Partnering with ECHS to initiate Palliative Care in Armed Forces

Partnering with ECHS to initiate Palliative Care in Armed Forces

– Dr Savita Butola, Panisagar

The armed forces have their own way of life, their own organizational culture and their own challenges. The medical services within the forces are organized so as to meet their specific requirements. Palliative care awareness, which is lacking in the rest of our country is reflected in the forces too. This means that the palliative needs of the uniformed personnel usually go unrecognised and unmet.

Providers, both within and outside the forces, need to understand the special requirements of this population in order to meet them satisfactorily. The serving personnel in defence forces are provided care only within their own medical set up whereas in other uniformed forces, e.g., the Central Armed Police Forces, they can take treatment from approved hospitals of the state and private sector. In both cases, there are lack of services tailored to meet their special requirements. The healthcare providers within the armed forces understand the challenges of their lifestyle but need to be trained in palliative care, and the existing palliative care providers outside the forces need to understand the challenges and lifestyle of the armed forces so as to meet their special needs.

The frequent relocations and transfers to places far away from their native places makes continuity of treatment and follow-up difficult. The personnel stay apart from their families for most of their serving life, which means that the caregivers are often other personnel from their unit. For end-of life care, they might be in hospitals away from their families or might need to be transported to their hometowns which may not have any palliative services. Limited interaction of serving personnel with civilian healthcare providers makes it difficult for them to develop the trust that forms the basis of therapeutic relationships. There is no doubt that the medical staff within the forces are those who best understand these issues and therefore training them to provide essential palliative care would be the most efficient way of ensuring care for forces personnel and their families.

At present, the largest number of beneficiaries in the defence forces are the retired personnel. Having recognised this situation, the authorities in the Ex-Servicemen Contributory Health Scheme (ECHS), have taken the landmark decision of including palliative care within its service package. The revamped Comprehensive ECHS, launched in 2003, allows Ex-servicemen pensioners and their dependants who were earlier entitled for treatment in service hospitals only, to be now authorised treatment, not only in service hospitals, but also in those civil / private hospitals which are specifically empanelled with the ECHS. (https://www.echs.gov.in/)

Considering this as the first step, the ECHS is ideally placed to initiate palliative care services for the Indian Armed Forces. A proposal has been submitted to the Government of India for including Palliative care within the ECHS framework – designed to fulfil the specific needs of veterans and their families. This aims to ensure that palliative care becomes accessible to ex-servicemen and their dependents across the different parts of India, especially in the rural and remote areas.

To meet this objective, the ECHS will partner with the Indian Association of Palliative Care (IAPC). To begin  with, the IAPC will help identify palliative care centres which provide free services or those hospitals already empanelled with ECHS and also providing palliative care, which can be utilised by the retired personnel. Next, the IAPC will help in education and training of doctors, nurses, para-medics serving in the ECHS as well as caregivers and volunteers, so that over a period of time the ECHS Centres would become self-sufficient to provide generalist palliative care. This process of empanelling free services has already begun. The Dr B Borooah Cancer Institute in Guwahati, and Karunashraya in Bengaluru, have been the first to get empanelled.

As with any new endeavour, there are inevitable obstacles and challenges. The most important being the lack of awareness, the misconception that palliative care is limited to only end-of-life care, the lack of access to opioid analgesics, and opiophobia among both providers and beneficiaries. This will require advocacy and education of not only the medical staff but of the caregivers, administrators and volunteers as well. AWWA, HelpAge India and other NGOs can help in this regard.

Ensuring adequate allocation of human and financial resources is crucial to provide good quality and comprehensive palliative care which is tailored to the unique psycho-spiritual and cultural needs of this population. The partnership between the IAPC and ECHS therefore envisions the gearing up of palliative care services to meet not only the physical, emotional, and spiritual needs of the military personnel and families but in also promoting a culture of empathy and sensitivity within the uniformed forces.  It is hoped that over a period of time, the integration of palliative care into the armed forces healthcare systems will provide comfort and solace to those who have donned the uniform to serve their motherland.