1 September 2014 • Vol. I, Issue 3 www.carebeyondcure.org A six-monthly newsletter from the Cipla Palliative Care & Training Centre, Pune care beyond cure Founded in 1997 Statistics for 2014 New Patients Month January February March April May June 61 66 57 60 69 80 News from the Centre Here is an overview of the last six months: Patients who came to the Centre; conferences that staff attended; and programmes and workshops that made a difference Cases at the Centre The Centre admitted 393 new cases between January and June 2014. One of these patients came in with angiosarcoma, an aggressive cancer of the inner lining of the blood vessels. Doctors at the Centre have seen this rare cancer only a few times before. Patients came from several districts of Maharashtra, including Beed, Latur, Usmanabad, Jalgaon and Parbhani. A few came from as far away as Rajasthan and Bengal. Easier access to Morphine In our last issue, we made a ‘Stop Press’ announcement regarding the much- needed amendments that are finally being brought about in the Narcotic Drugs and Psychotropic Substances (NDPS) Act of India. Till now, morphine has been kept under draconian controls in India to prevent misuse. Now, major changes in the NDPS Act will bring uniformity across the country. The power to make rules regarding morphine and other essential narcotic drugs will be transferred wholly to the Government of India. The government’s next step is to issue a notification listing the essential narcotic drugs including morphine. The ‘NDPS Rules’ will spell out the procedure for stocking, distribution, transport, possession and use of these drugs throughout the country. Thus, morphine will become more easily available for medical use, bringing much needed pain relief and hope to nearly 1 million cancer patients. The Centre reaches out through OPDs There are many cancer patients on active curative treatment who could benefit from palliative care, but do not want to be admitted as in-patients. “In the past, patients came to the Centre at an advanced stage of cancer when hospitalisation was necessary. Then, as public awareness about cancer increased, patients began to come at an earlier stage of their illness. They did not require to be admitted,” says Dr Priyadarshini Kulkarni, medical director of the Centre (aka Dr Priya). The Centre saw this as an opportunity to extend the good work to many more people. As a first step, the Centre set up an Out- Patient Department (OPD) on its own premises in February 2009. Twice a week, patients and their families were offered free counselling and medical consultation. The OPD also helped identify those who were unable to come to the Centre but who could still benefit from a home visit by the Centre’s home care team. There were many cases where patients were unable to continue their active cancer treatment, usually for financial reasons. When these patients went to hospitals, they would be told that the disease had advanced and they should just go home. Unfortunately, there was not much contact between the major hospitals which are in the city and the Centre, which is quite far away at Warje. “Since patients were not being directed to us, we decided to reach out and go to them,” says Dr Priya.
Transcript
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September 2014 • Vol. I, Issue 3www.carebeyondcure.org
A six-monthly newsletter from the Cipla Palliative Care & Training Centre, Pune
carebeyondcureFounded in 1997
Statistics for 2014
New Patients
Month
January
February
March
April
May
June
61
66
57
60
69
80
News from the CentreHere is an overview of the last six months: Patients who came to the Centre; conferences that staff attended; and programmes and workshops that made a difference
Cases at the Centre The Centre admitted 393 new cases between January and June 2014. One of these patients came in with angiosarcoma, an aggressive cancer of the inner lining of the blood vessels. Doctors at the Centre have seen this rare cancer only a few times before.
Patients came from several districts of Maharashtra, including Beed, Latur, Usmanabad, Jalgaon and Parbhani. A few came from as far away as Rajasthan and Bengal.
Easier access to Morphine
In our last issue, we made a ‘Stop Press’ announcement regarding the much-needed amendments that are finally being brought about in the Narcotic Drugs and Psychotropic Substances (NDPS) Act of India.
Till now, morphine has been kept under draconian controls in India to prevent misuse. Now, major changes in the NDPS Act will bring uniformity across the country. The power to make rules regarding morphine and other essential narcotic drugs will be transferred wholly to the Government of India.
The government’s next step is to issue a notification listing the essential narcotic drugs including morphine. The ‘NDPS Rules’ will spell out the procedure for stocking, distribution, transport,
possession and use of these drugs throughout the country. Thus, morphine will become more easily available for medical use, bringing much needed pain relief and hope to nearly 1 million cancer patients.
The Centre reaches out through OPDs There are many cancer patients on active curative treatment who could benefit from palliative care, but do not want to be admitted as in-patients. “In the past, patients came to the Centre at an advanced stage of cancer when hospitalisation was necessary. Then, as public awareness about cancer increased, patients began to come at an earlier stage of their illness. They did not require to be admitted,” says Dr Priyadarshini Kulkarni, medical director of the Centre (aka Dr Priya). The Centre saw this as an opportunity to extend the good work to many more people.
As a first step, the Centre set up an Out-Patient Department (OPD) on its own premises in February 2009. Twice a week, patients and their families were offered free counselling and medical consultation. The OPD also helped identify those who were unable to come to the Centre but who could still benefit from a home visit by the Centre’s home care team.
There were many cases where patients were unable to continue their active cancer treatment, usually for financial reasons. When these patients went to hospitals, they would be told that the disease had advanced and they should just go home. Unfortunately, there was not much contact between the major hospitals which are in the city and the Centre, which is quite far away at Warje. “Since patients were not being directed to us, we decided to reach out and go to them,” says Dr Priya.
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The Centre’s first hospital-based OPD was set up at Yashwantrao Chavan Memorial Hospital, Pune, in March 2011. The hospital’s staff was trained in palliative care and the facilities of the Centre. The patients and their families were counselled and made aware about the concept of palliative care. Those patients and their families who had already been at the Centre willingly shared their experiences on a little known mode of treatment and how it had helped them.
Over the last two years, the Cipla Centre has set up OPDs at KEM Hospital, Sassoon Hospital and Kamla Nehru Hospital in Pune. Since 2011, almost 500 patients have been counselled.
Caregivers’ workshopsWhen someone has a terminal illness, it is very frightening for the family. That is why the Centre holds workshops for patients’ relatives: to empower them in caring for their loved ones. These workshops are designed to help dispel fear. The training reassures common people who are not medical professionals that they too can have the healing touch.
On March 1, 2014, the Centre held its first caregiver workshop for this year. Participants were welcomed by Dr Priya. Ms Nandini Thatte, Counsellor – Research & Training, started the workshop with an overview of the subject, and how to help caregivers cope with a family member’s suffering.
Ms Madhura Bhatwadekar, medical social worker, spoke on ‘Emotional challenges and distress triggers at home’. Dr Sonali Kulkarni, medical officer, covered the
subject of ‘Long-term care’, while Sister Vrinda Kulkarni, nursing superintendent, focused on ‘Everyday care’. Dr Mugdha Vaidya, physiotherapist, dealt with ‘Promoting patients’ independence’ and Ms Aruna Deshpande, medical social worker, spoke on ‘Work-life balance’.
The participants were keen to be a part of more specialised workshops on communicating with patients, physical exercises and stress management.
Dr Pradeep Kulkarni and Ms Nandini Thatte also conducted a lecture on professional caregiving at the Babasaheb Ambedkar Research & Training Institute (BARTI) on April 13, 2014. Dr Kulkarni
spoke to about 30 participants on the physiological, psychological and social aspects of cancer; and Ms Thatte spoke on caring for a cancer patient. The sessions at BARTI were designed specifically for laypeople who want formal training as caregivers and are willing to work in the community.
Meeting of experts in the field
The 21st Annual International Palliative Care Conference (IAPCON 2014), organised by the Indian Association for Palliative Care, was held in Cuttack on February 14-16, 2014. The Centre’s delegates were Dr Priya, Dr Santosh Chaudhari who is in charge of home care, and Dr Vivek Nirbhawane, medical officer. The theme of this year’s conference was ‘Evidence-based palliative medicine’. This theme is very significant, because as Dr Priya says, “Our impressions are
now backed up by scientific data.” She spoke on ‘Palliative care in heart disease’. Dr Nirbhawane spoke on ‘Patient database in palliative medicine’, and Dr Chaudhari on ‘Advantages of home care in palliative medicine’.
The conference had 1,500 delegates from India and abroad.
Dr Priya also attended the Worldwide Palliative Care Alliance (WPCA) board meeting in London, an apex body that sets guidelines on palliative care. She was elected to its board of directors.
Dr Priya participated in a session on‘Death and Dying’ in Hong Kong, conducted by Asia Pacific Hospice Palliative Care Network. She presented a paper on ‘Grief and Bereavement Issues in India’.
Ms Nandini Thatte attended a workshop on Cognitive Behavioural Psychotherapy for anxiety & depression in Mumbai from April 4-6, 2014 by Morphic Minds, an institute of psychotherapy in Nagpur.
Spreading the wordDr Pradeep Kulkarni and Ms Nandini Thatte of the Cipla Centre conducted an orientation session on ‘Palliative Care as an emerging speciality’ for the new batch of MBBS interns at Talegaon General Hospital & Medical College on March 6, 2014. Palliative care remains an unknown subject at the undergraduate level, and those in the field are keen to expose young doctors to it early.
The Centre also conducted a session at the Sassoon Government Hospital on March 24, 2014, where Dr Pradeep introduced palliative care to the third year MBBS students.
A caregivers’ training programme for doctors, nurses, social workers and laypeople was held on April 12, 2014, at Kothadia Hospital, Solapur. Dr Priya, Dr Madhulika Jain, Ms Thatte, Ms Madhura Bhatwadekar, social worker, and Dr Mugdha Vaidya, physiotherapist, gave presentations on various topics. It catered to people from a different region and thereby enabled the Centre to spread the word about such training and about palliative care in Solapur. The Centre hopes to hold more of these workshops outside Pune to spread awareness and to help build a more patient-sensitive and skilled community of caregivers.
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A home visit, as the Cipla Centre’s doctors show, is about extending support and empathy; it’s not about pain relief alone. Here is a day in the life of our home care team...
Pushpavati Naik is a 73-year-old breast cancer patient who is in remission, living with relative peace of mind in a one-room house in Gultekdi at Market Yard in Pune. Traffic on the road is sparse as it is polling day in Pune. Pushpavati, who quickly finished casting her vote, wanted to be back early to await the visit of Dr Santosh Chaudhari from the Cipla Centre and male nurse, Anil Chavan. She knows that she can talk to them about everything concerning her life, and not her medical condition alone. Dr Chaudhari makes it clear that theirs is not a social call and declines her gestures of hospitality.
Pushpavati is doing well after her mastectomy (breast removal) in March 2013, but Dr Chaudhari is gently trying to persuade her that she should not become complacent. “You must go for a follow up visit every three months to Sassoon Hospital to make sure everything is in order.” Neglect can be costly, he adds. She agrees to go, but is more keen now to tell him about all her aches and pains. “You should sit with your feet up on a stool or table when you are watching TV,” he tells her, “and don’t ever stop taking your blood pressure medicines.”
How reassuring must it be for her when Dr Chaudhari tells her, “If there is ever anything you need, call me. My phone is always on.”
The home visits that the Cipla Centre’s doctors make are, first and foremost,
lessons in kindness and meaningful communication. Dr Chaudhari and Chavan listen attentively as Pushpavati talks about everything happening in her life – her son’s bouts of alcoholism, his consequent irregularity at his job with the Post and Telegraphs Department, her financial worries.
“Building rapport takes time, but it is important,” says Dr Chaudhari, “because it can prevent a relapse by making patients go for regular check-ups.” It’s unlikely that they will listen to instructions from a doctor they don’t know.
Care on wheelsHome visits were started by the Cipla Centre in 2003 to ensure that palliative care did not stop after the patient went home and to check that the relative they had trained was continuing to carry out what had been taught. Now, a decade later, the demand for home visits has grown. The Centre has received hundreds of registrations through the OPDs it conducts at various hospitals in Pune. Dr Chaudhari and Chavan fit in about 10 visits a day in the Pune-Pimpri-Chinchwad area, and the Centre is hoping to have another team for other parts of the city.
The team usually uses an ambulance
for quicker navigation, but often locating where the patients live is not easy. The patient they are visiting next is Narendra Lallubhai Gohil, who lives within what resembles a maze of small asbestos sheet-covered structures. It’s hot as a furnace inside the room where he, his wife and son are having lunch. The 64-year-old carpenter had cancer of the oral cavity which left his right cheek disfigured, but his spirit is intact. Now he cajoles Chavan, “Give me carpentry work to do at the Centre, then I will come for a check-up. I want to earn my keep.” Chavan tells him with mock sternness, “First go to the dentist and get your caries attended to, then I will recommend you for carpentry.” This is the Cipla team’s way of telling him to maintain oral hygiene. They have a reason to emphasise this as in 2008, he had come to the Centre with his wound maggot-infested. Keeping a cancer wound clean and regularly dressed is imperative, says Dr Chaudhari, and this is where Gohil could have slipped up, leading to the infection.
Pain relief tops the agenda of home visits and the team sometimes goes beyond the usual area it covers to attend to somebody who needs medication.
Their next patient for the day could serve as counsellor to others. B.K. Gujar, an ex-armyman who served in five wars, has a malignant tumour in the pancreas which he was advised not to remove. The team’s job is to monitor his condition periodically and replenish his medicines. They believe his case is miraculous as he has no pain nor the diabetes that such a tumour often causes. “I’ve been given this disease,” says the soft-spoken former soldier. “Let me face it, is what I told myself.”
Making a home visit is like soldiering, in a sense. It is to persist with missionary zeal in caring for those beyond cure.
On home ground
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The skies had turned charcoal grey, lending an air of anxiety to the proceedings. In a few minutes they opened up, and sheets of rain, completely unseasonal showers, came pounding down. By 4 pm, thankfully, on May 3, just prior to our 17th Annual Day function, the weather Gods smiled upon us as the sun reappeared and all was well.
Our guests of honour this year were noted National Award winning Marathi film director Umesh Kulkarni and S.C. Nagpal, retired Chief Commissioner of Income Tax, north-western region.
Dr Madhulika Jain, Director, Medical Administration, expressed gratitude in her brief speech to the chief guests for making the time to come and the staff, volunteers, patients and their relatives who had been instrumental in the growth of the organisation.
From a teen to an adult Dr Priya spoke about how the Centre was transforming from a teen to an adult. She said that it was becoming more professional by bringing in talented individuals. She also stressed on the need to train more people so that we could reach out to more segments of society. Another feather in the cap for them was
that the Centre would be the new secretariat of the Indian Association for Palliative Care and she would be its secretary for the next three years.
Mr Umesh Kulkarni, expressing generous praise for the Centre, said, “This place radiates positive energy.” He recalled the time he set out to make his first film, Valu, and needed financiers for it. Many of the people he approached backed out upon hearing that the lead role would be played by a valu (‘ox’ in Marathi). Left with no option, he decided to produce the movie himself. He said that the joy of making his debut movie was heady, as was the experience of making his second and third too. By the time he embarked on his fourth venture, though, his enthusiasm took a dip. In contrast, “The Cipla Centre has been serving patients with the same dedication and zeal for the last 17 years. This kind of dedication and commitment is noteworthy,” he observed.
Mr Nagpal too spoke in glowing terms of the Centre’s approach to community service. He said, “The Centre has been instrumental in bringing joy to sick people and those in pain in and around Pune.”
The guests were felicitated with bouquets made by our patients and relatives.
An Evening to Remember
Unseasonal showers could have marred our
17 th Annual Day function,
but didn’t. Marathi film director Umesh Kulkarni spoke on the meaning of commitment. An accomplished roller skater who performed the lavani and the Tata Consultancy Services band had everyone spell bound
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Enthralling actsA cultural evening followed. The compere for the show was Ms Vinaya Sathe. The programme started with a welcome song by the Centre’s senior volunteers, followed by Santvani, a piece in tribute to Lord Vitthala, performed by the Cipla staff. Then came Ms Nupur Joshi’s ‘Lavani on skates’, which had the audience spell bound. She danced to the musical accompaniment of a popular Marathi Lavani geet. A national skating champion for the past seven years, she has performed in India and abroad, this being her first performance at Cipla.
Then came members of the Tata Consultancy Services rock band to keep the audience engaged. Having jammed regularly at places like the Hard Rock Café and at various other gigs, they developed cold feet momentarily when they saw their audience. There was a row of patients’ beds lined up, the occupants waiting eagerly for their performance. After an initial hiccup, they did get into gear and then there was no looking back.
The Centre’s nursing staff and nursing students too performed a couple of dance numbers. Mr Ram Parundekar, a senior volunteer with the Centre, proposed a vote of thanks.
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In their own wordsMr Arunkumar Daga, patient:The doctors gave great deal of attention to relieving me of pain. The staff members maintained a strict approach. Patients are not confined to the ward which is very good. The Centre does not convey the typically impersonal atmosphere of a hospital.
Mr Jagtap, husband of patientMrs Pushpalata:We came to the Centre after stopping curative treatment for my wife. The cleanliness of the place and its natural surroundings appealed to me instantly. I got empathy and mental strength from all the members of the staff.
Ms Rekha Kusalkar, patient:I liked all the facilities at the Centre, especially the handicrafts sessions and yoga.
Mr Vinayak Joshi, son of patientMrs Asha Joshi:I was impressed with the Centre’s work right from the time of making enquiries. I lost my mother, but gained strength through the treatment that was given to her.
Mr Suhas Patil, husband of patientMrs Surabhi Patil:I was satisfied with the support and care that the nursing staff and counsellors gave. They helped me face my wife’s prognosis.
Ms Anjana Raskar, daughter of patient Mrs Subhadra Tilekar: I liked the treatment, quality of food, staying arrangements and other facilities at the Centre.
Mr Gorakh Nikam, husband of patientMrs Sheetal Nikam: Everyone here expresses love and care. This Centre is not like a hospital, but a home.
Mr Nasser Inamdar, son of patientMrs Sunnabi Inamdar:I am very thankful to all the members of the Cipla Centre for their efforts in helping my mother recover from the terrible pain in the abdomen that she had been suffering from over the last one month. We came here on January 15, 2014, to get my mother admitted. In two days’ time, she said she was fine and free of pain. She told me that she had liked and enjoyed the activities organised by the Centre, the food and the treatment given to her. Cipla is doing valuable work for those who do not have further hopes. I wish the Centre all the best and many thanks to all those who are working here. May God bless them all.
Mr Mehmood Tanwir, son of patientMrs Khatun Tanwir: My mother was brought here in severe pain. We received very good treatment and very special care
from all the staff. I pray from my heart for their well being. The initiative taken by this institute is like light in the middle of darkness. It not only gives relief to the patient, but also to the family members. Words cannot express my feelings.
Mrs Jyoti Kotiyana, wife of patientMr Papa Kotiyana: The greenery and the clean and beautiful premises that the Centre is housed in was instantly calming for us, keeping at bay both the physical and psychological pain with which we came. At the time of admission, we were scared about my husband’s condition, but after the doctors spoke to us, we felt relaxed. They immediately started with the treatment and my husband’s suffering lessened. Everyone here helped take care of him and I am very grateful to them. The staff here not only takes care of the pain and symptoms, but also the other problems of patients and their relatives too. It is like they are teaching each one to lead a full life by being a good human being. How to behave with others can be learnt just by observing the behaviour of the staff members with others, right from the watchman to the medical officers. What life is and how to lead it well is usually found in books, but here, at the Centre, we saw in practical terms, what life actually involves.
Sitabai Ramchandra Wagh, aged 55, from Bhukum, Taluk Priangut, Pune, was admitted to the Centre on March 28, 2013. She was to be in and out of it four or five times in the course of the year, each stay being about 20 days’ duration. The disease claimed her on October 24.
Her son, Baba Wagh, says, “I have very good memories of the Centre.The service, the treatment and the way the staff took care of my mother were exceptionally good.” Since he spent long spells of time at the Centre, he managed to make some good friends with whom he remains in touch.
Baba recalls that his mother was in an anxious state, worrying about the family’s financial condition that was further strained due to her illness. Once
she was admitted to the Centre, counselling sessions helped her greatly and she was able to address these anxieties. This also paved the way for smoother communication between Sitabai and her family. Baba was, in turn, relieved by the fact that, given his financial state,
he would not have to raise lakhs of rupees for his mother’s treatment.
According to him, the Cipla Centre ‘was a blessing in disguise’. Not
only could he give his mother treatment, but also the comfort which he would not have been able to provide at home. What’s more, here it was absolutely free of cost.
All this drove a deep urge in him to give back something to the Centre. His initial attempt was to rehabilitate a patient’s son, Akshay Jadhav. Akshay used to be the caretaker for his mother at the Centre. When she died, Baba placed him in a computer training centre where he worked as a helper and at the same time learnt computers so that he could start
earning his own livelihood. Baba also helped another caretaker, Prasad, get a job in Kalyan, Mumbai. Prasad’s parents had died at the Centre.
It did not stop there. He checked with Sister Bindu, the Centre’s matron, about what he could give in the form of a donation. Sister Bindu told him about their need for wheel chairs for bathing patients and how the ones that were available in the market were not very comfortable. Since Baba had his control and automation business; he thought, why not design one to the specifications given by the matron? He set himself to the task of designing a sample wheel chair. Everybody liked his design and it was approved immediately. Baba now custom-made four more wheel chairs. During a handicraft session with relatives, he handed over these chairs to Dr Priyadarshini. He also gave a small speech, addressing the relatives mainly, about how they ought to be thankful and help the Centre by keeping the premises clean, conforming to the rules and trying to be of help in whatever way possible.
Baba remains in touch with the Centre and is ever ready to extend any help that may be required of him.
Return giftRelatives of patients often want to repay the Centre for the support and care that their family member has received. We profile Baba Wagh, one who gave back in admirable ways
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Dr Pradeep Kulkarni, consultant at the Centre, came to palliative care after practicing as an anaesthesiologist for 25 years in Nanded, Maharashtra. He joined the Centre in 2011, quite unaware of what the discipline was all about, but eager to learn. In this interview, he speaks of the challenges he faces as a doctor who must look death in the eye every day.
What drew you to palliative care?After 25 years in anaesthesiology, I felt I wanted to learn something new. I chose palliative care because it is to do with pain relief, just as anaesthesiology too has to do with pain relief. Except that in the ICU, I was used to seeing a patient who was dying being resuscitated. While here, in palliative care, the attempt is to give the patient quality of life rather than resuscitation. I soon got adjusted to this approach.
What was the major learning for you in this switching of disciplines?I started learning how to communicate, which, as an anaesthesiologist, offered me no opportunities. And communicating in this set-up is difficult because patients ask difficult questions. Communicating requires preparation, one has to be able to anticipate the patient’s question. Earlier, when a patient would start crying I would run away. But I realise now that the first part of communication is listening, and every doctor should be aware of this aspect of palliative care. Listening to the
patient is critical, but most doctors think that they are too busy to do so.
Why is it so difficult to listen?Patients have so many worries, and they have no idea of the ramifications of the disease. The questions plaguing them are in the realms of ‘Why me?’ or ‘What will happen after death?’ There’s no easy
answer. It is therefore important to develop a relationship with the patient, create confidence in them. It is team work – or else, they won’t talk to us.
What are your duties as a doctor at the Centre?I listen to what the patient is saying. I treat symptoms, prescribe medicines for pain relief, work to contain the family’s worries. We also conduct a caregiver’s training programme.
It’s important for us as doctors to reach people in society through awareness programmes in medical colleges, pharmacies, industry, to convey that palliative care is a part of a doctor’s work. We also have a programme called ‘Training the Trainers’ where assistant professors of clinical subjects from various colleges come and learn from us about palliative care, which is important, as there are only 5 or 10 palliative care specialists in Maharashtra.
Which part of your job is most rewarding for you?Being able to fulfil a patient’s wish, however minor it be. Fifteen days ago, we had a 23-year-old patient with peripheral nerve sheath tumour which had spread to the lungs. She said she wanted to visit Saras Baug, a park in Pune, and we wondered how she would withstand the drive if anything were to happen on the way. So we had a wheel chair and ambulance accompanying the car. Three
or four days after that outing, she died, but we felt glad to have fulfilled her wish.
As patients approach the end of their lives, what kind of support do they and their families need?We have schools and colleges for learning, stadiums for playing, but there is nothing to teach us about dying, which is a definite eventuality.
Sometimes, the family member wants to shield the patient from the truth. But if you take the patient to a cancer specialist, subject them to various tests, they know that something is wrong. Right now, we have a mother who is a patient. In the beginning, the son did not want her to know that she was suffering from cancer, but after being here, a change takes place. Just this morning, he said that he is prepared to tell her.
Here, at the Centre, there are cases where we come across couples or family members who didn’t care for each other before, but when they realise that their relative is suffering from cancer, they start caring. They want to nurse the patient, take care of his or her needs.
What does ‘death with dignity’ mean?For a patient to die with dignity, he should be aware of what is happening to him. He should express any desires he has and he should be helped to fulfill them. There should be no stress weighing on him. We, as doctors, should find out what is on the patient’s mind, what or whom he is attached to, and provide him the relief he requires. ‘Dying with dignity’ entails proper care of the patient and his or her family.
‘Answering patients’ questions is not easy’Dr Pradeep Kulkarni of the Cipla Centre, a former anaesthesiologist, learnt the art of listening after working in palliative care
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Most people encounter death at the end of a process of being cared for over a long time. It is at such times that doctors have to plan for long-term care and offer support to the family too. Therefore, the planning and preparation for death should start six months or a year earlier. Care should be of such a quality that a person is relieved of mental torment about death or disease.
How do we sensitise doctors towards palliative care? Should we take the scientific route to deal with emotions?We have to teach doctors to treat what is treatable, cure what is curable, and palliate what is not curable. Doctors are well trained in scientific concepts and medical knowledge, but not as well in dealing with the feelings of those going through the traumas of cancer, for example. Palliative
care calls for spending more time with the patient at an emotional level. The medical field is not an impersonal one, but doctors’ hectic schedules have made it so.
Yes, we have to go through the objective scientific route to get through to the emotions. If there are scientific guidelines, then palliative care can be broadened. We think of symptoms, not of how the family is suffering. It’s important that our healthcare system should be decentralised, and that doctors should be taught how to break bad news. The concept of palliative care should be taught to medical personnel so that they can treat total pain, which includes spiritual, psychological, social and physical pain. This way, they will learn to care for the patient and the family, rather than treating only the disease.
For private circulation only. Cipla Palliative Care and Training Centre, Warje, Pune 411058. Tel/Fax: 020 25231133. Email: [email protected], Website: www.carebeyondcure.org.
Edited by Ms. Nandini Bhaskaran
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When help is just a phone call awayCancer patients and their families often feel alone and helpless. The right information about palliative care, conveyed with empathy, can give confidence. That is why the Centre offers a helpline service. People can call in and find out about the Centre’s facilities and the OPDs it conducts at various hospitals. The Centre registered with Just Dial in January 2014 and is prompt at following up queries.
From the visitors’ log book
Dr Wendy Pattermore, Palliative Care Physician, New Zealand
She held a discussion with the team about palliative care practices here and in New Zealand. January 14, 2014
Dr Villy Doctor, Founder, Light of Life Trust, Mumbai
Visiting the Centre was so enlightening. The work is truly compassionate and each and every life is valued and cared for. The Centre is kept so clean and hygienic and the relatives look so relaxed and happy. This is excellent, wonderful. No words can describe the Palliative Care Centre. March 11, 2014
Dr Pradeep Bavadekar, Managing Director, D. MITCONConsultancy & Engineering, Pune
This is a great facility, and a great service being rendered to mankind. March 11, 2014
Dr Rangarajan, Chartered Accountant, RGN Price, Mumbai, and a Rotarian
The Centre is providing yeoman service to humanity. It was a moving experience to visit. April 13, 2014.
carebeyondcure
If readers would now like to send us theirThoughts, Ideas or Suggestions,
Orientation Programme on Palliative Care for Doctors: The Centre is conducting a six week long orientation programme on palliative care for the doctors from the Indian Medical Association (IMA), Pune Chapter. The programme commences on September 4, 2014 and ends on October 9, 2014. Lectures will be held once a week. Eminent experts in the field of palliative care from all over the country are invited to take sessions.
World Palliative Care Day Celebration: There will be a week-long celebration on the occasion of World Palliative Care Day, which is annually observed on the 2nd Saturday of October. This year it is on October 11. The celebration will be concluded with a walk for palliative care.
Workshop on Orientation to Palliative Care for Professionals: This is a one-day workshop open to all social work professionals and psychologists working in the field of healthcare and wish to work in, or understand palliative care. The sessions will highlight how working in palliative care calls for a different attitude, skills and knowledge. The group is limited to 20.
