Unbearable Pain: India’s Obligation to Ensure Palliative Care

Human Rights Watch researchers recently produced a report entitled “Unbearable Pain: India’s Obligation to Ensure Palliative Care”, based on their observations in various cancer centers in India, including the Mehdi Nawaz Jung Institute of Oncology and Regional Cancer Centre (MNJ) in Hyderabad where they met with Dr. Gayatri Palat, Program Director of the INCTR Palliative Access (PAX) Program in India. Dr. Palat has had a major role, with the strong support of the director of the MNJ Cancer institute, in developing the first palliative care program in the State of Andhra Pradesh which has about 65 million inhabitants. Dr Palat was therefore one of the core members of the research group which contributed to the development of this report.

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Pictures and Video by Brent Foster - Human Rights Watch

The press conference organized in New Delhi to announce the release of the report on October 29th, 2009 was quite special. Instead of the usual rush to get it over and run to the next conference, journalists were truly appalled by the findings of the report.

It is estimated that more than 1 million advanced cancer patients in India experience severe pain in any given year. The report underlines that many major cancer hospitals in India do not provide patients with morphine, despite the fact that more than 70 percent of their patients are incurable and likely to require pain treatment and palliative care. Although the government has increased its funding for cancer, the situation remains extremely unsatisfactory for end of life patients in India. Dr. Palat told Human Rights Watch, « oral morphine is so cheap but people have to pay 3,000 rupees [about US$60] for travel to get it. This means that we cannot provide good terminal care [and patients simply go back to their villages to die.”

Journalists were really eager to understand the deep causes of the main problems faced by palliative care services in India, which are mainly linked to a lack of communication and training, poor integration of palliative care into health services and restrictive drug regulations. Most journalists even lingered after the meeting to talk to palliative care experts in India and to express their feelings, mostly anger and compassion in front of such unbearable suffering.

Dr. Gayatri Palat is a member of the INCTR PAX team headed by D. Stuart Brown and Dr. Fraser Black to help advance access to palliative care for patients and families in India, in order to relieve the pain and suffering of many patients who are dying or have incurable diseases. Working with local groups, PAX uses the INCTR Network to set up regional centers that provide specialist palliative care, teaching programs and advocacy for changes in government policy to improve access to palliative care and ensure adequate supplies of essential medicines. It supports additional educational resources for health professionals practicing palliative care, such as workshops, the PAX Palliative Care Handbook and other educational material. In addition, PAX provides consulting services to national and regional governments wishing to assess their palliative care needs, improve opioid availability and plan services to improve disease as well as to improve survival rates.

Link to the HRW video

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