PALLIATIVE CARE: ADDING LIFE TO LIVING When cure is not possible, care is always possible!By Dr Amit Dias

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PALLIATIVE CARE: ADDING LIFE TO LIVING When cure is not possible, care is always possible!By Dr Amit Dias

IMAGINE an elderly man with advanced cancer who is unable to sleep because of severe pain. Or a woman with dementia who no longer recognises her family and is completely dependent on others for daily care. Think of a stroke survivor confined to bed, developing painful pressure sores, or a person with advanced Parkinson’s disease struggling to walk, swallow and communicate.
For many such patients and their families, the greatest need is not simply another test, scan or prescription. They need relief from suffering, skilled care, support and dignity.
That is where palliative care comes in. According to global estimates, approximately 56.8 million people require palliative care every year, including 25.7 million people in the last year of life. Yet, globally, only about 14% of those who need palliative care receive it.
Palliative care is often misunderstood as care given only when a person is about to die. Nothing could be further from the truth. Palliative care is about adding life to living.

What is Palliative Care?
THE World Health Organization describes palliative care as an approach that improves the quality of life of patients and families facing problems associated with life-threatening illness. Palliative care is specialised, compassionate care that prevents and relieves suffering and helps a person live with comfort, dignity and the best possible quality of life.
The important word is early. Palliative care does not have to wait until all treatment has stopped. A person can receive palliative care alongside chemotherapy, surgery, rehabilitation, dialysis or other disease-specific treatment.
What do we do when illness continues to cause suffering despite our best efforts to cure or control it?- the answer is palliative care.

What Happens in Palliative Care?
PALLIATIVE care is not one medicine or one procedure. It is a package of coordinated services, depending on the needs of the patient and family.

Pain and Symptom Relief
Pain relief is one of the most important components of palliative care. Patients may suffer from:
• Severe or persistent pain
• Breathlessness
• Nausea and vomiting
• Constipation
• Fatigue and weakness
• Poor appetite
• Difficulty sleeping
• Anxiety and restlessness
• Swelling and discomfort
• Problems with swallowing
Pain and breathlessness are among the most common and serious symptoms experienced by people needing palliative care. WHO notes that appropriate medicines, including opioids when clinically indicated, are essential for the management of serious pain and some other distressing symptoms.
The aim is simple: no person should suffer unnecessarily when suffering can be relieved.
Wound Care and Bed Sore Management
A bed-bound person is at risk of developing pressure sores or bed sores, especially over the back, hips, heels and other pressure points.
These wounds can be extremely painful and may become infected. Palliative care services help through:
• Regular skin assessment
• Repositioning and turning the patient
• Pressure-relieving mattresses and cushions
• Appropriate wound cleaning and dressings
• Infection and pain management
• Advice on nutrition and hydration
• Training family caregivers in preventing further sores
Good nursing care can make a tremendous difference to the comfort and dignity of a bed-bound patient.
Personal and Nursing Care
Patients may need assistance with everyday activities that many of us take for granted. For families, learning nursing skills can reduce anxiety and make home care safer and more manageable.
Mobility and Rehabilitation
Palliative care does not mean keeping a patient in bed. Even small improvements—such as being able to sit comfortably, move independently to a chair or attend a family function—can greatly improve quality of life.
Nutrition and Swallowing Support
Serious illness may cause poor appetite, weight loss or difficulty swallowing. Families are often distressed when a loved one “is not eating.” The goal is not simply to “force calories” but to maximise comfort, safety and wellbeing.
Care of the Mind and Emotions
Serious illness can bring fear, sadness, anger and uncertainty. Families too experience stress and exhaustion. Counselling and psychological support can help patients and caregivers cope with anxiety, depression, changing relationships and difficult decisions.
Social and Financial Support
Illness can create practical problems beyond the hospital. Palliative care involves doctors and nurses, but also social workers, counsellors, physiotherapists, occupational therapists, volunteers and others.
Spiritual Care
Serious illness often raises questions about meaning, hope, relationships and purpose.
Support for the Family
Perhaps one of the greatest strengths of palliative care is that it recognises the family as part of the unit of care. They need care too. Our work with people with dementia has highlighted how important it is to address issues of caregivers.

Palliative teams teach families how to:
• Give medicines safely
• Turn and position a patient
• Prevent bed sores
• Manage basic symptoms
• Feed someone safely
• Recognise danger signs
• Seek help at the appropriate time
Where required, families can also receive support during bereavement.

Smt Sayonara Telles Laad, Dr Amit Dias, Adv Savio Travasso at an awareness programme on Palliative Care, Living Will and Human Rights for the Jyeshth Nagarik Manch with President Prakash Naik and members on 16.8.26.

Remember PALLIATIVE as “CARE”

There is a need for more awareness on Palliative Care. For the lay person, one simple way to understand palliative care is through the word:

CARE
C – Comfort
Relieving pain, breathlessness and other distressing symptoms.
A – Assistance
Helping with nursing care, daily activities, rehabilitation and practical needs.
R – Respect
Respecting the patient’s dignity, choices, values and wishes.
E – Emotional Support
Supporting the patient and the family emotionally, socially and spiritually.

Palliative care, at its heart, is CARE.
Palliative Care in Goa: A Strong Foundation to Build Upon
GOA has an important foundation of palliative care services that deserves recognition and further strengthening. Dilasa Palliative Care Centre at Farmagudi, Ponda; Shanti Avedana; Novi Survat; Goa Medical College & Hospital and the South Goa and North Goa District Hospital palliative care services represent important models of palliative care that can be strengthened and scaled up. Goa’s health system has also formally recognised the importance of palliative care: the State Government constituted a Steering Committee under the National Programme for Palliative Care, 2023 bringing together the Health Department, Directorate of Health Services, Goa Medical College, district hospitals, IMA and voluntary-sector representation, including Dilasa.

Adding Life to Living
THE true value of palliative care cannot be measured only by the number of days a person lives.
It can be seen in:
• A patient who finally sleeps because their pain is controlled.
• A wound that is carefully dressed and no longer causes unbearable suffering.
• A bed-bound patient who is turned regularly and spared a painful pressure sore.
• A person who is helped from the bed into a chair to sit with family.
• A frightened patient who finds someone willing to listen.
• An exhausted caregiver who learns that they do not have to manage everything alone.
Palliative care is therefore not merely about adding days to life. It is about adding comfort, dignity, meaning and companionship to the days that remain.