Palliative care services in west bengal
Palliative care has been developing in India since the mid-1980s, but there is a dearth of service in many parts of the country. West Bengal is one among them. While mapping the existence of services in this state, just five centres were identified. Nongovernmental organizations, public and private hospitals, and hospices are the predominant sources of provision. Development of services is uneven, with greater provision evident in and around the city of Kolkata where the concentration of hospitals are high. But for the majority of the state, coverage is poor.

Barriers to the development of palliative care include poverty, population density, geography, opioid availability, and workforce development. Experts in the state says adapting the sustainable and affordable model of community-based palliative care services like in the southern state of Kerala would help to improve the situation.

Department of Radiotherapy, Medical College, Kolkata
The department of Radiotherapy at Medical College, Kolkata has been delivering palliative care service to cancer patients. They have a morphine dispensing unit that functions six days a week.

The department still doesn't have any inpatient care facility .In an attempt to provide home based palliative care to patients, "Aporajito", an NGO, has been working in close collaboration with the department since the last one year.

It is also one of the course centers of The Certificate Course in Essentials of Palliative Care run by Indian Association of Palliative Care through 26 centres in India for Doctors and Nurses.

Contact: Dr. Shyamol Sarkar, HOD – Radiotherapy & Palliative care Unit, Govt. Medical College, 88, College Street, Kolkata. Phone : 09831097315.

Mr. Subrato Dhar, Palliative Care Unit, Govt. Medical College, 88, College Street, Kolkata, Phone - 09831143376

Ruplal Nandy Memorial Cancer Centre, Chandernagore (RNMCRC), Hoogly


RNMCRC is the field extension center of Chittaranjan National Cancer Institute situated approximately 50 kms away from the city of Kolkata. Community based cancer awareness, cancer screening and early detection and home based palliative care services are being provided from the center for the population of the district of Hooghly and surrounding districts.

Contact– Dr. Partha Sarathy Basu, HOD – Gynaecologic Oncology, CNCI

Ruma Abedona Hospice, Rishra, West Bengal
This centre is operational since 9th February 2005 and is located 50 kms from the city of Kolkata in the Hoogly district of West bengal. They have a Day care centre and a home care service. The services are free of charge.However patients are requested to extend whatever possible help from their part.

A group of volunteers of the hospice.

Since its inception RAH volunteers, doctors and nurses have been attending patients with terminal cancer in most parts of the state. As told by the director, they have adopted the Home Care System of Cansupport, NewDelhi for providing home based palliative care.

The strongest aspect of RAH is the support of a strong team of volunteers .This particular aspect is obviously lacking in other palliative care centers in the state. Ruma Abedona Hospice (RAH) also conducts regular volunteer training programmes and is supported by Bill and Joan Grosser (Australian Support Coordinators) of Perth, Australia.

RAH also conducts free health check-up camps mainly for terminally ill patients as well as general patients from economically poor background in every alternative month in Ranigange, Burdwan, Bankura, Arambag and in different parts of Hooghly district.

Contact: Mr. Santanu Chakraborty, Director, Phone – 09830088821

Volunteers of RAH during a home visit

Sambedna, Madhyamgram, Kolkata
Sambedana is a volunteer's group working to make palliative care accessible to the patients. They have been working in close association with Ruma Abedona Hospice to provide referrals of patients requiring home based palliative care. The office is located in Madhyamgram in the northern part of West Bengal.

Department of Palliative Care, Cancer Centre WelfareHome and Research Institute ( CCWHRI), Thakurpukur, Kolkata
CCWHRI has started its Palliative Care Unit in August 2010 .Outpatient , inpatient services and free home care is provided by the unit. Shortly it has started a new palliative care ward that provides solace to many patients who require treatment for exacerbations. The patients in need for pain and palliative management are referred from other units of the hospital. The Institute is planning to develop a referral centre and a nodal training centre for doctors, nurses and volunteers.

Wings: The palliative care unit has three wings - the OPD, the inpatient ward and the domiciliary care wing.

Outpatient clinic

a) Outpatient department – Functions as a pain clinic from 10am to 5pm from Monday to Friday.Two medical officers cater to the OPD patients.

b) Inpatient ward – It is just beside the palliative care OPD room. At present there are five beds with round the clock service of doctors and nurses. This will soon be integrated into a 30 bedded palliative care ward.

C) Domiciliary care – It is at present twice a week done by an interdisciplinary team of a doctor, nurse and social worker. The visits are free of cost for all patients.

Home visit

Treatment for patients who are very poor is free of cost. Many of the patients are not able to afford the burden of cost of the treatment. They waived off all the hospital charges.

Collaborations: The institute has collaborated with Organizations like the Indo-American Cancer association, Helpage India and Global Cancer Concern India . It also has the support of Hitaishini, a breast cancer support group, for support and rehabilitation of such patients.

Palliative care helpline : +919830021479
Contact - Dr. Sanghamitra bora, coordinator, pcu, Phone- +91- 9432590980

Palliative Care Team at CCWHRI

Palliative care services in Jharkhand – an overview

Abhijit Dam, MD, FCCP, FPM, Dip Pall Med(Cardiff)
KOSISH-the hospice

Still today, when I ask many of my colleagues if they are interested in palliative care or would like to pursue the certificate course, the standard answer is 'oo kaun cheez ba?'(what is it?); this portrays a definite lack of awareness of the concept….but then the same situation is prevalent in most parts of India as evidenced personally from my project "Hospice Tour India" in 2009.

Jharkhand is a new state (formed in 2000) with the governance being changed 10 times in 11 years! Sadly, illiteracy, poverty, exploitation and corruption are the rule of the day with the consequence that death means a 'mouth less to feed'. Quality of life takes a backseat and many medical practitioners are busy fleecing their patients till their last breath….chemotherapy (& expensive regimens at that) continue without due justification till the very end (I believe that this is true in many parts of the world). Oncologists are skeptical about referring their patients to palliative care (economic concerns probably) and most health professionals look upon you as murderers when you mention palliation for non-cancer chronic illness. Morphine availability is a slowly realizing dream now (although you can get Fentanyl patches! Just wonderful isn't it!). Till last month there was just one retail medical shop in the whole of Jharkhand supplying morphine (often with many preconditions to supply the tablets!).This month after our efforts another retail counter has got licensing.

Kosish is the first and only NGO in Jharkhand providing palliative care services to the community (mostly rural) by its team of professional unpaid volunteers, which provides its services free of cost.

The activities started in 2005 and had to fight many odds. People would look at us with suspicion and our colleagues would laugh. We focused on working with locally available, affordable, accessible and acceptable resources. Non-availability of morphine did not bother us and we focused on pentazocine lactate and ketamine. We developed the 'Kosish Cocktail" for use in the domiciliary set-up. Our original scientific research was presented at national and international conferences and published. The American College of Chest Physicians awarded us with a letter of commendation. We not only focused on cancer but also on non-cancer palliation, with care of the elderly being our forte. We learned to give equal importance to the other aspects of pain, like spiritual, psychological and social…..something very simple but ignored.

We even published a booklet on the spiritual aspects of the last days of life in Hinduism. Our volunteers translated the 'Handbook of palliative care for volunteers' published by the Pain and Palliative care society, Calicut, into Hindi. Till date, we have cared for more than 200 patients and extended our services to cover neighboring West Bengal (Purulia, Adra, Kantadih). We also helped the cancer centre at Thakurpukur, Kolkata, to develop their palliative care services.

In the last few years, another service has come up in the town of Jamshedpur, with the local Cancer hospital starting a service there. Prof. S.Nayak had also addressed a gathering at Deogharh (giridih) a couple of years back. Unfortunately we still have to develop a system of local co-ordination between our units.