1. BARRIERS
ON
PALLIATIVE
CARE

2. PALLIATIVE CARE
‘Palliative’ is derived from the latin word
Pallium, a cloak.
Palliative care is the active total care of
incurable disease patients and their
families, by a multiprofessional team,
when the disease is no longer curative or
life – prolonging treatments.
Palliative care neither intentionally
hastens nor postpones death.

3. Barriers…
 Lack of knowledge, awareness among
professionals / public
 Lack of importance in society
 Specially, lack of education in common
people
 Lack of training programme availability
 Duration of care is very short, even if
available
 Poor drug availability
(only 3 states – Rajasthan, U.P. & M.P.)
 No proper NGOs to face this kind of problem

4. Barriers…
 Addiction fear
 Risk of Adverse Effects
 Lack of policy and its implementation
a) National
b) Institutional
 Lack of existing resources – Health Care
Centres
a) Primary
b) Secondary
c) Tertiary

5.  Lack of effective communication
 Cultural / Religion Barriers
 Language : A great barrier in India
 No proper budget allocation
 Great ignorance by medical profession
 Not recognized by MCI or WBMC
 Restriction of Anti-Narcotic Cell / Central
Excise
 Avoidance of Patients or their families
 Personal Fears, Lack of confidence, Worries,
Competence
 Lack of skill to negotiate the patient for
consuming in Palliative care support

6. Barriers to pain relief
 Lack of guidelines or research
 Ignorance on psychological and
social issues
 Poor availability of treatment
 Cost of treatment is unaffordable
 Fear from Opioids
a) Fear of respiratory depression
b) Fear of constipation
 Strict narcotic regulations
 Depression

7. Regulatory barriers
 Having several steps in the
licensing process.
 Multiple licenses are needed.
a) Import
b) Export
c) Possession
d) Transport

8. Major reasons for relative failures
include
 Inadequate follow-up
 Geographical factors
 Changing Officials
 Lack knowledge of Palliative Care
 Loop of Red Tape
 Lack of simple and realistic system for
implementation of the amended rules

9. Poppy Field

10. How to overcome???
 Sufficient Fund
 Professionals (Doctors, Nurses, Volunteers
& Social Workers) should have a standard
training programme on Palliative Care
 Essentially, educate the public
 Beneficial policy making & its proper
implementation
 Fight for improving to access the essential
drugs (viz. Morphine)
 Advocacy is essential. Mass media – The
Press, Television and Radio all have an
important role to play

11.  Volunteers can overcome the problems of lack of
resources, they are more committed than paid
employees. Trained volunteers act as an effective link
between the patient and medical team
 Identify a local, respected person and develop a
Palliative Care Team as well as a morphine pocket
 Organise at least a work shop on Palliative care and
oral morphine at govt. level
 One can communicate effectively to the patient and
family members
 We can councell and establish a partnership to the
patient as well as patient family members
 Govt. can use their existing resources – Health
Centers -
a) Primary
b) Secondary
c) Tertiary

12.  If NGOs can work with the Govt.
Machinery, it could prove to be of
benefit to the patient
 Palliative care delivery system
should be realistic in Indian condition

13. Present Situation
Last two years, Trivandrum Institute of Palliative
Sciences (TIPS) has developed six weeks’
training programme for Doctors, Nurses and
Volunteers and Palliative Care Assistants. Now-
a- days, Kerala is remarkably achieved but it is
so little compared with the rest of country.
In West Bengal, there are two palliative care
units which are :
1. Saroj Gupta Cancer Centre &
Research Institute.
2. Calcutta Medical College.