An International Comparison of Palliative Care and Best Practice in the Provision of Culturally Sensitive Palliative Care to the Indian Community in a Hospice and Hospital Setting.

Following a successful application for a travel scholarship from the Florence Nightingale Foundation, the Widening Access Clinical Nurse Specialist from The Prince & Princess of Wales Hospice (PPWH) in Glasgow recently travelled to India with her colleague (Cultural Liaison Officer) in order conduct an international comparison of models and delivery of palliative care services in the Indian Community. The main rationale for this visit was to observe and compare palliative care practice in India within Community, Hospice and Hospital settings with current service provision within the Hospice/Hospital palliative care teams in Glasgow. A second focus was to study the cultural differences and potential challenges of providing palliative care to a diverse Indian population from multi-faith communities and different social economic classes in order to apply findings from the visit to developing culturally competent care and services in PPWH for local south Asian communities and the hospice widening access programme. Through direct interaction with Indian communities the applicant gained insight into ways of increasing awareness about Hospice services and palliative care within the local South Asian communities in Glasgow.  Knowledge of barriers and misconceptions about palliative care was increased by this research.

They travelled first to Pune in the state of Maharashtra where they visited the Cipla Palliative Care Centre, which is a 50-bedded symptom management / respite care centre. They also participated in a march for the centre’s World Palliative Care Day, which is an annual event that aims to raise awareness of palliative care. As part of the march, the project lead gave a short speech to approximately 1,000 followers regarding Palliative Care in Scotland. Following this, they visited the Tata Memorial Cancer Hospital, where they spent time with the Palliative Home Care team visiting cancer patients in the slums of Mumbai. Finally they concluded their trip by being shown round the Shanti Avedna Hospice, which was the first hospice to be established in India in 1986. This is a 100-bedded hospice that is a charitable organisation run by the Sisters of the Holy Cross Catholic Order.

Observations from the study tour will be used to enhance the content of a Hospice toolkit being developed to improve the competency of Hospice staff in the delivery of clinical care to ethnic minority communities.  The knowledge and experience gained throughout the visit will be shared via the development and delivery of training that will augment the skills of Hospice staff and volunteers. The experience, knowledge and skills gained throughout this study will also be utilised in developing relationships and services for local South Asian communities, informing future service delivery whilst ensuring culturally competent palliative care. The project lead will share their experience by acting as a resource for other organisations with an interest in widening access to health care for ethnic minority patients and their families.

This report outlines the background to the project and the rationale of the subsequent visit. The experiences gained from the trip are discussed including: the barriers to accessing palliative care services in India such as poverty, population density, opioid availability, workforce development and a limited national palliative care policy. Each organisation visited is briefly described and the cultural differences and potential challenges/barriers to accessing palliative care are also reflected upon. Comparisons and limitations of palliative care services and delivery are made between the Indian and Scottish models of care. Recommendations for practice are explored and conclusions made.

In summary, the visit to India was an eye opening experience. The extent of poverty observed was humbling and thought provoking. However what will be remembered more than anything was the unfailing commitment, love and respect shown by every single member of staff who worked in the organisations that were visited. Doctors, nurses, social workers and volunteers all showed these qualities uncompromisingly. It is through their dedication to teamwork that these organisations are able to deliver holistic care to all patients every day in these very difficult circumstances and that is to be greatly admired. In conclusion, the element that is shared between the UK and India is their values for compassion and respect for the dying.