Indore: Concerned over lack of palliative care units in India, especially in state, oncologist Dr Digpal Dharkar has set up a unit at Indian Institute of Head and Neck Oncology (IIHNC) to provide free nursing care to underprivileged patients with life-limiting illnesses. Explaining the current scenario of nursing care in India, Dharkar said “India is in the midst of a socio economic transformation.
While improved health care has contributed to an increase in average life span of citizens, as far as palliative care is concerned, the facilities and services available are no doubt inadequate.
”Quoting a study by WHO Collaborating Centre for Policy and Training on Access to Pain Relief director Rajagopal as saying “Less than 1 per cent of India’s population has access to palliative care,” the oncologist argued that “Anyone, who has seen the pain a patient suffers during the last stages of life and also the consequent helplessness and trauma that the care givers experience, would immediately acknowledge the importance of palliative care with its ‘high touch low tech approach’.”
“To one’s wonder, the large central Indian state of Madhya Pradesh, with a population of 72,598,000 spread over 3, 08,000 sqkm, has just seven palliative care centres, a dauntingly small number,” Dharkar rued, adding that this number was not adequate enough to provide nursing care to all the patients as the number of people suffering from life threatening diseases, especially cancer, was rising.“The reason why hospitals do not prefer housing a palliative care facility is that it has a non-commercial component attached to it.
As most patients cannot afford the expensive care after already exhausting their pocket in bearing the heavy cost of treatments and medical examinations prior to reaching the palliative state, the facility hardly has any takers and thus, is not profit-generating,” Dharkar explained.
However, Dharjar did not hesitate to disclose that though he had decided to start a charity palliative care unit separately, it was not an easy task.“We faced major problem of attrition, because we picked up untrained doctors as we could not afford to pay hefty amount to the trained ones,” Dharkar said. After being trained as specialist, many doctors moved to private hospitals with better pay packages.“Nevertheless, we have many supporters and we will continue to provide palliative care, because it is an important aspect of resorting life in a person after survival from diseases,” Dharkar said.
Possible solutions to attrition
• In long term, increase trained personnel
• Offer more certificate courses in palliative care to doctors, nurses and para-medical staff, especially to those in rural areas
• Increasing mobile palliative care services for home visits as existing trained personnel would be in a position to reach a larger patient base
• Empower family members with training about home-care of terminally ill patient. It is emotionally and financially acceptable
• Training and creating a cadre of home care attendants who would not require high educational qualifications. This has the added advantage of providing employment to economically disadvantaged
• Highlight benefits of palliative care to make it rewarding and attracting profession to cover present shortages