Palliative Care Status Update in India: North East Zone

The States of Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland and Tripura contribute towards the North East Zone as per the constitution of the IAPC. We thank all the contributors for their support in furnishing the required information.

ARUNACHAL PRADESH

Background / Context:

Arunachal Pradesh is the eastern most part of the country and the state which welcomes the first ray of sun.

Palliative Care service provision began at Tomo Riba Institute of Health and Medical Sciences (TRIHMS), a Tertiary Cancer Center, in November 2018 with the help of Drs. Sushma Bhatnagar and Cynthia Goh as a result of the CTC 3 program in which two doctors and a nurse were trained in palliative care. Service provision had a humble beginning with two doctors and a nurse being trained in palliative care and with a full time OPD room and a single bed near the OPD for opioid titration and observation, to provide immediate pain relief for those in pain.

Service provision at the center has now expanded to include a four bedded dedicated palliative care unit, with inpatient and a 6 day OPD service availability. The center also offers home care services as per need, interdepartmental consultative services in addition to End of life care services.

Papum Pare district in Arunachal Pradesh,records the highest incidence of cancers of stomach, liver, cervix, ovary and thyroid in the country as per data published by PBCR of NRCP.

Arunachal Pradesh currently has only two doctors, Dr. Tashi Chotton and Dr. Hage Sonia trained in palliative care service delivery.

Policy

Arunachal Pradesh currently does not have a State Palliative Care policy. Efforts towards the same are in motion.

Though Arunachal Pradesh has 25 districts, palliative care services (OPD, IP and consultative services) are available only in the Tertiary Cancer Center, a government hospital situated at Naharlagun, Itanagar, the capital of the state.

Drugs Availability

The center has an uninterrupted supply of opioids, such as Tab. Morphine IR, Tab. morphine CR and injection morphine as this is the only centre providing morphine and other opioids in the state.

Education: Training and Awareness

A one day orientation programme for Papum Pare district was conducted on 15 February, 2018.

Other activities include workshops with the Students’ Social Welfare Department of Rajiv Gandhi University DOIMUKH.

A sensitization workshop by the NHM under the National Program for Palliative Care, was conducted to sensitize 150 doctors and 50 nurses on pain and palliative care from all the districts in the state.

Current Challenges towards implementing PC within the state

  • Shortage of trained Manpower
  • The state’s difficult geographical terrain makes service provision a challenge
  • The impact of COVID-19 pandemic

Future Plans to expand PC throughout the state

The state plans to conduct training program for doctors and nurses in the system by organizing training activities, state wide, in a phased manner.

About the Author: Dr. Tashi Chotton is an MD (Anaesthesia) and has completed her Fellowship in Pain Medicine. She was trained in palliative care under the CTC 3 program, the IAPC’s CCEPC course, and the IACA course. She is currently posted as the State Nodal Officer for Palliative Care in Arunachal Pradesh.

ASSAM

Background / Context

The Birth of Palliative Care (PC) in Assam was in the form of an NGO, Guwahati Pain and Palliative Care Society (GPPCS) in 1999 and Dr Dinesh Goswami was the pioneer of PC in Assam.

India’s North-East, is known as the cancer capital of India, due to the high incidence of Head and Neck Cancer caused by the consumption of tobacco, areca nut and alcohol. Assam, with a total population of 34.18 million accounts for most of the cancer cases of North-East, thereby making the  need for PC huge.

PC services are currently available at Dr. Bhubaneswar Borooah Cancer Institute (BBCI), the State Cancer Institute (SCI) at Guwahati, Assam Medical College Hospital (AMCH) in Dibrugarh, Jorhat Medical College Hospital (JMCH) in Jorhat, and at Cachar Cancer Care hospital (opioids are available in all these centres). Three out of the above four centres are of Assam Cancer Care Foundation (ACCF).

Policy

Access to palliative care services are available at only 5 of Assam’s 33 districts.  As of date, Assam does not have a State Palliative Care Policy.

Drugs Availability

BBCI & SCI at Guwahati, AMCH in Dibrugarh, JMCH in Jorhat ,Cachar Cancer Care Hospital and Digboi Palliative Care have opioids available at their centres. Though promising, this still leaves a big void in equal access to PC for patients from every corner of Assam

Most districts continue to not have access to opioids for severe pain resulting in thousands to die in pain, and with their issues remaining unattended due to lack of PC facilities.

Education: Training and Awareness

One year fellowship programs are available at BBCI and SCI.

The IAPC’s CCEPC courses are available in BBCI.

The number of people trained in Palliative care continues to remain far less than the actual demand.

Current Challenges towards implementing PC within the state

  • The need for a strong and gentle leadership
  • The need for additional mentoring by IAPC
  • The lack of sensitization of those at helm of affairs for a State Palliative Care Policy, that will facilitate the integration of the much needed PC into the health system

Future Plans to expand PC throughout the state

Sensitize policy makers to begin PC departments in existing medical colleges to educate doctors and nurses in the periphery. A ray of hope in a dark night is the Assam Cancer Care Foundation which is a joint venture of Tata Trusts and the Government of Assam to spearhead the Palliative Care movement in Assam.

About the Author: Dr. Tanma Mahanta has been working in palliative care since 1999 and is a Palliative Care Physician working at Palliative Care Unit (ACCF) at AMCH Dibrugarh. Dr. Mahanta has a Diploma In Palliative Medicine from Edith Cowan University, Perth, Australia with the help of a scholarship (courtesy Dr. Robert Twycross). She has also completed the 6 weeks BCCPM course at IPM Kozikode and the 6 weeks training at MNJ Hospital, Hyderabad.

MANIPUR

Background / Context

Manipur has a total population of about 28 lakhs and statistics shows that for every one lakh population about 350 persons need palliative care. Manipur, therefore, has nearly 10,000 patients who currently require palliative care, with the numbers only projected to grow in the future.

The Palliative Care Society Imphal (PCSI) is the first Non Governmental Organization to initiate palliative care in Manipur in 2015, under the leadership of Dr. Jugindra who got trained from Kerala.

PCSI has a team of doctors, nurses and social workers trained in palliative care providing OPD consultations, home care and in patient services when symptomatic management is needed.

Pallaitive care services are also offered at the Regional Institute of Medical Sciences (RIMS) and Shija Academy of Health Sciences.

Policy

There are a total of 16 districts in Manipur. According to the National Program for Palliative Care, Manipur, the State palliative care cell was formed in 2017 and nine districts have been approved for palliative care services (2018-19).

Referral protocols have been formulated to link district hospitals to Regional Institute of Medical Sciences (RIMS).

88 Health and Wellness Centres (HWC) across the state have been established by the National Health Mission where OPD and home care palliative care services are being offered.

Drugs Availability

Opiods are available in a few of the Health and Wellness Centres (HWC) and at most of the district hospitals. The community health officer’s at the HWC’s make a referral to either the RIMS palliative care clinic or Palliative Care Society, Imphal, for opioid prescription.

Education: Training and Awareness

Initially, the foundation course on palliative care was done in collaboration with Institute of Palliative Medicine (IPM) involving 16 districts to train 80 doctors, 40 nurses and 40 paramedicals.

In 2020, The National Health Mission, Manipur, issued a directive for doctors, staff nurses, social workers, and paramedical staff to undergo weekly online training in basic palliative care. This training was attended by over 300 health care professionals and was offered by Pallium India in collaboration with Pallicovid, Kerala.

Till date, three international conferences (PALLICON) were organised by PCSI in 2015, 2017 and 2019 to sensitize the audience about palliative care, the policy developments and to discuss various topics related to palliative care. The conference was attended by national and international doctors, nurses, students and other professionals.

Current Challenges towards implementing PC within the state

  • The limited number of professionals trained in Palliative Care
  • The lack of awareness among the health care professionals and the general community
  • The lack of adequate infrastructure, policy and appropriate referral services.

Future Plans to expand PC throughout the state

PCSI is currently collaborating with IPM to set up a WHO training centre in Manipur. There are also activities underway to begin a dedicated palliative medicine department at the the Shija Academy of Health Sciences.

 

 

About the Author: Dr. Nandan Choudhary is an MD in Palliative Medicine from AIIMS, New Delhi, and was from the first batch of MD (PM) at the center. Post completion of his MD, Dr Choudhary began providing Palliative Care in Manipur. He is currently associated with the Palliative Care Society, Imphal, and works as a Senior Resident at Shija Academy of Health Sciences, Imphal.

MEGHALAYA

Background / Context

Meghalaya has a current population of approximately 34.4 lakhs spread over 11 districts. Palliative Care in Meghalaya formally commenced from North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong in March 2014. Service provision includes OPD services as well as free homecare with the help of volunteers from the different Non Governmental Organizations like the Voluntary Health Association of Meghalaya (VHAM).

Palliative Care began to function as a Unit under the Leadership of Prof. Prithwis Bhattacharyya (Department of Anaesthesiology & Critical Care) from March 2016. The Palliative Care Unit at NEIGRIHMS is located in Mawdiangdiang, Shillong, and caters to patients suffering from terminal illness in the early as well as through their last stages. The Unit provides free homecare services, free Morphine Tablets to all patients along with. Patches are being provided free of cost to BPL or Low Income group patients.

Initially, the unit rendered care to 464 patients in 2016 and has since then witnessed an exponential increase in patient interaction due to an improved awareness of palliative care and has currently rendered care to 24,636 patients, via both the home visit and follow up combined

Policy

Though Meghalaya does not currently have a State Palliative Care policy, the State Govt. of Meghalaya has currently begun implementing the National Palliative Care Programme under NHM at the State and District Hospitals, with their doctors, nurses etc. being trained by NEIGRIHMS. Developments are also underway towards the integration of the Health & Wellness Clinics into delivering Palliative Care Program throughout Meghalaya.

Drugs Availability

The State Government is procuring Morphine.

Our Unit provides free Morphine Tablets to patients who need it, while patches are being provided free of cost to BPL or Low Income group patients.

Education: Training and Awareness

The unit at NEIGRIHMS coordinates with different agencies (WISE, Bethany Society, etc) to help and support those impoverished family members, especially those who have lost an “Earning Member” to provide vocational training and subsequent gainful employment.

Several CNE and CME programmes and workshops have been conducted with a focus on creating awareness and educating the Nurses and Doctors. The following programmes have been conducted by the Unit:

  1. 500 participants have been trained via the CME conducted on Palliative Care in Feb 2018
  2. 30 volunteers have been trained in the Palliative care workshop conducted in June 2018
  3. The World Palliative Care Day celebrations in 2018, hosted several workshops, a bike rally and a musical evening to generate awareness for terminal cancer patients and Palliative care.
  4. 150 professionals were trained in PC in the Training of Trainers program in March 2019
  5. 1500 participants were trained in the National CME cum CNE & Workshop on Pain & Palliative Care conducted in August 2019
  6. The State National Programme on Palliative Care (NPPC) Meghalaya organized a Foundation Course Training on Palliative Care for Medical & Health Officers, Staff Nurses & HCWs in collaboration with Palliative Care Unit, NEIGRIHMS & Pallium India in March 2020.
  7. 2nd Part continuation Foundation Course Training on Palliative Care for Medical & Health Officers, Staff Nurse & HCW was held in March 2021 and was organized by the State National Programme on Palliative Care (NPPC) Meghalaya in collaboration with Palliative Care Unit, NEIGRIHMS & Pallium India.

Current Challenges towards implementing PC within the state

Will be updated shortly

Future Plans to expand PC throughout the state

Plans are underway towards the integration of the Health & Wellness Clinics into delivering Palliative Care Program throughout Meghalaya, the Final Policy Document for which is currently being developed.

About the Author: Dr. Prithwis Bhattacharyya, is the Head of the Palliative Medicine Unit at North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS) at Shillong. Dr Bhattacharyya has also attended the WHO Palliative Care Training at Oxford, UK in 1992.

MIZORAM

Background / Context

Mizoram is the second least populous state in India with a population of 1,091,014 (2011 Census), and records the highest cancer incidence among males in the country; and among females it stands second next to Papumpare district of Arunachal Pradesh. The state reports an average of 811 cancer deaths per year with almost two-thirds of patients coming in late or advanced stages of the disease with a need for palliative care. Of the approximately 1500 new cancer cases registered annually, approximately 450-500 of them register for palliative care.

Palliative Care services began at the Mizoram State Cancer Institute (MSCI) in February 2006 after one doctor (Dr Jerry L Pautu) and one nurse (Laltlanengi) were trained at Kochi in November 2005, initiated by WHO.

Palliative Care was then established with technical and financial support from Pallium India. An MOU was signed between Pallium India and Mizoram Health Services, after which one medical officer and one nurse were trained at Trivandrum Institute of Palliative Science, Trivandrum in July 2007. After 2 (two) years of being funded by Pallium India, Palliative Care was then taken up by the Mizoram State Government in December 2009 in accordance with the MOU. The National Palliative Care Programme (NPPC) is currently being implemented in the state.

MSCI currently has 2 Doctors, 3 Nurses, and 1 Multitask worker. The center offers daily OPD services, free distribution of morphine tablets to those in need, Counselling services, Minor procedures like pleural fluid aspiration, ascitic fluid aspiration, NG tube passage, catheterization, dressing of wound, etc is also carried out.

The center began offering IP services since December 2012 with 8 beds. In May 2013, the number of bed assigned increased to 10. Weekly home care services began in February 2017 with funding from the NPPC.

The Key providers rendering Palliative Care in the State include the Mizoram State Cancer Institute Palliative Care, the Mizoram State Referral Hospital, the Civil Hospital, and the District Hospitals of Champhai, Kolasib, Lawngtlai, Lunglei, Mamit, and Saiha. Synod Hospital is the other separate entity under mission hospital (NGO), that provides palliative care in the State and which is also equipped with an RMI status to procure medical morphine.

Policy

The State Health Department, Govt. of Mizoram, is taking steps to include Palliative Care under the State Health Policy. However, the NPPC is being implemented in Mizoram since October 2016, with one doctor and four nurses being recruited and trained for Palliative Care.

Currently, seven of Mizoram’s Eight districts Aizawl, Lunglei, Champhai, Lawngtlai, Mamit, Kolasib and Saiha districts are being covered under the NPPC. All of these districts have been granted the Registered Medical Institute License (RMI)  for procuring, storing and disseminating medical morphine.

Drugs Availability

Oral Morphine (10mg, 20mg, 30mg and 60mg) is currently being distributed free-of-charge to patients at MSCI. Inj Morphine is available for hospital use.

All the 7 district hospitals also have access to and distribute oral Morphine (10mg, 20mg and 30mg) free-of-charge to those in need. Mizoram is the first state in North East India to disseminate medical morphine, free of cost to patients.

Education: Training and Awareness

1 Physician and 5 Staff Nurses were trained in the Orientation Training of District Palliative Unit on Palliative Care in 2016.

A one day training of Doctors and Nurses in February, 2017 trained 8 Medical Officers (1 from each PHC/CHC/DH), 8 Staff Nurses (1 from each PHC/CHC/DH), 5 staff members from MSCI (MO & Staff Nurse under NPPC) and 1 MO and 1 staff nurse from Civil Hospital, Aizawl.

1 Physician and 1 staff nurse from MSCI, Zemabawk, were trained in the Two Days Training of Trainers Workshop in August, 2017.

5 MOs were trained in the one Day “Palliative Care Update” for Doctors, facilitated by Dr. MR Rajagopal, Chairman Pallium India, in February, 2018.

17 Doctors and Staff Nurses were trained under Aizawl East and Lunglei District training program in March, 2018.

2 Staff Nurse from MSCI, Zemabawk  underwent the three days training on “Educating Nurses to Improve Quality Palliative Care” jointly organised by End of Life Nursing Education Consortium (ELNEC), CIPLA Palliative Care and Training Centre in May, 2018

12 Doctors were trained in the “Palliative Care Update for Doctors” organised by Palliative Unit, Synod Hospital & Pallium Kerala in June, 2018.

41 Medical officers and 41 Staff Nurses from Aizawl West, Champhai, Kolasib and Lunglei District were trained in August 2018, under the ‘Training of Medical Officers & Staff Nurses’ training program.

22 members were trained in a palliative care workshop in February, 2019.

1 Medical Officer & 1 Staff Nurse from each District underwent the ten days Foundation Course on Palliative Care offered by Pallium India and Synod Hospital, in February, 2019.

11 Medical Officers and 8 Staff nurses of Mamit & Lunglei Districts and MSCI were trained in  September, 2019.

94 members were trained in the workshop under the NPPC in February, 2020.

15 members from Lawngtlai District PHCs & CHC attended the One Day Refresher Training for Doctors & Nurses of Lawngtlai District in February, 2021

9 Doctors attended the Online Training of Doctors Refresher Course in Palliative Medicine and 13 Staff Nurses attended the Online Training of Nurses in Palliative Care September, 2021 to January, 2022.

Current Challenges towards implementing PC within the state

  • Inadequate number of trained health professionals. This also limits coverage to only cancer patients.
  • Inadequate infrastructure - absence of a dedicated vehicle for home care visits, equipment and drugs for use in institutions and home care programs.
  • Inadequate funds to ensure an uninterrupted supply of morphine and other strong analgesics.
  • The unavailability of strong analgesics apart from morphine for patients who cannot take morphine.
  • Difficulty in accessing psychotropic drugs or sedatives in the market due to constant abuse.
  • The absence of social and financial support for patients’ and their families (eg. Education support, ration help, free medicine distribution etc).
  • The lack of bereavement services

Future Plans to expand PC throughout the state

  1. Continue to sensitize health professionals and general population regarding palliative care
  2. Continue rendering home care services
  3. Improve availability of alternative strong opioids
  4. Begin offering Grief and Bereavement support services
  5. Partner and collaborate with NGO’s
  6. Increase the publication of our research and studies

About the Author: Dr. R. Vanneihsangi is the Medical Officer at the Palliative Care Unit in Mizoram State Cancer Institute.

NAGALAND

Background / Context

Nagaland began provisioning Palliative care services since 2013, to provide quality of life to the suffering cancer patients, as the State began recording a relatively high prevelance of cancer when compared to the other states.

Palliative care services within the State are being provided at The Naga Hospital (NHK) at Kohima, Christian Institute of Health Sciences and Research (CIHSR), Eden Medical Centre, Dimapur (IP, OP and Home Based Palliative Care), Zion Hospital (IP and OP), and at the Impur Christian Hospital, Mokokchung which has been the designated Palliative care centre since 2017.

The palliative department at Eden Medical Centre integrates Geriatric care, particularly the care of Dementia, Parkinson’s disease, stroke care, frail elderly care and End of Life Care (EOLC) under their Home Based Palliative Care services.

The Saint Joseph Palliative Care Centre at Chumukedima, Dimapur, is currently under construction and will be first of its kind center to provide exclusive palliative care services in Nagaland.

Policy

It is promising to note that despite the State not having a State palliative care policy, a group of committed palliative care doctors intend to come together and initiate the steps towards getting one, within in a year.

3 of Nagaland’s 12 districts, currently have access to Palliative Care. Plans are underway to increase coverage to the other districts by motivating private practitioners and by training health care professionals within the public health system to actively implement palliative care in the Primary Health Care centers at each district.

Drugs Availability

The Naga Hospital, Kohima (NHK), Eden Medical Centre, Christian Institute of Health Sciences and Research (CIHSR), and Zion hospital has an uninterrupted supply of Opioid drugs both for inpatients and outpatients.

Though drugs are available at the Impur Christian Hospital Palliative Care, a government initiative, accessing the center is quite challenging due to its geographical location, resulting in only a small section of the patients to receive benefits.

The Drug Controller, Govt. of Nagaland, is very co-operative and therefore presents no hurdles or hindrances towards procuring the Essential Narcotic Drugs as per the amended NDPS Act.

Education: Training and Awareness

Still at its infancy, there are countable palliative care trained doctors and nurses within the state. These include 1 doctor trained in M.Sc. Palliative Medicine (Cardiff University), 3 doctors trained in the NFPM, 1 trained in the one year certificate program and 2 others who have been trained through the Foundation Course. 6 nurses have been trained at the foundation course in Palliative Care.

The IAPC’s CCEPC course, the Foundation course in Palliative course and Volunteer training programs are currently virtually available at Nagaland. The courses will be soon offered offline as well.

There has not been an exclusive training in Palliative Care offered by the State Government at the moment. I was however, invited by the State NRHM to deliver a lecture on Pain Management and Palliative care for health workers within the State’s PH system.

Current Challenges towards implementing PC within the state

  • Attitudinal issues and misconceptions that Palliative Care services are reserved for cancer patients or to be provided only at the end of life(EOLC)
  • Inadequate number of trained personnel, the lack of funds and the lack of a State Policy to upscale services to cater to the growing need for palliative care services.
  • The lack of community awareness regarding palliative care.

Future Plans to expand PC throughout the state

Formation of the Nagaland Chapter of Palliative Care with trained doctors to minimize bottle necks and increase the momentum of developing PC within the State

Design plans to increase coverage of palliative care to all the corners on Nagaland by creating a network of champions, volunteers, trained doctors and nurses

Organise CMEs and CNEs in palliative care as required.

About the Author: Dr. Nepuni Athikho is a Consultant & Head at the Eden Medical Centre Palliative & Elderly Care at Dimapur, Nagaland. He is also credited with starting Palliative Care at Christian Institute of Health Sciences & Research. Dr Athikho’s professional qualifications include an MBBS, DNB (Family Medicine), CCEPC, NFPM, PGDG (Geriatrics).

TRIPURA

Background / Context

The current population of Tripura is 41,84,959. The table below illustrates the number of patients needing palliative care services within the state along with their coverage as of August 2021.

Prof. Rajagopal, Chairman, Pallium India, an eminent activist in palliative care contributed towards establishing Palliative Care Services in Tripura. With active support of Prof. Rajagopal and Dr. Gautam Majumdar, Medical Superintendent, Regional Cancer Centre, Agartala, Morphine was made available in Tripura in 2007.

In November, 2011, the Agartala Regional Cancer Centre (ARCC) began providing home based Palliative Care services in Tripura. This service has now evolved to include a Palliative Care team consisting of a Doctor, a Nurse and a Cancer registry staff, who work with financial support from the National Health Mission.

At present, palliative care services are available at all the different levels of health care delivery within the state. At the tertiary level, the Atal Bihari Vajpayee, Regional Cancer Centre (ABV-RCC), located at Agartala has a team of trained doctors and nurses to provide OPD, IPD and Day Care services along with offering counselling services. The OPD at ABV-RCC also provides Tele-consultation services for supportive care on working days. The Cancer registry staff of ABV-RCC provide home based palliative care at the community level. Beside this, trained doctors, nurses and community health officers at the secondary and primary levels provide Palliative Care Services to patients including home based care.

Policy

Though Tripura does not have a State Palliative Care Policy, some Palliative Care activities have already  been initiated under the National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS).

The Central Govt. proposes to supplement their efforts by providing Technical & Financial support through implementing the National Program for Palliative Care (NPPC) under the National Health Mission.

The activities at District level under the NPPC program are closely monitored through the State Palliative care NCD Cell. Palliative Care activities at various sub-district level and home-based palliative care is rendered by utilizing the services of the NPCDCS staff under the district NCD Cell. This integration of efforts under the NPPC and the NPCDCS at different levels is necessary for the optimal utilization of the resources.

All of Tripura’s eight Districts have access to Palliative Care. In 2012, the Govt. of Tripura requested the Govt. of India to allow 8 centers (Dharmanagar DH, Kumarghat SDH, Kulai DH, Teliamura SDH, ABV RCC, Bishalgarh SDH, Gomati DH and Jolaibari CHC) that are located strategically, to cover for a 50 km radius area. The team also proposed that these 8 master palliative care teams will then be responsible to train the HCW’s in each of their districts.

Forty Non Communicable Disease (NCD) Clinics in the State (including clinics from the various District Hospitals, Sub-divisional Hospitals and Community Health Centers) have been identified to deliver services across the State. Trained Community Health Officers provision Palliative Care at the Sub Centre level.

Up until now, the NGO’s and Private Providers have not been actively engaged to provision services.

Drugs Availability

The Pain clinic at ABV-RCC manages the pain of cancer patients by practising the WHO step-ladder pattern of pain management.

Most drugs are currently available at ABV-RCC including Morphine (Parenteral & Oral), Tramadol (Parenteral & Oral), Paracetamol, Ibuprofen, Diclofence etc.

Other important medicines for supportive care including antibiotics, psychotropic drugs, bronchodilators, anti emetics, proton pump inhibitors, anti allergic etc. are also available at the State Cancer Institute.

Education: Training and Awareness

Provided below are the details of the health personnel trained at various levels, to provide basic palliative home care services through an institution.

40 HCWs (Doctors, Nurses, Pharmacists and Social Workers) were trained in the RCC via a 10 day certificate course offered by Pallium India and Australian Palliative Alliance in February 2014.

Public awareness activities such as VHSNC, TV talk shows, wall writing, flex etc. are regularly conducted to improve the skill and knowledge towards pain relief and palliative care, among both the medical and the general community.

Current Challenges towards implementing PC within the state

  • The lack of adequately trained staff
  • The lack of awareness and the need for an attitudinal shift from a ‘disease focused approach’ to ‘a patient centered Philosophy’ while planning care.
  • The lack of adequate communication about the patient’s goals and preference for care.
  • The need to obtain consent for Palliative Care from competent patients and not assume the same so that the patient realizes that they will be cared for by a multidisciplinary team.

Future Plans to expand PC throughout the state

Continue implementing the Palliative care Program by upscaling training for the existing manpower and by generating awareness through advocacy activities.

Continue the strengthening of Community and Home Based Palliative Care services by empowering teams to provide cost effective care at home, along with provisioning emotional, occupational, bereavement and counseling support. Bed ridden patients to also be cared for by the palliative care teams on a weekly basis. A ‘Palliative Care Tool kit’ to be provided to all the Community Health Officers at the Sub Center level to allow for better service at the grassroots level.

It is important to also arrange for financial assistance or support to be provided to the bereaved families especially for those with high financial vulnerabilities.

Design and implement actions towards integrating palliative medicine into the Medical Education system, the Healthcare system and the overall societal framework.

About the Author

Dr. Gautam Majumdar, the author of this article is presently working as the Medical Superintendent, of ABV-RCC, Health Deptt., Govt. of Tripura. He is the pioneer of Palliative Care services in Tripura.
Dr. Debalina Bhaumik, the co-author of this article is presently working as a State Program Coordinator of NPCDCS, National Health Mission, Govt. of Tripura. She is also attached with Telemedicine division of ABV-RCC, Agartala.

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