More than 50 million people die every year around the world and it is estimated that 60% of them would benefit from hospice and palliative care. But sadly the majority do not have access to these services.

In India, especially in Kerala, there are about 200 centres providing palliative care service. They all depend on morphine for pain relief.

Centres of Excellence available in India for palliative care are very few. Those existing are in rudimentary level without any sophisticated equipments, without doctors and paramedics trained for using such equipments.

Private sector is the major provider of health care in India. The existing Centres of Excellence are in government sector, depends on government doctors and nurses. They neglect the non-government sector.

The Palliative care involves symptom management, family support, counseling, ethical issues, and support group activities, providing homecare, nursing care, pain management, training, research, and management.

Provide holistic care by offering palliative surgery, palliative chemotherapy and palliative radiation all under one roof so that longer life with better quality could be offered

Offer pain relief by blocking the nerves in cases where morphine does not give relief, using sophisticated equipments such as C-arm, Ultra Sonogram and other imaging facilities.

Carry out research, to train the trainers, to conduct Continuing Medical Education (CME) and to set protocols for treating palliative care patients with a view of achieving high quality

Implement better symptom control by teaming up with paramedics like speech and occupational therapists etc

Conduct academic courses for doctors, nurses and community volunteers.

We adopt the definition of palliative care as approved by World Health Organization in 2002, and aimed at improving the quality of life of the patients with a life-threatening condition.

This include all people who are rejected by the hospitals for curative treatment such as people with advanced conditions of diseases such as cancer, dementia, end stage renal disease etc and people with restricted mobility such as paraplegic, quadriplegic, hemiplegics, other cerebral-vascular accidents and diseases such as parkinsonism and children with cerebral palsy and similar problems.

Caring the families is equally important as caring the patients.

Elezabeth approached a hospital with a wound on her cheek. The hospital has diagnosed her disease as Carcinoma in the cheek. The hospital has confirmed that the disease has spread to various parts of the body beyond curable stage and informs her of the same and advises her to go home.

Carcinoma in the cheek, in this case is incurable. However the illnesses associated with it, such as the pain, bad-smell, sleeplessness, bad-taste, etc., could be treated and the patient can enjoy a good quality of life under palliative currently practices by Alpha Pain Clinic.

Let us study the problems faced by Elezabeth in little more depth. Her apparent problems are:

• Pain
• Sleeplessness

What are not apparent are:

•  Fear of death
•  Rejection by the medical profession
•  Fear of worsening symptoms
•  Social Isolation
•  Concern about her family
•  Spiritual Pain (why this to me, Oh God!)


How Can Alpha Care Elezabeth at present?

•  Elezabeth's pain could be brought under control by dispensing morphine at the required doze.
•  Nurses could clean her wound carefully and dress up.
•  She could be given medical homecare at the required interval. Her pain, bad taste, bad smell and sleeplessness will go away.
•  She can then move about almost like any other member of her family
•  The trained community volunteers of her area of residence could visit her, spend time with her, slowly understand her non-apparent problems and could help her find answers.

At the Centre of Excellence, Elezabeth could have undergone neuraxial surgical approaches for intractable pain, surgery to remove the mass inside her mouth, give chemotherapy under the supervision of a medical oncologist, arrange radiation therapy if found necessary.

Elezebeth could have undergone plastic surgery for facial reconstruction, cryotherapy for recurrence of tumour.

This would have prolonged her life with a reasonably good quality.

To carry medical and academic tasks such as patient care, research and education, to work as a catalyst for improving the quality of palliative care in India.

In addition, the CoE will work for the social dissemination of scientific data obtained from the research that could be used for further enhancing the delivery of Palliative care.

The next task of CoE is to work as a springboard for social transformation at the bottom of the economic pyramid by providing family support by way of implementing various welfare schemes

Other important mission is to promote peace and harmony in the human community by involving people from all sections without discrimination.

To deliver high quality patient care in all areas of care such as:

•  Home Care
•  Day Care
•  Outpatient Care
•  Inpatient care


And developing and implementing guidelines, indicators and quality criteria for such care.

Implement and improve multi-specialty and inter disciplinary cooperation in palliative care.

To Work with government and the members of the community towards establishing a healthy financing of multi- disciplinary palliative care

To develop and set up new forms of care as may emerge.

Develop evidence-based palliative care in India.

Develop research policy in the context of the socio-economic realities in India.

Contribute to research proposals of national research programme as per the policy.

Carry out joint efforts to carry out of scientific research in association with government /other NGOs internationally.

Build working relationship and exchange programme with the similar Centres of Excellence in India / abroad.

Offer training and research facilities for both medical students and senior researchers in India and abroad.

Promote a scientific attitude and research among palliative care fraternity.

Working towards national and international recognition of the Centre of Excellence

Disseminate scientific data and information by way of publications in prominent scientific journals.

Implement palliative care in the medical curriculum and develop training facility to conduct postgraduate training for medical students

Implement training programmes for general practitioners and consultants

Set up Palliative Nursing School with accreditation.

Implement multidisciplinary accreditation.

Implement training programmes for community volunteers and trainers.

Social dissemination of scientific findings by the Centre of Excellence;

Acting as a mouth-piece with regard to socially relevant issues in palliative care by way of communicating expertise obtained and giving guidance

Caring the patients and the families is the responsibility of the community. Receiving such care from the community is the right of the patient and the family.

Studies conducted by Alpha Pain Clinic have revealed that once the physical conditions are controlled, the major problem affecting the patient in the rural areas is financial. Even the social isolation found to have an economic dimension. Therefore supporting the families should include schemes for the economic uplift of the families.

Major emotional issue affecting the patient is found to be the concern about the children in the family. Therefore education the children as per their aptitude becomes an important aspect.

In India's traditions and customs, the marriages are mostly family-arranged. Dowry system is a rampant reality. Getting a girl child married is considered to be the responsibility of the parent. In such scenario, if the parent happens to be the patient, community assistance to the family to get the girl child married becomes important to relieve the patient from the psycho-social pain.

Palliative Care is envisaged to be delivered with community participation. Indian community includes people of various religions, castes, sub-castes and political affiliations. People of all shades will be brought under the banner of palliative care and the service will be delivered without discrimination.

The cost of the care including the welfare measures will be borne essentially by the community. In other words, the community will be in the fore front of the service to care for the people who are suffering from pain and distress.

This will contribute to peace and harmony in the community.

Emergency Clinic
To work 24 hrs a day, 7 days a week to attend to emergencies brought in.

Observation Ward
There will be 6 beds in the observation ward

Minor OT
The emergency ward will be supported by a minor OT to conduct procedures that may be required

OP Suit
Six room OP suit to have Palliative trained multi specialty consultation.

Restaurant
Restaurant will be located in the OP area where patients and the families could relax.

Daycare Centre
The day care centre will have a relaxed atmosphere

Book & Flower Shop
The shop will be suitably designed.

Micro Biology Lab
The microbiology lab will be fully equipped to carry all tests that may be needed

Blood Bank
A latest generation blood bank will be installed where blood donation campaigns will be conducted.

Radiology Centre
Radiology Centre to have X-ray, C-arm, ultra sonogram, CT scan and whole body MRI scan.

Physiotherapy Centre
The centre will have various disease-based club memberships will have all modern equipments, exercise halls, rest rooms, recreation facilities, cultural programmes etc.

Pharmacy
The pharmacy with modern storage facilities will be implemented.

Major OT
The first floor will have two major OT suits with all the facilities.

Recovery Rooms
The recovery rooms will offer intense care after the procedure.

Prayer Rooms
The prayer rooms for various faiths will be designed

Quite Rooms
People could simply sit down and go for meditation.

Remembrance Hall
The memorials of those who have passed away will be observed here.

Waiting Rooms
The waiting rooms will be served with refreshments

Inpatient Rooms
The inpatient rooms will be housed in two floors, each with sufficient nurse stations, restaurant, house keeping, room service, sit-outs, garden, entertainment facilities etc.

Doctors Training
Facilities for training medical graduates, post graduates and consultants will be housed

Nurses Training
School of Nursing will be located in this floor

Library & Reading Room
The library to be rich with relevant books and periodicals.

Nurses Accommodation
The nurses will be accommodated in the top floor.