Achapan (70) lives with his wife, daughter, and his grandson atop a hill in Wayanad, Kerala. He built his two-room house through a State housing scheme for Scheduled Tribes. He worked as a daily-wage labourer till he had a stroke at his work site in 2009. Since then, he has had multiple episodes of hospitalisation. For follow-ups and medicines, Achapan walked at least 12 km through the hilly terrain to the nearest government medical facility. In 2018, a Wayanad-based community palliative care organisation arranged weekly home visits by a nurse and a volunteer team for Achapan. They provide free medicines and doctor visits when required. In these ways, the community organisation provides ‘total care.’
A global exemplar
The World Health Organization (WHO) considers palliative care as an approach to improve the quality of life of patients and families confronting life-threatening illnesses such as cardiovascular diseases, cancer, and chronic obstructive pulmonary disease. The 2018 Lancet Commission on palliative care and pain relief refers to such conditions as ‘serious health-related suffering’ that requires physical, social, spiritual, and emotional support alongside medical intervention. More than 80% of individuals who experienced serious health-related suffering in 2015 were from low- and middle-income countries. As a middle-income country with an ageing population and a growing non-communicable disease burden, how equipped is India to deal with large-scale serious health-related sufferings? Quite poorly as India struggles with approximately 4% coverage for palliative care unevenly anchored around mega cities. In sharp contrast with the rest of India, Kerala’s palliative care model is a global exemplar in inclusive care infrastructure.
