Dr. M.R. Rajagopal is popularly known as the father of palliative care in the country. A 90-minute-long film based his mission for a pain-free India will be screened at the Tata Institute of Social Sciences on Saturday.
The Hindu caught up with Dr. Rajagopal, founder chairman of Pallium India, a palliative care NGO based in Kerala, and asked him where the country stands today in terms of pain management and end of life care.
How do you define palliative care?
Palliative care is treatment aimed at improving the quality of life of patients and their family members when they face serious health problems. That suffering can be physical such as breathlessness, pain, a nasty wound or psychological, social, or spiritual such as depression, social isolation. It can also be a question that bothers you; like ‘What is point of life?’ Palliative care aims at identifying these issues, taking away what we can and easing their journey. Pain is the most common symptom. It affects the body and the mind. Unless we treat pain, we cannot take away the emotional stress or the suffering completely.
But palliative care is not a well-known stream in medical care in India...
Just 1%-2% people have access to palliative care or pain management in India, which is a land of paradoxes. We have a national programme for palliative care but even today medical students do not learn pain management from the curriculum.
For most severe pains like two-thirds of cancers, major trauma, surgical pain, one cannot manage without opioids, which reach less than 2% of the needy in the country. However, the country grows poppy, makes opium and exports it to the rest of the world. That is the paradox. There are some training programmes but those cater only to a minority of doctors. There is nothing for medical students in terms of pain management and new doctors don’t know anything about it.
What is the need of the hour in terms of palliative care?
India needs three things: a policy and a plan for implementing it; availability of the essential medications; and education and public awareness. Health care expenses will drop if palliative care is implemented well. What happens now is people get expensive chemotherapy even in their final days, which only adds to their suffering. It simply doesn’t make sense.
Does having a palliative care policy work?
Yes, but it should be implemented well. Only two States have palliative care policies in India: Kerala and Karnataka. In 2015, Maharashtra drafted a similar policy, but it is yet be finalised. In Kerala, the policy was implemented in 2008.
The State has 900-odd panchayats and each panchayat has a primary health centre. Every single nurse in the primary health centre in the State is now trained in palliative care.