Far from being integrated into the public healthcare system and health-related policy planning, the idea of palliative healthcare is shrouded in “myth” and is deeply undervalued. Right from administering morphine tablets for pain relief to counselling and volunteer-based community support for the terminally ill, this important wing of healthcare has not got the attention it deserves, believes K.B. Lingegowda, Head of Department of Palliative Medicine, Kidwai Memorial Institute of Oncology.
In all, in India, seven million deaths are recorded annually. Of these, around 4 million — many terminally ill — are in dire need of palliative healthcare.
Not just cancer care
However, Dr. Lingegowda points out, existing networks and facilities are able to cater to barely one or two per cent of this requirement. The definition of palliative care, he says, was modified in 2002 by the World Health Organisation from its earlier four-decade-old definition of “cancer care” to that of extending support to those suffering from any acute health conditions. He defines this wing of healthcare as “low-tech and high-touch”. “It depends on doctors and nurses for guidance; but the most important part component is an active volunteer base.”
What could truly be a game-changer in this field is framing a policy that recognises the importance of palliative healthcare, creates an ecosystem to train volunteers and implements it through existing public heath centres. “There is little understanding about palliative healthcare. In Karnataka, district hospitals are afraid to administer morphine,” he says.
These are the more basic issues. But if you want this concept to be understood and grow, the Government has to adopt it in a policy form, Dr. Lingegowda says. “We can train doctors at the district level, teach them how to train volunteers, enrol support from social workers and psychologists, and set the ball rolling. It could make a difference to the healthcare system,” he asserts, comparing this network to existing village-level initiatives such as women's self-help groups.
The Kerala model
In 2008, Kerala became the first State to introduce a palliative healthcare policy. Dr. Lingegowda, who has collaborated with the Institute of Palliative Medicine in Kozhikode, points out that in north Kerala the coverage of palliative care is around 70 per cent.
“It is being conducted by setting up neighbourhood networks for palliative care. Doctors and health experts train volunteers and social workers, creating a network of training in palliative care methods. This kind of network is extremely valuable in developing countries. In Kerala, students and citizens are coming out in large numbers to participate in this programme,” he says.
Several countries in the world have set up such networks. “We must also try and build a similar system in the State. But it does not happen overnight; it will have to be taken up at a policy level and then the network has to be created,” he says.