November, 2011
Second visit to Jamshedpur, Jharkhand

Participants

Palcare India Project

Meherbai Tata Memorial Hospital

• Dr Master, Medical Director
• Dr Urmila Patel, Senior Medical Officer  **
• Ms Sunita Ekka, Staff Nurse, Meherbai Tata Memorial Hospital

Tata Main Hospital

• Dr Madhusudanan, General Manager, Tata Main Hospital
• Dr Koshy Varghese , Anaesthetist, Critical Care Unit **
• Ms Jeseentha George, Staff Nurse, Tata Main Hospital **

(**Attended training in Trivandrum Institute of Palliative Sciences, Trivandrum, Kerala in 2009)

Australian Palliative Link International

• Dr Anil Tandon, Palliative Care Physician, Perth
• Wendy Scott, Clinical Nurse Consultant,  Perth

Pallium India 

• Dr. M.R. Rajagopal, Chairman,
• Mr Anosh Varghese, Project Officer, CanKids Kolkata

Summary

It was identified after the first visit that the need to return in the ‘soonest possible timeframe’ was required to continue and enhance momentum in the most effective way.  It was agreed by the mentors that the second visit should be more specific and focused on individual mentorship of the palliative care team members. Due to the identification of learning needs and current service delivery gaps, it was felt that future planned education be focused on the assessment and treatment of pain. There was also a greater mentorship focus on the team at MTMH, and greater focus on nurse to nurse mentorship opportunities.

Meherbai Tata Memorial Hospital (MTMH) is a 72 bedded charitable cancer institute and was established by the Jamshedpur Branch of Indian Cancer Society.  MTMH treats all types of cancer cases and it has a well equipped diagnostic centre.  The hospital runs on a non-profit basis and 10% beds are reserved for those living below poverty line.  It is generally agreed that 70 to 80% of inpatients have a ‘palliative’ diagnosis for which many are receiving treatment.

The Outpatient Department (OPD) Palliative Care Clinic runs every morning, 6 days per week and is free of cost.  Dr Urmila also provides consultancy to inpatients, while she also completes her routine oncology medical officer duties. Sunita works on the female ward.

The neighbouring Tata Main Hospital (TMH) is a 900 bed hospital with all major specialties. Dr Koshy works in the very busy Critical Care Unit and Sister Jeseentha works on a male medical ward. She also coordinates the opening of ‘overflow’ wards on demand.  Palliative Care is provided on a consultative basis, throughout the hospital, following phone referrals to Dr Koshy.

Clinical

The total number of consults completed during the week was 60.  This was almost twice as many patient consults seen the previous year.  Only 4 of these were seen at TMH, in line with meeting the objective of prioritising the learning needs of Dr Urmila and her colleagues at MTMH.  On very few occasions were other staff able to join the patient consultations and reviews.  We had not been advised that Sunita had been absent from work on maternity leave for some time.

 

Some improvements were noted. Morphine ampoules were available at TMH on several wards, but oral morphine was still not available. Improved symptom control was observed eg dyspnoea, constipation. There was increased awareness of the benefits of truth-telling and the risks of fostering false hope. Patient privacy and dignity was still limited by the environment and lack of screens/curtains etc. Collaboration across the two hospitals was still limited by time and opportunity. There was evidence of further training and Dr Urmila was enrolled in Cardiff diploma course in Wales. There were as yet few opportunities to work with the ‘Mahadeo Education & Welfare Society’ to enhance psychosocial and supportive care.