Visit to the Palliative Care Centre in Hyderabad, India

During a 6-week period in January – March 2012 Julian Hamfjord and Espen Brembo volunteered at the Department of Pain and Palliative Care, MNJ Institute of Oncology and Regional Cancer Center (MNJIORCC) in Hyderabad, India. The hospital is recognized as the center of excellence for palliative care in the state of Andhra Pradesh due to the efforts of the INCTR's Palliative Access (PAX) Program.

As health professionals from Norway Julian Hamfjord and Espen Bremboare accustomed to government funded and equal healthcare to all, also known as socialized medicine. By most citizens this is regarded as a valuable right and something taken for granted. They were therefore intrigued to hear that patients at the MNJIORCC are treated irrespective of their ability to pay. Even more so they were eager to learn more on how this system is practiced in the only government run cancer hospital in Andhra Pradesh, serving more than 80 million people.

When arriving at the hospital Julian and Espen were met by the great generosity of the department staff, Program Director of PAX India Dr. Gayatri Palat and Head of Department Dr. Gorijavolu Durga Prasad. As a result they soon became part of the day-to-day activities at the department. The department provides care for both adults and children in an in-patient and out-patient setting. The out-patient clinic sees an amazing number of patients 6 days a week, and every morning the corridor is bustling with people queuing up for consultations. The cause of contact is very diverse and could be anything from an emergency admittance due to superior vena cava syndrome or other intractable symptoms, to the renewal of a morphine prescription. Most patients admitted to the hospital fall in the category of low socioeconomic status below a set poverty line. This will entitle them to a government insurance program. Overall most of these patients will receive some palliative care free of cost – but there are still challenges for patients to cover other expenses like transportation, certain medications and mobility aids.

The MNJIORCC co-operates with the Pain Relief and Palliative Care Society, a nonprofit organization offering palliative care to patients with incurable illnesses. The society works hard to help patients with needs not covered by the insurance program. Furthermore, there are outreach programs in rural villages outside Hyderabad and a home care program servicing the city. They were impressed to see how these programs are implemented with the help of local volunteers, social workers, nurses and doctors. The efforts of the society are of high significance to enhance and optimize the palliative care provided by the hospital. Despite the joint good work of the MNJIORCC and the society, it is devastating to know that palliative care in the state of Andhra Pradesh is estimated to reach only 1 % in need of such care.

Their experience is that the palliative care approach provided by the hospital and society is of a high standard, following modern guidelines. Symptom management is not only focused on physical relief, but the team devotes much attention to psychological and social aspects. Poor opioid availability and lack of knowledge among health professionals in India on palliative care have for the last decades been a major challenge. The department actively works with the local government to simplify policies and has regular training courses for health professionals and volunteers. This is paramount to develop a rigid and sustainable palliative care network in the region. J. Hamfjord and E. Bremboare believe that the department setup at MNJIORCC could work as a model for other hospitals, hospices and home care teams in and outside the state.

It is evident that a lot has happened since the department was established in 2006, much due to good leadership and a dedicated team. Hopefully there will be major ripple effects from the setup at MNJIORCC so that access to palliative care is improved throughout Andhra Pradesh. They are looking forward to seeing this development, and certainly hope that there will be more opportunities for us to take part in this work.

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