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Feature End-of-life care

India faces a growing need for palliative care

BMJ 2023; 382 doi: (Published 04 September 2023) Cite this as: BMJ 2023;382:p1751
  1. Neha Bhatt, freelance journalist
  1. Delhi

India’s older adult population is expected to increase by 41% within the next decade, exposing an unmet need for palliative care. Shrinking family size and migration mean relatives can’t always pick up the slack, reports Neha Bhatt

On most days, 60 year old Kuttan is a worried man. He has chronic obstructive pulmonary disease as a result of long term treatment for tuberculosis, and is confined to his mud home in the hilly terrain of Bharathannur, a rural region in Kerala. He is unable to work. His son has a heart condition and can’t work either, so it’s up to Kuttan’s wife to scrape together family meals with the food rations they receive from the state. He also has a teenage daughter, and worries as the money to support her education is running out.

But one morning in late May, Kuttan brightens up. A team of palliative care professionals from the NGO Pallium India has come to visit from the city of Trivandrum, 50 km away. “Home visits are a crucial part of our work to attend to patients who are unable to make the journey to our centres,” says Deepak Sudhakaran, a community medicine specialist and palliative care physician and one of more than 6770 who have been trained by Pallium India across 28 states.

Kuttan has frequent bouts of breathlessness and it worsened the morning Sudhakaran visited. He often takes the wrong medications by mistake. “We help him with his breathing, check on his medication, counsel him on how to better take care of himself, and are trying to find solutions to the other issues that are causing him stress, such as his daughter’s …

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