Pallium India

On Thursday and Friday, I spent time with an NGO here in Trivandrum called Pallium India. It is an initiative started by an anesthesiologist here to attempt to adequately address the (essentially) complete lack of palliative care services in Southern India. Of course, a few of the larger hospitals offer palliative care services but these are limited to wealthy people. Additionally, they tend to be in-patient services that simply manage pain at the very end of life. Since most people prefer to die at home with their families, these services really don't offer much.

So, several years ago, Dr. Rajagopal, became interested in this gap in care. He was working in Cochin at the time and starte his group up there, first as an NGO that was later morphed into a government run service. When he retired (forced age of retirement for government employees is 55) he moved back here to his home in Trivandrum. Once again, he noted the lack of adequate palliative care services and basically redid what he had started in Cochin. (Side note -- there is a tremendous amount of reinventing the wheel in medicine here)

He started the program in Trivandrum about 2 years ago, I believe. What they do is provide a variety of outpatient palliative care services to poor people. They have some donated space in a central hospital that they run a clinic 6 days a week. Also, because obviously not everyone from the local area can make it in to Trivandrum to be seen, Pallium India has a number of satellite clinics in the surrounding areas they staff as well. They travel to a given clinic (different village each day) and see patients each day of the week except Sundays. Finally, for those patients that cannot get to any clinic, they will do regular home visits with the frequency depending on the acuity of the patient. For example, we went to the house of a man with fairly advanced metastatic oral cancer who is in pretty bad shape. They said they have been seeing him 1-2 times/week recently.

The group provides medical care, pain management, nursing care (often doing dressing changes), social work services and spiritual counseling. In addition to the cancer patients (about 50% of the patients), the group also acts as primary care providers for poor patients with advanced chronic disease such as arthritis and diabetes. Many of the patients we saw without cancer were elderly women whose husbands had died and had no children living with them. Therefore, they were alone and some seemed to come just to have something to do. There also seemed to be a fair amount of depression being treated. In total, they told me they have about 600 patients on their census.

I think this is the coolest thing I have done here. Definitely not as funny as the condom factory. However, this was somewhat more satisfying and I was able to get some pictures. I found Dr. Rajagopal to be a fascinating man who is incredibly dedicated to his patients. The nurses, volunteers, students and doctors working with him were incredibly gracious and patient. I am deeply thakful to them for allowing me to participate. I learned a tremendous amount about the variety of cultural interactions here that influence the delivery f health care. For anyone who wants to know more about this group, there is a website, www.palliumindia.com.