Professor Jan Stjernsward
WHO Emeritus Director, Cancer
& Palliative care, Switzerland

21st International Conference of Palliative Care, held in Bhubaneswar from Feb 13-16, 2014, focused on evidence based palliative medicine. The conference witnessed the participation of more than 600 delegates which included over hundred representations and guests from 15 countries By Siddharth Kundu

Way back in 2002, WHO had notified that the fundamental responsibility of health profession to ease the suffering of patients cannot be fulfilled unless palliative care has priority status within public health and disease control programme; it is not an optional extra. Though it took a dozen years since then, on 23 January 2014, the utive board of the WHO passed a resolution for integration of palliative care into health care. This did not just happen; it took years of sustained advocacy by a lot of committed people.

Advances in medical Science, breakthrough in technology and increasing consciousness of civil right are some of the factors which have contributed to the thought that the people who need palliative care deserve a better quality of life. As we are aware, the physical, psychological and spiritual aspect of patient care are best looked after by a partnership of different kind of health professionals, community volunteers and family members, said Keshab Desiraju, Secretary, Department of Health & FW, Ministry of Health & FW, Government of India.

According to Dr M.R. Rajagopal, Chairman, Pallium India, Director, WHO Collaborating centre for training and policy on access to pain relief, Trivandrum, among all our successes and failures in the last quarter century of palliative care in India, it seems to me that our biggest success has been that the Government of India has, in the last few years, finally accepted this responsibility of the health care system, at least to some extent. Out biggest failure is that we have not got the common man aware- Today, palliative care is something that we dish out to people when we want to; it is not something that they feel they have a right to claim. Advocacy is the key, and that is not where the palliative care processionals skill lies. It is a responsibility that we have to accept and a skill that we have to acquire if the burden of disease- induced suffering in the country is to be reduced.

Professor Jan Stjernsward, WHO Emeritus Director, Cancer & palliative care, from Switzerland applauded the new generation of Palliative care workers coming to IAPCON 2014. He stated that The new generation of Indian palliative care workers coming to the IAPCON 2014 Conference should become rightly proud by knowing the history and achievements of their Indian leaders “past and present “ second to none! “ something I will exemplify. Having worked in India since close to early 1980s, I am indebted to my Indian colleagues. Much of WHO public health approach, policies and strategies were done and influenced in close collaboration with Indian colleagues, who made me learn a lot, something reflected in the WHO Pain Ladder, still the global standard for a method able to cover all, WHO global public health policies and guidelines for its implementation, for national cancer control and palliative care programs and official recommendation to all WHO member states, all common sense and evidence based. India has thereafter taken global leadership for a great part of the world for relevant solutions in palliative care.

Also read: Need to Strengthen Palliative Care in India

There were 12 plenary lectures by eminent palliative care experts from abroad. 72 faculties delivered their lectures in 18 different sessions. There were 54 free research presentations by palliative care 2 enthusiasts and 30 poster presentations. Three separate workshops were conducted for Doctors, Nurses and Volunteers held at AIIMS, Bhubaneswar and the main conference was held at KIMS.

CANCER CAPITAL

• Approx. 70-80% cancer pts. are diagnosed late when treatment is less efficient,
• 60% of them dont have access to quality cancer treatment,
• Out of 300 plus cancer centre in India, 40% are not adequately equipped with advance cancer care equipment,
• This study further suggests India will need 600 additional cancer care centre to meet the req by 2020

Morphine to be Accessible

The recent passing of the much awaited, Narcotic Drugs and Psychotropic Substances (NDPS) Act Amendment Bill by the Parliament will ensure that morphine, the essential medicine for pain relief, becomes more accessible to those suffering from chronic pain.

It is certainly a welcome step in the right direction, though it is too little and too late. The simplified regulation will ensure that the barriers that prevented the needy from accessing morphine were being removed.

However, hurdles and barriers continue to be there. Imagine the plight of Indian doctors being ignorant about the usage of morphine tablet for two generation ! They not only lack the experience, most of them may not have even seen a morphine tablet !! Creating awareness, sensitising the medical fraternity, teaching medical undergraduates about pain and palliative care; and training them to put
their knowledge into practice will take the toll of time

Regulations have been simplified but it will not translate into overnight increase in morphine demand. During 2013, about 300 kg of morphine was consumed for pain relief, while the actual annual requirement was around 36,000 kg. Moreover, the amendment will come into force only when the President of India signs the bill.

A total of 80 abstracts in different areas of Palliative Medicine were received and in order to motivate the younger generation, they will be published in Indian Journal of Palliative Care.

There was a major panel discussion on the topic Corporate Social Responsibility and Role of Industry, coordinated by Dr Sukhdev Nayak (Organizing Chairperson IAPCON, Professor & HOD Department. of Anaesthesiology AIIMS, BBSR) and Dr Sushma Bhatnagar (Chair Scientific Program, IAPCON, Professor & HOD of Anaesthesiology, Pain and Palliative Care, AIIMS) with esteemed panel participants like Dr G K Rath (Chief of B.R.A.I.C.H., AIIMS), Dr Paul Sebastin (Director- RCC Trivandrum), Dr NibeditaPani (Professor & HOD of Anaesthesiology, Cuttack Medical College & Hospital) and A K Goyal (Senior General Manager & an Industry expert) and panel was concluded by Professor Jan Stjernsward (WHO Emeritus Director, Cancer & Palliative care, Switzerland) with a consensus of more academic & industry interface with a major emphasis on Geriatric Palliative care & facilities in India.

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