December / 2013ehealth.eletsonline.com34

Who defines ‘Palliative care’ as an approach that improves the qual-ity of life of patients and

their families facing the problem as-sociated with life-threatening illness, through the prevention and relief of suffering by means of early identifica-tion and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Palliative care in India is in very early stages of development and is steeped in issues like narocotics laws, lack of awareness and exper-tise and finally the treatment costs. Today only 14 states in India have been successful in making regulatory changes to make morphine easily ac-cessible for pain management. The government is yet to review and re-vise the to make morphine available to end-stage cancer patients. This will be a great help to hundreds of thou-sands of patients across India.

The Indian Association for Palliative Care (IAPC) has renewed its request l to the government to speed up the pas-sage of the bill that seeks amendment in the Narcotic Drugs and Psychotropic Substances Act. The bill was introduced in 2011 and continues to linger.

Why morphine?Unlike pain mediation that comes with a ceiling dose and side effects, mor-phine is relatively a safer option. It comes with no ceiling dose and it can be easily customised to manage the pain.

India is among the largest produc-ers of poppy in the world and we ex-port morphine to developed countries

to help overseas patients but unfortu-nately it is denied to our own country men ! SushmaBhatnagar, head of the palliative care at AIIMS, estimates that only one percent of Indian patients with end stage cancer are able to re-ceive morphine for pain management.

Prevailing rules require hospitals to procure five licenses -two from excise commissioners, two from state drug controllers and one from the transport department — to procure morphine. Moreover, even if these five licenses are obtained, things may not work in tan-dem. There is a possibility of mismatch and the entire exercise goes waste with the lapse of a single license.

Lack of education and awarenessAs of now medical colleges in India don’t have palliative care in their cur-riculum. Of late, Medical Council of India has introduced courses in pal-liative medicine( 3 year post graduate course in palliative medicine). We also need to broaden the course of pallia-tive care byeducating not only the cli-nicians but also, patients, and families with regard to the elements and appro-priateness of palliative care.

Cancer is universal but the great-est problem that we face in India is lack mass awareness about cancer and lack of government support in early detection. In India, cancer is de-tected mostly in its later stages, when it has compromised the function of one or more vital organ systems and is widespread throughout the body. The solution lies in early detection and this can come only with greater awareness.

Palliative care aims tol provide relief from pain and other

distressing symptoms;l affirm life and regards dying as a

normal process;l intend neither to hasten or post-

pone death;l integrate the psychological and

spiritual aspects of patient care;l offer a support system to help pa-

tients live as actively as possible until death;

l offer a support system to help the family cope during the patients illness and in their own bereave-ment;

l use a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;

l enhance quality of life, and may also positively influence the course of illness;

l apply early in the course of illness, in conjunction with other thera-pies that are intended to prolong life.

POLICY

By SiddharthKundu, General Manager at a leading pharma laboratory

Palliative Care Where Love is the Prescription

Siddharth Kundu