A Champion for the Sick and Dying in India

The famed Swiss medical doctor, Albert Schweitzer, once said, “We all must die. But that I can save him from days of torture, that is what I feel as my great and ever new privilege. Pain is a more terrible lord of mankind than even death himself.” All day, every day, Dr. Muttacaud Rajagopal fights torture. But you won’t find him walking the halls of a justice department or in the wards of a prison. You’ll find him making rounds in a hospital, at the bedside of a patient with advanced cancer, or making a home visit to a family whose father has been incapacitated by excruciating pain. Dr. Raj, as he is known to many, fights the torture of untreated pain.

Dr. Raj is regarded as India’s leading palliative care physician. For almost 20 years, he has fought valiantly at home and abroad to put an end to the unnecessary suffering from severe pain that millions of people face in India and around the world. In the role of a clinician, health program manager, academic and activist, Dr. Raj has likely done more than any other advocate to promote the rights of patients with pain to live and die with dignity and access to proper pain treatment.

In India alone, an estimated 1 million patients with advanced cancer suffer from severe pain every year, despite the fact that strong pain relievers, such as morphine, are inexpensive, safe, highly effective and simple to administer. The suffering of these people is so severe that the UN Special Rapporteur on Torture has held that denial of appropriate analgesics can constitute cruel, inhuman and degrading treatment. Dr. Raj has devoted his career to ensuring that patients in pain are not subjected to this torture.

In 2009 Human Rights Watch released a report, Please Do Not Make Us Suffer Anymore, in which patients in India who suffered from severe and untreated pain “expressed the exact same sentiment as torture survivors: all they wanted was for the pain to stop.” Patients who are denied access to adequate pain treatment have often told doctors that they would prefer death over the unbearable pain they are forced to endure.

After extensive palliative care training, Dr. Raj traveled through rural Kerala setting up palliative care services to provide home-based care to patients too sick to come to his clinic. The network of palliative care providers that emerged from this work is widely recognized as the most successful community-based palliative care program in the world. In 1996, the World Health Organization recognized it as a demonstration project.

For many years, Dr. Raj passionately tried to convince the Indian government to reform its outdated narcotics regulations and in 1997 filed a complaint with the Delhi High Court arguing that the failure of the government to ensure the availability of morphine was a violation of human rights and India’s constitution. In a clear tribute to his tenacity and eloquence, in 1998 the Indian government recommended that states adopt new regulations that would simplify access to morphine for healthcare institutions, saying that the old rules caused “undue suffering and harassments." Following this success, Dr. Raj organized workshops for healthcare providers, drug regulators and health policymakers in more than a dozen states to ensure the successful implementation of the new recommendation. Due to these efforts, 14 of India's states have now adopted the model rule. However, despite Dr. Raj’s diligent efforts, the Indian government still failed to meet the basic standards set forth by the recommendations. In response, Dr. Raj has taken the case to the Supreme Court of India, where the case is currently under consideration.

Meanwhile, Dr. Raj continues to improve the quality of life for patients suffering from untreated pain by setting up palliative care units in hospitals across India, training doctors and nurses in palliative care and pain management, securing licenses for morphine, and continuing to put pressure on the Indian government to minimize the harsh regulatory barriers that deny patients access to proper pain medication.

Dr. Raj is one of the undisputed leaders of the palliative care movement worldwide, and he has been a valued partner of the Open Society Foundations for many years. His work is motivated by the conviction that no human being, no matter how sick or poor, should suffer from pain in cruel, inhuman and degrading conditions. It is no exaggeration to say that without Dr. Raj’s leadership, Kerala would not be a global model for community-based palliative care today.

Shruti Sharma, a breast cancer patient in India said of her pain “I would sleep maybe an hour and a half per night. I could take any number of sleeping pills [without effect]. With morphine, I can relax. This place [the palliative care unit] is heaven-sent.” Thanks to Dr. Raj’s dedication, enthusiasm, and passion, more patients in India, like Shruti, are able to share in her optimism and finally find the relief to unbearable pain that they deserve.

5 Comments

We need to raise our voices to ensure availability to Opioid to those who need it most

Hey Dr. Raj, you are doing good work in terms of Pain Relief Treatments for sick and dying in India. Keep up the good work. Yes Dr. Jana there is a dire need to ensure availability to Opioid to the needy ones.

This is indeed a great endeavor!

where is the palliative care unit established in the state of Andhra pradesh?

can anyone share some info?

Palliative Care Dr. Raj's work is highly appreciable. Help Age India / HI International are also doing such jobs and Govt. need to allot more funds for encouraging such humane activities.

Here in the USA I have witnessed the withholding of morphine by RN's lacking empathy (yes, not all nurses are compassionate souls, some are control freaks) in nursing homes within days of patients dying of cancer and while under so-called hospice care that wasn't on the premises and could not be accessed. We have a sick health care system in the United States -- it is not advanced as many European countries are in many quality of life arenas.

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