Two years after palliative care centres were set up in eight of Maharashtra’s most backward districts to cater to patients with incurable medical conditions and acute pain, the project has hit a roadblock: six of these centres have been without doctors for six months now.
While nurses and medical social workers are available, they are not palliative care specialists and, more importantly, cannot prescribe the pain-relieving morphine. Also, five of these centres hold the licence for morphine but only three have it in stock.
The centres, set up in 2014 as part of the National Palliative Care Policy, offer both in-patient and out-patient services. They were a boon for the 970 cancer patients registered with them, saving them the trip to the Tata Memorial Hospital in Mumbai for morphine. In all, 21,638 patients are registered with these centres at Amravati, Chandrapur, Gadchiroli, Wardha, Nandurbar, Satara, Washim and Bhandara.
Palliative care doctors on contracts were posted at these centres until last year, but left due to a four-month delay in salaries, sources said. State government officials said advertisements have been issued for the vacancies, and responses are awaited. Dr. Sadhna Tayde, joint director, Directorate of Health Services (DHS), said, “There is a dearth of doctors. These posts are supportive as we have physicians and doctors for treating non-communicable diseases. Other doctors overseeing non-communicable diseases have been roped in and the facilities are functional.”
The staff at each centre should ideally comprise a doctor, a social worker and four nurses. “We have nurses and social workers in all centres. A major part of the work involves home visits, which is going on,” Dr Chetan Patil, palliative care coordinator with DHS, said. Besides cancer patients, the centres cater to paraplegics, victims of strokes and those battling uncontrolled diabetes, among others.
Morphine difficult to get: doctors
Pain in cancer patients is considered to be the most acute and is managed with morphine, while painkillers work on patients suffering from other illnesses.
An amendment to the Narcotic Drugs and Psychotropic Substances Act made it possible for authorised healthcare facilities to stock and dispense morphine, and palliative care centres were a step towards taking morphine to the cancer-afflicted in the remotest parts.
“The amendment has come, but morphine hasn’t. And where morphine is now available, there is no doctor to prescribe it,” said a senior doctor, who declined to be named, adding a big push is needed to ensure all eight centres get the licence to use morphine.
Besides better awareness on the availability of morphine, comprehensive training for caregivers is also needed. WhileTata Memorial Hospital does hold training sessions for palliative care, changes are needed to make the drug more accessible.
“More people should be enabled to prescribe morphine,” Dr. Kunal Saxena, managing director, Rusan Pharma, said. The firm specialises in pain management medication, including morphine. While palliative care specialists point out that doctors are still scared of using morphine, Dr. Saxena says there is a need to expand the scope of learning beyond morphine. “There are other drugs, but there is poor awareness. Also, people should know the authorised centres where the drug is available,” he said.
The amendment has come, but morphine hasn’t. And where morphine is now available, there is no doctor to prescribe itSenior doctor
