By Dr. Chitra Venkateswaran, IAHPC Board Member
The lockdown is easing in my home state of Kerala, India and the nature of my work has changed drastically over the last few months. I witness a lot of collective anxiety, distress, and grief in my community, nationally and internationally. I am often preoccupied with reflections on what one can contribute despite the restrictions imposed by this pandemic. As an individual, as a mental health professional, as a palliative care physician — the multiple roles coalesce into efforts to bring some meaning, some alleviation to people’s suffering.
How do we manage this distress? What will happen if there is a surge in our country and deaths increase in number? How do we contribute in the event of a delicate situation where a surge in the pandemic rapidly deteriorates the ability to manage it?
These internal reflections, which probably plague many of us in palliative care, helped to bring about a quick response: the development of guidance and recommendations to empower health care workers directly involved with COVID-19 management.
The fact that Kerala’s public health system and the State government have shown readiness to include palliative care as one of the components in the integrated care for COVID-19 is encouraging. This was a consequence of the State experiencing two major humanitarian crises over the last two years (Nipah virus and floods in 2018 and 2019). These disasters have facilitated policy-level changes and established disaster-response public health systems in the community. In these previous crises, palliative care had a significant role not only in providing direct care for the vulnerable but also offering psychological and social support. Palliative care was also responsible for a massive movement to provide relief for communities’ needs. This community participation and volunteerism is a strength of Kerala’s palliative care models. Moreover, Kerala has also had a State palliative care policy since 2008, which was revised to a much more comprehensive policy in 2019.
So, it was a natural step forward for two experts — Dr. M.R. Rajagopal of Pallium India and Kerala’s Dr. Suresh Kumar — to be invited as members of the State Advisory Board to manage COVID-19 from the beginning of the present crisis. At the same time, Dr. Athul Joseph Manuel, a palliative care physician, took on the role of Nodal Officer (person in charge) for COVID-19 in Ernakulam district. Spurred by this urgent need, we all interacted to plan how we could contribute to care. The decision was to develop a palliative care guidance and recommendations towards integrated care for COVID-19.
We accomplished this by creating a virtual, 22-person multidisciplinary task force with members from various Kerala districts, other Indian States, and other countries. We named the task force PalliCOVID Kerala.
This team, along with Pallium India, started to meet in the last week of March 2020. Following 11 one-hour Zoom meetings of the working group, an e-resource titled “Palliative Care in COVID-19; A Resource Toolkit for LMICs” was developed, then submitted to the Government of Kerala. This resource has been approved for use in State-level training for COVID-19. It includes an e-book, treatment algorithms, and short webinars, as well as voiceovers on PowerPoint for low bandwidth settings. The focus is on a multidisciplinary approach, including psychological, social, and spiritual support, addressing burnout and specific issues related to COVID-19. The content was developed in the local context but can be adapted to other low- or middle-income settings.
As a palliative care team member, our motivation is to always aim at making a difference to others, especially the most vulnerable. Amidst uncertainties and disrupted routines, working together as a team using technological platforms brings us closer, to maintain our focus on compassionate care and alleviation of suffering.
* World Health Organization Performance Status.
** Multiple Organ Dysfunction Syndrome.
*** Should be incorporated at all stages.
Learn more about Pallium India in the IAHPC Global Directory of Palliative Care Institutions.