As the World Hospice & Palliative Care Day is being observed on Oct. 8, palliative care has come under spotlight. Palliative care tries to achieve this improvement in quality of life for the

patient and family. Palliative care is not just the care of the dying. It starts as supportive

care when the diagnosis of a life-threatening illness is made and continues later as terminal

care and beyond the death of the patient as bereavement support for the family. Palliative

Care is not in conflict with curative care. The principles of symptom control and psychosocial

support used in palliative care are beneficial to the patient even when the disease is

curable.

In addition to advanced cancer, patients with other end stage systemic diseases and AIDS

benefit from palliative care. Availability of palliative care services will also help to reduce

suffering in the majority of the elderly in their last phase of life.

There are more than 50 million people in need of palliative care in this world. Most of them

live in the developing world which does not have many facilities to look after such patients.

Development of palliative care services need to be a priority area for us. Palliative care

workers and policy makers all over the world are thinking of ways to offer regular

meaningful coverage to thousands of patients in pain and misery.

The concept of a public health approach in palliative care is recent but is increasingly been

seen as the only solution to the problem of poor quality and coverage in palliative care. It is

important to exchange ideas in this area, discuss and learn from each other.

One of the major differences between the care of the acutely and chronically ill is the need

for regular life-long supportive care in the latter. The medical establishment, with its

hospital-centered services, is geared basically to look after patients with acute illness. Such a

system of care has limitations in offering continuous regular care to patients with chronic

and incurable illness.

The challenge before palliative care workers in the developing world is to evolve a culturally

and socio economically appropriate and acceptable system for the long-term care and

palliative care, accessible to most of those who need it. This has not happened in most

regions of the world. Only 8 percent of people, who require it, are able to access palliative care

services globally.

Innovative models of care are emerging in different regions of the world. Groups of

palliative care workers in Australia, UK and Latin America have come up with such models.

Kerala, with a population of 34 million and an estimated 125,000 patients with incurable

diseases in need of palliative care, has managed to evolve a sustainable system of care with

community participation. This is based on the assumption that since most of the patients

prefer to be at home in the last phase of their life, it will be ideal if palliative care services

are available to them in the community. Community-Based Palliative Care is the term

commonly used to refer to palliative care services organized by the local community, with

home-based care as its cornerstone. The evolving palliative care program in Kerala has

shown that it is possible to improve the quality and coverage of health care programs

through community participation supported by government policies.

The Kerala model of palliative care represents a potential way in which the civil society can

engage in active dialogue and collaborate with the state to provide comprehensive and

sustainable care for the vulnerable section of the society.

— Dr. Suresh Kumar is the director of WHO Collaborating Center, Kerala, India.