Project Hamrahi – Pushpagiri, Kerala

October 2010

Participants

Pushpagiri Palliative Care Service
Dr Thampi Thomas (Medical Director of Unit)
Dr Jacob, volunteer and physician

APLI
Dr Sok-Hui Goh
Dr Andrew Goh

Pallium India
Prof. Rajagopal, Chairman and Founder

Summary
The Pain and Palliative Care Society, Pushpagiri began in 2002, where the main thrust is to look after cancer patients at the last stage of their lives. It largely caters for the poor and those from the lower strata of society. Apart from symptom control, the society also helps families of patients who die or those who become incapacitated at the early stage of their illness in the form of construction of homes (2) and education – putting 5 girls through nursing school. Apart from caring for cancer patients, the Society embraces patients who are bed bound from various causes such as paraplegia from MVA, spinal cord compression, paraneoplastic syndrome, myositis ossificans etc. They manage regular foley cather change monthly (sialastic catheters too expensive) as well as supervising pressure area care. There are no domicillary care services and all the care is provided by family members.

Pushpagiri provides all the infra structure facilities such as Out-Patient Clinic, In-patient ward, an office, as well as doctors, nursing and other paramedical staff. The donation of a van has enhanced the service, enabling them to conduct home visits and operate an outreach outpatient clinic. Often patients are found to be too poor to find the fares to attend the outpatient clinic at Pushpagiri Hospital.

The unit is glued together by Reverend AC Kurian, Vicar General who tirelessly campaigns for financial support and volunteerism. There is a core of dedicated volunteers who enables this service to run on donations from both local and overseas benefactors. There is no social security or medicare funding for patients – this unit’s major thrust is for the poor, by covering patient’s costs of medical treatment including consultations, investigations and medication. Pushpagiri hospital (a private Catholic hospital) provides the infrastructure (a 20 bed ward and OPD clinic) and pays the salaries of Dr Thampi and nurse aides.

Morphine availability – they have access to 1.5kg oral morphine tablets (10 & 20 mg tabs) per year through Dr Thampi (the only person who has the permit to access and prescribe the medication)

Dr Sok-Hui’s main activities were clinical, attending ward rounds with Dr Thampi, an anaesthetist, and Dr Jacob, outpatient clinics and going on home visits. The home visit team included a volunteer coordinator, intern, auxillary nurse and driver. The team saw a total of 11 patients. Some of the homes were far away, in the poorer areas. Some were over 20kms away. The home visits proved to be “the highlight of my experience as I was able to engage the whole team in informal hands on teaching and general discussion on the precepts of palliative care”. Other teaching included to the interns who rotated weekly through the unit, and to nurses, including an interactive session on self care and spiritual care of patients and demonstrating the subcut route of giving injections.

Finally, it was agreed that further visits would not be planned for this unit, as they had a well developed and developing model of care.