Kerala: an exemplary story in palliative care
- As India struggles with approximately 4% coverage for palliative care unevenly anchored around mega cities, Kerala’s palliative care model is a global exemplar in inclusive care infrastructure.
Palliative care
- Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness.
- It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.
- Palliative care is required for a wide range of diseases.
- Majority need palliative care in chronic diseases such as cardiovascular diseases, cancer, chronic respiratory diseases, AIDS and diabetes.
- Others include kidney failure, chronic liver disease, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological disease, dementia, congenital anomalies and drug-resistant tuberculosis.
Barriers to palliative care
- Each year an estimated 56.8 million people are in need of palliative care, most of whom live in low- and middle-income countries.
- For children, 98% of those needing palliative care live in low- and middle-income countries with almost half of them living in Africa.
- National health policies and systems often do not include palliative care at all.
- Training on palliative care for health professionals is often limited or non-existent.
- Lack of awareness among policy-makers, health professionals and the public about what palliative care is, and the benefits it can offer patients and health systems
- Cultural and social barriers, such as beliefs about death and dying;
- Misconceptions about palliative care, such as that it is only for patients with cancer, or for the last weeks of life; and
- Misconceptions that improving access to opioid analgesia will lead to increased substance abuse.
Kerala’s palliative care model
- Kerala is evolved as a unique model in the service delivery of palliative care through the community-based approach.
- The services are provided through community-led projects at free of cost. The services are provided in a home care model.
- The palliative care model in practice in the state of Kerala is ideally fit for the resource-poor setting like India due to its cost-effectiveness and community-based approach.
- Voluntary efforts with multidisciplinary teams mostly manage the palliative care services in Kerala.
- The Worldwide Hospice Palliative Care Alliance and WHO attributed community involvement and ownership as the attributes of sustainability of the palliative care model of Kerala.
Conclusion
- Finally, the Kerala story exemplifies how diverse groups of people — across religious, caste, and gender divides — forged solidarities to create care infrastructure.
- These community organisations are strong reminders of how people organise across differences.