Networking for palliative care Newsletter of Cipla Palliative Care and Training Centre care beyondcure June 2011 www.carebeyondcure.org Cont'd on Page 8 Learning, sharing, caring together ama Lonkar did not have much time left and she knew it. She was Rworried about the future of her daughter. She wanted to be assured about the child's continuing care and education. She wanted to go home and tie up some loose ends concerning her property. Even though she had no family support, all that she wished for came true before cancer took her away. Apart from the Cipla Centre team, the network members who made this possible included: a neighbour who volunteered to stay with the patient, the orphanage that granted admission to the child, the NGO that provided legal support and the ambulance service that ferried mother and child back home. Girija Iyengar stayed in a village far from Chennai and was keen to go home. She desperately wanted to distribute her assets, when she was still in a position to do so. A strict adherent to the tenets of her religion, she was already a loner in the family because of various disputes. The team at Cipla Centre, where she was admitted, began tapping its network of resources well before her journey to her village started. Right through the journey her travel companion updated the team about her status. The doctors at the Centre had already briefed doctors in locations en route to her village and they were ready to help her at a moment's notice. When her condition suddenly worsened, the local doctor sought advice from Cipla Centre about the best course of action. Fatima Patel was in a different situation in Kolkata. She had run out of morphine that she had carried from Cipla Centre and was in intense pain. The only place from where she could obtain morphine demanded that she first register as a patient for a fee. And she was not in a position to pay. Sending morphine from Pune would have taken too long and was, in any case, difficult on account of strict laws governing the transport of the drug. Once again, it was time to tap the network. A local palliative care centre responded to requests from Cipla Centre and gave her morphine. ll illnesses are considered medical problems with the Acommunity pitching in with some sort of support in a few cases. However, going by the theory of primary health care put forth by the World Health Organization (WHO), chronic and incurable diseases requiring palliative care are essentially social problems with medical components. Palliative care involves multiple dimensions of pain management. Even today, of the millions of people who desperately need palliative care, a very small percentage is lucky to have access to it. The best bet to reach comprehensive palliative care to all across economic and geographical divides is through networking. The successful Neighbourhood Network in Palliative Care (NNPC) in Kerala is a fine example of the power of networking to reach out to the community at large. Started in 2001, NNPC provides palliative care to about 10,000 patients at any given time through a network of 230 clinics, 60 full-time doctors, 350 nurses and, most importantly, more than 10,000 volunteers. Most of the funding needs are met through local donations. It takes many hands to keep pain at bay and to make life work.
Transcript
Networkingfor palliative care
Newsletter of Cipla Palliative Care and Training Centre
carebeyondcureJune 2011
www.carebeyondcure.orgCont'd on Page 8
Learning,sharing, caring
together
ama Lonkar did not have much time left and she knew it. She was Rworried about the future of her
daughter. She wanted to be assured about the child's continuing care and education. She wanted to go home and tie up some loose ends concerning her property. Even though she had no family support, all that she wished for came true before cancer took her away.
Apart from the Cipla Centre team, the network members who made this possible included: a neighbour who volunteered to stay with the patient, the orphanage that granted admission to the child, the NGO that provided legal support and the ambulance service that ferried mother and child back home.
Girija Iyengar stayed in a village far from Chennai and was keen to go home. She desperately wanted to distribute her assets, when she was still in a position to do so. A strict adherent to the tenets of her religion, she was already a loner in the family because of various disputes.
The team at Cipla Centre, where she was admitted, began tapping its network of
resources well before her journey to her village started. Right through the journey her travel companion updated the team about her status. The doctors at the Centre had already briefed doctors in locations en route to her village and they were ready to help her at a moment's notice. When her condition suddenly worsened, the local doctor sought advice from Cipla Centre about the best course of action.
Fatima Patel was in a different situation in Kolkata. She had run out of morphine that she had carried from Cipla Centre and was in intense pain. The only place from where she could obtain morphine demanded that she first register as a patient for a fee. And she was not in a position to pay. Sending morphine from Pune would have taken too long and was, in any case, difficult on account of strict laws governing the transport of the drug.
Once again, it was time to tap the network. A local palliative care centre responded to requests from Cipla Centre and gave her morphine.
ll illnesses are considered medical problems with the Acommunity pitching in with
some sort of support in a few cases. However, going by the theory of primary health care put forth by the World Health Organization (WHO), chronic and incurable diseases requiring palliative care are essentially social problems with medical components.
Palliative care involves multiple dimensions of pain management. Even today, of the millions of people who desperately need palliative care, a very small percentage is lucky to have access to it.
The best bet to reach comprehensive palliative care to all across economic and geographical divides is through networking.
The successful Neighbourhood Network in Palliative Care (NNPC) in Kerala is a fine example of the power of networking to reach out to the community at large. Started in 2001, NNPC provides palliative care to about 10,000 patients at any given time through a network of 230 clinics, 60 full-time doctors, 350 nurses and, most importantly, more than 10,000 volunteers. Most of the funding needs are met through local donations.
It takes many hands to keep pain at bay and to make life work.
Recent advances in the management of breathlessness
2
reathlessness is a frightening symptom to both witness and Bexperience. It is common in
many conditions, especially in the palliative setting, profoundly affecting the quality of the person's life.
Breathlessness has been variably defined as an unpleasant awareness of breathing, or an uncomfortable sensation. There are many causes of breathlessness, too numerous to mention here, but they all fall into one of two categories; cancer related or non-cancer related. The incidence of breathlessness ranges from 21 percent to 90 percent in cancer patients, depending on the severity and type of cancer involved. In those people, who suffer from heart failure or lung disease, the incidence is approximately 65 percent and 90 percent , respectively.
AssessmentD u r i n g t h e a s s e s s m e n t o f breathlessness, it is important to ask why. Is the problem expected or unexpected? What sort of action should be taken, if at all?
As breathlessness is a subjective experience, patient self-report is vital in assessment—not simply staff report. A quality of life measurement might be more appropriate for a holistic assessment, including the impact that the breathlessness has on a person's physical, emotional and social functioning. Physiological indicators such as arterial blood gases, oxygen saturation, spirometry or respiratory rate are technica l indicators and may not necessarily correlate with the degree of breathlessness.
Recent advances in managementT h e t r e a t m e n t o f breathlessness depends on the under ly ing causes and the potential to reverse the reversible. Management requires, if possible, involvement of a multidisciplinary team and needs to focus on the following:
1. Address and relieve d i s c o m f o r t a n d distress of patient and the caregiver; and
2. Reverse or treat the disease process if p o s s i b l e , a n d appropriate.
Role of opioids
Opioids, either oral or parenteral, are now considered to be the gold standard in reducing ventilatory demand. Low dose oral opioids can improve b r e a t h l e s s n e s s , s o m e t i m e s dramatical ly . However, before administering opioids it is necessary to consider pathophysiology, previous exposure to opioids, the rate and route of dose titration, and coexisting pathology.
Titration of opioid dosage for managing breathlessness is the same as that for controlling pain. Initial doses for breathlessness should be lower and increments smaller. In patients not exposed to opioids, as little as 2.5mg of normal release morphine every 4 hours may be sufficient. While putting a patient on opioids, concurrent laxatives should be prescribed as op io ids are known to cause constipation.
Other pharmacological measures
Anxiolytics may assist in the anxiety component o f breathlessness. However, these may be poorly tolerated in some patients, especially in those with liver failure. The use of sedatives in the management of breathlessness requires careful consideration and more research is needed in this area.
Long acting beta agonists may be beneficial in breathlessness due to COPD, in reducing the work of breathing. Bronchodilators help in relaxing muscles and improving muscle tone in the airways.
The use of Oxygen has been shown to offer no greater benefit than room air, administered through nasal cannulae at 2 litres per minute, especially in people with cancer, who are mildly or non-hypoxic, i.e., paO >55 mgHg. 2
Non-pharmacological measures
Non-pharmacological interventions must be tailored to the individual so that they are congruent with their values and beliefs concerning health and illness.
It is important to listen to the patients' experience. Fans, open windows or cold washes on the face are often helpful.
Strategies such as relaxation training and distraction seem to help as do cognitive behavioural therapies.
Physical conditioning has been shown to be useful in COPD patients, and in those with cancer. Acupuncture may be beneficial in people with COPD; more research is needed.
Advanced planning in the event of an acute exacerbation is vital and conversations regarding where the person wants to be cared for in such an event needs to be documented.
Controlled breathing e x e r c i s e s a n d techniques such as an upright leaning forward position and pursed l i p b r ea th ing a r e also beneficial. Chest w a l l v i b r a t i o n , neuroelectrical muscle stimulation, walking aids, and breathing training have been found to be effective.
Psychological support, breathing exercises and the development of coping strategies can ass is t pat ients in t h e m a n a g e m e n t o f r e f r a c t o r y breathlessness.
Based on the original published by Katrina Breaden, Flinders University, Adelaide, Australia in Indian Journal of Palliative Care, with the author's permission. Year: 2011 | Volume: 17 | Issue: 4 | Page: 29-32
Pleural effusion Anaemia
Causes of breathlessness in advanced cancerDebilityCancer
Progestogens stimulating ventilation or causing increased sensitivity to carbon dioxide
COPD Pneumothorax
Concurrent
Asthma Panic disorder; anxiety, depression
Heart failure Fever
Acidosis
3
IAPC conference makes a case for networking
octors, nurses a n d o t h e r Dprofessionals
from all over the world deliberated over the best ways to incorporate the art and science of n e t w o r k i n g i n t o palliative care at the 18th International Conference of the Indian Association of Palliative Care (IAPC) held in Lucknow from February 11 to 13, 2011.
C i p l a C e n t r e w a s r e p r e s e n t e d a t t h e c o n f e r e n c e b y Dr Priyadarshini Kulkarni, Dr Sonali Kulkarni, Dr Geeta J a h a g i r d a r a n d M a d h u r a Bhatwadekar, medical social worker.
Dr Priyadarshini Kulkarni presented a paper on “A case for hospital-based palliative care: Prescription for progress of palliative care in India.” Dr Sonali Kulkarni
presented a poster on “How spouses cope with anxiety in advanced cancer”, which won the second prize. Madhura Bhatwadekar's poster on “Networking and sharing for maximising patient comfort: A case study”, bagged the third prize.
Amar Lulla 1948-2011
Amar Lulla played a pivotal role
in the growth of Cipla Ltd for 35
years. He was a Trustee of Cipla
Centre right from its inception.
He nurtured and supported the
Centre all along. All of us at
Cipla Centre shall miss his
presence. Close as the Centre
was to his heart, we are sure he
will always be around in spirit
to guide and encourage us.
Tribute7000th patientGirish Patne
orn in 1951, in Khed, Ratnagiri, Girish Patne was always keen Bon business. As the son of a
government transport contractor, a motor mechanic's diploma after completing XI standard appeared to be the right thing to do. When the opportunity came up to join father, he grabbed it and finally took over when Girish was about 21.
Father's death and rising competition compelled Girish to turn to the stone crushing business. He even bought a quarry. Then some difficulties cropped up on the family front and he moved to Panchgani. Here he got into the construction business. Panchgani was where he also educated his two daughters and a son.
The problem started in June 2010 with back pain and fever. Then he spotted blood in the urine. Diagnosed with cancer, one of his kidneys had to be removed. “Radiation treatment started. Then I was prescribed some expensive pills at the hospital with no assurance of the outcome. Then a friend told me about Cipla Centre,” Girish said.
When he was brought from Panchgani and admitted to Cipla Centre on March 2, 2011, Girish was in a bad shape. “I could not talk. Then within a couple of days, I felt much better. I like it here. I like my morning walks here in the garden. This Centre has been built with a lot of thought,” Girish said.
Every patient is special at Cipla Centre. Did he know that, as the 7000th
patient, he was even more special? “Thank you, I am very comfortable here,” Girish smiled. “But I wish there was some medicine that could cure me. I have some loans to repay. I just need a few more years for that ….”
Girish was discharged from the Centre on March 7, 2011.
Annual Day 2011
A fun evening with family and friendsan those who are always trying to ease others' pain ever have fun? CThe answer at the annual
programme on April 30, 2011 was a resounding yes!
The programme began on a sombre note as the gathering stood in silence to pay homage to Amar Lulla, Trustee, Cipla Cancer and AIDS Foundation, who passed away on April 22, 2011. S V Iyer, Managing Trustee, paid rich tributes to Lulla.
Then, compere Aruna Deshpande took over. As always, there was some memorable music and some dazzling dances. Volunteer Avinash Badwe skilfully told a tale of horror that had everyone on the edge of their seats. In a delightful twist, it turned out to be a comedy at the end!
Those who always associated Vinay Naik with nothing but some serious research work rubbed their eyes in disbelief as he presented a masterful break dance. Mansi Oak, 9-year old granddaughter of volunteer Ashok Tilak presented a song.
As has come to be the norm, dance items presented by Yashashri Borhade and group, won not just prolonged applause but insistent cries of “once more”.
Once again, Anagha Vaishampayan accompanied the singers on the harmonium, while Mohan Chandekar provided support on the tabla.
Best performance award winnersThis year, the awards were given to those who have shown commendable progress in patient care.
The winners: Brother Joseph Borade, Sister Shaila Barreto and Aarti Pardeshi, mausi.
Winners in gamesGems game: Pooja Thombre, Suvarna Sanas, Dhanashree Pawar
Picking grapes: Sayaji Sonawane, Gauri Mane, Ganga Kamble
Paper glass pyramid: Mangal Dhemre, Yashashri Borhade, Ramnivas Prajapati
Balloon game: Ramnivas Prajapati, Sayaji Sonawane, Dr. Sonali Kulkarni
Bucket-the-ball: Vishnu Thapa, Ashok Kalokhe, Joseph Borade
Solo act: Break dance: Vinay NaikStory telling: Avinash Badwe
Earlier, on April 28 and 29, the fun games tested the part ic ipants ' concentration, agility and the ability not to join the spectators in their laughter.
As the final “event” on Annual Day, everyone partook of a sumptuous meal. Someone was heard saying that even the dinner was different every year.
6
Painter interruptedne word he used often to describe his stay at Cipla Centre Owas “amazing”. “I am not an
Indian; I have not performed any special service to enjoy this degree of comfort at no cost at all. It is amazing. The British like to boast about their welfare state but what Cipla has created here is a mini welfare state inside a huge capitalist state. Amazing!”
It is rather unusual to compare Cipla Centre with a “state” of any kind, but then Peter John Walter (83) was an unusual patient.
Born in London, his school education was cut short by the Second World War. He left school at the age of 14 and went on to join a factory making bomber aircraft. “It was tit for tat. Germany was bombing London and I was helping to make aircraft to bomb them back,” Peter said with a glint in his eyes.
After the war, Peter took up painting and sculpting to earn a living. Every year in July he would go to a Greek island where he would earn money painting portraits. The work would last for about two months.
Enjoying the sun, lying on his bed outside his ward on a bright February morning, Peter was worried if he would have the “certain level of physical fitness required to go back to painting portraits this year.”
He was unable to get a fix on the year he first came to India. It was in the late 1960s, perhaps. “I had to take a flight to Kabul and then change planes to reach India. I had a one-way ticket and it cost me more than that it does now—500 pounds,” Peter remembered.
He came to India and then to Pune on account of “developing spiritual reasons”, as he put it. His bond with the Osho commune strengthened over the years.
Two years ago, he was working on a sculpture project in his studio in Goa, when he discovered that it was getting too painful to stand for long. The diagnosis followed: blood cancer.
As advised by a doctor, some of his friends from the Osho commune had brought him to Cipla Centre, initially just to get a feel of the place. However, once he saw the facility, he was “utterly satisfied”.
“When I was told that I had cancer and that it would not respond to any treatment, I decided to stay back in India,” Peter said. “I would rather be here with my friends than be back in London with my ailing old relatives, where I cannot hope to get this quality of care.”
Peter was particularly happy with the meditation sessions. “When they chanted “Om”, I felt a strong connection with this place. I felt everyone shared the same feelings that I did.”
Now that he was feeling better and was relatively free from pain, did he have any plans for the future?
“I have been writing a book based on my life … writing in snatches. I want to illustrate that, too. I will need about 9 months with sufficient energy, to complete that,” Peter paused and smiled.
Peter's book is fated to remain incomplete as he passed away on the morning of February 21. He had wanted to die in the land of Osho, remain conscious till the end and have his death “celebrated” the Osho way. He did achieve all of that.
Peter Walter
he would have loved to be a police constable or a teacher. She had Sbeen selected for training for
both the jobs. Instead, she ended up being a cleaner and then a construction labourer.
Today, Mangal Dhemre, 38, is helping “police” the proper care of patients at Cipla Centre and doing her bit to “teach” others to cope better with anxiety by letting them share their worries.
After her husband's death, Mangal mausi (as she is popularly known) ended up with the responsibility of bringing up her three young sons. Life was tough.
It was while she was working as a construction labourer that she came across an employment advertisement released by Cipla Centre. It was not easy for her to find the “remotely located” Centre, but she managed to reach and got the job. That was on November 21, 2001.
“Conditions at home were grave but the people at Cipla Centre helped me tide over it,” she remembered. “They supported me and gave me strength to stand on my feet.”
Before she was introduced to the wards, she was responsible for the upkeep of the office. “Sister Lorraine taught me how to take care of a patient,” she said. It took her a while to get used to the sight of cancer wounds. And it was not at all easy to cope with death.
A quick learner, she soon realised that her job was to take good care of the patient's needs. “I am very happy when they are comfortable, free from pain and wholeheartedly thank me for whatever little I do for them,” she said.
She had to face opposition from family and friends who warned her about working with cancer patients. “They warned me that I would also get infected by cancer. But I was not afraid and preferred to continue working here.”
Today, she is proud of her sons Sagar aged 19, Aakash (17) and Anand (13). All three are studying and the older two are also working to help mother support the family. “I am relatively free of household responsibilities and have some time. I want to do the patient assistant course conducted by Yashwantrao Chavan Maharashtra Open University here at Cipla Centre. That will help take care of patients more efficiently,” Mangal said.
This mausi is on course to do moreMangal Dhemre
7
Scaling forts, building bondsA science graduate, Sudhir Joshi had a long innings as a Food Inspector with the Food and Drug Administration Department. When he retired in May 2000, his friend, Kanchan Abhyankar, was already working at Cipla Centre as a volunteer. She persuaded him to pay a visit to Cipla Centre. “I just came to see the place and decided that I must work here,” he remembered. He started in August 2000.
After a few days of orientation with various activities, Joshi started on home visits. Initially, he was accompanied by another volunteer, Sadanand Deshpande. “When I started home visits on my own, I was tense. I was never sure if I was talking right and doing things properly. What if I made some mistake? But others in the team helped me,” Joshi said.
He found it very demoralising to see patients in pain. When one of the patients died, he did not feel like
continuing the work. “Then I remembered my friend Kanchan, who was suffering from cancer. I felt I would let her down, if I quit. So, I decided to continue.”
He is now actively involved in maintaining records of patients and calls them up to keep track of their condition. He goes for home visits outside Pune city and makes it a point to visit the local primary health care centre to spread the message of palliative care. He also takes a keen i n t e r e s t i n h e l p i n g a r r a n g e entertainment programmes for patients and their families.
Married to Madhuri (a renowned classical singer and fellow volunteer), Joshi has two sons. He is an avid trekker and has scaled many forts. When he is not helping others surmount the challenge of cancer, he is looking for more difficult forts to conquer.
he first death he encountered almost made him give up being a Tvolunteer at Cipla Centre. But, he
persisted. Today, “the satisfaction that I get from helping others and the rapport that I develop with patients help me keep getting better as a person.”
Sudhir Joshi
him. Here, at Cipla Centre, they welcomed him and were very keen to admit him.”
Recalls Nandini Thatte, Medical Social Worker: “The patient had growths in the mouth, making it difficult for him to talk. Also, Captain Sharma had difficulty understanding Marathi. Yet, there was a great bond between the two. Captain Sharma was willing to take total responsibility for the patient. He signed all the papers and even took care of the patient's laundry.”
Meanwhile, back in Lohot's village, the family was getting worried. They were used to his sudden pilgrimages to various parts of the country. He would always state when he would be back and he normally kept his date. This time he was due back in a week or so, but it was close to two months after his departure. They were not sure where to start searching for him.
Bound in spirit
The Cipla Centre team's gentle questioning soon established that
Sriram Lohot was no destitute. He gave them his son's mobile number and the family came to visit him soon. They were relieved and very grateful to C a p t a i n S h a r m a f o r reuniting the family.
Then, it became necessary to take Lohot to the public
hospital for a surgical procedure so that he could
breathe more easily. Given his weak state, Lohot did not survive
the procedure. He passed away on February 1, 2011.
“They informed me that he had slipped into a coma,” Captain Sharma said. “By the time I reached the hospital, he was no more. It was sad. I was with the family at their village for his last rites.”
Did his commendable deed make Captain Sharma a hero among his friends? “Oh, no! I have not told them about this.” Apparently, whenever he came away to be with Lohot, they thought he was sneaking away to be with his girlfriend!
“They were two strong spirits,” Nandini remarked. “Mr Lohot did not let his lack of sight and the cancer interfere with his pilgrimages. Captain Sharma was a total stranger for all practical purposes but his dedication to the patient was commendable.”
Our salute to you, Captain! If only there were more such soldiers like you to reach the light of palliative care to the thousands resigned to the darkness of pain!
27-year old army man hailing from Jammu, studying Aengineering in Pune. A
simple farmer from Gangapur B u d r u k v i l l a g e i n Maharashtra, 65 and blind from birth. They had just one thing in common: both were deeply religious, each in his own way. This is the story of how fate brought them together and to Cipla Centre.
On January 7, 2011 Captain Sharma was outside Sant Dnyaneshwar Temple at Alandi near Pune, distributing fruits to the poor who had assembled there. One person refused the fruit. Someone next to him told Captain Sharma, “He has not eaten for several days. He is not well. We took him to a doctor. But he could not swallow the pills also.”
Captain Sharma decided to take the man to a nearby hospital. There, when they undid the cloth covering the weak pilgrim's face and head, Captain Sharma noticed the bleeding wound that covered the old man's right cheek. There was nothing much the small hospital could do. The best option was to rush him to the government hospital in Pune.
It did not take long for the doctors to diagnose cancer of the mouth, that too at an advanced stage. A doctor recommended Cipla Centre. Soon, with a volunteer's help Captain Sharma brought the patient to Cipla Centre on January 25, 2011.
“I found the contrast striking,” Captain Sharma said. “Back at the hospital, they appeared to be eager to get rid of
For private circulation only. Contact: Cipla Palliative Care and Training Centre, Survey No. 118/1, Warje, Off Mumbai-Bangalore Highway Bypass Road, Pune 411058. Tel: 020 25231130/31.
Always causing trouble! Now the nurse says you kicked some bucket
The theme of the 18th international conference of the Indian Association of Palliative Care (IAPC) held in Lucknow from February 11 to 13 was “Networking in Palliative Care.” Subjects discussed at the conference i n c luded r e s ea r ch , da t abase d e v e l o p m e n t , t r a i n i n g , c o m m u n i c a t i o n s , c l i n i c a l management, spirituality, role of government, paediatric care and hospital-based palliative care, all important subjec ts for every professional working in palliative medicine. Yet, no single individual or institution can claim expertise in all the subjects. Could there have been a better testimony to the significance of networking than the conference itself?
Says Dr Priyadarshini Kulkarni, Medical Director, Cipla Centre: “In palliative care, networking is not just
about doctors exchanging notes or attending a conference. The final objective is to improve the quality of life of the patient and the family. Many hands must come together to make this p o s s i b l e . W h a t e v e r b e y o u r qualification or profession, whatever be your age or location, all it takes is conviction about the cause of palliative care and compassion to help a fellow human being in pain, for you to become an important link in the chain.”
Cipla Centre has been fortunate to have the help of a dynamic network in its mission to render care to more and more people.
The volunteer who is up early to brief members of a laughter club, a family doctor who has volunteered for training in communicating bad news, a rickshaw driver who carries the message of free palliative care at Cipla Centre, a bank manager who takes time off to play the violin to entertain patients—the links are too many to count.
MCI announces MD course in palliative medicine
The commencement of this course will be an important step in empowering the medical fraternity to extend the reach of palliative medicine to more and more patients.
Algerian oncologists visit Centreipla Centre hosted a group of visitors, Cm o s t o f t h e m
oncologists, from Algeria on February 17, 2011. After a tour of the Centre they congratulated the team for “working for a noble cause.” Remarked Dr Boudjella, “What you give and what you do for the patients is great and I hope we can give the same kind of service in our centre in Algeria.” The group included Dr Djamila Yekrou, Dr Daoudi Samia, Dr Djamila Rahou, Dr Kerrar Abdelouahed, Dr Boudjella Abdelkader el Hakim, Prof
Ferhat Rabah, Prof Adane Nee Rabhi Saïda, Ahmed Belkharroubi and Abdelkader Bousahba.
Learning to give care at home
wenty volunteers participated in a workshop for caregivers Torganised at Cipla Centre on April
9. Dr Priyadarshini Kulkarni, medical director and Nandini Thatte, medical social worker and clinical psychologist conducted the workshop. They briefed the participants about the importance of learning the basic aspects of caring for a highly-dependent patient. They stressed that the caregiver had to have a good understanding of one's own emotional status along with that of the patient. The workshop ended with a brief practical session on handling an immobi le , bed-r idden pat ient. According to Thatte, “this was the first of a series of training programmes on care giving that the Centre intends to conduct in future. We received some useful feedback from the participants. The forthcoming sessions will be targeted at people from all walks of life and will have more interactive and hands-on sessions to cover various physical and emotional aspects of care giving.”
To modify an old African proverb, if you want to hold someone's hand and offer comfort, you may be able do it alone. But if you want to provide effective palliative medicine, where and when the patient needs it, you must network.
he Medical Council of India (MCI), the statutory body that controls Tmedical education in the country,
has approved palliative medicine as a medical specialty.
It has initiated steps to start a three-year post-graduate course to be called "MD in Palliative Medicine".
The president of Indian Association of Palliative Care (IAPC), Dr Nagesh S i m h a , h a s a n n o u n c e d t h e appointment of an IAPC task force to prepare a draft curriculum to be submitted to MCI.
