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Palliative care still in the woods

C. Maya

World Palliative Care Day today


Kerala still delivers 80 per cent of palliative care

Palliative care is still solely dependent on NGOs


THIRUVANANTHAPURAM: Twenty years since pain and palliative care began to be delivered in India, it continues to be regarded as charity and not as the right of a patient with end-stage or chronic diseases to live with dignity.

Rather than the maze of bureaucratic and legal hurdles that stand in the way of the easy availability of morphine, it is the attitude of those in the health care system that has made pain relief inaccessible to more than 98 per cent of those who really need it, says M.R. Rajagopal, the pioneer of Palliative medicine in India, who is also heading Pallium India, a non-governmental organisation (NGO), which renders training in palliative care as well as dispenses opioids free of cost.

“It is very easy for the health care system to turn its back on the patient and say that nothing more can be done to cure him. The demand for palliative care should come from the doctors themselves,” he feels.

Pain and palliative care is not something that takes over when the medicines cannot offer a cure.

Thousands of patients with end-stage renal diseases, motor neuron diseases, burns, paraplegia or spinal injuries spend their days in excruciating pain but somehow, pain and palliative care is restricted to being an appendage of cancer care institutions.

“Palliative care has still not become part of mainstream medicine. Our medical professionals are not very aware of the principles of pain relief because it is yet to figure in our medical curriculum. Many still fear that use of morphine for pain relief can lead to addiction because they have never got any training in pain management. Our government does not even have a Palliative care policy. These are the actual barriers before us; narcotic regulations are just the tip of the ice berg,” Dr. Rajagopal says.

About 340-odd medical colleges are there in the country but only five are offering some training in palliative medicine.

In 1998, the Union government issued clear guidelines on the use of morphine for pain relief by recognised medical institutions but 15 States are yet to amend their narcotic regulations.

Kerala still delivers 80 per cent of palliative care in the country and has about 75 centres that dispense liquid morphine or tablets to patients. The Regional Cancer Centre began the first pain clinic in 1986 but it was the Neighbourhood Network group, formed in Kozhikode in 1993 by Dr. Rajagopal, that made palliative care a community-run affair.

While the Kozhikode model has been hailed as the best example of how palliative care services can be delivered in low resource settings by the World Health Organisation, palliative care is still solely dependent on NGOs.

Every primary health centre should have at least one doctor and nurse trained in palliative medicines. These should all be linked to NGOs and local bodies so that palliative care becomes a community-run activity.

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