IN general people seem to think ‘palliative’ care is relevant only for those who are about to die.

It is not realised that ‘palliation’ or ‘just simple care and comforting’ is an integral part of any illness management. We all need support and comforting especially when in a helpless situation and illness of any kind does make us feel ‘vulnerable’. It is true some feel more vulnerable and ‘helpless’ than others but that is not the point I am trying to make.

Now let’s look at a few specific eventualities. Conditions which inflict physical discomfort and/or pain, incapacities, the very thought of possible suffering eg going for surgery, the possibility of protraction of symptoms and ‘incurability’, any feeling of hopelessness will make most of us shaky and feel somewhat helpless and we would seek some ‘support and help.'

Just a chat with someone who seems to care becomes a great help. Such befriending and expression of simple companionship and a touch of closeness make a lot of difference in coping with a difficult situation be it physical or psychological.

Palliation or ‘soothing’ has always been recognised as an integral part of health care but there is no agreement among the professionals on who is supposed to initiate and deliver it. Doctors may feel that there job is only to diagnose and ‘cure’ ; nurses may feel that they are only expected to look after the physical ills and to help the afflicted recover quickly; social workers may feel it is the responsibility of the health care people. Relatives may feel lost and the patient suffers silently.

Palliative medicine is a distinct branch of clinical medicine and the medical students of today are expected to be trained in it. Yes that does happen in theory but these issues are practical skills requiring human understanding and skills, requiring just not class room teaching but a nurturing of human caring behaviour.

Palliation is always considered during the management of patients with cancer disorders; the cancer doctors and nurses are usually well trained in this and tend to deliver this kind of care better.

Even within cancer care, there seems to be wide variation; patients with certain categories of cancer eg those affecting brain and blood tend not to receive palliative care in depth. Recently a charity involved with Brain Tumours have made such an observation and called for more and better support for these categories of patients.

That, however, is too specialised outside the domain of most health care activities. One however must bear in mind that ‘cure’ and ‘care’ must complement each other; palliation or simple care – perceiving the feelings and understanding thoughts of people who are in receipt of usual ‘curative’ treatment either in hospital or at home must also be taken into serious consideration. A good chat may be equally important as a drip or oxygen and equally therapeutic for an early recovery.

Occupational and diversional therapy is also a well established method helping many chronically sick and disabled patients; music , painting & art, weaving , making small items eg baskets , group singing , even simple acting etc do help patients feel better and ‘recover’ from their ills. In a broader sense these also are ‘palliation’ — soothing the mind, taking it away from the trauma and turbulence of medical treatment. Sadly such aspects of care are being slowly withdrawn; many feel these are irrelevant luxuries and the provisions of health service have been ‘minimised’ a great deal.

Medicine is changing fast. It is simply not good enough just to treat the ‘illness’ without treating the ‘patient’.

Arup Banerjee