Palliative care in Manipur: A Keralite student's perspective

Dr Bishurul Hafi *

It has been one year since we joined with the team palliative care society of Imphal for the first time, in visiting homes of chronically ill, and debilitated individuals. With a very little knowledge in Manipuri language, we were totally sceptical about the productivity of our effort and time.

But, after having an acquaintance with the ill individualsthrough continuous visits and interventions by the team members, we realised the very fact that humanity has no barrier. Since then, we learned that language or race cannot create barrier to smiles and kindness to the ones in distress.

Being from Kerala, the only state with government policy on palliative medicine, and from Calicut, the Zamorincity with largest training and hospice centre in South Asia, we were fortunate enough to get exposure in dealing with terminally ill patients from the college days itself.

Palliative medicine is the branch of modern medicine dealing with end-of life care and can be argued as a relatively modern concept, originated from the West.

But, while analysing the philosophy of palliation according to its WHO definition ("an approach that improves the quality of life of patients and their families, facing the problems associated with life threatening illness, through the relief of sufferings by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual"), it overlaps with most of the ancient Eastern philosophies as well.

All the religions and celebrated cultures glorified in caring and consoling the patients in pain, from the time immemorial. However, the modern form of hospices developed only after Dame Cicely Saunders established one in UK in 1967.She is regarded as the founder of modern hospices movement. Entire world is witnessing a dramatic growth of this movement in the last decade.

Unfortunately, scenario is grim in our nation. In a survey on the 'Quality of Death'- ranking end-of life care across 40 countries, conducted by Economist Intelligence Unit in 2010, India stood last behind even undeveloped country like Uganda.

There are at least 50 lakh estimated people who need palliative care in India, and only 2% of them currently acknowledged it. But this trend is bucked by Kerala state, where 50% of the needy patients of around 1.25 lakh have easy access to the palliative care system.

Among the 1000 palliative care centre clinics in India, approximately 80% are situated in Kerala. We achieved it solely because of the selfless sacrifices of the doctors, other medical and paramedical staffs as well as community volunteers.

Community participation in palliation via NGOs, clubs, political and religious groups or local government bodies is the backbone of the system. They form Neighbourhood Networks in Palliative Care, which is lauded internationally as the most effective active community involvement in palliation.

Thus the network of palliation in Kerala, which started from a tiny, single room pain clinic in the darkest corner of Calicut medical college, now recognised as one of the most effective prototype, popularly known as 'Kerala model'.

There are many sincere efforts from all over India to spread the palliative services. Interestingly, in the state of Manipur, palliative network is growing fast enough to accommodate a top place amongst most states of India.

Under the effective, thoughtful and keen leadership of Dr Jugindra, who is an alumni of Calicut medical college himself, palliative care society of Imphal could even organise an international conference on palliation with delegates from across the globe, which is still a distant dream for many big states.

Seeing the public unity in various social movements here, we can hope effective formation of neighbourhood networks in all localities of the valley as well as on the hills.

Leaders of the society can aim to set up the first ever training and hospice centre here, which will serve as the corner stone for all humanitarian activities under this platform in entire North East and even Myanmar.

Medical personals, students, celebrities, politicians, police, clubs etc all should join hands for this social movement for the needy helpless individuals. We can dream and work for a brighter future, a better Manipur..