Compassionate Growth: A celebration of every step forward

Holy Word Inland Mission

The first meeting of Holy Word Inland Mission had discussed the unmet needs of people in the community requiring palliative care. This first meeting evolved into a grass roots movement led by the Mission’s Managing Director, Mr. Santhosh P. Thomas. Then we started activities by providing free wheelchairs. This group moved forward quickly.

Holy Word Inland Mission has a group of volunteers to make available the services for the helpless sick and disabled at free of cost. Our volunteers’ team including doctors, nurses, counsellors, social workers, volunteers etc are standing to ensure the services of Holy Word Inland Mission. Holy Word Inland Mission had formed a welfare program for poor and helpless patients and their dependents in palliative care and we named the program as ‘Supportive Unit Program’ on 1st January 2014. Through this program, now we are able to support regularly for 70 needy people in palliative care in every month. The ‘Supportive Unit Program’ is implementing the below mentioned services and supports at free of cost. Food kits, financial support for medicine, Nurses interaction, Support Groups and Palliative Family Get Together.

Holy Word Inland Mission has also started ‘Mental Health Awareness Programs’ and other general awareness programs. The ‘Mental Health Awareness Programs’ is implementing the below mentioned services at free of cost. Counselling Services, Bereavement Care and Ask Doctor Online Program. In order to develop community participation, Holy Word Inland Mission has also started a motivation program and named it as ‘Mission Fellowship’.

Holy Word Inland Mission also provide prayer supports for anyone who contact us. Holy Word Inland Mission has also a ‘Needs Assistance Program’ to implement the services to help the people with clothing, house maintenance, livelihood support, provide free wheelchairs etc. Holy Word Inland Mission continues with our services and now these services have become a catalyst for positive change in Society.

Hospicio South Goa District Hospital

In 2020 after undergoing a Ten days Foundation course in Palliative Medicine /Palliative nursing/Palliative Care conducted at DILASA Conference hall Farmagudi Ponda organised by Pallium India in collaboration with IMA Ponda charitable trust and The Goa Cancer Society, Sister Lisma Barneto and myself Dr Ravin Rego set on a mission to offer palliative care services at the old Hospicio Hospital based at Margao Goa in keeping with the vision of the founder Fr Antonio Jaoa De Miranda whose heart was ablaze with love and compassion of his fellowmen, dying on the streets and foothpaths in and around Margao.

The main focus of our services was home care based visits which we conducted beyond our duty hours.Other services provided were OPD services and IPD services.We used whatever resources available with the hospital and with the able support of the hospital management.

As months passed by and the hospital infrastructure not able to cope up with the patient load in October 2021 all departments from hospicio hospital were shifted to Hospicio South Goa District Hospital Fatorda Margao.

In January 2023 ,Directorate of Health Services Govt of Goa in collaboration with CIPLA foundation started a palliative care services programme at Hospicio South Goa District Hospital which got christened to SERENA palliative care on 1 august 2024 with the launch of its website.

A team from Hospicio south Goa District Hospital comprising of Dr Ravin Rego/Sister Lizma Barneto and Sister Rehmat Agha underwent a certificate course on Essentials of palliative Care in 2023 organised by Indian Association of palliative care and LIEN Foundation.

What does SERENA Palliative care do?

The SERENA Project focuses on relieving physical,emotional and psychological suffering of registered patients and their care givers through person centred and integrated health services.We aim to build a sustainable model for palliative care that is responsive to cultural ,social financial and familiar factors.

King George’s Medical University, Lucknow

King George’s Medical University was founded in 1905.

Cancer Palliative Care Unit in Department of Radiotherapy which started with the support of Jiv Daya Foundation, Dallas USA since 2016. After completing the tenure with Jiv Daya Foundation in 2021, Cancer Palliative Care Unit again started with the support of Cipla Foundation. Home Care Services to Cancer Palliative Care patients in the range of 35 km also initiated in 2022.
In this 8 year Cancer Palliative Care unit screened and assessed and followed around 14000 cancer patients for palliation through various ways. Palliative care services providing following facilities:

• Pain and Symptomatic management
• Fungating wound Management/Debridement/Dressing
• Nutritional Support
• Blood Transfusion support
• End of life Care Support
• Telephonic Counselling
• Financial Support through the Counselling
• Free Medicine Support with other General Utility Support
• Cancer Support group/Family counselling
• Home Care
• A full fledged 10 beds attached with monitoring system is dedicated to Cancer Palliative Care
• Pain and other symptomatic Care
• Support for blood transfusion services to the case that can not arrange Donor
• Counseling to Patient and caregivers for oral nutritional support, nasogastric tube feeding, tracheostomy care, colostomy care, Reduce risk of infection from other procedural care
• Counseling for financial assistance for Asadhya card, CM Fund or any other services available
• Proper communication channels to get help from District hospital/ Local Physicians if patient is non-ambulatory/emergency
• Other social support, events for patient’s caregiver, awareness generation session used to organize time to time

Krishna Vishwa Vidyapeeth (Deemed to be University)

Krishna Vishva Vidyapeeth, a ‘Deemed to Be University’ in Karad, Maharashtra, India, is accredited with an ‘A+’ grade by NAAC and holds ISO 9001:2015 certification. Its hospital features a 1,125-bed multispecialty tertiary care facility recognized by NABH.

The Department of Oncology, operational since 2005, identified the need for a palliative care unit, established in 2007 with one trained consultant. This center became the only palliative care facility in South Western Maharashtra, serving four neighboring districts and making oral morphine available in the region for the first time. It contributed to the Maharashtra State Chapter Palliative Care Policy in 2012 and aided in developing a palliative care unit at Satara District Hospital. Notable events include a palliative care workshop with Tata Memorial Hospital in 2008 and a symposium in 2017.

In 2018, comprehensive home care services were initiated. A dedicated team comprising a palliative care physician, nurse, and social worker visits 20-30 patients monthly. In 2020, the Department of Pain and Palliative Care was formed, employing four palliative care physicians and nurses, alongside psychiatrists and social workers. Staff are members of the Indian Association of Palliative Care and Asia Pacific Hospice Palliative Care Network. The department head served as a Central Council Member of IAPC in 2014-15.

The Palliative Care Unit registers 80-100 patients monthly, with 20-30 receiving inpatient services. The psycho-oncology department conducts regular clinics, offering supportive services such as rehabilitation, prosthesis, dental care, stoma services, and nutritional advice.

In 2021, the department launched the International Fellowship in Palliative Care for African countries. In 2022, the center was recognized as an ESMO Designated Centre for Integrated Oncology and Palliative Care, becoming the only medical college hospital in Maharashtra to hold this distinction.

Lakshmi Pain and Palliative Care Trust

Lakshmi Pain and Palliative Care Trust is a hospital based unit started 21st Sept 2000 with outpatient, inpatient, home care facilities. We are a team of trained professionals. Hospital staff is our extended team.

Our Main Objectives: Providing Palliative care without financial burden to patients, Educating HCPs and Creating Public Awareness.

Our Vision: To make Palliative Care easily available across the entire state of Tamilnadu.
To achieve our vision, we needed to satisfy 3 mandatory requirements – 1. Simplify Drug Policy 2. Easy Availability of Oral Morphine 3. Education

In 2000 we achieved the 1^st requirement thanks to workshop facilitated by Dr. M.R. Rajagopal in Chennai. Since 2003 we interacted with Health Dept., Tamilnadu.

2007 – Successfully implemented the drug policy, through an SOP by the Director Drug Control, for Easy Availability of Morphine – a landmark achievement. We have been conducting Public Awareness Programs through various media since 2000 and talks in various medical institutions (details in website).

Having achieved the first two, our focus continued on education. Thanks to IAPC, we are faculty since 2007 in all its teaching programmes.

2010 to 2015 Developed Curriculum for ‘Fellowship in Pall. Medicine in The Tamilnadu Dr. MGR Medical University, course available till date.

2015 till date we conduct courses for social work students from MSSW.

Since 2017 till date working with the NHM, training doctors and nurses from 32 districts in TN. Outcome: NHM started Palliative Care OP in all 32 district hospitals. Took part in the Govt. conducted ‘Makkal Thedi Maruthuvam’, training home care nurses in palliative care.

In spite of so much effort so far, in answer to “Ten Years Since the Resolution: How are we doing?” less than 4% are receiving the care! To cover the millions, it is mandatory and high time we joined hands to include palliative care syllabus in the MBBS Curriculum as every doctor will be equipped with the knowledge.

Mahatma Gandhi Medical College and Research Institute

Hospital Palliative Care Team (HPCT)…. Our journey till date

“Coming together is the beginning, keeping together is progress and working together is success” – Henry Ford

This notion is the soul of palliative care at Mahatma Gandhi Medical College and Research Institute. Multi-disciplinary approach is the key to the functioning of our palliative services. What started as a silos palliative care foundation course under IAPC in 2017, led to the “calling”for few of us doctors to initiate palliative care services in our hospital. An in-depth need analysis showed that team approach was best suited for us and so was formed our HPCT in 2018 which included oncologists, surgeons, anaesthesiologist, psychiatrist and nursing staff. Since then, we have grown leaps and bounds working on all 3 prongs- Patient care, Research and Academics in palliative care. The success of our OPD services led to a dedicated 10-bedded palliative ward. Our persistent delegation with authorities helped us break our opioid availability issues.

Covid pandemic led us to reform our HPCT in 2022 (HPCT version 2.0). We strengthened our policies and strategies for better patient care. We use a bottoms-up approach to create awareness among public and in house employees. Our academics include regular sessions for UG students and medical interns.

Taking palliative care into the community was one of our biggest milestones. We collaborated various NGOs to deliver home-based palliative care. Postgraduates from Anaesthesiology are sent on a 10-day clinical attachment with SANJEEVAN (Home-based PC NGO) for community palliative care services. Its the first in our country for PG training. We are collaborating with other medical institutions in Pondicherry to build a network for palliative services both in training and research, which is essential to take us to the next well. Every peak of a mountain is the beginning to the next, HPCT will continue our journey in fostering patients with palliative needs.

Meenakshi Mission Hospital and Research Center

Meenakshi Mission Hospital and Research Centre (MMHRC) has come a long way (33 years) and carved a niche in the Tier II city, Madurai where it transformed into medical hub administering services in Oncology and Non-Oncology domains. Since its inception, significant expansion from 10- bed hospital to 1000- bed health care provider, has possibly enhanced the services in a humble way that anybody in need of care can be availed in MMHRC with all the privileges.

In 2013, the 1st and the only Hospice Centre (within hospital premises) in Tamil Nadu was initialized in collaboration with Lions club to serve terminally ill patients. MMHRC is the 1st institution in Madurai to recognize, authorize and organize the Institutional Palliative Care with a vision to foster holistic care accompanied with evidence-based medicine under Dept. of Medical Oncology since April 2024. The idea behind this intervention is to institute concurrent, adjuvant, and neo-adjuvant palliative care to all 3 categories of patients (Curative; Palliative and EOLC), and their care givers, fracturing the primordial notion of palliative care.

Currently, Palliative Care Unit, Dept. of Medical Oncology, extends full pledged OPD, IPD, & Hospice care facilities to Adult, Geriatric and Paediatric Oncology patients under one roof concurrently with Oncological services. Achievements hitherto humbly accomplished hospice care been given for more than 3,104 patients at subsidized cost. Palliative care services for more than 12,646 patients accommodated in the unfathomed journey. Active sessions in Palliative care to Oncologists, research, and observership to scholars who inclined to explore the evidence-based medicine annexed with holistic care in MMHRC has been commenced recently.

Future prospects include – Home care, Tele- health, Geriatric Care, wound care, respite care, certification, workshops and training to empower community level palliative care in Madurai & suburbs.

PALLIARE ↔ PALLIATIVE = “PROTECTION”.

National Institute of Mental Health and Neurosciences (NIMHANS)

The Journey of Neuropalliative care clinic: ‘Santvana’

‘Santvana’ is the culmination of a long cherished dream for the team in NIMHANS that there is place where people with the diagnosis of a life-limiting chronic neurological disorder can be assured of continuum of care till end of life. Started in November 2021 as collaboration between NIMHANS and CIPLA foundation, it marks a paradigm shift from oncology to non-oncology palliative care. ‘Santvana’ is the first structured neuropalliative care initiative in the public health sector in India.

We aim to provide symptom and pain relief, emotional, psychosocial, bereavement and spiritual support to the suffering, capacity building training for multi-disciplinary healthcare team, referrals and follow ups. Long term care pathways are put in place for follow-up of patients through tele-health services, home-based care and reintegrating back to the community services for continuity of care. During follow-ups and home visits, the team listens to the concerns and needs to guide with appropriate treatments, link to resources required, to provide financial assistance by liaison with other NGOs and Institutions.

Till date, 3795 people from different parts of India are enrolled for advanced care by the multi-disciplinary team, 181 from in and around Bangalore in the ongoing specialized home care services. Compassionate care is at the centre of everything we do, and we want to make sure all who need neuropalliative care in the country are able to access it through developing evidence for the service models, speaking in healthcare scientific forum and conducting several trainings, workshops, symposiums for nursing, social work, psychology and counselling professionals and collaborating with several stakeholders. We hope to contribute towards building communities that care for its frail and the ill through our community networking, capacity building and sensitisation programmes, bringing specialised care to the door-step.

One Billion Literates Foundation

One Billion Literates Foundation (OBLF) was founded as an education-focused NGO working for children from marginalised backgrounds in Anekal. Our foray into public health grew out of our response to the COVID19 pandemic, when we realised first hand the challenges faced by marginalised groups to access healthcare. We began in mid-2022 with community-based primary healthcare (PHC). Based on the insights we developed into unmet health needs, we integrated a component of Geriatric & Palliative care (GPC).

Work began in January 2024, when a Palliative Care physician joined as Director. Initially limited to Home Care in the 32 villages where our PHC work is ongoing, the GPC work has since developed as a separate program serving all 228 villages of Anekal Taluk. An independent centre was established in August 2024 with an OPD and physiotherapy unit. We also conduct monthly OPDs at one destitute home and one Govt Primary Health Centre, with plans to cover more. The team currently consists of two doctors, two nurses, two physiotherapists and a community engagement lead along with other support staff and CHWs. All clinical staff either possess relevant postgraduate clinical training, or undergo 6 weeks training with St.John’s Medical College, Bangalore.

The program supports not only individuals with advanced life limiting illnesses but also those with progressive limitations and age-related functional decline. We also strongly leverage digital technologies such as cloud-based EMR and nurse-led telemedicine. Another distinguishing feature is our growing cadre of CHWs (one from each Panchayat) who drive an ongoing process of identifying and engaging with potential partners and influencers from different segments of the population. Our aim is to identify local champions who can help facilitate a more caring and compassionate community towards those with the greatest need. In recognition of our work, Govt has invited OBLF to set up an inpatient PC unit in Bangalore urban.