From the President’s Desk
We sincerely hope and pray that we are inching closer towards the end of the India’s second wave of the COVID-19 pandemic. I wouldn’t be wrong in saying that each of us have been impacted and left shattered physically and/or emotionally. Several of us are also grieving and attempting to accept and cope with the losses experienced.
“Death is inevitable, and nobody can deny it”. As a doctor practicing palliative medicine for years, I was confident that I had understood and accepted the inevitability of death. I always strived to assure a dignified death for my patients who are terminally ill; and provide support and guidance to their families as they navigated a very difficult time in their lives. I wanted to prepare the terminally ill patients and their families to accept the inevitable and therefore actively advocated for end of life care measures. I never felt helpless in any of these situations. Instead, I was driven to ensure that my team and I provided our patients with quality care and comfort till the end, while also preparing them for the inevitable.
Nonetheless, when I personally witnessed innumerable deaths due to COVID-19 in the past two months, where the young and healthy deteriorated and succumbed to death right in front of me within a span of a few hours, I felt broken and helpless! I was unable to accept their death! I wanted to fight and defeat it. Yet, we couldn’t win! They were not dying due to any severe illness, but due to some unpredictable complications caused by corona virus!
I was then faced with the very familiar question, ‘Why’? Why does this happen to mankind? I am unable to unravel the mystery and discover a solution. It was not only the weak or the elderly who perished in front of me, but, most of them were unfortunately youngsters. How can one recover or cope with something like this?
While we are relieved with the gradual reduction in the number of daily cases being reported across the country, we must continue to exercise caution as the percentage of emergencies continue to warrant our attention. Matters of concern range from the observation that over fifty percent of the COVID-19 infected patients reach hospitals in critical conditions, to the reporting of severe post COVID symptoms among those who have recovered, to an alarming increase in the rise of the potentially fatal black fungus infection.
Rehabilitation of COVID recovered patients, the management of COVID health issues (both physical and psychological) is another area of concern that is lurking at the back of every health care professionals’ mind. It is distressing to know that several of those recovered have had their lungs damaged severely and will need to be on long term oxygen support.
Witnessing and experiencing so many deaths and emergencies within such a narrow time frame has resulted in the incidence of serious emotional issues among the health care professionals themselves. Are we equipped with a system to address their mental health issues? Are we even concerned about their well being?
Health care professionals do not have the luxury of time to rest or grieve. They have to continue in their mission as long as the pandemic reigns in our country.
Doctors of my generation have not been witness to a health care emergency of this severity and magnitude in our professional journey. We are all trying our best as we march forward by investing our heart and soul to continue providing care for those who need it; even risking our own safety.
Team IAPC has been striving towards making available to you the relevant updates and related resources, to empower you to better address the current and unprecedented situation. I extend my gratitude to all those experts who have supported us in this task.
I am extremely proud to share that our palliative care fraternity spread across the country, has been braving all odds, as they continue to work relentlessly towards continuing to provide care to the chronically and terminally ill, and bed-ridden patients, in the best way they can under the current circumstances. I invite you to read this newsletter which brings to you their stories and experiences.
I cannot emphasize enough that it is our national duty to adhere to the Covid protocols as it is the most effective way to protect ourselves, our families and our society from this deadly pandemic. We must be conscious and adopt the necessary precautions to fight the third wave, which has been predicted by experts.
Wishing you all well and safety,
With best wishes.
Dr. Sushma Bhatnagar
Remembering our COVID Warriors
It is devastating to know that several hundred front-line COVID warriors in India lost their lives to COVID, as they continued to discharge their selfless service towards protecting the society and saving the lives of their fellow beings from this dreaded COVID.
We are still unsure of the exact statistics of the other categories of health care workers, the police personnel, the volunteers, and of the many others who are working in the different areas who have lost their lives to COVID. The Indian Medical Association (IMA) recently published data to denote the number of doctors who had lost their lives during India’s second wave of COVID-19. Post the publication of this data, several different organisations came forward to honour and pay tribute to those who lost their lives while serving the society.
The statistics released by IMA last week, report that 513 doctors have died in India during the second wave of COVID-19; Delhi alone contributed to 103 of those casualities. The IMA had also reported that India had lost 748 of her doctors’ during India’s first wave in 2020. The IMA also shared that these statistics only accounted for the death of an IMA member doctor and that the actual number of deaths were certainly higher. They also went on to add that, of the 12 lakh+ registered doctors in India, only 3.5 lakh of them had an IMA membership.
We express our Heartfelt tribute to all The COVID WARRIORS who have lost their lives
In Memory of the Doctors we Lost
The contribution and sacrifice of doctors who lost their lives during this pandemic, while in the line of duty, was honoured by The Quint, as they collated and presented the courageous stories of these COVID warriors.
Please click here to read the stories of these selfless COVID warriors.
The poem ‘Hibernation’ has been penned by Ms Nanditha Vismaya to describe India’s current situation as she is being ravaged by COVID-19. The poem showcases the multitude impact of the pandemic on our very resilient society. It also acknowledges the selfless work extended by our saviours, the front line health workers, who continue to work tirelessly to serve those innumerable people who are either gasping for air, or, who have already taken their last breath of air.
Please click here to read the poem.
Trauma and Grief during the Pandemic
Experiencing the death of a loved one under the best of times is devastating enough. Having to experience the death of a dear one during the pandemic, brings with it another layer of challenges and trauma that one has to endure. These additional challenges might possibly be due to the very nature of COVID-19, where the loss on several occasions is very sudden and unanticipated. The social isolation, the stigma, the loneliness and the various other limitations imposed by the pandemic makes the already difficult experience extremely traumatic for those who are grieving.
Please find below a couple of resources that aim to offer guidance and thereby potentially empower you to effectively provide support to those experiencing grief during the pandemic.
- Part-I of the Trauma and Grief Series, developed by NIMHANS, Bengaluru
- ‘New ways of grieving, mourning’, an article by our very eminent psychiatrists, Dr. Santosh K. Chaturvedi and Dr. Prabha Chandra
The National COVID Memorial:
Where Life Stories Live On
The National Covid Memorial is a virtual space that has been created by an NGO, Covid Care Network (CCN), for the thousands of Indians who lost their battle with Covid. CCN aims to improve access to care and psycho-social support for COVID-19 patients and their families through participatory, collective and coordinated actions by Covid winners and associates.
The National Covid Memorial provides a space for people to submit a memorial for their loved one’s as Covid snatched away their near and dear mercilessly and without providing an opportunity for them to bid farewell to their loved ones. This webpage houses stories engraved in words that shed tears. Social workers helped by doctors, health workers and journalists will help run the memorial. Please click this link to submit a memorial.
You could also visit https://covidcarenetwork.org/ to identify further information on how you can receive support or also offer support.
The Dos and Don’ts for post-discharge Covid patients
The Government Medical College and Hospital, Chandigarh, has recently published a very informative, simple-to-read and understand information book, to highlight the useful Do’s and Dont’s for post-discharge COVID patients. The bilingual book, published in English and Hindi, depicts information pictorially, and with minimal text, thereby making the book easy to read and remember.
While there exists a plethora of resources for ways to prevent or manage COVID, this information book provides guidance on, what to do and what not to do, post-discharge for a COVID patient. Additionally, the book also enlists the various precautions for the prevention and control of COVID-19 along with a few lifestyle measures that one can adopt. Please click this link to read this information book.
Palliative Care Services during COVID-19
The May edition of our Newsletter, brought to you the experiences of CanSupport, New Delhi, as they continued to provide their patients with home care services despite being in the midst of Delhi’s Covid peak. This edition brings to you, the efforts and experiences of DNip Care, New Delhi and Ruma Abodana Hospice, West Bengal, as they continue their mission of providing home care services despite the challenges faced.
PC service provision by DNip Care during the pandemic
Author: Mr. Suresh T, Nursing Officer, Safdarjung Hospital; Volunteer DNip Care
The second wave of the pandemic made the provisioning of home care services for palliative care patients in Delhi extremely difficult. Though challenging, we managed to continue our Nurse led palliative homecare services even though we could not maintain our usual scale of operations. We began extending consultations by leveraging technology as adopting Tele-medicine allowed us to care for patients and their families as we were able to now meet them virtually.
Please click here to read the full article.
Did we ever expect that a pandemic could cost us this much?
Author: Mrs. Meheli Chakraborty, CEO, Ruma Abedona Hospice, West Bengal
One of our palliative care patient’s has to undertake a journey of 200 km to be able to visit us. He has no one in his family. His only asset was a cow; and his only source of income for the past 7 years, are the proceeds he earns from selling the milk and dung produced by his cow. The Covid imposed lockdown leaves him with no alternative except to make this long journey, as his only access to Morphine is through us. Now, to be able to make this journey, he was forced to sell his cow so that could hire an ambulance for the journey.
Please click here to continue reading the story.
The bed-ridden and elderly patients in Kozhikode get vaccinated in their own home
We are delighted to share with you that the Government of Kerala and the Kozhikode Corporation have begun an initiative to vaccinate their bed-ridden patients and the elderly within the comfort of one’s own home. This program is being delivered in collaboration with the State’s Health Department. It is a matter of pride to learn that palliative care homecare teams have been providing support to this initiative.
It was reported that nearly 100 bed-ridden patients in Kozhikode Corporation have received their first shot of the vaccine under this program. Various home care units, including units from Institute of Palliative Medicine, and other services under the consortium of Palliative Care Services in Kozhikode City are participating in this venture.
Adaptations to palliative home care in India in a COVID pandemic
An experiential narrative
“We, at Dr. Dhiliwal’s Pain & Palliative Care, Mumbai, successfully provided home care services during this pandemic”, says Dr. Sunil Rameshchandra Dhiliwal. Dr. Dhiliwas shares his experiences of delivering home care services during this period in an article titled ‘Adaptations to Palliative Home Care in COVID-19 Pandemic’. The article has been published in the Indian Journal of Medical Sciences.
Click here to read the article.
Mother’s Day, 9th May
Compassion is one of palliative care’s core values. A mother holds a pivotal role in each of our lives; we also realize that every palliative care professional frequently adorns the hat of a mother to a patient.
We wish to commemorate mother’s day by presenting to you, 2 separate heart-warming stories which radiate a mother’s resilience, astounding courage and selfless love as she continues to care for her child who is suffering from a chronic and incurable illness.
- The silent hero nurturing little Aadhi
Story shared by Dr. Biji M S, Asst. Professor, Department of Palliative Medicine, Malabar Cancer Centre, Thalassery.
- Let us just be there; for the mothers
Story shared by Dr. Spandana Rayala, Consultant, Pediatric Palliative Care Service, Sunflower Program, Hyderabad, Pain Relief and Palliative Care Society.
Please click here to read the stories.
International Nurses Day, 12th May
Compassionate, patient, empathetic, warm, sensitive, comforting, a confidant, etc. are a few of the attributes that describe a nurse. Though a total stranger to the patient and the family, yet, a nurse is someone who cares for and nourishes a patient day and night while also possessing the ability to keep a patient’s loved one calm, even in the most distressful situations.
The role of a nurse as articulated by a healthcare worker from one of the palliative care units in the country is as follows: “Doctors are the brain of the hospital, while the nurses are the heart of a hospital.. If the brain fails, the heart can still function for a while, but, if the heart fails, everything else fails immediately”.
We honour, appreciate and celebrate these selfless souls. We present you with a couple of very interesting reads featuring two of our very senior palliative care nurses, Sr. Hanife MacGamwell and Lt. Mrs. Alice Stella Verginia. Please click on the below articles to read about their professional journeys’, their accomplishments and their perspectives on nursing.
- ‘Palliative Care Nursing: A choice I never doubted’, authored by Sr. Hanife MacGamwell.
- Alice Stella Verginia – A leader in Palliative Care in India.
World Family Medicine Day, 19th May
Globally, the World Family Medicine day, is a day ear marked to celebrate and acknowledge the role and contribution of family doctors and primary care teams in healthcare systems around the world. It is these doctors and teams who essentially take healthcare service provision to every nook and corner within a country.
We cannot further emphasise the importance of integrating these family doctors and the primary healthcare teams in the implementation of a country’s national healthcare programs as a step towards ensuring Universal Coverage of Healthcare.
We bring to you Dr. Shrikant Atreya’s outlook, as he shares his perspectives on ‘The Role of a General Practitioner / Family Physician in delivering community-based palliative care services’.
Please click here to read Dr. Atreya’s article.
World Telecommunication and Information Society Day, May 17
The United Nations, observes May 17 as the World Telecommunication and Information Society Day to appreciate and generate awareness regarding the innumerable possibilities that can be leveraged by using Internet and other information and communication technologies.
In a country like India, the crisis brought on by the pandemic would have been several folds worse, if not for the availability of technology to deliver health care to the innumerable patients spread across the length and breadth of the country.
To commemorate this special day, we present you with stories from two geographically widely dispersed palliative care units as they share their experiences in adopting and efficiently delivering palliative care telemedicine services to those paitents who might not have had access to any health care services otherwise.
1. E-Palliative Care Service by Malabar Cancer Centre (MCC), Kerala
The primary objective of e-palliative care is to allow for the physician to be at the home care patients’ bedside by improving access between the physician and a bed bound patient using technology. The laptop is usually placed at the patient’s bedside as the nurse connects the patient to the palliative care physician who is geographically located at the hospital, through the e-palliative web application, thereby enabling the patient and their caregiver to see and communicate with their palliative care physician. Over 50 patients are consulted every month through this e-Palliative care services at MCC.
2. Tele-Consultation Service by Dr. B. Borooah Cancer Institute, Assam
Adopting tele-consultation services was done primarily to ensure continuity of care for those patients who were experiencing either physical, psycho-social or spiritual challenges, and were unable to physically visit the hospitals due to the restrictions imposed by the pandemic. Every Friday, our team of doctors, nurses and social workers from the Palliative Medicine Department attend the Tele-consultation service and cater to 10 to 15 patients per day.
Please click here to continue reading both these articles.
IAPC Academy Lecture Series
Despite facing adverse situations and managing the Covid crisis, the palliative care fraternity from across the country and beyond, ensured that they participated in the IAPC Academy webinars that are being held every Monday between 6:30 a.m. and 7:30 a.m.
We are happy to report that even though several parts of the country were experiencing Covid peaks, during the month of May 2021, our webinars were witness to an average of 80 participants per session. As a first, the series in May covered several nursing issues which were delivered by Sr Hanife MacGamwell and Lt. Mrs. Alice Stella Verginia, our very eminent Nurse Faculty. Sr. Hanife MacGamwell presented a session on ‘Nursing management of all ostomies’, while Lt Mrs Alice Stella Verginia presented on ‘Nursing management of pressure sores and malignant wounds’.
The series in May, began with a lecture by Dr. Prince John, a palliative care practitioner who specializes in palliative care for the elderly. Dr. John delivered a session on ‘The practical aspects of integrating palliative care with geriatric care and long term care’. The next session, ‘Communication with adolescents and young adults’ was presented by Mr. K. V. Ganpathy, a well-known psychologist. Dr. Gauraiya Chinchalaker’s session on ‘Sleep and Sleep disorders in Palliative Care’ concluded the sessions for May.
We invite your enthusiastic participation for the upcoming session in June 2021. Please find below the schedule for June 2021.
IAPC’s CCEPC is scheduled to commence in July 2021
We are happy to inform you that the IAPC’s Certificate Course in Essentials of Palliative Care (CCEPC) is open for registration now.
The online classes are scheduled to begin in July 2021. We request the interested candidates to kindly register for the course and embark on the wonderful journey of palliative care. Please click here to find our more information about the course and other related details.
BMJ Announces a Certificate Course in Palliative Care
A 3 month Certificate course in palliative care has been announced by BMJ. This e-learning course aims to provide confidence to doctors and healthcare workers to effectively manage their patients who are suffering from life-threatening diseases and their families in the best possible manner. This course is targeted for healthcare workers who are keen to enhance and upgrade their knowledge in palliative care. Please follow this link to access further information about this course.
Reflections on palliative sedation in clinical practice: A live webinar
As a part of the European Union funded Horizon 2020 Palliative Sedation project, the European Association for Palliative Care (EAPC) will be presenting a FREE 60 minutes webinar on Thursday 3rd June, 2021 (14.00 CET). This is the first in a series of webinars on the interesting and yet sometimes still challenging topic of palliative sedation. Please click here to view further details.
Virtual Conference on Health Care Transformation
This year’s annual conference by the American Academy of Hospice and Palliative Medicine (AAHPM), Hospice and Palliative Nurses Association (HPNA) and National Hospice and Palliative Care Organisation (NHPCO) will focus on Health Care Transformation. The conference is scheduled to be held on 29th July 2021. Please note that registrations before June 14, 2021 will enjoy the benefits of the early-bird registration rate. For further details on this, please click this link.
IAHPC Reduces Membership Fees through July 31st
Please note that the International Association for Hospice & Palliative Care (IAHPC) has implemented a 20% reduction in their membership fee until July 31, 2021 across all membership categories. To join as a member or to renew membership, please click on this link.
To offer Help and Support during Challenging Times
- Sukh Dukh Helpline: https://palliumindia.org/2020/10/sukh-dukh-helpline
- Canhelper: https://www.cipla.com/press-releases-statements/can-helper-indias-first-toll-free-emotional-support-helpline-cancer
- Bereavement support India: http://www.bereavementsupportindia.in/