APLI NEWSLETTER

April 1999

The 6th national conference of the Indian Association of Palliative Care (IPAC) was held in Calicut, Kerala, from 19th - 21st Feb. The conference was hosted by the Pain & Palliative Care Society of Calicut and attended by over four hundred delegates.

The conference theme was "Palliative Care for the Third World," aiming to address third world problems and seek solutions. Groups held workshops on ethics, home care and curriculum development during the three days, with each group reporting back in the final session

Following negotiations during the conference, the Minister of Health announced important changes to laws governing opioid handling. Licenses for the prescribing of opioids and their transportation throughout the state of Kerala were to be streamlined by July ’99 in an effort to allow easier access and availability of the drugs to patients. This was an exciting step forward for Kerala.

Delegates were invited to visit the Pain & Palliative Care Society Clinic at the Medical College, Calicut. The Clinic was established in 1994 and now sees up to sixty patients a day. Being "mainstreamed" and with inspiring leadership, it enjoys the support an enthusiastic stream of junior doctors, all of whom work voluntarily "after-hours". It also has a committed and regular group of volunteers, who play a major role in the running of the clinic, and show great kindness to patients, family and visitors. The famous "Listen." sign was in evidence throughout the clinic. As was a genuine sense of welcome for everyone. Dr Rajagopal, Director and Dr Suresh Kumar, Deputy Director, were elected by the IAPC to positions of Chairman and Secretary of the Association. It promises to be an important year of development ahead.

The 7th Conference will be held in Bangalore next year, with the theme "Palliative Care, Institution and Beyond" Anyone interested in palliative care in India and the developing world would do well to consider attending and participating.

• check out APLI on-line for further updates
• http://www.petermac.unimelb.edu.au/apli/

Dr Ranjit Oomen from Sabah, Malaysia spoke at Caritas Christi in March during a brief visit to Australia.

Some points:

• Palliative Care Unit on the general hospital grounds in Sabah. Budget drawn from medical/surgical services and recognition of palliative care component of these services.
• Embracing of ideology and principles of palliative care within the community and active support by the community.
• Active home care program.
• Regular education forums by palliative care team.
• Australian support, with a doctor working with the service for approximately one-year recently.
• Palliative care can be provided in any setting.
• Morphine is not yet widely available.

Annette joined Palliative Care in 1995 when she moved to Sydney. She brought a great commitment and heart to her work and was appointed to the unit at a difficult time of transition, putting patient care ahead of all else.

Annette joined APLI in 1998 and in characteristic fashion, actively supported and contributed to APLI activities. She spoke at the APLI forum organised in April 1998 at Concord Hospital; about her recent first visit to the Philippines to teach and visit the palliative care team of Dr Cathy Krings in Manila.

Annette was on her second visit to the Philippines in January when she suffered a sudden and fatal heart attack. Her family and colleagues in the Central Sydney Palliative Care Service sadly miss her.

I would just like to share with other Palliative Care (Nurses) my experience of visiting the Philippines to assist with teaching Palliative Care to their health care workers. I had volunteered to go because I think that I was at a stage in my career and my life where I needed to do something for others less fortunate than myself. … I am by no means a expert in Palliative Care, but after working for several years as a Clinical Nurse Specialist I thought I had some practical expertise to offer these nurses.

… I spent time on the three-bedded Palliative care Ward which was situated in a 48 bed Oncology Ward, and only staffed by two nurses. … Relatives and assistant nurses carry out the basic care of patients. There was very little furniture or equipment on the ward, all of which was very old. However, what the nurses lacked in resources they made up for in kindness and caring.

…Filipinos have to pay for their medical care and have to buy all their medications. The Philippine Cancer Society provides morphine tablets free to those who cannot afford to pay. Morphine is only available in tablet form of 20mgm and 30mgm and injections. … Patients taking 6mgms of morphine every 4 hours had to quarter a 20mgm tablet. …

Most of the homes I visited were in the poorer areas of Manilla where the people live in shanties. These shanties consist mostly of one very small room with no indoor toilet or running water. The patients lay on the floor or in a bed if they are lucky enough to have one.

…I held a two-day Hospice workshop for the nurses, volunteers and other health care workers. …After the first day I learnt that the nurses need to be involved and are not keen to sit listening to a lecturer! With a few quick changes the second days format was completely different and even involved impromptu singing from the participants. I am maintaining the friendships I made in the Philippines and am busy completing tasks I bought home with me.

My goal now is to be able to accept the invitation to return to the Philippines next year.

See next newsletter for details.