Assam and UP are at the lowest, each below 40.

When we reflect on the Economist’s Quality of Death index, it is obvious that the quality of end-of-life care, comparatively, is a lot worse than general healthcare in India – at 167th place out of 180 countries.

Long Way to go!

We love children, but we can be very cruel to them.

2018 May 30

Quoting an eye-opener by Dr Sudha Sinha and colleagues in the Journal of Palliative Medicine, Cancer Treatment and End-of-Life Care, Pallium India’s friend, Dr Aju Mathew writes: “75% of patients in this study from a government hospital in India received end-of-life chemo within 30 days of their eventual death. 50% within a week. Similar numbers in West are ~ 20% and 10% respectively.”

Thank you, Dr Sudha Sinha and colleagues, for giving visibility to these cruel figures.

Read: Cancer Treatment and End-of-Life Care

Andhra Pradesh comes together for palliative care development

2018 May 29

Sumitha T. S., Project Executive at Pallium India, writes:

My third visit to Andhra Pradesh, and my first to Vijayawada, was to attend an opioid availability workshop. Quite different from the usual scene, this workshop was led by the Director General, Drugs & Copy Rights, Andhra Pradesh, and CEO of Dr. NTR Vaidya Seva Trust, Dr Ravi Shankar IPS, a rare combination of healthcare and bureaucracy. Dr Nandini Vallath (Consultant- TIPS), Dr NS Raju (Age Care Foundation-Pallium India), Dr Vidya Viswanath (Asst Professor, HBCH&RC), Dr MBR Prasad (Director, AP Drugs Control Administration) and Dr Ravi Shankar IPS were the key speakers. After the presentations, came the panel discussions. The participants included doctors in various specialities, pharmacists, dealers and concerned government officials from across the state.

Many questions were raised, regarding Narcotic Drugs and Psychotropic Substances (NDPS) Amendment Act (2014), NDPS 1, NDPS 2 and transport license in the state of AP and palliative care training.

By the end of the day, we were hopeful that palliative care will be taken forward by the state with the support of Dr NTR Vaidya Seva Trust which is already planning to include “palliation” in their empanelled hospitals.

Age Care Foundation, our collaborators in AP, received Recognized Medical Institution (RMI) status after meeting all the criteria recommended in the amended NDPS Act. This now helps them stock and dispense less expensive but strong opioid analgesics meant to relieve excruciating pain.

Following the workshop, a sensitization meeting for doctors was facilitated by Dr Ramanamma through IMA Vijayawada. Dr Nandini Vallath gave a talk on palliative care and emphasized the importance of communication and symptom management. The session ended by 10:00 pm and then the team travelled to Visakhapatnam. Our train was at 1:25 a.m. but none of us was tired, because the day had given us a lot of hope – a lot of hope indeed, for palliative care in Andhra Pradesh.

The next day, in a hospice at Vizag, we met a young Mathematics graduate from Odisha. She speaks Oriya, Hindi, English, and a little Telugu. I had a very interesting conversation with her. She said, everything in this world is related to Maths. I informed her that my grandfather, who was a maths teacher, used to tell us the same. I learnt an Oriya phrase from her: “tome kemethy acho” which meant “how are you”. She kept asking for her “favourite smiling doctor” – Dr Vidya Viswanath. It had been two days since Dr Vidya came to the hospice. I apologized and told her that her doctor was travelling to attend some important meetings.

This young girl in end stage with metastasis had reached AP with pain but now she is free from pain. This could be why Dr Vidya became close to her heart, as she had given her pain medications.

As I speak to her, I reflect… These very effective and affordable pain medications can relieve suffering, but do not reach all the people who need it. Why is it that we are unable to make everyone pain-free? Why should one travel all the way from Odisha to Andhra Pradesh? Why can’t all doctors be close to their patients? Does pain include only physical pain? Absolutely NO. This maths graduate was reading her favourite book in the hospice when we were there. Mrs Satya, a social worker and volunteer enquired about her favourite dish and prepared it for her the very next morning. The young patient’s smiling face reminds us of so many people who could not smile at this stage of their illness. This hospice is a pivot of caring doctors, nurses and volunteers.

In the evening my colleague and I went for a walk in the beach at Vizag. The entire beach was spic and span, in spite of the crowd – this is something we should learn from VUDA (Visakhapatnam Urban Development Authority). Dustbins are placed at fixed distances. I managed to get scolded in Telugu from a man when I unknowingly dropped a piece of paper into his black bag, mistaking it for a dustbin. However, I am glad it happened, as he also directed me to a real dustbin rather than nowhere.

The delicious food of AP is also worth a mention, with a special thanks to pessaratu dosa made by aunty. Our thanks to Satish (our project manager) who took us for a very special tea, to the sea port and to a Punjabi Dhaba, and to Raju sir for providing us with an Andhra meal. “Good food is to be enjoyed always!

On our last working day in AP, we had a meeting with Sathya Sai Seva Trust. Dr Raju explained to them about palliative care and sought their help in reaching out to the common man. The way he advocates for palliative care is so convincing that nobody could say no.

We request you all to help us reach out to everyone who is enduring health-related suffering, in every part of our country.

I learnt a lot from Dr Raju, Dr Vidya, Dr Ravi Shankar IPS, Dr Nandini Vallath, Dr Ramanamma, Mrs Sathya, hospice and Sathya Sai Seva Trust. Thank you all for giving us a space and special thank you to Satish for putting in all his efforts to make this happen.

IAHPC Free Membership to Postgraduate students

2018 May 28

International Association for Hospice and Palliative Care (IAHPC) is offering a one-year free membership to students of qualifying institutions who are currently enrolled in a palliative care post-graduate program for any health-related field (Medicine, Nursing, Psychology, Social work, Pharmacy, Spiritual Care, Physiotherapy, Pharmacy, etc.) leading to a formal degree (Diploma, Masters, PhD, Specialist training, and Fellowships).

To qualify, institutions must fulfill the following criteria:

The students may join by completing the application form in this link: https://hospicecare.com/submit/join-iahpc/post-graduate-student/

With the application students need to submit the following:

A copy of a valid, current institutional identification card is provided.

A certificate/letter from the school/university certifying that the applicant is a post-graduate student at the institution is provided. The certificate should be not older than 3 months.

If you have any questions or your students need any help in joining, please send an email to Ms. Genevieve Napier, IAHPC Programs Officer.

Congratulations, dear Zippy.

2018 May 28

Dr Zipporah Ali, the palliative care pioneer in Kenya, received the Women4Africa International Humanitarian Award at the Women4Africa award event held in London recently. The award is in recognition of all the palliative care providers in Africa and across the globe and the many patients (and their families) who deserve better quality of life.

Hearty congratulations, Dr Zipporah Ali. You are so inspiring!