In 2023, IAHPC provided five Leadership Development (LEAD) grants: $1,000 USD in year 1 and up to $1,500 USD in year 2. Recipients’ progress reports were evaluated and adjusted at the end of year 1. India’s Cancer Aid Society was one of the recipients.

Palliative Care Awareness Program at St. Mary's College of Nursing in Lucknow conducted by Prof. Sarita Singh of King George's Medical University. Photograph by Preeti Gupta; used with permission.

Great Ambitions: Palliative care enrichment in India at all levels

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By Alison Ramsey
IAHPC Pallinews editor

There is no denying that India’s Cancer Aid Society thinks big. Its plan is to further the groundwork for palliative care throughout a country that recently surpassed China as the most populated in the world.

Cancer Prevention (and palliative care awareness) in Sarvodaya Balika Inter College Village Gopalganj, with Piyush Gupta on the microphone. Photo used with permission.

The society’s efforts in the year since receiving IAHPC’s LEAD grant in 2023 are building upon advocacy, including that of Pallium India’s Dr. MR Rajagopal: there is ample room for multiple advocates in a country where laws governing essential medicines to treat pain have only recently somewhat improved accessibility to the medical community. Not to mention the uphill battle in convincing people that treating health-related suffering will not lead to addiction or cause death. 

The society is midway through an ambitious two-year plan aimed at three key targets: government, health care workers, and communities.  Secretary Dr. Piyush Gupta sat down with IAHPC recently to talk about it.

Health care workers target: A terrific response 

This is where Cancer Aid Society’s actions have produced significant and potentially lasting change. Covid-19 actually helped. “We didn’t go into lockdown,” says Dr. Gupta. “We got education going instead” by incorporating the National Association of Palliative Care for AYUSH & Integrative Medicine (NAPCAIM).

Thousands have taken—or are currently taking—its courses [see the box], an encouraging indication of growing interest in palliative care. In 2022 an international conference drew about 150 delegates, a number that doubled when another was held in 2023.

Non-profit NAPCAIM, launched in 2020, now has 203 paid lifetime members in 52 chapters and close to 300 students enrolled in courses.

Furthermore, fruitful liaisons are happening as people from multiple disciplines get involved.

“Most of the time, palliative care is ‘taken’ by anesthesiologists,” he says, however “In one institution, where the anesthesiologists were not cooperative, a radiologist became our lead to start the palliative care outpatient department.” If the interest exists, “you can groom people and develop their palliative care skills.”

Partnering with AYUSH practitioners, who use traditional complementary and alternative medicine practices, has been vital to meeting its objectives, in terms of networking, developing course content, and furthering interventions and integration of palliative care, says Dr. Gupta. “Homeopathic medicines,” he notes, “can be very effective in managing pain.”

Community target: Awareness flows from practitioners

National Workshop on Youth Empowerment under LEAD grant at Rajagiri College of Social Sciences. Photograph by Piyush Gupta; used with permission.

The Cancer Aid Society believes that the more health care workers know about palliative care, the more quickly people seeking treatment will become aware of its benefits. 

“The US opioid disaster has made people apprehensive,” says Dr. Gupta, but other models of care, in Germany for example, successfully treat pain with opioids in ways that avert addiction issues. “Here, we have licences” required for institutions to dispense opioids, “in the US, they have none. It’s a vast difference.”

Education trickles down from health care workers to patients.

Patients undergoing the great physical and/or emotional pain that can accompany the end of life, or a life-threatening disease, are more likely to be receptive to the core values and practices of palliative care. And more and more people are gathering the skills to help.

“I never thought that people would be taking to palliative care in such a big way,” says Dr. Gupta. “Almost anyone we are getting in touch with, they are interested. Medical professionals, volunteers, those integrating music, acupressure, yoga, spiritual healing practices…everything! We now have experts in all domains.”

Government target: Stalled

The greatest goal in this realm is to ensure that each state’s "drugs controller" is aware of the new legal provisions that ease access and streamline the paperwork necessary for health care institutions, both private and public, to acquire and dispense essential controlled medicines.

Dr. Gupta says that the society was hampered in 2023 by state elections, and federal elections in 2024. By July of this year, he hopes that all stakeholders will be in place and advocacy can begin in earnest.

In the meantime, the “amended Narcotic Drugs and Psychotropic Substances (NDPS) Act shall be used for licensing of the government hospitals to use narcotics to treat pain.” The license should be for a period of three years, whereas at many places it is given for just one year.

State officials are still not always aware of the NDPS Act amendment from 2014, which states that government hospitals that apply for it cannot be denied a license to receive and dispense opioids.

Caption information: see Dr. Gupta’s email [email protected], [email protected] 

[India’s population is currently estimated at 1.428 billion.]