Palliative care in Kerala, India: A model for resource-poor settings

Background: The need for palliative care is increasing throughout the world. Developing countries are progressively faced with an ageing population, whose changing health needs require urgent action. Insufficient access to care for both cancer and AIDS patients make palliative care the only humane and feasible response in many contexts. Material and Methods: In order to describe the need for palliative care in Kerala and the development of the new palliative care policy, we have collected and reviewed information from government officials, health professionals involved in cancer care, patients and their families, sponsors, and members of palliative care teams across Kerala. We also collected data on the functioning of the newly established palliative care clinics. Results: The Pain and Palliative Care Society developed in a few years a network of 33 palliative care clinics across Kerala, providing care free of charge to patients in need. Outpatient treatment with a supportive home care service was adopted as the main mode of operation. Trained volunteers from the community assisted in providing care, and family members were empowered to the highest degree in order to ensure continuity of treatment. In 2002 the network of clinics saw about 6,000 new patients, about 25% of incident cancer cases. Conclusions: The synergistic effect of motivation and knowledge, coupled with the use of local resources, has made possible the development of a network of palliative care services, available for free to terminally ill patients. The challenge of adapting such a model to other developing countries is discussed.