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According to the World Health Organization (WHO), there are around 2.5 million people in India with cancer. Another 5.7 million are HIV Positive. To these figures must be added the innumerable others in the 1.13 billion population who are suffering from incurable diseases, such as chronic conditions of the heart, lungs or kidneys. Clearly, the need for reliable, readily-available palliative care services is immense. Yet the vast majority of patients battling with the pain, debilitating symptoms and deep psychological needs associated with incurable diseases do so alone in India, without even basic medical support. It has been estimated that less than three percent of patients have access to pain-relief services.
Dr Gayatri Palat was trained as an anaesthesiologist but started to specialize in palliative care when she realized the extent of the problem. “In India, by the time most patients seek help their cancers are at an advanced stage and curative treatment is no longer an option. That is the reality,” she says. “But when we can't cure, there is little else to offer. Administering simple pain relief injections just isn't enough when dealing with chronic pain. Such patients have a huge burden of symptoms and psychological issues.”
Today, Dr Palat is Programme Director of the Indian Palliative Care Network (IPCN), based in Hyderabad, India. “There is widespread lack of awareness of all aspects of palliative care among health professionals, policy-makers and the general public in India,” says Dr. Palat. At the same time, Dr Palat points out, there's no official policy in place to introduce palliative care services. It is not part of the undergraduate curriculum and there are no training schemes. IPCN was formed to help address these urgent issues and established its first centre at the MNJ Oncology Institute and Regional Cancer Centre in Hyderabad in 2006.
Another problem facing those trying to establish palliative care services in India is the shortage of opioids, such as morphine, which are effective in cancer pain control. Laws are stringent due to fear of misuse and, as a result, very few drugs are available for medical purposes. This means that professionals are not trained to use them and instead resort to weaker analgesics which are often of little benefit to patients. Ironically, pharmaceutical companies have little interest in obtaining the necessary manufacturing licenses because morphine is cheap to produce and therefore not hugely profitable.
Dr Palat believes that international organizations such as the IAEA/PACT have an important role to play in helping to change attitudes towards palliative care. “They can influence policymakers and professionals; recommend palliative care be incorporated into national health cancer programmes; and they can provide funding for capacity building to help such services be established where they do not exist at present,” she says.
Although the situation is bleak, Dr Palat says there are some signs of change occurring, thanks largely to initiatives taken by several non-governmental organizations and individuals. At the same time, the government has established a task force within the National Cancer Control Programme for the implementation of palliative care. A community-based palliative care programme is in place in the southern state of Kerala, providing excellent coverage. Palliative care courses are slowly being introduced in some teaching institutions and, in a number of states, laws are being amended to make opioids more easily available.
A huge challenge lies ahead but with the cooperation of the authorities, international organizations, the media and the general public, Dr Palat hopes palliative care services will soon be more widely available to those so desperately in need.
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