Skip to main content

Dying in India: Palliative Care Provides Hope

Imagine you have a terminal illness and were given a prognosis of 3 months...or less.

In a developed country like the United States (US), you may have health insurance coverage and adequate financial resources to choose to die comfortably at home, surrounded by family. But if you’re poor and living in a developing country with few social and health care resources, you may not fare as well.

For many elderly suffering from terminal illnesses in India, Where do I go? and Who will take care of me? are questions they face toward the end of life. A recent BBC news article, "Bringing Hope to Elderly and Terminally Ill Indians," brings to light this reality.


In Delhi, India, Mother Theresa’s Missionaries of Charity runs a shelter where the old and dying can be “abandoned” by family members who are no longer able to care for them.


Although palliative care systems are set up around India, only about 1% of Indians in need actually receive palliative care.

This post will highlight one particularly unique palliative care program set up in Kerala State, India. Dr. Suresh Kumar, an anesthesiologist, started Pallium India, a palliative care system that focuses on caring for ill individuals at home, since many of them are not well enough to travel.


The program is financially supported through private donations, allowing for services to be provided pro bono.

At Pallium India, as in other palliative care practices, presumably, pain relief is a major concern for many cancer patients and the providers caring for them. Although India is one of the largest producers of opium, the use of legal morphine in the country has seen a substantial reduction following the passage of the Narcotic Drugs and Psychotropic Substances Act in 1985 (as discussed in a 2007 NY Times article).


Although obtaining morphine in India is an arduous process that deters many pharmacists and health care providers alike, Dr. M. R. Rajagopal of Pallium India advocates for the use of the opiate derivative for patients in pain.

Furthermore, Pallium Care is unique in that college students serve as volunteers, and the program’s model is based on providing medical care to the elderly and terminally ill while engaging the community.


Kerala has a high literacy rate and being a smallish state (comprises 3% of Indian population), possesses a strong sense of community that contributes to the success of this palliative care model.


Due to its success in providing care through community participation, Pallium India is expanding globally. The US arm of Pallium India aims to disseminate information about palliative care among Asian-Indian populations in the US, but, I wonder, how sustainable this model would be in places that lack a strong sense of community, say like major urban centers in industrialized nations….


By: Julie N. Thai, GeriPal International Correspondent

Comments

Pallium India is really doing the generous work to take special care for elderly people and taking Palliative care with utmost sincerity. I think such care organization should get much predominance and advertisement and India Govt. should take special care and render all kind of helps needed to succeed the deeds.

Popular posts from this blog

The Future of Palliative Care: A Podcast with Diane Meier

There are few names more closely associated with palliative care than Diane Meier.  She is an international leader of palliative care, a MacArthur "genius" awardee, and amongst many other leadership roles, the CEO of the Center to Advance Palliative Care (CAPC).  We were lucky enough to snag Diane for our podcast to talk about everything we always wanted to ask her, including:
What keeps her up at night?Does palliative care need a national strategy and if so why and what would it look like?The history of CAPC and the leadership centersAdvice that she has for graduating fellows who want to continue to move palliative care forward as they start their new careersWhat she imagines palliative care will look like in 10 or 15 years?What is the biggest threat facing palliative care? So take a listen and if you want to dive a little deeper, here are two articles that we discussed during the podcast:
A National Strategy For Palliative Care. Health Affairs 2017Palliative Care Leadership…

Advance Care Planning before Major Surgery: A Podcast with Vicky Tang

This week's podcast is all about the intersection of geriatrics, palliative care, advanced care planning and surgery with our guest Dr. Vicky Tang.  Vicky is an assistant professor and researcher here at UCSF.  We talk about her local and national efforts focused on this intersection, including:
Her JAMA Surgery article that showed 3 out of 4 older adults undergoing high risk surgery had no advance care planning (ACP) documentation. Prehab clinics and how ACP fits into these clinicsThe Geriatric Surgery Verification Quality Improvement Program whose goal is to set the standards for geriatric surgical care including ACP discussions prior to surgeryHow frailty fits in and how to assess it (including this paper from JAGS on the value of the chair raise test) So take a listen and check out some of those links.  For those who want to take a deeper dive into how GeriPal and surgery fit together, check out these other podcasts: Zara Cooper on Trauma Surgery, Geriatrics, and Palliative Car…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …