Ludhiana, March 27, 2015: The department of Medical Oncology and Anesthesia at Dayanand Medical College and Hospital organised a 2 day education course for MBBS students on basics of pain and palliative care. The course was conducted on 26th and 27th March under guidance from Dr M R Rajagopal who is the Director and Founder Chairman of Pallium India – a Non- Government Organization in Trivandrum, Kerala which works with full zeal towards providing effective palliative care and pain control to the needy patients.
Dr Rajagopal is an expert in Pain and Palliative care of international repute. He is a life time advisor to the International Association for Hospice and Palliative Care (IAHPC) and is vice chairman of Asia Pacific Hospice Network (APHN). He is a member of the International Experts’ Committee of the WHO Collaborating Center at Madison-Wisconsin. The international organization “Human Rights Watch” honored him with Alison Des Forges award at Los Angeles in November 2014. He also received the Dr MIMS award for Best Doctor from the Chief Minister of Kerala last year. He was nominated for the CNN-IBN Indian of the Year 2014 Award.
He gave a brief introduction about the existing palliative care services in Kerala and other Southern Indian states which have brought India on the world map of palliative care. Dr Rajagopal explained that individuals with life limiting illness including terminal cancer, COPD, heart failure, stroke and various other diseases are eligible to be benefitted by palliative care which mainly aims at controlling the symptoms and bringing comfort to the patient and their families. He also mentioned that this is probably the best branch in medicine to describe the age old notion of medicine as a “noble profession”. He praised the efforts being made by the DMCH in providing excellent healthcare in this region and assured of all support in developing good palliative care services which is a real need of the hour.
Dr Sandeep Puri, Principal, DMCH addressed the students at the beginning of the two day education program for MBBS students and interns. He emphasized the importance of this upcoming specialty and that the course will help them become better doctors. During this program, the MBBS students were explained about the basics of good pain management, communication skills and general principles of palliative care. MBBS students Ms Shriya and Mr Manish mentioned on behalf of their colleagues that the education sessions were very good, different to the usual learning and will help them a great deal in their professional lives in future.
Dr Kunal Jain, Medical Oncologist and Palliative care specialist appraised about the efforts being made by the DMCH administration to bring effective palliative care for the needy patients of this region. DMCH recently got associated with an NGO from USA – Jiv Daya Foundation to start their palliative care program. He also said about stringent laws making it difficult to access opioid medications which are the cheapest and most effective means of managing pain and suffering in terminally ill patients.
Dr. Suneet Kathuria, Professor of Anesthesia, has been running a specialized Pain Clinic at DMC&H for many years and he also interacted with students.
The government of Punjab must ensure that all government and private hospitals in the state should stock the essential medicine, morphine, and have at least one doctor trained in pain management and palliative care. The hospitals also should have humane end-of-life care policies so that those who are in the evening of their lives are given compassionate care aimed at relieving suffering, and not needlessly aggressive artificial life support measures, which only worsen suffering.
According to the World Health Organization, “the fundamental responsibility of the health profession to ease the suffering of patients cannot be fulfilled unless palliative care has priority status within public health and disease control programs; it is not an optional extra”.
About 80% of patients with advanced cancer develop moderate to severe pain and require strong pain medications, such as morphine. Many of these patients also develop symptoms like diarrhea, breathlessness, and psychosocial problems. Palliative care is highly effective in treating these symptoms. According to the World Health Organization, “most, if not all, pain due to cancer could be relieved if we implemented existing medical knowledge and treatments”
Palliative care is a low-cost intervention, which does not require expensive diagnostic equipment or medications. In the year 2012, the Government of India launched the National Program in Palliative Care (NPPC). State Governments can get budgetary allocation for palliative care if Program Implementation Plan is submitted to Ministry of Health & FW of Government of India.
On 22 February 2014, the Indian Parliament passed the Narcotic Drugs Amendment Act, which emphatically states the principle of balance, that while curbing illicit use of opioid drugs, Governments have the responsibility to ensure that they are also available for medical use for those in pain. We need to ensure implementation of this amendment, with the necessary precautions, but eliminating meaningless bureaucratic wrangles.
Punjab needs a concerted effort at promoting access to palliative care in the state, according to Dr Kunal Jain, Assistant Professor in Dept of Medical Oncology at DMC and Dr. M.R.Rajagopal, Director of the WHO Collaborating Centre at Trivandrum, Kerala and Chairman of Pallium India