KOZHIKODE: Despite the fact that it is mandatory for palliative care providers to have passed Auxiliary Nursing and Midwife (ANM) Course, besides three-month training in palliative care, it has emerged that nearly 1.25 lakh patients in the state, who need care to alleviate their physical agony, are being tended to by unqualified persons.
Against this backdrop, the state’s Primary Level Palliative Care Programme raises questions since the community level service is mostly delivered by untrained hands. More shockingly, they carry out specialised care treatment and invasive procedures without the supervision of a doctor or registered nurse.
According to Kerala State Palliative Care Policy (2008), the Primary Level Palliative Care Programme is funded by the Local Self-Governments and a trained auxiliary nurse should provide basic home care to the patients in areas under that particular LSGI.
And an RTI query has revealed that the community nurses have been carrying out invasive procedures like catheterisation, NG tube insertion, Ascites tapping, IV cannulation etc without the supervision of a doctor or a registered nurse. Currently, there are around 1,063 community nurses associated with the Primary Level Palliative Care Programme in the state. The registration with Kerala Nurses and Midwives Council (KNMC), an autonomous body constituted by the Government of Kerala under the provisions of Nurses and Midwives Act, 1953, is mandatory for nurses to work in the state. However, several persons working at the community level do not hold a valid registration certificate issued by KNMC or Basic Certificate Course in Palliative Auxiliary Nursing. Some have not even passed Class XII.
Confirming this, KNMC Registrar professor Valsa K Panicker said, “The issue has come to our notice. We get enquiries from the District Medical Offices across the state regarding the registration of community nurses engaged in primary level palliative care services. However, it was noted that some of them were not registered nurses or do not even possess the basic qualification.”
“Majority of the persons in need of palliative care have chronic diseases such as cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. Extra care should be taken to ensure that they are given the right treatment and care. Even a minor error in treatment can prove fatal,” she added.
The honorarium for community nurses was increased from Rs 6,000 to Rs 10,000 in 2015. Incidentally, a Government Order( GO) dated February 21, 2015, issued in this regard clearly states, “it has come to the notice of the government that several of the community nurses engaged in the Primary Level Palliative Care Programme in the state are unqualified”. However, no action was taken to address the issue.