We believe that continuous education and training constitute an important facet of our activities because it is vital to bring quality health services closer to the cancer patient. To this effect we are attempting to enhance the existing standards in both the public and private health system.

We conduct training programmes on early detection and palliative care, specially for doctors, nurses and paramedical staff from the government health delivery system, the most comprehensive network in the interior, rural areas and available to weakest sections of society. If there is capability enhancement of the governmental medical and para-medical personnel, quality medical service will be within the reach of the poorest of poor in the remotest corners of the region. The major and minor surgical procedures that the Foundation doctors perform at the district hospitals in cooperation with the respective district administrations also serve to demonstrate the surgical oncology procedures to the local doctors.

In India... So far, the largest and most ambitious training programme undertaken by us was the AUSAID supported pilot project for developing a district based Palliative Care model. The decision to take up this project was based on the findings of our WHO funded survey on incidence of pain in rural areas. The survey had revealed a need to offer palliative care facilities closer to the home of the terminally ill cancer patient. The AUSAID project was implemented in the district of Dhar, a predominantly tribal area of Madhya Pradesh, with active support of the Dhar District Administration. According to Dr. Robert Twycross, a well-known Palliative Care expert, this project has the potential for replication in the other districts of India.

Dr. Robert Twycross has held several bedside palliative care clinics in Indore.

Under the provisions of the 7th Indo-French Joint Commission in Scientific and Technical Cooperation, several Indo -French Workshops have been organised.

In 1996, we instituted the Prof. S.K. Mukherjee Annual Oration as a tribute to the memory of Padmabhushan Prof. S.K. Mukherjee, who was a living legend in the field of medicine in central India. The orations given by international luminaries offer the local medical professionals an opportunity to interact with leading experts. So far, 5 Orations have been organised.

In April 1997, Ms. Gilly Burn, palliative care nurse from UK, and two of her associates, Ms. Dawn King & Ms. Hillary, participated in a one day palliative care training program for nurses. The programme, held at the Mission Hospital, Indore, the co-host, was attended by a large number of nurses from various hospitals in the city.

A team of our doctors took a series of lectures on various aspects of cancer care for the students of B.Sc. (Nursing), Choithram School of Nursing.

The nursing staff and students of the school of nursing attached to the Mission Hospital Indore receive our guidance in their regular classes every year for a period of one to two weeks. In addition, the trainee nurses get hands on experience in looking after cancer patients when they do their training stint at the Mission Hospital, where a lot of our operative work is done.

Certificate training programmes on early detection of cancer have been organized for general practitioners of Indore.

Four 3-day palliative care sensitization programmes have been held in Indore, Jaipur, Raipur and Bhopal; for government doctors from the states of Rajasthan, Gujarat, Maharashtra, Chattisgarh and Madhya Pradesh. The Ministry of Health, Government of India, under WHO Biennium Fund, funded these programmes . The feedback as well as the action plans prepared by the participants’ reveals a clearing up of misconceptions about cancer, its treatment, and an awareness that abysmal quality of life need not be the lot of terminally ill patients.

A Training program on cancer awareness was arranged for the workers including doctors of the Family Planning Association of India, Indore Branch. FNAC and Pap smear tests techniques were taught to the nursing staff.

Programmes have also been organised for the students of the School of Social Work, Indore, and the Choithram School.

A lot of awareness generation lectures have been held at schools, colleges, going students, for women's organizations and other forums. This is a continuous activity.

... and abroad

So far 12 doctors and two non-medical professionals have been sent to France, U.K. and U.S.A. on training for periods ranging from 1 month to a year.

This was the objective of the project proposed by us and approved by AUSAID, of the Commonwealth of Australia. The approach we adopted was to train the medical personnel of the government health system. Thus, enabling them to offer palliative care at the home of the terminally ill patient or at the health centre close to his/her home.


Development of a district based model for palliative care

The project started in April 1998 and the final programme was held in the first week of December 1999.

We selected Dhar for this project because it is a predominantly tribal area mainly dependent on the government for the delivery of health care.

The district of Dhar is divided into 13 blocks with approximately 2000 primary health workers, mid wives, social development workers, village level local body members, doctors and nurses. Our objective was to involve all these people and create a district level palliative care delivery system.

Given the fact that 28 different trainers would be conducting the awareness programmes. We put in place a monitoring committee to ensure parity vis-à-vis inputs given. The monitoring committee was made up of representatives of the Dhar district administration and the Foundation. The conduct of each awareness programme was observed by at least one member of this committee.

The middle tier to consist of health workers who would be taught how to monitor the treatment given by the palliative care consultants. This cadre was necessary because a doctor cannot make daily visits to the houses of the terminally ill patients. It is these health workers who will ensure that the instructions are being followed and equally importantly, they will offer the emotional support, which is so important for the terminally ill patient and the family. (Graph 2 ) The 3rd tier was made up of doctors who received an exhaustive 10-day training in palliative care. These doctors were from the district health set-up and post training, they are equipped to work as independent palliative care consultants. They are, of course welcome to seek support from our faculty any time the need arises.

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