Palliative care and UHC in India: Still Uncharted Waters?

This article was exclusively written for The European Sting by Ms. Sharon Gigy, a final year medical student studying in K.S. Hegde Medical Academy, Karnataka. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

‘Even when I’m dying, until I die, I’m still living’                  – Paul Kalanithi, When Breath becomes Air

This was the beginning of my journey towards understanding what “palliative care” actually meant. Like many others, even I had a skewed comprehension of what the term actually meant. There is a widespread misconception that palliative care is given to hasten the process of death or is restricted to certain medical conditions like cancer. I believe that the first step en route to making palliative care more accessible as declared in the Universal Health Coverage (UHC) is to clear all the misconceptions shrouding it and pushing it into obscurity. This holds especially true in a developing country like India where the number of patients who need palliative care is growing constantly.

In India, a shift from communicable to non-communicable diseases has been noticed in recent years. Home to nearly 1/6^th of the world’s population, India has a growing concern, palliative care. But less than 1% of its population has access to adequate palliative services (1). Despite having an organisation like the Indian Association of Palliative Care (IAPC) within the country; lack of personnel training, budget allocation, poor awareness activities, inadequate drug availability and improper implementation, India places at the bottom of the Quality of Death index in the world.

Currently, it is difficult to provide palliative care to all in a rapidly growing setting like India without making a few changes at grassroot level. Firstly, addressing that a substantial need for inclusion of basic training in palliative care in medical and nursing colleges is required. Also periodic training in palliative care through Continued medical education for existing professionals should be carried out (2). Secondly, palliative care rotation at tertiary, community and primary health care should be made mandatory for all students during internship. Lastly, awareness drives must be conducted to expel any misconceptions that people may have about palliative care and they should be encouraged to accept it as a viable option if need be.

Although, these steps may sound very trivial they are of utmost importance for making palliative care more accessible to the population in the long run. Future endeavors must aim to improve the availability of palliative care centres around the country complete with qualified doctors. Attempts should also be made to highlight the problems within IAPC and corrective measures should be taken for further advancement.

As quoted by Paul Kalanithi in his book; until a person dies, he/she is still living. The main purpose of palliative care is to help alleviate the suffering and improve the quality of life of patients as well as their families who are facing a life threatening illness during this time period. Palliative care also provides other supportive measures whether physical, psychosocial or spiritual until the patient’s last breath (3).

Different people have different needs, cultures and beliefs, therefore palliative care can vary greatly from one individual to next and should be tailor made for each individual’s necessities. The concept of palliative care is yet unknown in many parts within the country. Efforts should be made to bridge this gap between awareness and availability for further development.

To conclude, we have a long way to go before palliative care can be accepted within the boundaries of UHC in India. But small steady steps in the right direction will surely make this a reality in the foreseeable future.

References

1. The current status of palliative care in India | Cancer Control [Internet]. Cancercontrol.info. 2020. Available from: http://www.cancercontrol.info/cc2015/the-current-status-of-palliative-care-in-india/#:~:text=Home%20to%20one%2Dsixth%20of,and%20palliative%20care%20(1).
2. Jain V. Palliative care in India: Trials, tribulations, and future prospects. J Mahatma Gandhi Inst Med Sci 2018;23:55-8
3. Connor S. Global Atlas of Palliative Care, 2nd Ed 2020 [Internet]. The Worldwide Hospice Palliative Care Alliance. 2020. Available from: http://www.thewhpca.org/resources/global-atlas-on-end-of-life-care

About the author

The author, Sharon Gigy is a final year medical student studying in K.S. Hegde Medical Academy, Karnataka. She is an active member of Medical Student’s Association of India (MSAI). As a child, she has always enjoyed debating and aspires to set up a platform where like-minded people can gather and discuss issues which matter most to them. She enjoys competing and has participated in many national level competitions. Her hobbies include figure skating, making posters, learning new languages and basketball.

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