A first time initiative by National Rural Health Mission and Tamil Nadu State Health Society with support from NGOs envisages alleviating pain of persons suffering from incurable or life-threatening illness in rural areas, by providing relief and support at their doorstep. The first leg of the project that provides palliative home care has been initiated in Andanallur block in Tiruchi district.

The community based rural relief and palliative care is being taken up as a pilot project in four districts in Tamil Nadu - Tiruchi, Nagapattinam, Tiruvallur and Kanchipuram. The project in Andanallur block covers close to one lakh people spread over 19 villages through three primary health care centres (PHC) in Kulumani, Perugamani and Andanallur. The project in Tiruchi is executed by the Sudharsana pain relief and palliative care services.

Palliative care at doorsteps would bring adequate relief to terminally ill patients in remote areas as self-treatment is the existing mode of medical care, said Mohan, Deputy Director (in-charge), Public Health. With close to Rs.15 lakh per year sponsored by the NRHM, a qualified team of doctors, nurses and social workers would provide home care, ensuring every PHC is visited twice a week, Mohansundaram, director, Sudharshana told The Hindu. A home care van has been assigned exclusively for the purpose.

A door-to door survey to identify persons diagnosed with renal, neurological, cardiac ailments, cancer and HIV-AIDS was conducted by village health nurses, midwifes, anganwadi workers and social workers, following a sensitization programme for medical and paramedical persons. As many as 827 cases have been identified from close to 80,000 who were surveyed. Of them, 55 were suffering from cancer, 26 had HIV-AIDS 76 were tuberculosis patients. Subsequent surveys would be conducted to identify patients in need of palliative care. Many of the identified cancer patients were found to be in an advanced stage and had cancerous lesions, sores and oozing wounds, said Dr.Mohansundaram. As terminally patients are disposed to phobia, depression or suicidal tendencies, consultant psychiatrists would provide counseling.

Under the project, PHC s would function as day care centres dispensing drugs and minor medical procedures to alleviate pain. A hospice facility for patients on their last legs is proposed to be set up in the PHCs to ensure patients are given a ‘dignified exit from life’, said Dr.Mohnasundaram.

The initiative aims at making support and care readily available by involving family members in taking care of the ailing at home. By educating them on correct administration of drugs, methods of feeding, care of wounds and sterilization, family members are empowered as caregivers.

Challenges in identification of eligible patients came in the form of unavailability of agricultural labourers during the day, migration for employment and hesitancy to disclose HIV status. The Tiruchi branch of Indian Medical Association and cancer centres in the district have been requested to provide inputs on prospective patients to expand the reach of the initiative.