Current training facilities and services available for palliative care in India
Dr Prince John - Cipla Palliative Care and Training Centre, Pune, India
The Cipla Palliative Care and Training Centre was established in around 1997 and it’s been nineteen years into service now. Initially it started off as a centre for AIDS and cancer patients but due to the taboo associated with AIDS we restricted ourselves to cancer care. Over the years we’ve grown and it is a fifty bedded centre. We have in-patient care, OPDs, out-patient facilities in different hospitals as well, not just our centre. We have a very well established home care team, we do about 200 odd visits in a month.
Over the years palliative care has been growing so has the Cipla Palliative Care and Training Centre so the second part is training. We are involved in a lot of training for doctors, nurses, paramedical, even caregivers. So we run the IPC training course; we have a one-year fellowship which is university recognised which is the only course which is university recognised in our country. That’s for doctors, MBBS and postgraduates as well; we’ve already completed two batches of the same. We have an intake capacity of two students every year for that and it’s one of the most well-equipped centres, I would say, in the country as far as palliative care goes. Our model is different, we have a family care model in which we train and empower the caregivers in providing care for the patient. So we have a facility in which the patient and the caregiver stay together, they get trained in palliation of symptom management, what medicines to give at what point of time, what other drugs, when given, in case of SOS which drugs to give in case of an emergency and how to do a good dressing and things like that. So they are basically taught how to care for the patient on a regular basis and our patients go back home and when they need they come back again.
What are the main challenges?
There are a lot of challenges in terms of acceptance from the medical community, acceptance from the patient community and general community in general. So awareness is a big issue, people really are still not fully aware of what palliative care entails. The medical professionals really think of palliative care only as end of life care so we get a lot of referrals coming to us quite towards the end. At the same time we know that we are doing very little for those patients; we are trying our level best, symptom control is being achieved but the support that we would like to offer, the care that we would like to provide is still lacking because of this. People don’t come in time, that is the biggest issue. People are referred quite late, patients come to us very, very late and sadly we are restricted to cancer care only for now. Eventually we would like to expand to other chronic conditions as well but that’s still in discussion and for now we are focussing completely on cancer care. The biggest problem is referrals; the second problem is equating palliative care to end of life care which is the most commonest thing. Since it’s a free centre, we are a free centre, we provide all the services free of cost, it’s a little bit difficult for the upper middle class, middle class, people to accept it as well because the equate free care to no care. But when they come to our centre, when they see what we do most of our patients have given us feedback saying that we’re not going to go back home, we would love to stay. But that’s not how our centre works so we train them, counsel them, empower them and then they go back again but they frequently visit us.
What does the future hold for Cipla?
In the near future we are going to expand the home care as well. So we are going to be having two teams doing home care. We have a doctor, nurse and a social worker team doing the home care. In the future what we’re thinking of is we would like to collaborate and go ahead doing proper clinical research, proper research which is not really happening in our country. We have a lot of data which we are sitting on; we are probably the only centre in the country which is using an electronic medical record system since 2007. So we have a large database which we are sitting on and in the coming years we expect that we’ll publish a few papers, come out with relevant data which is relevant to our country which is really lacking.
Was it beneficial to have the IAPC conference hosted in Pune this year?
So the palliative care conference has come to the state of Maharashtra after a long time, basically; the last conference that we had was in Bombay in 2007 so as a state as a whole the conference coming to Maharashtra is a big thing and it’s been really wonderful because it’s Pune and our centre is based in Pune. It’s given us the opportunity to showcase our centre to a larger community of palliative care workers and showcase our model, tell them what we do and probably interact with the faculty. People, individuals, were involved in providing palliative care every day so it’s like a give and take thing, they’re experiencing something new, we’re learning something new. So it’s been a great experience.