From the President’s Desk
India is fighting, in all possible means against the dangerous second wave of COVID 19 which has already hit us hard and uprooted our normal life. It is heart-breaking to see the sufferings of thousands of people; it is extremely painful to witness so many deaths in a short span of time, weakening all our efforts to save them.
It is distressing to see the burdened and exhausted faces of our colleagues who are on repeated shifts, in ICUs and wards, pushing themselves to do whatever they can in this catastrophe. We are not thinking about ourselves; our effort is to save as many lives as we can.
In the middle of all this chaos, we could see a united effort from the international community to support India. Google, Microsoft, and many other multinational giants have already offered great help. The kind gesture of the international community makes us humbled. Countries including US, UK, France, Singapore, Russia, Middle East nations, and many more, have offered support, and cargoes containing medicines and oxygen have already been dispatched to India. We have no words to express our gratitude!
And our colleagues, palliative care providers, are silently continuing their mission braving all the odds. A big salute to their selfless commitment!
To keep ourselves safe and not letting others to be infected from us, are the added pronouncements from our side to save our country from this pandemic. I request all of you to follow the three effective measures, masks, social distancing, and hand hygiene. Double masking, a combination of surgical and cloth masking, has been suggested by experts to get protected from the new variant of COVID19. Protect yourselves and be safe!
In the May 2021 edition of the newsletter, a few scholarly articles suggested by experts are available for reference. We hope these articles will be helpful for healthcare professionals in their difficult journey.
With warm regards.
Dr. Sushma Bhatnagar
India is in grief. At this moment, we offer our heart-felt tribute to the thousands of Indians who lost their lives in this pandemic. We are with the grieving families; our deepest condolence to the thousands of families who lost their loved ones. The second wave of COVID-19 is so cruel that almost all of us are directly or indirectly affected. We all have similar gloomy stories to share;we all lost at least a loved one, a friend, a family member, a colleague….
Amidst of all these causalities and uncertainties, our colleagues, the front-line healthcare professionals are diligently fulfilling their duties, to save as many lives as they can. They are not concerned about their safety, they are not complaining about their never-ending duty hours, instead, they are providing all possible care to each and every patient.
You are the saviors! A big salute!
Amidst the pandemonium how does one cope?
Author: Dr. Seema Rao, Associate Director (Education& Research), Karunashraya, Bangalore
India is reeling under the onslaught of the pandemic today. The country is gasping for a breath of air. The hospitals are overflowing and overwhelmed. The healthcare workforce is depleted and exhausted, grappling to treat those in need. The incessantly raging funeral pyres are a grim reminder of the havoc brought about by this pandemic. In these uncertain times fear, worry and stress are our constant companions. Robbed of supports, livelihood and resources, we are all grieving collectively, mourning the loss of normalcy and of lives. For many of us in the healthcare sector, feelings of helplessness abound. The struggle to treat patients amidst severe resource crunch, the visuals of dying patients in hospital corridors, the inability to effectively care for the dying are somethings that will haunt us for the rest of our life And as we work tirelessly, there is no time to grieve. Experts predict an upsurge of mental health issues in both the patients and the healthcare providers alike in the COVID-19 era.
Amidst the pandemonium, how does one cope? We will need to work hard to manage our emotions – writes Dr. Seema Rao.
In this article Dr. Seema Rao shares her thoughts and suggests coping mechanisms to overcome the emotional trauma.
To read the article, please follow this Link
Useful resources for Stress Management during COVID-19 pandemic
Dr. Santosh K. Chaturvedi, Former Dean and Professor, NIMHANS, Bangalore, suggests a few useful resources to manage stress for front-line healthcare professionals, who are unable to cope with the unprecedented emergency.
The current times of the resurgence of the pandemic has led to an aggravation of stress among the frontline healthcare workers. Coping with the uncertainty of the pandemic, facing severe morbidity and mortality, are big challenges. Since the knowledge about covid-19 is gradually being gathered, the impact of the situation on people’s mental health is also becoming evident. Already the PTSD-like experience similar to what happened last year – lockdowns, hospital beds, ICUs, ventilators – is being re-lived by everyone again this year. This time there are newer issues such as oxygen unavailability and Remdesivir.
How do we cope with these? The experience is being gathered and the evidence base is still getting accumulated.
Here are some resources which can be helpful for the frontline workers. What has helped one in the past will probably be helpful again. General principles are given in the WHO resources below. Other resources are helpful in understanding and managing COVID-specific stress. Not everything will work for everyone and depends on one’s personality. It would be useful to learn from each other and share each other’s experiences.
For frontline healthcare professionals
- Self-care of Frontline Health Care Workers: During COVID-19 Pandemic – PubMed (nih.gov)
- A “Mental Health PPE” model of proactive mental health support for frontline health care workers during the COVID-19 pandemic (nih.gov)
- Traumatic Stress in Healthcare Workers During COVID-19 Pandemic: A Review of the Immediate Impact – PubMed (nih.gov)
- PSYCHOSOCIAL CARE FOR FRONTLINE HEALTH CARE WORKERS DURING COVID-19 (nimhans.ac.in)
- A resource for general physicians and health professionals on the mental health aspect of COVID–19 prepared by NIMHANS
- Resources for children – https://nimhans.ac.in/health-information-nimhans/covid19-information/
Following links with free text articles would be useful for the general public, patients and relatives
Dr. Chaturvedi generously offers his help to those who find it difficult to cope with the mental health issues due to the current pandemic. If there are any specific issues or topics individuals would like to discuss with Dr. Chaturvedi, they are welcome to contact him via email – firstname.lastname@example.org || Website: https://santoshchaturvedi.in
Managing a dying person at home in COVID-19 pandemic
Author: Dr. Stanley C. Macaden , Honorary Palliative Care Consultant, Bangalore Baptist Hospital (BBH) and The Christian Medical Association of India (CMAI)
The second severe multi-variant Covid-19 wave, and recent surge has caused unprecedented challenges for the health care system all over the country and many parts of the world. A common denominator now is the crucial lack of hospital and ICU beds to treat those with serious and critical COVID-19 infections and especially the care of the actively dying. The only remaining and possible course of action is to provide them the best possible care at home, that is managed by the immediate family and supported by community health care providers and volunteers.
A guideline for the family and those caring for the affected is outlined here. Some of the specific instructions are as applicable in Bangalore. However, the same can be modified as appropriate for any local situation.
Shared decision making (by patient, family, and heath care providers) through good communication is key in this whole process.
Please do not panic. These guidelines and support of a Palliative Care Team will help you take care of your loved one at home.
Please click on this link to read the guideline.
Management of COVID-19 Respiratory Distress
Respiratory problems are identified as serious and life threatening conditions in patients with COVID-19. Managing respiratory issues in COVID-19 patients is a challenge for treating physicians. Dr. Rajam K. Iyer, Pulmanologist and Palliative Care Physician, Bhatia and Hinduja Hospitals, Mumbai, suggests a few scholarly articles on effective management of respiratory issues in COVID-19.
- Management of COVID-19 Respiratory Distress
- Dexamethasone in Hospitalized Patients with COVID-19
- Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial
- Pragmatic tips for managing COVID-19 at home, when hospital or medical care is not accessible
Nothing could stop them; here they are to provide Palliative Care
National capital, Delhi, is in chaos. The life in the city has been shattered in the second wave of COVID-19. Hospitals are overloaded due to the sudden, unexpected, surge of COVID-19 cases. In spite of all these adverse circumstances imposed by the health care emergency, a group of palliative care providers in the capital city has been working tirelessly to provide the essential service to the terminally ill patients, risking their own lives.
Here you can read the dedicated effort of Cansupport-India’s largest free home based palliative care service, which has a network of 28 home care services in Delhi and NCR, caring an average of 2,600 patients at any given time. Fighting all the odds, the home care teams maintain their service without any gap.
Dr. Reena Sharma, Medical Director of Cansupport shares their effort to provide care in a choking city.
To read the article, please follow this Link
C0VID-19 in Children: Guidelines for Parents
Guileline for parents prepared by Indian Academy of Pediatrics (IAP) on COVID-19 in children is available Here
Covid-19: Countries rally to support India through “storm that has shaken the nation” – Reports The British Medical Journal
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1086 (Published 26 April 2021) Cite this as: BMJ 2021;373:n1086.
The report is accessible Here
Along with free online training, the BMJ also provides free access to clinical guidance & recent articles (with regular updates) on COVID -19
To access training, clinical guidelines, and other articles, please follow this Link
Online Lecture Series:
Every Monday between 6:30 a.m. and 7:30 a.m.
Practical aspects of management of pain and other Symptoms and setting up and integration of Palliative Care services were discussed in the IAPC Academy Lecture series, held in the month of April 2021.
The lectures in April started with a session by Dr. Lulu Mathews, an eminent academician, who heads the academic section of IAPC and Institute of Palliative Medicine, Kozhikode. Her talk was on managing children with non pain symptoms. Her talk, based on case scenarios and with discussions on practical aspects of management, was appreciated greatly.
This was followed by a well appreciated talk by Dr. Vidya Viswanath of HBCH&RC, Visakhapatnam, on setting up an integrated oncology – palliative care model in a tertiary hospital.
Dr. Mahesh Menon, a well-known pain specialist based at Mumbai was the faculty in the third week and his talk on interventional pain procedures helped the participants to understand more about relevant procedures to alleviate pain in cancer patients.
The lectures in April concluded with an excellent session by Dr. Mayank Gupta, a promising young faculty in Palliative care. His talk was on Empiric evidence on integrating chronic and interventional pain service with palliative care services in a hospital setting.
CCEPC 2021 Postponed
Considering the critical situation in India, the online theory session for Certificate Course in Essentials of Palliative Care 2021 has been postponed. The modified schedule will be announced soon.
Applications, brochures and list of centres through candidates can register for the course are available on IAPC website. Registration for the course is open. Candidates can select one of the centres from the list, and submit application to the centre coordinator. To get more details, brochure and application form, please click on this Link
Webinar Series by ICS & IAPC
The 3rd module of the webinar series organised by Indian Chest Soceity (ICS) in association with Indian Association of Palliative Care will be held on Saturday, 1st May 2021 from 7 PM to 8 PM.
Topic: Handling the difficult symptoms.
Register at: https://blueberry.webcastlive.co.in/c1174/
Fellowship in Pediatric Palliative Care
The Pediatric Palliative Care Fellowship Program offered jointly by the Hyderabad Centre for Palliative Care and Two Worlds Cancer Collaboration is now accepting applications. This one year clinical fellowship is endorsed by the Royal College of pediatrics and child health (UK). The fellowship prospectus and more information can be found on the Two Worlds Cancer Website:
Online Training on Basics in Palliative Care Nursing
The Department of Palliative Medicine at Tata Memorial Hospital, Mumbai offers an online training program on “Basics in Palliative Care nursing” from Saturday, 8th to Sunday, 30th May 2021. Online lectures will be held on every weekend – Saturday and Sunday, from 10 AM to 1 PM, followed by two weeks hands on training in the clinic.
Qualification: BSc Nursing / GNM. Preference will be given to those who are working in the field of Palliative Care.
Registration fees: RS.750/-.
Hands on training: Two weeks hands on experience in the clinic in a phased manner within the next 1 month.
Medium of Teaching: English
Please download the application form here. Eligible candidates may send their application along with basic certificates by mail on email@example.com on or before Saturday, 1st May 2021.
Late and incomplete applications are liable to be rejected. For any queries please contact: Mrs. Lucy Quadros – 9022478573
Foundations of Palliative Care
Apply now for the international online training program, Foundations of Palliative Care. The program will be held on Monday 12th, Tuesday 13th, Monday 19th and Tuesday 20th of July 2021. Deadline to submit applications: Thursday, 10th June 2021. For details contact firstname.lastname@example.org
Operational Guidelines for Palliative Care at Health and Wellness Centers
An important step by Government of India in implementing NPPC
An important step has been taken by Ministry of Health and Family Welfare, Government of India, towards implementing the National Palliative Care Program in India. Operational Guidelines for Palliative Care at Health and Wellness Centres has been published on Wednesday, 14th April 2021.
These operational guidelines are intended for State and District Program Managers and service providers to strengthen Palliative care services within the comprehensive primary health care package provided through Health and Wellness Center. Other companion documents include training manuals and standard treatment guidelines that would be updated and disseminated on a periodic basis. The addition of palliative care as part of comprehensive primary health care represents the inclusion of a new sub-population group into the activities of the HWC. This requires orientation, sensitization and learning from experiences with implementation across states.
Since the launch of the National Program for Palliative Care (NPPC) in 2012, the Government of India has been earmarking funds under NRHM flexi pool for initiating and scaling up palliative care services in various states depending on the Program Implementation Plan submitted by each state.
This operational guidelines will be helpful for states to plan and submit palliative care projects to Government of India. This will help them get funding from the Government of India to implement the program at various states.
The NPPC strategy is in line with 2014 World Health Assembly Resolution for achieving universal access to palliative care as part of Universal Health Coverage2 (UHC).
Download the Operational Guideliens Here
Oxford Textbook of Palliative Care for Children
The new edition of the Oxford Textbook of Palliative Care for Children is out on 31st May and brings together up-to-date information, current knowledge, evidence, and developments of clinical practice. It is suitable for both experienced clinicians and those new to the field of children’s palliative care. There are four sections in this edition which are: ‘Foundations of Care’, ‘Child and Family Care’, ‘Symptom Care’ and finally, ‘Delivery of Care’.
To order your copy, visit the Oxford University Press website
Palliative Care Dialogue with Dr. Tedros, Director General, WHO
A Palliative Care dialogue with the World Health Organization (WHO) Director General Dr. Tedros and representatives of Civil Society Organizations was held on Wednesday, 28th April 2021. The round table meeting discussed major issues like maintaining supply chain of OPIOIDS, awareness creation and accessibility of palliative care services.
This round table was curated by International Association for Hospice and Palliative Care, the Worldwide Hospice and Palliative Care Alliance and the International Federation on Ageing. The meeting was open to all members of civil society organizations (CSOs).
Dr. Tedros, Director General, WHO addressed the meeting.
“The COVID -19 pandemic has caused severe shortages of essential controlled medicines, and disruption of health services, in particular in low-income countries with weak supply chains and with limited or no local production. WHO is working with countries to ensure the continuity of essential health services and equitable access to medicines, including for palliative care”, said Dr. Tedros.
For details, please follow this Link
A new PC service in Bhubaneswar By Karunashraya
A new palliative care project will be launched by Karunashraya, in Bhubaneswar, Odisha with the financial support of Bagchi Couple. Odisha cabinent approved this 130 crore project for Bagchi-Karunashraya Palliative Care Centre, last week. Odisha government will provide 20 acres of land free of cost for the two projects funded by Bagchi couple, Bagchi-Shrishankara Cancer Hospital& Research Institute, and Bagchi Karunashraya Palliative Care Centre.
This will be the second Palliative Care Project of Karunashraya Bangalore. Karunashraya hospice in Bangalore has already completed 25 years of service.
Subrato Bagchi, Chairman, Odisha Skill Development Authority, and Susmita Bagchi, Chairperson, Mo School Abhiyan will donate INR 340 crores for setting up the cancer institute and palliative care centre.
2nd April World Autism Awareness Day
2nd April, 2021 was celebrated as the World Autism Awareness Day. Joined by the international community, hundreds of thousands of landmarks, buildings, homes and communities around the world came together on 2nd April, Autism Awareness Day, to Light It Up Blue in recognition of people with autism and those who love and support them. Autism-friendly events and educational activities took place throughout the month, with an aim to increase understanding and acceptance of people with autism, foster worldwide support and inspire a kinder, more inclusive world.
Dr. Lulu Mathews, Program Director, Academics, Institute of Palliative Medicine, Kozhikode recollects her difficult journey with the parents of an autistic kid, as a friend as well as a doctor.
Read about her journey Here
‘Vaccines bring us closer’
World Immunization Week
World Immunization Week – celebrated every year in the last week of April – aims to promote the use of vaccines to protect people of all ages against disease. The relevance of vaccines is more evident in 2021. The COVID-19 pandemic is a devastating reminder of the chaos caused by diseases we cannot prevent. Thanks to vaccines, we now have a way of ending this pandemic and to rebuild our lives.
Support to set-up Virtual clinic for Palliative care
Teledoctors, a group providing assistance to set-up virtual clinic offers their support for free to start virtual clinic for Palliative Care Consultations. Please find the details below.
A few useful Resources
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/