RESUMEN
Managing pressure ulcers remain a challenge and call for a multidisciplinary team approach to care. Even more daunting is the management of such patients in remote locations and in resource constrained situations. The management of pressure sores in a patient with progressive muscular atrophy has been discussed using resources that were locally available, accessible, and affordable. Community participation was encouraged. A holistic approach to care was adopted.
RESUMEN
BACKGROUND: Inavailability of morphine continues to plague most parts of India. Good palliative care must, however, focus on resources that are locally available, culturally acceptable, financially affordable, and easily applicable. These factors were all integral to the development of the "Kosish cocktail" for use in severe pain. This cocktail is a mixture of ketamine, midazolam, pentazocine lactate, and other adjuvants for use in the domiciliary set-up as intermittent subcutaneous injections in a morphine-naïve community. Our aims and objectives were: (1) To assess the efficacy of the "Kosish cocktail" in treating severe pain in terminally ill patients; (2) To assess the safety profile and note any adverse effects; (3) To evaluate its use in domiciliary set-ups in terms of safety and efficacy; (4) To empower the patient and the family in the process of patient care. MATERIALS AND METHODS: Eight patients with advanced cancer and severe pain, who were already on WHO Step II drug therapy, were enrolled for this study. The cocktail was administered subcutaneously in every four hours and SOS. Subjective and objective parameters were recorded and the data analyzed using Student's t-test with a P<0.05 being considered significant. RESULTS: There was a statistically significant improvement in the subjective parameters 12 hours after the initiation of therapy, except for the persistence of fatigue. CONCLUSIONS: On the basis of this qualitative study, the authors confirm the efficacy and safety of the use of the Kosish cocktail in treating severe pain, and strongly recommend it for newly started hospices, especially for use in the domiciliary set-up.
RESUMEN
Most of the needs of elders for support and assistance in the later stages of life are fulfilled by informal helpers. The position of a large number of older persons has become vulnerable due to which it cannot be taken for granted that their children will be able to look after them when they need care in old age, specially in view of the longer life span implying an extended period of dependency and higher costs to meet health and other needs. The condition of the rural elderly is even more pitiable, contrary to our beliefs, as availability, affordability and accessibility to medicare facilities are poor. We undertook the task of organizing a health camp in a rural set-up with the idea of implementing our concept of "preventive palliation" in which excellent palliative care was coupled with a pinch of prevention, like routine checks of blood pressure, routine physical check-ups, etc, so that any aberration can be detected early and necessary rectification measures can be implemented. These periods of routine check-ups can also be used to assess the psycho-social, cultural and emotional problems, if any. Such an approach, say every monthly, gives the elderly something to look forward to and ensures a high degree of customer satisfaction and greatly reduces the burden on the current health system. The challenges faced and the data obtained from this study were shocking. The elderly living in rural areas of the tribal state of Jharkhand suffer from poor physical and mental health, a factor which was rather unexpected in the Indian cultural system in the rural setting. Simple strategies like implementing routine health check ups with provision of "nutritious meal program" can go a long way in mitigating these problems in a cost-effective and simple manner. To make the government-based programs accessible and available to the end-users, participation of local bodies like NGOs is mandatory. Preventive palliation, a concept introduced by Kosish, is the way forward for providing palliative care to the rural-based elderly in most parts of India. This concept takes into account the local cultural, social, financial and long term feasibility and sustainability aspects of the care process.
