Preparing for Death – Palliative care in India.

Home to one-sixth of the World’s population, today, we are a country of 134 crores people.
Palliative care in India. - by Ranvir Shah

Home to one-sixth of the World’s population, today, we are a country of 134 crores people. India has a huge burden of suffering from life-limiting diseases. Our country registers 1 million new cancer cases every year and up to 70-80% of them present with Stage IV disease diagnosis, where options of cancer-directed treatment are very limited. It is estimated that at least 60-80% of these patients need palliative and end of life care. In India, less than 5% of patients have access to palliative and end of life care, and less than 2% of the patients have access to strong analgesics needed for pain relief. Annual palliative care need in India is estimated to be 3-4 million.

Palliative care in India hasn’t taken off, it is also because medical practice in India is disease-based, not person-based and as a result, palliative, or hospice, care is difficult, if not impossible to find. A famous incident of Mumbai police officer, Himanshu Roy’s suicide which is said, that he took this extreme step out of acute depression, due to incurable cancer.

His oncologist said, “it wasn’t so much the disease itself but the emotional trauma it had on him that may have led to Roy taking the extreme step.” “He needed palliative care and psychological counseling specific to his depression, neither of which appears to have been available to him,” he added.

Diseases affect both the patient and their families, not only physically and socially but psychologically, and spiritually. I’ve seen many patients and their families take the journey through chronic and terminal illness. In the year 2006, instituted the Pratham Hospice Trust a charitable trust in Chennai, India. Its objective is to establish services for the care and effective treatment of terminally ill patients, and those beyond hope. It also aims to work closely with other hospices, clinics, and homes for the sick to provide such PALLIATIVE CARE.

Death is the harsh truth of life and in palliative care death is distinguished between a “good death,” and, “bad death.” I am sure the name tells it all here, a good death is where one dies peacefully, without pain, in the presence of their loved ones. A bad death is where the patient dies alone, in pain, and usually in the hospital. India registers more bad deaths. According to human rights research, more than 7 million patients need palliative care in India every year.

Only two states in India have palliative care policies, Kerala and Karnataka. In 2015, Maharashtra drafted a similar policy, but it is yet to be finalized. In Kerala, the policy was implemented in 2008. Kerala provides two-thirds of the country’s palliative care services.

We need a palliative care policy and a plan for implementing it, availability of the essential medications, and education and public awareness. Health care expenses will drop if palliative care is implemented well.

The Role of Palliative Care at the End of Life:

The objective of palliative care is to lessen the pain of patients and the sufferings of their families. The main focus of palliative care is anticipating, preventing, diagnosing, and treating symptoms experienced by patients with a serious or life-limiting illness and helping patients and their families make medically important decisions.

 

The Role of Palliative Care at the End of Life. - Pratham Hospice Trust, Ranvir Shah

Dr. M.R. Rajagopal is popularly known as the father of palliative care in the country. The Padma Shri award winner is the founder chairman of Pallium India, a palliative care NGO based in Kerala, and asked him where the country stands today in terms of pain management and end of life care. He is also one of the founders of Pain and Palliative Care Society (PPCS) in Medical College, Calicut.

With people like Dr. M.R. Rajagopal and initiatives such as Pratham Hospice Trust, we can work together to make a world a better place for living.

There is a heart-touching documentary film titled “Hippocratic: 18 Experiments in Gently Shaking the World” of Dr. M.R. Rajagopal on palliative treatment for the poor.

 

 

With the Pratham Hospice Trust, I aim to provide palliative treatment for poor, lonely, neglected, and dying in pain.

  • In surroundings that will be conducive to the comfort and peace of mind of such patients, so that they can be cared for until death.
  • With facilities that would make it possible for them to live without pain and suffering, and in conditions that would help them face the end with dignity.
  • By a focus on the prevention of pain and relief from suffering rather than life prolongation.

With people like Dr. M.R. Rajagopal and initiatives such as Pratham Hospice Trust, we can work together to make a world a better place for living.

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