End-of-Life & Palliative Care
The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering through assessment and treatment of pain and physical, psychosocial and spiritual needs. (WHO)
The field of palliative care is growing rapidly. A recent article from NPR Health News highlights the current state of palliative care in America and the growing need for licensed palliative care practitioners within the US to adhere to patient needs and meet the best practice standards. India has some of the highest rates of oral and oesophageal cancers, yet only a tiny faction of those coping with life-threatening or life-limiting illness have access to effective pain relief. There is a lack of facilities, personnel trained in palliative care, and cultural awareness of the importance of palliative and end of life care.
Join the "Father of Palliative Care" in India, Dr. Rajagopal (Dr. Raj), who leads this program, and witness the realities of providing care for terminally ill patients and those suffering pain in a low resource environment. Dr. Raj is a world-renowned leader in the field and has been featured in The New York Times and New England Journal of Medicine. In the fall of 2014, Human Rights Watch honored Dr. Raj for his tireless efforts, more than two decades worth, battling conditions that cause patients to suffer unnecessary pain.
Sit in on classes with trainees from India and around the world to learn about the four core competencies of palliative care and how Indian culture influences perceptions of life, illness, suffering and death. Join small healthcare teams on homecare visits within the city of Trivandrum and nearby coastal villages. In addition, rotate at healthcare facilities including a private hospital and hospice care centers. Throughout rotations, assist Dr. Raj and other physicians, nurses and social workers in providing primarily free services to low income families. Gain access to the very personal patient-provider relationship unique to this field, while learning how to implement a pragmatic palliative care model in the developing world. Understand how culture impacts communication and decision-making amongst patients, families and physicians.
Become immersed in Indian culture while staying on a college campus in Trivandrum, and explore museums and other attractions, such as the Shree Padmanabhaswamy Temple of Lord Vishnu, nominated as one of the Seven Wonders of the World. CFHI participants may also organize weekend trips to nearby destinations such as the beach resorts of Varkala and Kovalam.
*Please note that this program is 4-weeks in length and is only offered at specific times during the year (see dates below).
CFHI’s local partner in Trivandrum is a nonprofit organization founded in 2001 to increase access and standards of meaningful palliative care for people with life-limiting or life-threatening illnesses. The organization was established as a neighborhood network, employing doctors, other clinical staff and nearly 12,000 volunteers from the community to help provide quality medical care to 15,000 patients in the region. As a result of their efforts, the provision of home-based palliative care in the state of Kerala has increased from 2% to 70% in 10 years. Provision in the rest of India is still around 2%. Assist in their efforts through home visits, as well as inpatient and outpatient rotations at the following sites:
Home Visits- Join small healthcare teams on home visits in Trivandrum and neighboring villages, providing care to homebound patients. Patients are visited regularly by palliative care staff and may be living with developmental disorders like cerebral palsy, paraplegic as a result of accidents, or suffering from cancer, AIDs or mental illness. During each home visit, staff offer physical, emotional and psychological support to the patient and their family members. They may check vital signs, administer medications, perform physical therapy, change bed sheets or catheters, redress wounds, check for bed sores, etc. The cost of treatment is based on a sliding-fee scale, with the majority of patients receiving care free of charge.
Hospice Centers- Travel to small palliative care centers in neighboring villages to treat patients who require more individualized attention and are unable to or cannot afford proper medical care at home. In addition to providing health services, one center also runs rural projects to eliminate poverty and empower women.
Hospital for Women and Children (Sree Avittom Thirunal Hospital, Government Medical College, Trivandrum)- One of many hospitals located on the Government Medical College campus in Trivandrum, services here are confined to women, mothers and children under the age of 12. This hospital has one of the highest rates of deliveries in Kerala. Specialties offered include cardiology, neurology, pediatrics, nephrology, surgery and psychiatry. Rotate within the hospital’s palliative care pediatric clinic.
CFHI is considered a global health ethics leader therefore CFHI programs uphold strict standards and comply with all local laws regarding student involvement in health settings. Your experience on the program depends on your previous clinical training (if applicable), Spanish level, and the relationship you build with your supervising preceptor. Above all, YOU are the most important factor in making the CFHI experience as fulfilling as possible by being respectful, inquisitive, and open to the wide variety of learning experiences which you will encounter.
India is the seventh-largest country in the world and the second-most populous with over 1.2 billion people. There are over 20 languages spoken across India’s twenty-nine states. The country is also the birthplace of four of the world’s major religions—Hinduism, Buddhism, Jainism and Sikhism. India offers a rich history, vibrant culture, and diverse landscape unlike anywhere in the world, as well as breathtaking architectural wonders like the Taj Mahal and Golden Temple.
Trivandrum is the capital of the state of Kerala. It is located in the southwest corner of India and is known for its academic and urban feel. Built on seven hills and located by the sea, Trivandrum was described by Mahatma Gandhi as the “Evergreen City of India.” Today, it is a popular tourist hub and a major academic center with numerous educational institutes. The most common language spoken is Malayalam, but English, Tamil and Hindi are widely understood.
Things to Do
CFHI participants have free time during most evenings and weekends and may choose to organize weekend trips to nearby destinations and take part in cultural activities offered within Trivandrum.
As an ancient city with a vast cultural history, Trivandrum is home to many historical sites, parks, museums and palaces, including Shree Padmanabhaswamy Temple of Lord Vishnu, nominated as one of the Seven Wonders of the World. The temple recently received worldwide publicity when investigators discovered gold, diamonds, jewels and other artifacts valued at $22 billion. The Napier Museum, Sree Chithra Art Gallery and other local museums feature rare Indian paintings, historical artifacts and archaeological findings. On weekends, participants may visit the beach resorts of Varkala and Kovalam, an array of hill stations and trekking sites, such as Ponmudi and Munnar, before making their way to Alleppey, the famous backwaters of Kerala. Here, visitors can cruise down rivers and lagoons on a traditional houseboat with a private guide—a quintessential Kerala experience.
Participants stay in shared accommodations (2-3 students per room) on a college campus in Trivandrum. Accommodations are comfortable, but may not include air conditioning, internet, and consistent hot water. Two meals per day of traditional southern Indian cuisine are provided. Laundry services are available for a small fee.
Eligibility: Who Can Apply?
This CFHI program is ideal for students and non-students of all levels and health disciplines with an interest in palliative care and a passion for global health and medicine. The primary focus of the program is to build a working knowledge of palliative medicine and to gain exposure to how holistic care is provided at the community level for patients with life-limiting and life-threatening illness. For more information, please read CFHI's general eligibility requirements.
Language Spoken: English
While the native language of Kerala's capitol city of Trivandrum is Malayalum, English is widely spoken. All CFHI Staff in Trivandrum, as well as the majority of healthcare professionals, communicate effectively in English. However, Malayalum is most often spoken with patients during homecare visits and at clinics and hospitals. To help you along a CFHI preceptor will interpret whenever necessary.
Participants should arrive in Trivandrum, India on the program start date and will be picked up from the airport by a CFHI representative and taken to their accommodations. A welcome orientation will take place the Sunday or Monday after arrival.
All US citizens should apply for an Indian tourist visa in advance. More information and specific instructions on visa applications will be provided by CFHI after acceptance into the program.
- Guidance from CFHI staff in San Francisco before departure
- Program-specific materials with information on making travel arrangements, visa requirements, recommended immunizations, etc.
- Airport pick-up upon arrival and transportation to accommodations in Trivandrum with local CFHI representative
- Welcome orientation with other participants covering safety, transportation, and other logistics
- CFHI Local Team: providing instruction, logistical support, and 24/7 emergency response
- Weekly meetings and lectures on local healthcare system and socio-economic determinants of health
- Placement and coordination of clinical/public health activities
- Accommodation and two meals a day
- Local cell phone
- International emergency medical and evacuation insurance
- Airport drop-off upon departure
- Access to CFHI alumni-only LinkedIn group featuring news and career opportunities related to Global Health
- CFHI alumni newsletter highlighting events, resources, and ways to stay involved
Uniquely CFHI, 50% or more of student program fees go directly to the communities they will be visiting, benefiting the local economy at large and specifically underserved health systems. Read more.
Hema Pandey- CFHI India Director: The role of the India Director is to coordinate and manage activities for all CFHI programs in India. Hema has been instrumental in establishing CFHI's growing presence in India, developing new program sites and researching CFHI's growth potential in-country. She has worked for CFHI since 2005. She holds a Bachelor’s Degree in Business & Commerce from Kurukshetra University and a PG diploma Fashion Design from International Institute of Fashion Technology. Her professional interests include rural and urban healthcare, water and sanitation, gender, social development. She likes helping CFHI students achieve academic and personal goals and develop leadership skills during their time on program. In her free time she enjoys photography, travelling with family, volunteering, basketball, and cycling.
Dr. M. R. Rajagopal - CFHI Trivandrum Medical Director: The role of the Medical Director is to arrange clinical placements, supervise the participant experience at these sites, and provide instruction on healthcare topics during weekly meetings. Dr. Rajagopal (Dr. Raj) specializes in palliative and hospice medicine, and advocates for improved policies and palliative care reform in India. He is often referred to as the ‘father of palliative care in India’ in honor of his significant contribution to the field, and has been featured in the New York Times and New England Journal of Medicine. As a result of Dr. Raj’s efforts, the Parliament of India amended the Narcotic Drugs and Psychotropic Substances Act (NDPS) Act of 1985, bringing essential pain relief medicines like morphine to those suffering from chronic pain. Dr. Raj and his colleagues continue to work tirelessly to advocate for increased access to effective pain relief for those burdened by debilitating illnesses, such as HIV AIDS and cancer.
What Alumni Say
"As a fourth-year medical student, I found great value in the classroom instruction in communication, symptom management, bioethics, and end-of-life care. However, I was most touched by my clinical experiences with the patients, especially on the home visits. Getting to step inside someone’s home and observe the home-care team’s interactions with the patients and families was a privilege. Empathizing with a patient’s situation is necessary in palliative care, and there is no better way to do this than to visit a patient in his or her home.
I highly recommend the “End-of-Life and Palliative Care” program to anyone who is interested in palliative care, whether you are a student, doctor, nurse, social worker, or just someone looking to learn more about palliative care and experience the hospitality and beauty of Kerala (also known as “God’s Own Country”). It was a life-changing experience for me, and I am grateful to CFHI and Pallium India for allowing me to take part in the program."
“I am so grateful for having learnt first-hand about palliative care, a field I admittedly was unfamiliar with before arriving in India. Visiting patient homes really hits a personal note and allows you to feel connected with the patient and their family in a holistic way, to think outside their symptoms. And I cannot say enough about Dr. Raj and his dynamic team of palliative care professionals. Words are incapable of doing their admirable work justice." Read more
-- Lyndsey Brahm, March 2012 (Prospective MSc Public Health)
Read an emotional and inspirational narrative by two-time CFHI alumna Alex Macy (March 2012, Prospective MSc of Narrative Medicine), published in the September 2012 issue of the Journal of Pain & Palliative Care Pharmacotherapy.