Development of Inpatient and Outpatient Palliative Care Services at RGCIRC, Niti Bagh, South Delhi – An Exciting and Enriching Experience

Palliative Care in simple words means specialized medical care for patients suffering from life limiting illness. Our journey of establishing this field at Rajiv Gandhi Cancer Institute and Research Centre, Niti Bagh started in 2017 with a thought to help those in need and a mission to make people understand regarding this emerging branch of medicine. It was started with certain goals in mind:

• To spread awareness amongst patients and their family members on how integration of early palliative care into standard oncology practice can help providing increased quality of life with good functional capacity.
• Acknowledging that all terminal illnesses exhibit the iceberg phenomenon. Palliative medicine not only promises to take care of the physical pain (referring to the tip of the iceberg) but also involves healing the pain deep within the heart – the psychological/emotional/spiritual burden (part of iceberg below the surface). With each visit, the Palliative Care team helps build a rapport with the families alongside psychological counselling which eases the unsaid load.
• For a Medical branch, which deals mainly with life limiting diseases like cancer, a good EOLC (end-of-life-care) or hospice care program is essential. The patients and their carers must be informed about the anticipated events in their disease trajectory and must be educated regarding the concept of “good death”.
• Goals of care and answers to difficult questions especially in patients nearing death or not able to carry out self-care in an empathetic manner was also deemed necessary for being a Specialized Palliative Care personnel.

Dame Cicely Saunders, the founder of Palliative Care movement once said:

“You matter because you are, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die”

A phased approach was planned and followed for a new beginning of the era of Pain and Palliative Care department at RGCIRC, Niti Bagh.

Phase I (Year 1^st) – After completing the Fellowship in Pain Medicine, a concept of minimally invasive pain and spine intervention (MIPSI) for treating chronic pain (cancer pain, joint pain, back/neck pain, disc pain, etc.) was notified to the general public in the form of “Pain awareness camps” and round table meetings (RTMs)

Phase II (Year 2^nd) – An integrated “Pain and Palliative Care” approach which should be done as early as possible in the disease course of cancer patients, was told to people involved in taking care of chronic pain patients. It was high time when we incorporated IPD for Palliative Care of bedridden patients not able to do activities of daily living and it was successfully introduced. This was highlighted in the Indian Society for The Study of Pain – ISSP Delhi Chapter meet organized by Dept of Pain and Palliative Medicine, RGCIRC, Niti Bagh.

Phase III (Year 3^rd) – Our honorable Prime Minister has a vision of “Digital India” which is the future. We also dedicated this year to make and gather awareness information regarding pain management and palliative care on different social media/digital platforms like facebook, instagram, youtube, etc. This year the information of early palliative care was taken to another level – from Delhi to National level, so a conference “PAINCON” was successfully conducted with a theme “Comprehensive approach to total pain”. Faculties and delegates from different states of India as well as other allied oncology Specialties were a part of this National level Conference.

Phase IV (Year 4^th) – Whenever the work goes big, there should be a team which is to be built well in time to tackle this burden. HIGH QUALITY palliative care concept was launched by way of RIGHT EDUCATION. Team building is also an integral part of Palliative Care and is a continuous ongoing process. People joined in our thought process to provide quality services at world class level and we started twice weekly teachings for the same.

Phase V (Year 5^th) – Pain and Palliative Care is not just EOLC (end-of-life-care), it is actually a fragment of Palliative Care. It is a well-established fact that we have two spectrums of life – one is birth and on the other end is death. So, this year was dedicated to doing lectures at different platforms all over India so that the mind-set of the youngsters which usually feel that Palliative Care means EOLC, could be changed. It was explained through educating the masses that Palliative Care can do wonders for the chronic disease patients and the leading question which came out everywhere “HOW” was clarified and answered.

We feel proud today that the Department of Pain and Palliative Medicine at RGCIRC, South Delhi gives holistic services and treats pain with a concept of “Total pain”. Services offered have a broad range now which includes basic pain management via WHO step ladder approach, basic as well as advanced pain interventions under local anesthesia, epidural/intrathecal pump implantations, percutaneous vertebroplasty, supportive care, hospice care, respite care, management of refractory/difficult cancer pain scenarios, psychological handling of anger/anxiety/depression and EOLC for terminally ill nearing death. The palliation of symptom burden by us has a broad spectrum now starting from onco-palliative care services for cancer patients to non-onco palliative services for patients suffering from Alzhiemer’s, Parkinson’s, refractory arthritis, geriatric population, neurological diseases, etc.

Martin Buber once said “All the journeys have secret destinations of which the traveler is unaware”

This is a new journey which has begun with two deliberations in mind:

• “We cannot change the destiny of each and every patient, but it’s a fact, we will definitely benefit some by Palliative Care” and 

• “There’s always hope in Pain and Palliative Care”

Dr. Sunny Malik
Consultant In Charge
Dept. of Oncoanaesthesia, Pain and Palliative Medicine
Rajiv Gandhi Cancer Institute and Research Centre
Niti Bagh, South Delhi