International Association for Hospice & Palliative Care

International Association for Hospice & Palliative Care

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Promoting Hospice & Palliative Care Worldwide


2008; Volume 9, No 1, January



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India: Award and involving the community in the provision of palliative care

The Pain and Palliative Care Society (PPCS), Kozhikode has won the Indiavision ‘Person of the year 2007’ award. There were eight nominations for the final round this year. The jury, chaired by Sri MT Vasudevan Nair, was unanimous in selecting the Pain and the Palliative Care Society for the award.

The Pain and Palliative Care Society (PPCS) was formed in 1993 by a group of doctors and social activists in Calicut. The aim was to improve the quality of life of people living with incurable diseases through palliative care.

The Pain and Palliative Care Society started a palliative care clinic, in Calicut Medical College Hospital in December 1993, to offer symptom relief and emotional support for incurably ill patients. Later, a limited home care program was also started..

In the next few years, PPCS facilitated the initiation of similar palliative care clinics in many places, starting with Manjeri (Malappuram). All these palliative care clinics were doctor led, with the help from a few volunteers from the community.

The problems of patients with advanced diseases are complex. Physical problems like pain are only a part of the wider issues causing extreme misery in such people. Many of them are in need of enormous psychological and social support. A doctor or a hospital, or a health care institution, will not be capable of offering the holistic care that such patients need.  The only possible answer to this problem is to involve the local community in the care of the patient and family. This realization has led the palliative care groups in Malabar to initiate a community owned movement in the care of the incurably ill, terminally ill, elderly and bed ridden patients in the region. This has been named the Neighbourhood Network in Palliative Care (NNPC).

Community owned programs:

The Pain and Palliative Care Society is internationally recognized today for the lead role it has played in the initiation of the successful community based palliative care program (NNPC) in Kerala and its further development through the Institute of Palliative Medicine.

NNPC was formally launched in 2001 as a joint venture of four. Since then, this community initiative has changed the life of thousands of patients with chronic and incurable illness. Active interactions with patients, family and volunteers from the community has also resulted, over time, in the replacement of a rather hierarchical doctor-led structure in palliative care in Northern Kerala with a network of community volunteer-led autonomous initiatives. Under the program, people who can spare at least two hours per week to care for the sick in their area are enrolled in a structured training program (16 hours of interactive theory sessions plus four clinical days under supervision). On successful completion of this ‘‘entry point’’ training (which includes an evaluation at the end), the volunteers are encouraged to form groups of 10 -15 community volunteers and to identify the problems of the chronically ill people in their area and to organize appropriate interventions. These NNPC groups are supported by trained doctors and nurses. NNPC groups usually work closely with the existing Palliative Care (PC) facilities in their area, or build such facilities on their own. Volunteers from these groups make regular home visits to follow up on the patients seen by the PC team. They identify and address a variety of nonmedical issues, including financial problems and patients in need of care; they organize programs to create awareness in the community, and raise funds for PC activities. Community volunteers act as the link between the patients in the community and the health care providers in the institution. NNPC does not aim to replace health care professionals with volunteers. Instead, what is being attempted is to supplement the efforts of trained doctors and nurses in psychosocial and spiritual support by trained volunteers in the community. The 64 palliative care units with more than 4000 volunteers spread over the seven northern districts in Kerala now look after more than 7000 patients at any point of time. Similar initiatives are now being formed in Alleppey and Kollam districts in the south. Patients include those with advanced cancers, people with old age problems, people bed ridden with spinal injury, those with kidney diseases, and people with chronic psychiatric illness. The majority of the patients and the community volunteers are from the lower socioeconomic strata of the society. The activity is particularly strong in Wayanad, Kozhikode and Malappuram districts.


The Pain and Palliative Care Society, through its activities in facilitating NNPC has proved that a combination of community participation and purposeful government programs can make good quality care a reality for thousands of people with chronic and incurable illness. This successful model of social interventions in health care has also shown that Keralites are still capable of organizing themselves on a platform of social justice to take care of the marginalized members of the society.


From the Pain & Policy Study Group

"New 2005 Global and Regional opioid consumption statistics
Pain &Policy Study Group’s (PPSG) website users can now find global and regional consumption data for fentanyl, hydromorphone, methadone, morphine, oxycodone, and pethidine from each Country Profile page on the PPSG international website.  These can be accessed at or from the PPSG homepage under International Resources.

We hope you find this information useful in addressing patient access to essential opioid pain medications throughout the world.  Please contact us if you have any questions about this new resource.

Policy Evaluation Resources for the Practitioner
An article, titled "Improving state pain policies: Recent progress and continuing opportunities," was published in CA: A Cancer Journal for Clinicians.  This article presents recent results from the PPSG's national policy evaluation project, and describes how practitioners can use each state's findings to inform and guide state-level efforts to improve policies affecting appropriate pain management and patient care.  Although the policy evaluation resources are specific to the U.S., the criteria used to evaluate policy also have international relevance because similar requirements or restrictions can be found in drug control and professional practice laws in other countries.  The article is available at "


“ASCO/NCI Event on Cancer in the Developing World
Now Available Online

The joint American Society of Clinical Oncology (ASCO) and National Cancer Institute (NCI) Science Writers' Seminar on Cancer in the Developing World is now available at, and a new issue of BenchMarks on the Global Burden of Cancer will be posted shortly at

Cancer in the Developing World, held on December 20, 2007, featured internationally recognized experts providing an in-depth, informative look at many issues surrounding cancer in less developed countries including: geographic incidence, survival and mortality trends; the state of cancer prevention, screening and treatment in less developed countries; perspectives on cancer care from Africa, Asia and India; major international cancer initiatives such as prevention, tobacco control and palliative care; and ASCO and NCI initiatives to address the global cancer burden.

Presentations by the following experts are featured:
Nancy E. Davidson, M.D.; ASCO President, Sidney Kimmel Comprehensive Cancer Center
Lynn Ries, M.S.; SEER Cancer Registry, NCI
Tony Mok, M.D.; The Chinese University of Hong Kong-Hong Kong, China
Ketayun Dinshaw, M.D.; Tata Memorial Hospital-Mumbai (formerly known as Bombay), India
Clement Adebayo Adebamowo, M.D.; University College Hospital-Lagos, Nigeria
Joe Harford, Ph.D.; Director; Office of International Affairs, NCI
Deirdre Lawrence, Ph.D.; Tobacco Control Research Branch, NCI

The audio track, slide presentations, bios and fact sheets from this Science Writers' Seminar event are also available through ASCO's online press center Logon to and click on the Meet the Experts link.

Past ASCO media events are also available online and cover such topics as:
Personalized Cancer Medicine - Translating Breakthroughs in Biology into Better Treatment for Patients (December 2006)
Targeted Therapies - The Next Generation (December 2005)
Cancer Survivorship - Increasing Survival, Improving Lives (December 2004)
The Virus Cancer Link (December 2003)
New Strategies in Cancer Prevention and Screening (December 2002)

The American Society of Clinical Oncology (ASCO) is the world's leading professional organization representing physicians who care for people with cancer. With more than 25,000 members, ASCO is committed to improving cancer care through scientific meetings, educational programs and peer-reviewed journals. For ASCO information and resources, visit Patient-oriented cancer information is available at
For more information about cancer, please visit the NCI Web site at
or call NCI's Cancer Information Service at 1-800-4 CANCER (1-800-422-6237).

Kelly Powell, ASCO Communications
703) 519-2935
[email protected]

NCI Office of Media Relations
(301) 496-6641 
[email protected]

 "From the International Observatory on End of Life Care

Dear colleague,
The International Observatory on End of Life Care has posted a country report of hospice-palliative care development in Thailand, which may be found at:
The relationship between life and death has interested the Buddhist population of Thailand for centuries. Yet the roots of the country’s modern hospice-palliative care movement can be traced back to the growing interest in pain relief during the 1980s and the urgent need to address the AIDS epidemic in the 1990s. Currently, at least 13 organisations provide 40 hospice-palliative care services, mostly to inpatients. Eight of these organisations are government facilities (tertiary hospitals and cancer centres), one is a private hospital and two are faith-based institutions. Alongside these providers, a wide range of groups give compassionate care to the dying.
With very best wishes over the holiday season,
On behalf of the Observatory team."

Anthony Greenwood
Information Officer
International Observatory on End of Life Care
Institute for Health Research
Lancaster University
Lancaster LA1 4YG
Tel: +44 (0)1524 594976

Click here to view the International Observatory on End of Life Care Web Pages.

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