Tamil Nadu in need of palliative care policy

Chennai: The State Health Department recently announced that palliative care will be offered at all government hospitals. Even so, the state lacks a palliative care policy.

Inadequate palliative care has added to the pathetic condition of the people suffering from life threatening diseases. Palliative care is aimed at improving the lives of patients and their families, who are suffering from life-threatening illness by reducing the pain and aiding through physical and psychological problems for all age groups.

World Health Organization (WHO) has brought up a global resolution to improve access to palliative care as a specific part of national health systems, with home based primary health care but India has no unique palliative care policy and it just remains a part of National Rural Health Mission.

“A policy was formulated for palliative care in the country about five years ago, but no provisions have been made under the policy as there was no fund allocation. Training of staff and doctors is a very important factor of palliative care, but owing to lack of funds it could not be implemented properly,” said Dr Suresh, director, WHO collaborating centre.

He said only 0.72 people receive palliative care on an average among the population of one million afflicted. Therefore, states should initiate independent programmes and policies on palliative care.

The neighbouring state of Kerala has a live model of palliative care where volunteers from the local community are trained to identify such problems and help the individual. But attempts of health department in Tamil Nadu to launch a state policy have been only on paper.

Doctors say that palliative care is necessary for a wide range of diseases and rise in chronic diseases mandates it. “Palliative care is needed to address practical needs and provide counselling for people suffering from various diseases prevalent in the State such as cardiovascular diseases, cancer, chronic liver disease, respiratory diseases, AIDS, diabetes, kidney failure, arthritis, neurological disease, dementia, congenital anomalies and tuberculosis,” says Preetha Mahesh, secretary, Chennai Pain and Palliative care.

She added that a community-based primary healthcare system using local manpower, adequate funds and resources is necessary for implementation of a policy on palliative care.

When contacted, health department officials said the process is underway. “The state is initially planning to start palliative care services in 11 districts, where palliative care will be offered after training of doctors and staff. The policy will be initiated after the programme is extended to other districts after its implementation in listed districts,” he official said.

Children need special focus for palliative care

Providing palliative care to children with life-limiting illnesses becomes more significant as they are more sensitive and need to be psychologically taken care of.

Various challenges associated are lack of training, counselling for the family and limitations with using painkillers that can have adverse effect on the child.

“Children suffering from illnesses that range from HIV to cancer are deprived of palliative care and a distinct methodology has to be followed for their palliative care. There is no universal method to track paediatric palliative care that worsens the situation and only one per cent children receive palliative care," said psychiatrist Dr Vivian Kapil.

He added that communicating with the child involves understanding cognitive, emotional development of the child at an age when he is unaware of disease.
Adults can accept death after a point of time, but it becomes difficult in children.

Therefore, a local level provision that should start with monetary and training resources, so that paediatric palliative care should be accessible to all children regardless of any differences, he added.