'Better late than never': Integration of palliative care into India's Armed Forces

Author: Lt. Alice Stella Verginia, Calicut

I wish all the Indian Army personnel a very happy ARMY DAY!!

Having been a part of the Indian Army, I felt really happy to learn that a palliative care centre was opened at the Base Hospital, Delhi Cantt. and at the Army’s Eastern Command. This made me wish and hope that all Defence Hospitals from across the country would soon establish a palliative care unit! If the armed forces can think about delivering good quality palliative care for their army personnels’ and families, I feel that the hour has come for the health system in the country to realize the imminent need to integrate palliative care in the main stream. I feel that all chronically ill patients and their families, whether they belong to the army or not, deserve quality palliative care when they are alive, in their end of life care and via bereavement support to the families after they pass on, in just the way a mother would care for her new born child.

Palliative care is a therapeutic model; an approach to care and an inter-professional model of care that applies to all patients with chronic illnesses or life threatening illnesses. It aims to reduce the illness burden and suffering of the patient and the family from the time of diagnosis and forward. Palliative care has to therefore be viewed as a major component of health care that targets improved patient experiences, improved care for the population, and a way to reduce the per capita cost of care. Primary palliative care should be an essential part of best practices employed by all health professionals. It should encompass interventions provided by clinicians with no specific identity as palliative care providers, but who have competencies in treatments that address the objectives of palliative care.

The integration of palliative care curriculum into the UGC programs is important as palliative care education will transform the budding health care professionals to deliver the concept of total care to patients and their families. The in-service health care providers in the Defence like doctors, nurses and nursing assistants also need to be mandatorily trained in palliative care. Efforts are to be made to ensure that palliative care is not limited to only care for the terminally ill but for anyone who is admitted in the Defence Hospital with chronic illness and in need of total care.

In Defence Hospitals, the patients’ family members are not allowed to stay with their loved ones. The doctors and nurses at the hospital become the sole caregivers for these patients. I can assure you that while all their physical problems are addressed, some of their psychological, social and spiritual issues needs to be explored further.

A person experiences job stress under normal circumstances and are most often prepared for its consequences, both in terms of its physical impact and mental impact. The situation is however hugely different when there is a health problem / diagnosis. The patients’ in the armed forces therefore need support which goes beyond physical support to include psychological, social and spiritual support.

During the tenure of my services in the armed forces, I have come across innumerable patients’ and their family members who have communicated to me about their problems which go beyond the usual physical issues. These patients include those who lost their limbs during a war or an accident, those who are stroke patients, those who are experiencing the loss of a spouse, a child, a parent/s, a sibling, and it goes on… On several occasions, these soldiers need TOTAL CARE; they need someone with whom they can be vulnerable and share their intimate feelings and most importantly, someone who will listen to them without being judgmental. A soldier’s life or rather an ‘ARMY PERSON’S LIFE’ is not easy. They, along with their families need a lot of support while they are in service and also post their active service.

In 2018, I had the opportunity to be a faculty for a 10 day Foundation course in palliative care that was organised for the doctors and nursing assistants from the Assam rifles personnel’s Silchar. This program was jointly conducted by the Trivandrum Institute of Palliative Services, the National Cancer Grid, the Assam Rifles and the Cachar Cancer Hospital and Research Center. The trainees were visibly passionate towards the concept of palliative care as some of the trainees were personnel’s who were chronically ill. This personal connect made them emphasize that palliative care was an absolute and essential need, and that palliative care services be made available in all the Defence Hospitals, across the country. I was also overwhelmed when I realized that one of the trainees, a nursing assistant, was actually a former student of mine from the Military Hospital, Jhansi, who I had taught in 1987. He also reiterated with conviction, that based on his experiences of working in the armed forces, the need to integrate the concept of total care was critical and essential in Defence Hospitals across the country.

I strongly believe that Palliative care is therefore for all and that not one should be left behind. Palliative care is the need of the hour and its importance is seen most brightly now, in a world that is filled with uncertainties.

About the Author: Lt. Alice Stella Verginia completed her nursing education in army hospitals (1983) and was commissioned in 1986. She has over 15 years of experience in Palliative Care and is an authorized ELNEC trainer. She is also a National faculty for palliative care and a Faculty for the National Program in Palliative Care, Govt of India, Ministry of Health, New Delhi. She has completed her RNRM, BCCPN, NFPN, ELNEC.