Pallium India, which works in collaboration with several national and international organizations to improve the accessibility and affordability of pain relief drugs like opioids, sees palliative care is not only for people with cancer. There are scores of other conditions like neurological, cardiac, respiratory, renal, hepatic, musculoskeletal and frailty of old age which require palliative care.
It is a misconception that palliative care is only for those with cancer. By definition and by international practice, it is not so. Therefore one cannot discriminate. So serious health related sufferings irrespective of the causative condition, should be treated, Dr. M.R Rajagopal, Chairman, Pallium India and Director, Trivandrum Institute of Palliative Sciences, a WHO Collaborating Centre for Training and Policy on Access to Pain Relief told Pharmabiz.
According to World Health Organization, palliative care is for all life-threatening diseases. A paraplegic person confined to his bed for 24 hours has his life threatened by the limitations placed on his quality of life. Life in its fullest sense has to include quality of life and if quality of life is seriously threatened, palliative care must step in, he added.
The Lancet Commission on Global Access to Palliative Care and Pain Relief recommends that palliative care should reach all serious health related suffering. So in Pallium India’s Trivandrum Institute of Palliative Sciences, roughly half the patients that we see have cancer. The other half come with a variety of illnesses: neurological, cardiac, respiratory, renal, hepatic, musculoskeletal and frailty of old age, said Dr Rajagopal.
The greatest challenge is the obviously anticipated resistance to change. The health care system moves in a certain fashion in the country, the bulk of it being in the private sector and with most health care cost being out-of-pocket for individual.
A change would involve acceptance of basic ethical principles as well of a change in the way the system functions. Such changes can be inconvenient for the system and will be resisted. Hence the first step is improved awareness. The biggest failure of palliative care movement in India has been poor advocacy. Thus advocacy at every level of common man, healthcare professionals and the Government are all important aspects essential for the change.
Adequate budget provision as well as realistic strategy for implementation of the National Program for Palliative Care can also create a positive change. Such change would involve implementation of the amended NDPS Rules of 2015 by every State Government and Union Territory. There is also need for access to undergraduate palliative care education in medical, nursing, pharmacy, medical social work and in other allied courses, said Dr Rajagopal.
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