Pallium India demonstrates the power of volunteers

  IMG_4376  K.N. Nair

Imagine if respected members of the community could help teams of doctors and nurses do effective home visits to care for immobile or terminally ill patients. Volunteers at Pallium India have done exactly that in the state of Kerala in the south of India. Pallium India provides inpatient and outpatient palliative care for seriously ill patients and is currently hosting our group from the University of Iowa.

Pallium India faced the challenge of how to get health workers to remote areas and to maintain contact with patients and their families. Their innovative solution was to train community members as a primary point of contact for the patients and their families. Over 2000 people in the state of Kerala have volunteered to act in this liaison role between their community and Pallium. They underwent a 2 day training—8 hours of classroom work and 8 hours of practical training during home visits.

Volunteers at Pallium are respected and crucial members of the team before, during and after the home visit. First, they make sure that the vehicle carrying the team does not lose precious time trying to find the right house.   Getting lost can be demoralizing for a team, but more importantly, it robs time from the patients and families.

Bhaskanan Pillai (on the right, with a patient)

Pallium volunteers come to the home visit, update the team on the interval since the last home visit, keep the paperwork straight, stay current on the new plan and how soon the volunteer needs to assess the patient for a response to any change in therapy. The opinions of the volunteer are voiced and trusted.   Sometimes the volunteer better understands the level of caregiver fatigue, or knows the family or the history better than the rest of the team.

                                                                   New volunteer with me and the Pallium nurses

Volunteers serve Pallium because of their own personal stories or due to the full spectrum of care that Pallium provides without regard for the ability to pay. Some volunteers work every day (and have their cell phone on at night). The volunteers build support for Pallium in their communities. In turn, Pallium has trained them well and there is no question about their role on the team.

Well done Pallium India! Creative use of team work and resources to optimize care and to ensure good follow up for patients!

Thanks again to Professor J0 Eland for her photos and to Team Iowa for their humanism and perceptive engagement during home visits and in class.



Pallium India


University of Iowa is sending its 1000th student to India during Winter Term 2015 in a program that has been the brainchild of emeritus geography professor Dr Rangaswamy Rajagopal for over 5 years.

Among other programs in art, engineering, physical diagnosis and special education, Dr. Rajagopal asked the internationally renown Dr. M.R. Rajagopal (no relation) to host students in the palliative care program he leads, Pallium India. You can (and should) read Dr.Hannah Fox’s blog about the challenges of providing access to pain control in a country where morphine has not been historically available.

With their average census of 600, Pallium India teams provide outpatient clinics, home visits and inpatient care. Today I just came back from a home visit day in the countryside in which the Pallium team (doctor, nurses and volunteer) saw 9 immobile patients in their homes because they could not come to clinic. Pallium services were free to them because they meet the financial criteria for government food subsidies.

They had a variety of medical illnesses: stroke, advanced colon cancer, trauma, polio sequelae, dementia, prostate cancer.   They were all cared for by their families. The nurses asked me how we did home visits and took care of the elderly in our country. They were startled to hear that the elderly frequently are cared for outside the home.


The day started early and we drove to the rural community and stopped at the home of a community Pallium volunteer who stayed with the Pallium and Iowa teams throughout the day to make sure that we found the homes easily and could provide follow up afterwards. We hiked to some homes and drove directly to others. The Iowa team felt an enormous privilege to be with this highly respected clinical team. We gathered what we could in the clinical interactions, all conducted in Malayalam, the language of Kerala.

The Pallium team stopped for lunch at a roadside restaurant. The Iowa team had decided to have snacks while the Pallium team ate their rice with curries and condiments—all super chili hot and served on a large banana leaf.

We also learned what we could about the local economy. Rubber trees were everywhere we went. The families appeared
to be collecting sap in coconut shells.     The sap is manipulated in some way to produce what looks like dirty dish towels hanging on the line, but has the feel of vinyl. The dog mistakenly thinks it is the focus of this photo.


Our Iowa team was moved today by being invited into homes to bear witness to the accomplishments of Pallium India and the courage of families caring for their loved ones with ingenuity (see the pulleys for one of our patients) and love.


My thanks to Jo Eland, my fellow faculty member for her superb photos.