Tata Memorial Hospital (TMH) is one of the largest cancer centres in the world, with more than 70 000 patients registered annually. The Department of Palliative Medicine at TMH is well established with both adult and paediatric outpatient clinics as well as inpatient consultations. Respite palliative and home care services and emergency department consultations. There is an excellent education program including a Homi Bhabha National Institute paediatric palliative medicine fellowship (2 years), a 1-year paediatric palliative care fellowship, and post-graduate training in palliative medicine (3-year program).
The children’s palliative care team includes a dedicated palliative care physician, paediatric palliative care fellow, as well as a psychologist, and a nurse. There are more than 300 new referrals for paediatric palliative care each year, and 500 follow up patients. In addition, TMH supports 3 other paediatric palliative care outreach programs at other hospitals in the region, where almost 500 children are assessed annually.
In February 2023, I visited TMH to see the palliative care programme and meet the team in person for the first time in several years since during COVID our interactions had been restricted to online. I was fortunate to be able to see the TMH palliative care outpatient clinic and learn about how palliative care is provided by the team, supporting children and their families facing cancer and other serious illnesses.
TMH, is just down the road from BJ Wadia, which I had just been visiting and so after completing my visit at BJ Wadia, I met Dr. Jayita Deodhar, head of Palliative Medicine at TMH. I spent the first day of my visit to TMH in the outpatient clinic with Dr. Manasi Patil, a Paediatric Palliative Care Fellow. Oral morphine was readily available, and the team was well versed in using this to manage pain for children of all ages.
The paediatric palliative care clinic includes a small counselling room where the team’s psychologist can meet with a child while their parents or caregivers are speaking with the doctor. The room is decorated with brightly colored drawings and an emotions chart which helps children with words to express how they are feeling.
After the busy palliative care outpatient clinic wrapped up, Dr Jayita and I lead a session for all of the palliative care residents of the department, discussing how to implement palliative care services for children and sharing experiences from my clinical service in Canada. Currently, there are 11 adult palliative medicine trainees and 1 pediatric fellow, as TMH was the first hospital in India to offer specialist training in palliative medicine.
The next day, I travelled with Dr Pradnya Talawadekar, a paediatric palliative care project leader; Dr. Shamali Poojary, Assistant Professor in Palliative Medicine; and Dr. Manasi to visit one of the paediatric palliative care outreach clinics, at Chhatrapati Shivaji Maharaj Hospital in Kalwa, which is about 30 km north of TMH, just outside of Mumbai.
This clinic demonstrates how a children’s palliative care clinic can be implemented within a government general hospital by a small but dedicated and enthusiastic team. The team includes a paediatrician, nurse, social worker, physiotherapist, and an administrative officer.
Since many of the children have cerebral palsy and other conditions which lead to developmental delays, the physiotherapist is particularly important, providing stretching and strengthening as well as helping families to acquire assistive devices such as AFOs (ankle foot orthoses).
A child with cerebral palsy receives physiotherapy support from the paediatric palliative care outreach clinics, at Chhatrapati Shivaji Maharaj Hospital in Kalwa. The child was able to be fitted with AFOs to assist with mobility.
Parents attending the clinic were very enthusiastic about how the palliative care team had supported them and their children, particularly during COVID lockdowns, when the team arranged home visits and ensured that the children were delivered a regular supply of their medications.
The program has also supported parents by helping them start small income generating activities such as tailoring.
Later we had lunch with Dr Vandana Kumavat, Professor and head of the department of paediatrics, and the other hospital paediatricians. We also met with the hospital’s paediatric residents providing a training session on paediatric palliative care with an interactive discussion about which children can benefit from palliative care and how it can help.
Overall this visit was very informative for me, seeing how the team at TMH provides palliative care, but also how they have been able to expand their impact through outreach programs at other hospitals in the region. To learn more about these programs contact Dr Pradnya Talawadekar (childrenspalliativecare@gmail.com)
The TMH outreach work has been reported in more detail in a recent publication:
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