HOSPICE SERVICESr>
HOSPICE SERVICES
INTRODUCTION |
Hospice is a new concept to take total
active care of advanced untreatable and terminal cancer cases. It is
a serene, queit and comfortable place like an ashram where the patient
is admitted when he is dying beyond salvation and where the survival
is defined in days and weeks. |
The various services provided here
aim to give comfort, quality and dignity to life. |
To know more details kindly go through
project proposal submitted. |
The project proposal is being submitted
for community partnership and financial help |
We are planning such a project at
-
(A) Cancer Services Center with Hospice
at Dharamshala (Himachal Pradesh)
(B) Home Care Cancer Services and
Palliative Care of advanced elderly at Delhi
|
(Project Proposal)
Appeal
- We invite the various concerns for Community partnership
and Financial Assistance.
Administrative
Information
Title of the Project |
HOME
CARE CANCER SERVICES AND PALLIATIVE CARE
|
Purpose |
To serve the terminal cancer
patients and advanced elderly . |
Name of Organisation |
Cancer Detection Society of
India |
Address of Organisation |
H8, Hauz Khas, New Delhi - 110016 |
Fax No. |
91-11-685-0397 |
Tel No. |
91-11-651-1628/656-0867 |
E-mail |
drsuraaj@yahoo.com |
Legal Poroject Holder |
Dr. Suraj Verma
MBBS, MS FICS (USA) |
Designation |
President - Cancer Detection
Society of India |
Address |
H8, Hauz Khas, New Delhi - 110 016
|
Project period |
It shall be an ongoing constinuous
project |
|
SUMMARY
- Cancer has become an increasingly common disease. Its a disease
of the olderly and affects either sex almost equally. Due to socio-economical
conditions and lack of education, rural and urban rural are unable to reach
to a right place for diagnosis at an early stage. 80-90% come to know the
disease when it is very advanced, and treatment is difficult. |
Therefore, a multi pronged approach
is planned to control and contain the disease. The project is already going
on which not only educates the people and creates awareness but also controls
cancer occurance by --- |
1. Early detection by organizing
Cancer Detection Camps.
2. Early diagnosis of detected cases.
3. Early management, guidance and
counselling.
4. Early rehabilitation.
5. Early transfer of detected cases
to Regional Cancer Centres(R.C.C.)
6. Early transfer of terminal cases
to Palliative Care Units.
7. Providing Home Care Palliative
Services.
Activities
: We plan to achieve our objectives by three ways.
I. |
Primary Prevention
:
By educating people about factors causing
cancer, e.g., Smoking, Chewing Tobacco, Paan Masalas, alcohol drinking,
pollution, colouring agents and preservatives.
We shall supply educating literature,
hold exhibition, motivate people to attend our Cancer Detection Camps
and help our survey team.
|
II. |
Secondary
Prevention : |
|
This is an acitve and alert
activity which works as indicator and helps monitoring the survey and work
done by health workers. If motivation is proper the response in Cancer Detection
Camps will be good. A careful search and screening is done in these camps.
The isolated cases will be sent for diagnosis. The further management is
through our networking at various Regional Cancer Centres (R.C.C.). |
III. |
Home
Care Team: is being introduced
to take care of untreatable terminal cases. The care will include dressing
of wounds, maintain air and food passages, care of vital organ functions.
To provide pain relief and psychological support (See details under statement
of need). |
|
|
BACKGROUND
:
Geographical, political and soical
context will be assessed during our survey. We shall find out.
- If similar work has beed done
already or is going on by any other health agencies viz. Govt. or NGO.
- Available facilities by Govt.
or N.G.O.
- Identification of people needing
Palliative Care.
- How these identified people were
helped in their quality of life.
- The status and working of Panchayat.
- Scope of Home Care Team for disadvantaged
and Handicapped Elderly & Terminally ill patients of cancer and other ailments.
Our study and survey will be done
under following headings:-
Age, Sex, Address, Occupation, Education,
Surroundings,Diet, Habits, Religion & Complaints.The health status thus
will be assessed during careful survey.
We shall establish networking with
all health agencies working in this area and provide our Home Care Team services
as partner in Community services.
We are covering an area of 100,000 population
and expect to get 10,000 elderly above the age of 50 onwards, out of which 5000
may come for screening.The younger group may also report for screening which
in case we encourage to include in our study.
At national level it has a significance since
the society has done massive work in N.E. States, We are planning similar project
for Shillong or Guwahati to cover all seven sister states , Darjeeling and Sikkim.
A copy of work done in these states is enclosed.
Manpower and Task
Force
- |
Cancer Surgeon - Male |
One |
|
Gynacologist - Female |
One |
- |
Staff Nurse, |
Two |
- |
Health Educators & Surveyors |
One |
- |
Project Coordinator |
One |
- |
Lab. Technicians |
One |
- |
Radiographer & visiting psychologist. |
One |
All are paid staff. Doctors are on visit basis.
Project Time Table
Cancer Prevention is a continuous process which
helps in maintaining regular follow-up.
To achieve our objectives we plan
yearly projects. A careful survey with motivation and educating literature supply
will help in creating awareness. This process is the key to successful prevention
of disease. The detected cases will be transferred to RCC for early diagnosis
and management, which helps in control of cancer avoiding complications. We
shall have networking with other NGOs & join them in their campaign against
cancer.
Our mobile Home Care cancer services
team will attend the terminal cancer cases and those who have finished their
treatment and are waiting for next follow up.
The
Concept of Palliative Care
The palliative care is the total
active care of patients at a time when their disease is no longer responsive
to curative treatment. The concept is also defined as," The care of terminally
ill patients suffering from untreatable diseases."
A terminal illness is further described
as one in which:-
- a patient has casual illness with
a progressive evolution
- a patient with one or multiple
organ failure
- a patient has irreversible progressive
complications
- a patients survival is defined
in weeks to days.
Its extremely difficult to define
terminal illness since it is a controversial issue. The time and acceptance
among those involved with Palliative Care decision are crucial for preparing
for the patient's imminent death. Therefore, an approach is needed for such
patients based on the concept and principle of increasing the quality of life
rather than prolonging life.
Moreover, it is said that Palliative
Care is borne out of frustration in the minds of oncologists due to their inability
to provide comprehensive treatment. Now since the concept has acquired wider
application therefore, in last International Conference a terminology evolved
describing palliative care as care of people who are facing irreversible"End
of quality in life."
WHO (World Health Organisation) defined
, "Palliative Care is the total active care of patient whose disease is
not responsive to curative treatment. Control of pain, of other symptoms and
of psychological and spiritual problem is paramount. The goal of Palliative
Care is the achievement of the best quality of life for patients and their families."
However, inspite of various view
points and controversies, there is a universal acceptance that Palliative Care
should -
- provide quality of life with dignity
and comfort
- alleviate pain and other distressing
symptoms
- Maintain psychological, physical,
social and spiritual potential of the patient
- Rehabilitate the patient and his
family
- Affirm spiritual belief that death
is the ultimate truth.
Although, the principal and practice
of palliative care evolved from our cancer patients suffering with agonizing
pain in the advanced untreatable stage, we gradually realized in our practice
that pain relief was not the only problem. there are psychological and physical
symptoms which need to be attended and same is needed in Elderly care as well
as other diseases like AIDS, motor neurone, addicts of drugs and alcohol.
Statement
of need to continue Cancer Control programme
with Home Care- Palliative
Team
We know that people of all ages get
cancer, but it is more common in middle aged and elderly. Almost 0.5 million
cases are recorded every year in India.
Cancer will occur in three families
out of four in U.S. Every year 40,000 cases are registered at All India Institute
of Medical Sciences New Delhi,out of which 10,000 cases are new.
The number of new cases of cancer
is decreasing in women. Lung and oral cancers are the leading cause of death
in males and breast, cervix & uterine cancers in females, 40% of all cancers
in women are cervix cancers. Cancer is caused in two steps by two kinds of agents
initiators and promotors.
Initiators start the damage to a
cell that can lead to cancer. For example, cigarette smoking.
Promotors usually do not cause cancer
by themselves. They change cells already damaged by an initiator from normal
to cancer cells. For example alcohol promotes cancer in mouth when combined
with an initiator such as tobacco.
About 80% of all cancers may be related
to the things we eat, drink and smoke as well as the environment and work place
other risk factors, such as genetics are unavoidable.
Head and neck cancers are 28% of
all the cancers in India out of which 10% are oral cancers. In all 150 cases
of oral cancers are recorded out of 100,000 population.
An overall survey reports that Tobacco
related cancers are 48%, life style cancers are 15% and occupational 8%, the
rest are unknown and other various cancers in the body. 80% to 90% of such cases
report at an advanced stage.
About one million people die prematurely
every year due to tobacco related diseases.
In any case cancer does not spare
urban or rural population. Those who are educated, sophisticated and rich also
show almost equal incidence of certain cancers in comparison to those who are
uneducated, villagers, and poor. This is why the life style cancers are as high
as 15% of all cancers.
In view of such high incidence and
patients at advanced stages,we realized the need to organize cancer detection
camps regularly . The problems faced in our camps call for the necessity of
introducing Palliative care by a Home care Team.
How the need of Palliative Care Home
Team was identified-----
- |
It was during our survey, cancer
detection camps and various rehabilitation progammes incorporated in our
ongoing project we observed that - |
|
|
Majority of old cases having
completed their treatment at various centers keep on complaining of pain.
Since they report for treatment at an advanced stage which 80-90% cancer
cases do, the response to treatement is very limited. Moreover, such cases
have been given either chemotherapy (CT) or Radio-therapy (RT). The therapy
leaves toxic effects after 2-3 weeks of the treatment e.g. vomiting, burning
pain, loss of appetite causing weight loss and sleeplessness. Under such
conditions the patient avoids regular treatment which results in |
|
- |
Poor response to therapy |
|
- |
Early complication |
|
- |
Early recurrence |
|
- |
Loss of confidence in therapy |
|
- |
Fear of death and bereavement |
|
- |
Poor general health |
|
- |
Irritability and isolation |
|
- |
Irreversible progressive spread
of cancer |
|
- |
Survival chances and prognosis
fails |
|
- |
Emotional and psychological
problems |
|
- |
Involvement of vital organs
by disease resulting in untreatable terminal stage. |
It is here that a remedy evolved
which was given the name of Palliative Care. And to provide such a care by a
trained team at the door step of needy is known as Home Care Team.
Aims of Home Care Palliative Services
Team
Such a team, in addition to providing
suitable help to the problems above mentioned will look into
1. |
Improvement in quality of life |
2. |
A comfortable life by alleviating
pain and distress |
3. |
Maintain dignity |
4. |
Give psychological support during
emotional breakdown. |
5. |
Maintain physical, social and
spiritual potential |
6. |
Maintain vital functions e.g.
eating, drinking, respiration, heart, urination and defecation. |
7. |
Good sleep |
8. |
Dressing of wounds and supply
of required medicines |
9. |
Counselling and guidance |
10. |
Meeting with religious and spiritual
leaders |
Although the concept is only 15 years old it
is unfortunate that such services are hardly available. Out of 100,000 patients
needing Palliative Care only one patient is fortunate to receive such a care..
The introduction of Home Care Team will be of
immense value in our ongoing project without much of extra liability on the
project cost, since most of the infrastructure is already available with us.
Home Care Palliative Team
A Team of multi discipline professional is composed
to provide a holistic approach which includes-
1. |
A doctor in Palliative Care
to alleviate pain |
2. |
Trained Staff nurse - to dress
the wounds and care |
3 |
Psychologist to provide support
to patient or other people needing such a care in social context. The psychologist
also provides support to families of the diseased and rehabilitation of
both. |
4. |
Volunteers to coordinate the
visit of team and distribution of medicines |
5. |
Driver |
6. |
Vehicle |
7. |
Rest others as and when needed |
Palliative Care through-----
HOME CARE SERVICE
To whom and how the services
will be provided.
The designed services are planned for patients
or older people who are too sick or cannot afford financially to reach to
treatment centers. It shall also list older peple who are disadvantaged
and handicapped. |
The patients of older age needing the services
will be coming from various publicity methods viz cable T.V., newspaper
ads, radio or by attachments and networking with NGOs working in the same
field. |
The team will fix the date, day and area
regularly recorded through helpline. The mobile medical van equipped with
necessary gadgets needed for such services will take the Home Care Team
to the patients's door to provide the necessary and timely services. |
The team provides multi-professional approach.
The doctor in the team diagnoses the ailment, alleviates pain by supplying
morphine or giving Nerve Block to relieve the pain. He treats the complaints
as presented. |
The trained nurse takes care of accessories
and the aids the patient is wearing. She dresses the wounds and takes care
of urinary and stool bags. cleans catheters and keeps the vital functions
of eating, drinking, urination and bowel movements. |
The psychologist is a very
important member of the team who provide emotional and social support.
|
He attends to the tormented state of mind,
fear and anguish of the patient. The apprehensions of bereavements, guilt
and isolation are peculiar problems. He makes up the mind of patient to
face pain and problems bravely. He calls religious leaders who keep chanting
mantras giving peace by transcendence and brings spiritual leaders to attend
the patients' ultimate issues . He makes the patient accept the end, forgive
and reconcile. |
Thus a meaningful and supported holistic
approach is provided in partnership by Home Care Team. |
Follow -up - An organised and disciplined
programme is worked out so that the given services are continuously montiored
and evaluated. The follow-ups are essential part of services in achieving
the desired results. The services should be open, sincere and honest by
the teammates.A close surveillance is kept. |
Information about Cancer Detection
Society of India
- Registration 3 Jan. 1991 No
S/21603 under Society Act XXI
- Achievements -Please click
highlights page
-Aims & Objectives of the
Society---
- Prevention of Cancer by -
1. |
Early detection and diagnosis |
2. |
Early management of isolated
cases |
3. |
Mass Awareness in rural and
urban population |
4. |
Rehabilitation of positive cases |
5. |
To eradicate social menaces
e.g smoking, chewing tobacco, paan masalas and alcohol drinking |
6. |
To educate people about harmful
effects of the food preservatives, colouring agents and pollution |
Society Decision Making:
All decisions are taken by the Governing Body
duly elected after every 2 years. which constitutes-
President, Secretary, Treasurer, Chairman of
Committees, e.g. managing, cancer camps, rehabilitation and mobile cancer camps
committees.
Experience and Role of the Older people
We have just completed our first project with
Help Age India, please see projects page.
We plan to use the services of healthy and
unemployed older people. Those who are ready to be volunteers for camps will
work free and others will be paid for their part time services like registration,
motivation and distribution of cancer educating literature. We have included
a few in our management committees also. Moreover, the list of older people
already in our team is given with their age and duties assigned. They will be
joining our to this project as well. We have a proper and regular networking
with Indian Society of Palliative Care, our Seminar like Grow Grey Gracefully
was inaugurated by Shri Tejinder Khanna,Lt. Govenor of Delhi,NCT.on 17 Nov.
1997 and various lectures in the Rotary Clubs of Delhi have been quite fruitful.
We plan long term projects with Help Age India also. The enclosure will acquaint
you with massive work done in this field by the society.See High lights page.
Monitoring and Evaluation
We have our management team which checks the
survey registers and various survey reports. The cancer detection camps attendance
itself will show how well the people are motivated during survey.
Each surveyor is given a target and in each camp
100 to 130 people are screened every week. Such 40 to 50 camps yearly will complete
our target of 5000 Elderly. The cancer incidence is 1:1000 and we expect 5 cases
in 5000. If this target is not achieved, we shall check the survey records and
re-examine the predisposed cases e.g smokers, tobacco, chewers, ladies with
vaginal discharge and breast masses. We shall be satisfied if a group of people
is found free of these menaces. These subjects will be requested to work as
our motivators and facilitators. The work report is made every three months
and evaluation is done whether desired target is achieved in survey during these
three months.
Funding and Cost
We have recently done a project with Help Age
India,nearly 60,000 population was surveyed to collect 10,000 persons above
50 years of age out of which 5080 reported for screening in the cancer camps.
The whole of the recurring and nonrecurring expenditure
was taken care by Cancer Detection Society of India.This project is being submitted
for the favour of entire financial support which includes Cancer Control Programme
and Home Care Team for Palliative Care. Since we have almost entire infrastructure
no additional liability will be there.
Sustainability
No NGO can survive without funds.There are many
institutions at National and International level that look for good projects
for long term association as a partner in the community services.Let us work
together with a committed patnership.
We appeal to all concerned and varios funding
agencies to join hands for such a low profile project.
We are active in N.E. States. The work done in
the region by us is also entered in Highlights page. It shall be a pleasure
for us as well to join and organize similar cancer control services as a partner
in your human endeavours.
Project Cost
Components - I
Recurring (for one year)
Salaries
General Duty Doctor (part time)
|
8000 x 12 months |
96,000/- |
Gynaecologist,each camp. |
1000 x 52 weeks |
52,000/- |
Cancer Surgeon |
1000 x 52 weeks |
52,000/- |
Staff Nurse One |
4000 x 12 months |
48,000/- |
Auxilliary Health Worker (Two) |
3000 x 12 months |
72,000/- |
Health Surveyor (Two) |
3000 x 12 months |
72,000/- |
Project Coordinator |
5000 x 12 months |
60,000/- |
Driver |
3500 x 12 months |
42,000/- |
Venue Rent |
5000 x 12 months |
60,000/- |
Visits of Support group like
Psychologists Physiotherapist, Spiritual Scientist etc. |
|
25,000/- |
|
Total |
5,79,000/- |
Component - II (Recurring) |
|
|
- Publicity material & Stationary |
|
50,000/- |
- Biopsy, FNAC, Endoscopy material |
|
50,000/- |
- Chemicals & Preservatives |
|
35,000/- |
- Disposables & Dressing
materials |
|
20,000/- |
- Medicines to be supplied in
camps & Home Care Service |
|
40,000/- |
- Photography |
|
15,000/- |
- Petrol |
|
35,000/- |
Miscellaneous & Incidental |
|
20,000/- |
|
Total |
2,65,000/- |
|
|
|
Component - III (Non Recurring)
|
|
|
Mobile Van - will be provided
by Cancer Detection Society of India |
|
|
|
Grand Total |
8,44,000/- |
Projects:- |
1. |
Projects Done
Click Highlights
|
2. |
Projects being
Done (on going projects) |
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On Going projects
(Join Us)
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