October 9 is World Palliative Care Day. Every hour over 60 patients die in India from cancer and in pain. If the deaths from other lifethreatening illnesses are added, the number would be staggering. Such patients could have benefited from palliative care measures.

In Kerala every panchayat has around 100 patients who are bedridden or in need of palliative care. With 1000 panchayats in Kerala the number of such patients in need is around one lakh. On World Palliative Care Day, we express our solidarity with such patients and their families.

The WHO defines palliative care as the 'active total care of patients and their families by a multiprofessional team when their disease is no longer curable and life expectancy is predicted short'. The nature of illness could be any, even the aged need to be cared for. Today palliative care principles are juxtaposed into the treatment trajectory from the day of diagnosis. The word 'palliative' is derived from the Greek word 'Pallium' which means cloak or cover. Therefore in palliative care, symptoms are cloaked by a treatment plan whose primary aim of patient comfort is seeking to add 'life to years'. Palliative care is defined as a 'low technology but high touch 'specialty' (low tech and high touch). Touch is therapeutic, reassuring, and comforting.

Palliative care affirms life and regards dying as a normal process. It neither hastens nor postpones death. It integrates the psychological and spiritual aspects of care. It offers a support system to help patients to live as actively as possible until death. Palliative care is patientfocused and not disease centred. The concept of palliative care is opposed to euthanasia.

The first pain clinic in the country was started in 1985 at RCC, Trivandrum. Kerala Government became the first government in the world to have a 'Palliative care policy' passed in 2008 and to have it included in the primary health care system.

The Regional Cancer Centre is the only cancer centre in the world to have its own oral morphine manufacturing plant. Morphine is given free to poor patients in severe pain. The Regional Cancer Centre again is the only tertiary care cancer centre having a weekly 'teleclinic' on Tuesday afternoons dedicated to palliative care which benefits patients in an area 60 km around Adimali.

Hope: The hope structure in palliative care is to make the patient wanted and not to feel abandoned. It is to say 'No matter what happens to you we will not desert you' and 'You may be dying but you are still important to us'. In fact, good palliative care goes into the family in preparing for anticipatory grieving and bereavement support.

Rehabilitation of spouse and taking care of the children's future should be considered as ideal and essential in special circumstances. Such attitudes improve the 'hope quotient' of patients.

'Good Death,' the British medical journal, came up with a special edition in 2003 describing as to what constitutes a 'good death'. A good death is to have known when death was approaching and to have accorded the person dignity and privacy. The patient dies without distress or pain in the place of his/her choice which is usually the home environment. It behoves us to give the same care to those who 'leave life,' the care we gave them when they 'entered life.'