Hospices: Adding a new dimension to palliative care

By M H Ahssan

The sight of a terminally-ill patient left to writhe in pain and die in misery once the doctor has pronounced that that the disease has reached a stage of no-cure, is not uncommon. This image is symptomatic of the abysmal state of palliative care management in India, which, according to experts, only three per cent Indian patients requiring palliative care are fortunate to receive.

Hence, the western concept of hospice (an institution offering team-oriented specialised care for the terminally ill patients) slowly gaining ground in the Indian soil adds a new dimension to palliative care management. In the last decade, India has witnessed hospices like Shanti Avedhana (Mumbai) Amrita Kripa Sagar Cancer Hospice (Mumbai), AIMS (Kochi), Cipla (Pune) among a couple of others coming up to meet the challenge of providing care for the no-cure diseases.

Explains palliative care specialist Dr C Rajagopal, Amrita Institute of Medical Sciences (AIMS), Kochi, "Indian doctors give up on terminally ill-patients once medicines have failed and then they are asked to be taken home. The last days of these terminally ill patients are spent in utter misery. This is where a hospice would help in reducing pain."

Echoes, Dr Mary Ann Muckadam, palliative care specialist, Tata Memorial Hospital, "Hospice provides a pain-free and dignified death. The focus is caring."

With increasing understanding of the importance of hospice, hospitals are dedicating units for it; palliatiave care is believed to require specialised care. The Rajiv Gandhi Cancer Institute and Research Centre(RGCIRC), New Delhi and AIMS, Kochi have successfully set up their hospices. Even Command Hospital, Pune is building a 100-bed hospice attached to it. Explains Lt Col A Chakraborty, former project director, of the hospice being built at Command hospital, "Only experts in palliative care can relieve the emotional and psychological pain that these terminally ill patients are going through."

Doctors and medical staff at the hospices aid the patient in reducing their pain with the help of medication. Their emotional needs are also taken care of through meditation and counselling. Patients at the last stage of cancer may suffer from pain, respiratory and digestive problems, pressure sores, fatigue and anxiety, as well as complications following chemotherapy. A hospice offers high-quality care at low cost and many symptoms can be treated, if necessary, with inexpensive drugs, experts point out.

But unlike the hospices in the west, Indian hospices are emphasising more on training patients and relatives in palliative care than in staying in the hospice. Explains Dr Y P Bhatia, CEO, RGCIRC, Delhi, "With weak family bonding, most of the terminally ill patients in the west are abandoned and hence forced to spend the last days in the hospices. But in India, where most terminally-ill people have their family to take care of them, we train the patients or/and relatives in palliative care in hospice and send them home as soon as possible."

RGCRI also sends their personnel to the patient’s house for training. With terminal diseases, especially cancer, being financially demanding, brief stay in hospice is less expensive.

Along with emergence of hospice, there is a gradual acceptance of professional care givers for palliatiave care. Says Mumbai-based care giver, who suffers from Parkinson’s disease, "Training the patients and the relatives to look after palliative care gives them a diginfied life."