Dr Rohit Lahori
Modern medicine is enough competent in handling acute medical problems and has achieved prominence in the health care sector through analytical research and intense study of etiological and therapeutic factors.
Presently most of our health services are disease centred, specifically designed for acute episodes. There is enormous need of Palliative care services for the ongoing care for those who have chronic diseases, progressive diseases or incurable diseases as they are unmet within the current healthcare delivery system. Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening Illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. The word “Palliate” is derived from the Latin word ‘pallium’ meaning cloak i.e. an all-encompassing care which “cloaks” or protects the patients from the harshness of the distressful symptoms of the disease, especially when cure is not possible. Palliative care is not really a new speciality. Care of the sick has been a constant concern of human society throughout history. We have ancient traditions in India, for special care and attention for those who are very old, ailing or dying.
The eighteen institutions built in India by King Asoka (273-232 BC) had characteristics very similar to modern hospices. We are presently building on these ancient traditions as well as expertise and wisdom of pioneers in this field to develop palliative care services. The modern hospice movement is attributed to Dame Cicely Saunders who founded the first modern hospice – St Christopher’s Hospice in London in 1967. Dame Cicely was triple-qualified professional, having practised as a nurse, social worker and doctor. This background influenced and impacted the way she approached her patient’s concerns. This led to the development of modern palliative care with its holistic dimensions. Palliative care improves the quality of life of patients and that of their families who are facing challenges associated with life-threatening illness, whether physical, psychological, social or spiritual. It is this holistic approach that distinguishes Palliative care from the conventional medical care. No single sphere of care is adequate without considering relationship with the other two. This usually necessitates genuine interdisciplinary collaboration and social interventions. A professional who understands the “care” concept would not say, “there is nothing more I can do,” as usually told take the patient home and care for him as nothing can be done now. Instead healthcare giver would seek to find things to do for the patient, so as to relieve suffering and improve the quality of life.
55 million people in India every year are pushed below poverty line by catastrophic health expenditure. While the lower income groups suffer greatly due to the above reason, paradoxically the affluent in our country are also marginalised, due to the absence of palliative care in healthcare institutions including both government and private sectors. Less than 4 percent of India’s out of 1.3 billion people have access to any palliative care. 1 in 5 suicides in India are committed by a person living with an advanced, chronic or life-limiting condition. Each year, an estimated 40 million people are in need of palliative care; 78 percent of them live in low- and middle-income countries. Adequate national policies, programmes, resources, and training on palliative care among health professionals are urgently needed in order to improve access. The global need for palliative care will continue to grow as a result of the ageing of populations and the rising burden of non communicable diseases and some communicable diseases. Early delivery of palliative care reduces unnecessary hospital admissions and the use of health services .Palliative care is required for a wide range of diseases. The majority of adults in need of palliative care have chronic diseases such as cardiovascular diseases (38.5%), cancer (34%), chronic respiratory diseases (10.3%), AIDS (5.7%) and diabetes (4.6%). Many other conditions may require palliative care, including kidney failure, chronic liver disease, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological disease, dementia, congenital anomalies and drug-resistant tuberculosis. Pain and difficulty in breathing are two of the most frequent and serious symptoms experienced by patients in need of palliative care. For example, 80 percent of patients with AIDS or cancer, and 67 percent of patients with cardiovascular disease or chronic obstructive pulmonary disease will experience moderate to severe pain at the end of their lives. India alone has 2.5 million cancer patients. There are 10 lakh new patients diagnosed with cancer every year, and 80% of them report in stage IV at the time of diagnosis. Only 0.4% have access to Pain and Palliative Care . Patients with “incurable cancer” may now survive longer with oncological interventions. Due to all these reasons, palliative care is ideally required to be incorporated into comprehensive cancer care programs
In 2014, the first ever global resolution on palliative care, World Health Assembly resolution called upon WHO and Member States to improve access to palliative care as a core component of health systems, with an emphasis on primary health care and community/home-based care. WHO’s work to strengthen palliative care focuses on the following areas. The Government of India has launched the National Programme for Palliative Care (NPPC) in 2012. Ever since then Government of India has been earmarking funds under NRHM flexi pool for initiating and scaling up palliative care services in various states depending on the Program Implementation Plan submitted by each state. Several states and UTS are providing remarkable Palliative care Services. J&K UT made the history by start the palliative care services in all the district hospitals of the UT with ten beds reserved for Palliative and geriatric care in all the district hospitals focusing on the need of palliative care in the community both at urban and rural levels. Two doctors and Two nurses have been trained under CCEPC (Certified Course in Essentials of Palliative care) by Indian Association of Palliative care. This is a game changer in the Government Health sector of J&K.
(The author is Interventional Pain and Palliative Care Specialist)
Dr Rohit Lahori