Historically Chennai has many firsts to its credit, especially in the field of Medicine. Jeevodaya is yet another feather in its cap, introducing Palliative Care to South India. Jeevodaya Hospice was established in 1990, as a non-profit, non-political, non-religious, charitable organisation to render Palliative Care services, free of cost, to advanced cancer patients irrespective of caste, creed or social status.
Palliative Care is derived from the word ‘Pallium’ which means a’ Cloak or a Cover’. The original definition of Palliative Care by WHO read ‘ Palliative Care is the TOTAL, ACTIVE care of patients whose disease is no longer responsive to curative treatment’. It has since been modified. The latest definition is ‘Palliative Care is an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification, impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
In India, at any given point of time, there are 3 million patients with advanced cancer and an equal number with other incurable illness. There is a sizable population of patients with HIV/AIDS and the geriatric population is increasing every year - all of them in dire need of Palliative Care Services. Though Palliative Care was introduced in India nearly three decades ago, it is still in its infancy with less than 1% of patients having access to Palliative Care. First the WHO and now the Indian Association of Palliative Care has taken over the responsibility of propagating Palliative Care in India, but we still have a long way to go.
Though Jeevodaya was originally started for the destitute, the homeless and the abandoned with the realization that anybody with a life threatening illness is indeed a ‘Medical Destitute’- we have thrown our doors open to anyone who may need our help, irrespective of their social status or the stage of their disease.
The Hospice movement was obviously started by people who saw with their hearts, people, who not only saw, but, who reacted to the plight of these unfortunate people by reaching out to help them, as they limped along slowly and painfully, to finish the last lap of their lives for, finish, it, they must!
The Hospice, a home away from home for terminally ill patients, is said to have originated in France several years' back and is a very popular concept in the western world. In England alone, a country which is smaller in area and population to many of our Indian states, there are around 200 Hospices. Of late, however, they are steering away from Hospice and moving towards home care. This is quite understandable, as these countries have developed an excellent health care system. With a manageable population, better socio-economic standards and higher literary background, a patient can very well be managed at home, if health care is delivered at his doorstep as it is done in these countries. This is as it should be, for there can be no place like home.
In India, on the contrary as in most third world countries, the panorama is entirely different and in no way comparable to the west. The Hospice movement, or for that matter Palliative Care itself is still in its infancy in India. The First Hospice "Shanti Avedna" was started in Mumbai in 1986. "Jeevodaya" the Second Hospice in India and the first of its kind in South India was registered in Chennai in 1990 and started inpatient care in 1995.
It is true that the family structure in India is such that the responsibility of looking after a patient rests with the family, but, to generalise and to assume that every patient has a loving family, caring for him or for that matter to assume that every patient has a family at all is to deceive ourselves.
We have studied the types of patients and the reasons for admission to our hospice and are convinced, more than ever, that there is scope to start many such Hospices all over the country.