From the President’s Desk

Dear Friends,

The country is shifting into a reverse quarantine phase, with more facilities open and more freedom for movement. With the stringent and systematic measures taken and the two-months-long shut down, we have somehow hoarded our health system from collapse and controlled the threatening effect of COVID-19 pandemic. Even though the positive cases in huge cities like Delhi, Mumbai, Ahmedabad, Kolkata, and Chennai and in a few states are high, the situation in other regions is much better. We salute all those who are working tirelessly to save the lives of our fellow beings.

We could see the effort of Palliative Care Community in India and their heightened spirit and cooperation in the time of an unprecedented health emergency, to provide Palliative Care to every individual who needs it. We have witnessed the successful adaptation of strategies to provide care while keeping social distancing, by making use of modern technologies like WhatsApp, video conferencing, Zoom platform, tele-consultation, etc. We have witnessed the risks taken by professionals and volunteers to find a way to deliver medicines and food supply to patients, even from faraway places and to assure them comfort. I hereby express my sincere thanks to all those who have been working to provide palliative care in this difficult situation. Now we do not feel helpless as in the beginning. We have successfully gathered as many information as possible, acquired knowledge, formed effective strategies, and well equipped to face the challenges.

I am happy to see that the initiatives taken by Indian Association of Palliative Care to guide and support those working in this field have resulted in keeping their spirit high and are helpful in making their efforts successful. The participation in each of the sessions in the series of ECHO programs on Palliative Care in COVID-19 reveals the enthusiasm and learning attitude of palliative care providers to manage the crisis. Experts from India and from other countries participated in the program, which started on 2nd April 2020. The program was delivered on all Thursdays from 6.30 am to 7.30 am till 28th May 2020. Congratulations to all those who have worked for the successful conduct of the program, especially the two collaborating organizations- Hyderabad Centre for Palliative Care and Two Worlds Cancer Collaboration, Canada. Indeed, it was a great job.

IAPC could finalize a position statement on Palliative Care in COVID -19 with the contribution of experts in the country. My sincere thanks to all those who worked for this. You can see details of the Position Statement in this newsletter and we hope it would be helpful in providing guidance to non-palliative care professionals as well.

We are coming out with a dedicated issue of Indian Journal of Palliative Care, which includes research articles and case reports from India on Palliative Care and COVID-19. Hope this will give you an insight to improve the outcome of COVID care in India.

Many of you would have received an online copy of the petition to amend guidelines for Tele- Consultation. I request you to sign the petition and support this initiative to make the supply of pain-relieving medication continued, as effectively as possible, during the restrictions. Please share with us your valuable suggestions to improve the activities of IAPC.

This too shall pass, and we are with you.

Dr. Sushma Bhatnagar
President,
IAPC


Palliative Care in COVID-19 Pandemic

Position Statement of the Indian Association of Palliative Care

This Position Statement is finalized by Indian Association of Palliative Care, with the contribution of Professionals working in the field of Palliative Care in India. This document aims to guide non-palliative care professionals about providing palliative care to serious COVID-19 patients and patients with chronic and life-limiting conditions needing palliative care and unable to access it.  All professionals have a responsibility to provide symptom management and end of life care to patients with serious COVID-19 , who are not eligible or not responding to intensive care measures. The position statement aims to guide all health care providers supporting patients and their families directly or indirectly impacted with COVID-19, in the hospital, hospice, or home

The purpose of the position statement is to:

  • Guide health care professionals caring for COVID-19 patients
  • Provide palliative care input into government decisions and policies about COVID-19
  • Support the ongoing provision of palliative care in India; and
  • Optimize preparedness of the palliative care services to respond to COVID-19 pandemic

The Position Statement includes guidelines in providing:

  1. Palliative Care for hospitalized COVID-19 patients with critical illness
  2. IAPC position on providing palliative care for adults with cancer and chronic end-stage organ impairment: Having COVID-19 or treatment limitation due to prevailing COVID-19 situation. 
  3. Palliative Care for children with cancer and chronic or end-stage organ impairment: Having COVID-19 or treatment limitation due to prevailing COVID-19 situation
  4. Psychological, social and spiritual support for patients and their families affected by COVID-19 and those with cancer and chronic or end-stage organ impairment whose treatment got limited due to COVID-19 situationn
  5. Home-based palliative care and nursing support for serious COVID-19 patients dying at home, and
  6. Recommendations on rational use of personal protective equipment (PPE) for Palliative Care providers

Please download all the above 6 documents here:


An Appeal to Sign the Petition

To Modify Tele-Medicine Practice Guidelines

We request you to sign a petition to Medical Council of India to modify Tele-Medicine Practice guidelines issued on 25th March 2020.

These guidelines contain Prohibited List of drugs which includes Medicines under Schedule X of Drug and Cosmetic Act and Rules or any Narcotic drug and Psychotropic substance listed in the Narcotic Drugs and Psychotropic Substances, Act, 1985.

There are patients, who require Essential Narcotic Drugs (ENDs) to control their severe persistent pain. The ENDs come under the NDPS Act and Rules. To maintain safe and rational use of ENDs, IAPC recommends that in-person evaluation be mandated for initiating the prescription of ENDs, while refills may be allowed through tele-consultation. We also request for permission to switch one END with another when deemed necessary, for continuing to treat the same pain condition effectively.

Please support the petition using this link:

http://chng.it/rmbtwwZj


Echo Series on Palliative Care in COVID-19

The Echo series on Palliative Care in COVID 19, an initiative by Indian Association of Palliative Care, organized with the support of Hyderabad Centre for Palliative Care and TWCC, Canada has been completed successfully with the final session conducted on 28th May 2020. The series, launched on 2nd April 2020, covered a wide spectrum of issues related to the COVID-19 pandemic. The series was planned with an aim to provide guidance to Palliative Care Community in the time of COVID-19 Pandemic. Our sincere thanks to all experts who led the sessions, coordinators, and participants.

The sessions held in May 2020

Session VI: Supporting Children Infected or Affected with COVID-19.

Session VII: Understanding COVID-19 Pandemic; pathophysiology, presentation and epidemiological & its implications.

VIII: Exploring equitable care in COVID pandemic times and Session.

IX: Sharing Experiences.

All the 9 sessions are available on IAPC website for reference:

https://www.palliativecare.in/category/echo-series/


World Health Assembly Adopts National COVID-19 Response Including Palliative Care

The 73rd World Health Assembly, held virtually for the first time in its history, on 18th and 19th May 2020, approved the resolution “COVID-19 Response,” committing governments to deliver palliative care services alongside safe testing and treatment for COVID-19. Governments must pay “particular attention to the protection of those with pre-existing health conditions, older persons, and other people at risk, in particular health professionals, health workers and other relevant frontline workers.” The resolution also calls for equitable access to medicines and vaccines.

Please see details here:

https://www.who.int/about/governance/world-health-assembly/seventy-third-world-health-assembly


IJPC: Current Issue with Research Articles on COVID-19

A dedicated issue of Indian Journal of Palliative Care with research articles and case reports from India on Palliative Care in the Time of COVID-19 is being prepared. This open access journal will be available shortly on IJPC website: www.jpalliativecare.com


Finally DNAR Gains Legal Basis in India

The current issue of the Indian Journal of Medical Research carries a position paper by the Bio Ethics unit of the Indian Council of Medical Research on Do Not Attempt Resuscitation (DNAR) orders and Cardiopulmonary Resuscitation (CPR). According to the ICMR Consensus Guidelines on ‘Do Not Attempt Resuscitation’, the decision of DNAR should be taken by the treating physician who is well versed with the patient’s medical condition, with information to the patient or her/his surrogate. While ordering DNAR, every effort should be made to treat the underlying disease and continue optimal medical care with compassion. This policy document describes the principles for DNAR, offers an algorithm and format for its implementation, and guidance on frequently asked questions. To get the document, please follow this link.


Redefining Palliative Care –

 A New Consensus-based Definition

The International Association for Hospice and Palliative Care (IAHPC) developed a consensus-based definition of palliative care (PC) that focuses on the relief of serious health related suffering, a concept put forward by the Lancet Commission Global Access to Palliative Care and Pain Relief.

The consensus-based definition is “Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers.” The definition includes a number of bullet points with additional details as well as recommendations for governments to reduce barriers to palliative care.

The three-phased consensus process involved health care workers from countries in all income levels. In phase one, 38 PC experts evaluated the components of the World Health Organization (WHO) definition and suggested new/revised ones. In phase two, 412 IAHPC members in 88 countries expressed their level of agreement with the suggested components. In phase three, using results from phase two, the expert panel developed the definition. Participants had significantly different perceptions and interpretations of PC. The greatest challenge faced by the core group was trying to find a middle ground between those who think that PC is the relief of all suffering, and those who believe that PC describes the care of those with a very limited remaining life span. Please follow this link to get the paper published in JPSM – Redefining Palliative Care: a New Consensus based Definition.


‘Living Will: What Every Indian Senior Citizen Should Know’

An online public lecture on ‘Living Will: What Every Indian Senior Citizen Should Know‘ by an eminent neurologist Dr. Roop Gurshani was organised by Vidhi Centre for Legal Policy and Forum for Indian Neurology Education on 9th May, 2020. The lecture is available at:

The lecture is available at:

https://www.youtube.com/watch?v=WWQEhJgk5YQ

Details of ADVANCE MEDICAL DIRECTIVE (LIVING WILL) AND HEALTH CARE POWER-OF-ATTORNEY AUTHORISATION is avaialable at:


Worth Reading

  1. To Tell or Not to Tell: Exploring the Preferences and Attitudes of Patients and Family Caregivers on Disclosure of a Cancer-Related Diagnosis and Prognosis
    A paper published in Journal of Global Oncology.
    Authors: Dr. Arunangshu Ghoshal (TMC Mumbai), Dr. Naveen Salins (Kasturba Medical College, Manipal), Dr Anuja Damani (TMC Mumbai) , Ms. Jayeeta Chowdhury (Tata Trust, Mumbai), Ms. Arundhati Chitre, Dr Mary Ann Muckaden (TMC Mumbai), Jayita Deodhar (TMC Mumbai), and Dr. Rajendra Badwe (TMC Mumbai).
    To get the paper, Please follow this link
  2. The Pandemic of Fear: What are we afraid of?
    Author: Dr Seema Rao (APHN Palliative Care Consultant, Lien Collaborative for Palliative Care)
    To read the article, please follow this link: https://aphn.org/the-pandemic-of-fear/?utm_source=ReviveOldPost&utm_medium=social&utm_campaign=ReviveOldPost
  3. Interprofessional Spiritual Carein the Time of COVID-19
    To get the document, please follow this link: https://www.palliativecare.in/covid-19-guidelines/10/

National Fellowship in Palliative Medicine& Nursing

Last date to submit application: 30th June 2020

This one year National Fellowship in Palliative Medicine/Nursing is one of the popular training programs in Palliative Care in India for Doctors with MBBS/BDS and Nurses with GNM/ BSc Nursing.

To get the application form and brochure, please follow this link: https://www.instituteofpalliativemedicine.org/courses.php

In 2020, the introductory theory sessions will be held as online classes in September 2020 so that candidates can attend the classes from their places.  Attendance in the online class is mandatory. For the successful completion of the course, candidates have to  do online assignments, a clinical audit and 20 days of clinical posting in any of the recognized palliative care centres in India before 30th June 2021. There will be a final evaluation at the end of the course at Institute of Palliative Medicine in August / September 2021.

This training program is conducted by Institute of Palliative Medicine, Kozhikode (WHO Collaboration Centre for Community Participation in Palliative Care and Long Term Care) jointly with Christian Medical Association of India.


For donations to IAPC and for further information write to nioiapc@gmail.com .

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