Easing the end of life
Palliative medicine focuses on relieving and preventing suffering rather than curing underlying disease or illness. About 60% of people would benefit from palliative care at the end of life. In India, this figure translates to 5.4 million people each year. Many others live with advanced non-communicable diseases that likewise require palliative treatment. With the rapid ageing of India’s population, demand for palliative care will grow, and most patients who need it will be both elderly and terminally ill.
In a "quality of death" study of 30 OECD countries and 10 select others conducted by the Economist Intelligence Unit in 2010, India ranked last, just below Uganda. Averaged across the country, less than 2% of people in India who would benefit from palliative care receive it. Without an accessible palliative care system to guide and treat them, most patients end up pursuing inappropriate, futile and expensive treatments that can cause medical as well as financial harm. Lack of palliative care facilities also leads to misuse of scarce resources intended for curative therapy (such as hospital beds) and to social isolation among the incurably ill, bedridden and dying.
A notable exception to these trends is the southern state of Kerala. According to the aforementioned study, Kerala provides two-thirds of the country’s palliative care services, although it is home to just 3% of India’s population. The first palliative care organisation in a low- or middle-income country to be designated as a World Health Organisation Collaborating Centre, the Institute of Palliative Medicine led the development of Kerala’s successful public health model in palliative care.
Run by the Institute of Palliative Medicine, this project was the first attempt to implement the Kerala model in a lower-income region of India. Its objective was to help a community in which no palliative care services were currently available build the capacity to provide such services to the region’s incurably ill, chronically bedridden and dying residents.
In the course of the project, the Institute of Palliative Medicine:
- Developed a sustainable, cost-effective, community-based system to care for people requiring palliative care in Villupuram District, in Kerala’s neighbouring state Tamil Nadu
- Trained primary healthcare workers and the general public – with a particular focus on students, to ensure long-term sustainability – in how to address the needs of people requiring palliative care in their neighbourhood
- Ran a palliative home care unit for people in Villupuram District as a demonstration project and a training facility
- Facilitated the development of palliative care services by governmental and civil society organisations in Villupuram District through the above measures