By Dr George Jacob
Kochi, Oct 8, 2024: World Hospice and Palliative Care Day is being observed on October 12 this year. This day is a unified day of action to celebrate and support Hospice and palliative care globally.
Palliative Care is increasingly being recognized as a rapidly developing medical specialty in a society that is witnessing rapid changes in health and social profiles in modern times. It focuses primarily on providing relief from pain and other distressing symptoms the ailing might experience, oftentimes in the end of their lives.
Palliative Care team has expanded to meet increasing needs by including healthcare providers viz; doctors, nurses, social workers, chaplains, sleep specialists, psychologists and other trained paramedical personnel like ambulance drivers, radiology technicians, physiotherapists, lab technicians and physically-abled helpers who are relied on as ‘helping hands.’
Palliative care increasingly gained prominence as a medical specialty due to host of reasons;
• Ironically, rapid strides in quality of healthcare have added to longevity. This has added to an elderly population affected by comorbidities like hypertension, diabetes and obesity, which leads to specific diseases like stroke, heart disease and organ failure. Besides, degenerative diseases like Parkinsonism, Dementia, and Alzheimer’s disease demand focused needs. Malignancies add to unique health requirements that compound an aging population’s vulnerability.
There’s another group of people who demand specialized and long-term healthcare needs- accident victims in a world that speeds at full throttle.
• Joint families have made way to nuclear ones, resulting in paucity of caregivers whose presence is crucial to tend to the sick at home.
• An aging population and lifestyle diseases that affect them do not always require specialized and costly inpatient treatment in hospitals, but require only minor medical interventions, fine-tuning of medication and monitoring at home.
• This includes changing, placement and caring of urinary catheters, and delicate caring of indwelling tracheostomy tubes, vascular catheters and feeding tubes, wound dressings, especially those related to bed sores and chronic ulcers and monitored administration of low-volume oxygen, IV fluids, drug administration and monitoring vital parameters like temperature, pulse and blood pressure. Palliative care specialists, in these situations provide domiciliary services, helping families save precious money that inpatient hospital care would entail, and help the infirm regain health in the comfort of their home, amidst their families.
Besides their role in domiciliary care, palliative care specialists have a significant role to play within hospitals as well. This is particularly relevant in patients affected by cancer. Especially those with advanced incurable cancers, associated with pain and other distressing symptoms. Palliative care specialists have significant role to play to alleviate pain, depression, psychological, and emotional lability in these patients.
• Palliative specialists come in handy to help these patients come to terms with reality of impending death, and to die with dignity through emotional, psychological, physical and spiritual moorings. Without pain, and other distressing symptoms, preferably in the presence of their near and dear. The ailing are spared the agony of miserable and lonely death in the cold and lonely environs of the ICU or other specialized areas within hospitals.
• They also have a significant role to play in patients who are brain dead following traffic accidents and cerebrovascular accidents like stroke and ischemic encephalopathy (situations where the brain is denied crucial oxygen due to cessation or reduction of blood flow following heart attacks, infections and other shock states), who depend on ventilators, and other gadgets supporting life. Though significant numbers of these patients are unconscious, they need specialized care viz; feeding through tubes, prevention of bedsores, care of indwelling catheters and tubes, and prevention of contractures through physiotherapy and appliances.
The role of palliative care team, and the concept of palliative care as providers of, and provision of not only health, comfort and quality of life, and dignified death is increasingly being recognized as a crucial adjunct of wholesome healthcare.
Society increasingly owes a great deal of gratitude to these providers of succor, comfort and dignity in the sunset of numerous human lives. Who lend their hands and shoulders to lives to walk into the sunset with dignity.
(Doctor George Jacob is Consultant Surgical Gastroenterologist, Lakeshore Hospital, Kochi, Kerala.)