Times of India
16 July 2011

For several days, Shyamala was shuttled to and from multi-specialty hospitals but never admitted. The 51-year-old, in the last stages of cancer, had severe vomiting and foul-smelling ulcers. The hospitals either directly turned down admission or discharged her in a few hours after prescribing some pain-killers. Last week, she was admitted to a clinic offering palliative care. Two days later, she died.

"But her death was peaceful. The clinic gave her good care. Had she been given some hospital care earlier, the suffering might have been less," says her husband R Ramakrishnan, a state government employee.

For many patients with incurable illnesses in the city, access to palliative care is not available. A random survey showed that in the city only four institutions offer palliative care and that less than 1% of patients receive it.

Palliative care physician Dr Mallika Tiruvadanan says there are too few institutions and even fewer physicians offering palliative care. The rise in the population of the elderly and the growing incidence of chronic ailments leading to organ failure have increased the demand for palliative care. Though the cure rates for diseases like cancer have improved, some diseases remain difficult to treat.

"We just don’t seem to have the space for these patients," says Dr Tiruvadanan. Low awareness about palliative care among patients and care givers and the lack of orientation programmes for doctors and paramedics are among the reasons, she points out. But hospitals say palliative medicine is not profitable. A cancer-specialist from a leading hospital, who does not want to be named, says: "When a terminally ill patient walks in we never know how sick he would get. In most cases, they are too weak to undergo surgeries or any other medical procedures. They just require medicines. With several patients, who can be saved, waiting for surgeries, it is, at times, impossible to maintain a terminally ill patient."

Many like Dr Tiruvadanan have been fighting to change such an attitude. "We want a 500-bed hospital to reserve at least 20 beds for palliative care. Some terminally ill patients can be kept at home but many will need hospital care. In fact, the city has more patients on the terminally sick roll than death roll," she says. Many like Shyamala will have a peaceful death if palliative medicine is treated as a specialty in hospitals.