KOCHI: While Kerala has always been at the forefront of palliative care for terminally ill patients since 2008, there is a need to integrate the same into the treatment of Covid-19 patients. Palliative care, which focuses on the patient, their families and the carer, is essential at a time when post-traumatic stress disorder is high among patients and carers. TNIE speaks to Dr M R Rajagopal, founder-chairman of Pallium India and the director of Trivandrum Institute of Palliative Sciences who has been advocating the same.
In 2014, the World Health Assembly had called upon member states to incorporate palliative care as a primary constituent of healthcare systems. However, years later, it is yet to constitute among the fundamental elements of a healthcare system as the latter concentrates more on the diseases and less on the person. In the current circumstances, there exists an urgency to combine palliative care to minimise distressing symptoms as a ‘humane, low-tech adjunct to ventilators and intensive care units’.
“In a pandemic such as Covid-19, the suffering of the patient is tremendous. Generally, attention isn’t given towards human suffering. This is the core issue I want to focus on. Suffering is three-fold -- physical such as breathlessness and agitations, emotional such as fear and guilt, and social issues including the stigma one faces as they get back home -- these need to be addressed,” Dr Rajagopal says.
And this isn’t an expensive affair. Rajagopal explains that connecting a patient via a smartphone to his or her relatives can go a long way. “The little things matter phenomenally. Instead of looking at just charts and MRI scans with PPE, the slightest compassion works tremendously. Utilising technology is essential; connection with the community and family must be maintained,” he says.For the same, Pallium India has been training doctors online on the basics of palliative care via a seven-and-half hour course over six days. An online support group for overstretched healthcare providers is also available simultaneously. Understandably, healthcare providers engaged in palliative care in the current times are also under severe stress.
“Matters are different when you choose to go into someone else’s suffering and emotional burden. The way of dealing with it is two-fold. If one is profoundly affected by the suffering of a person, they shouldn’t be keeping it to themselves; rather must share the problem. Sharing is a tool to protect ourselves, the healthcare workers,” the doctor says.
Kerala’s stance on palliative care is well-known globally. “In a panchayat, every bedridden patient is visited at least once a month by a trained palliative nurse. Procedures such as changing a urinary catheter at the patient’s home and providing free palliative care medicines are carried out without many hurdles. Palliative care in Kerala existed way before the state’s palliative care policy in 2004. We now have more than 450 non-governmental organisations working in palliative care, each taking responsibility for people within their locality. This doesn’t exist in several low or middle-income countries. This is a massive strength and is helping us deal with the current crises now,” says Dr Rajagopal.
Nevertheless, in the palliative care movement, doctors have tried involving communities. “During the lockdown, many were stranded and couldn’t get food or medicines. Hundreds of volunteers signed up to help them. In the face of tragedy, there are several who receive pleasure in helping others. This should be taken further. The state’s palliative care policy was revised last year; in it, promoting and encouraging community-based palliative care is essential. When the pandemic runs its course, though it will leave a lot of damages, the results can be different if palliative care is facilitated.”