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Palliative care- the missing chapter in Internal Medicine

By Our Special Correspondent

SHILLONG: Internal Medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. “There are 138 chapters in Harrison’s Internal Medicine but what happens if all chapters fail? Palliative Care is the missing chapter,” said Dr Rajagopal, Chairman, Pallium India while speaking at the inauguration of the Palliative Care Unit at NEIGRIHMS.

Dr Rajagopal who has blazed a trail in palliative care in India stated that palliative care in India is just two decades old. Pallium India which Dr Rajagopal heads is a model for compassionate, high quality palliative care that also brings support and relief to thousands of patients suffering from terminal illnesses. Dr Rajagopal informed the select audience at NEIGRIHMS on Thursday that the idea of palliative care is to enable patients to live quality lives and to die with dignity.

To this end the availability of drugs such as morphine is important, Rajagopal said and wondered why the drug which has the least potential for abuse is not made available to hospitals/health centres offering palliative care.

It may be mentioned that Dr Rajagopal and like-minded internists actually filed public interest litigation (PIL) against the overwhelming odds put up by an archaic regulation for procuring morphine.

On March 20 this year, the Government finally amended the NDPS Act and took away from the states the power to legislate on essential narcotics. The export and import licenses for procuring morphine by different states have been done away with and a general central guideline would have to be followed by all the states, Dr Rajagopal informed.

The inaugural session had eminent persons comprising Dr Rajagopal, Dr AG Ahangar, Director, NEIGRIHMS, Mr KW Marbaniang, Secretary Health Govt of Meghalaya, Dr P Bhattacharya, Registrar and HOD Anaesthesiology, Mr David S Swer, Asstt Controller of Drugs, Govt of Meghalaya speak on palliative care and the availability of Morphine.

Mr KW Marbaniang informed that the Govt of Meghalaya had amended the Narcotics Drugs and Psychotropic Substances (NDPS) Act in August 2012 and the rules for procurement of morphine have been simplified. However he claimed that there were not many applicants for the drug.

Referring to the importance of Continuing Medical Education (CME) on Palliative Care, Dr Ahangar said while death is certain every patient wants to avoid a painful death. “Morphine used judiciously is a blessing to those in pain. It is used to manage trauma, a coronary event, acute appendicitis amongst other things and procurement is subject to regulations laid down by the Drugs Control Act.

Later at a panel discussion on the issue of palliative care, Dr Judita Syiemlieh, leading oncologist at the Shillong Civil Hospital informed that Meghalaya has at least over one thousand cancer patients a year and there is a great demand for morphine but the drug is not readily available. She said that most patients get their quota of morphine from the Dr B Borooah Cancer Institute, Guwahati or directly from the wholesalers.

Mr AK Mathur, Director NEPA said if morphine is important to enable patients to live a life of dignity and to be pain free then the system for procuring the drugs should not be so stiff. While agreeing that regulations should be in place, he said they should not be a hindrance for health institutes to procure them.

The palliative care unit at NEIGRIHMS is led by Dr P Bhattacharjee. Several health care givers specially trained in palliative care were given their certificates at the function.

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