1. December / 2013
ehealth.eletsonline.com34
W
ho 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
awareness
As 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 to
l 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