A REPORT ON FIELD VISIT TO

“HOSPICE CARE
CENTRE
(SHANTI AVEDNA
SADAN)”

Submitted to: Submitted by:

Ms. Tarika Sharma Ms. Anam Ansari

Lecturer M.Sc. Nursing 1st yr

CON, ILBS CON, ILBS

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 INDEX

CONTENT PAGE NO.

Introduction

Purpose of visit

Person met during visit

Activities performed

Observations related to functioning

Major findings

Overall observation

Challenges experienced

Lessons learned

Recommendations

Conclusion

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DATE OF FIELD VISIT : 26/04/2019

ORGANIZATION VISITED : Hospice care centre- Shanti Avedna Sadan

VISITED BY : GROUP : M.Sc. Nursing 1st year

TOTAL NUMBER : 14

FACULTY/ MENTOR ACCOMPANIED : Ms. Tarika Sharma

ABSTRACT :

We visited Shanti Avedna Sadan which is situated in Safdarjung Enclave, Factory Road, Near
Safdarjung Hospital, New Delhi, Delhi 110029. We learned about its location, hierarchy and
functions that it performs. It provides care to terminally ill patient. Shanti Avedna Sadan is
India’s very first Hospice for the care of the advanced and terminally ill Cancer patients.

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ROUTE MAP

PHYSICAL LAYOUT

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INTRODUCTION
As a part of our field visit requirement, we have visited Shanti Avedna Sadan which is India’s
very first Hospice for the care of the advanced and terminally ill Cancer patients.

The Shanti Avedna Sadan is India’s first Hospice, an institution that takes care of the advanced
terminally ill Cancer patients. It is neither a hospital nor a home, but is in fact both, offering the
specialized care of a hospital together with the love of a home.

. So, by the means of this visit we learned how it is performing all the functions.

OBJECTIVES OF HOSPICE CARE CENTRE

General objective:
At the end of the educational visit to Shanti Avedna Sadan, students will understand and
appreciate the aims, functioning and roles of this centre.

Specific objectives:
At the end of the educational visit to Shanti Avedna Sadan, students will be able to :

 Get acquainted with the physical set up and organizational structure of Hospice care
centre.
 Discuss the vision and objectives of Shanti Avedna Sadan.
 Know its structure of organisation.
 Know its constitution and functioning.
 Identify the organisation which gives financial support to it.
 Identify the Process of admission of patients.
 Find out the problems faced by the management.
 Understand challenges faced by people working in hospice centre.
 Find out common social problem among relatives of patients.
 Know the daily activities performed by nurses and care takers of patients in regard of
care of patients.
 Understand the psychological status of patients’ attendants and acknowledge the
provisions given to them.

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LOGO OF SHANTI AVEDNA SADAN

The Logo shows a strong hand holding a weak hand to signify support, comfort and consolation
in the hour of need, within the flame of love under the roof of the Sadan. Shanti means peace,
Avedna signifies absence of Pain and Sadan is a home. Shanti Avedna Sadan therefore literally
means “Peace in the absence of pain home”. The Logo also has the words St.Augustine: “Where
there is love, there is no pain”, which continues as, “if there is pain, it is a pain that is loved!”

THE AIMS OF THE INSTITUTION

1. To care for the advanced and terminally ill Cancer patients and those cancer patients
suffering from AIDs also.
2. To offer this care to all who need it, irrespective of community caste or creed.
3. To give preference to the poor and needy
4. To five this care totally free of cost.
5. To conduct research for palliation in advanced Cancer.

MANAGEMENT STRUCTURE
The Sadan is managed by a Governing Body consisting of five Trustees and other Board
members as follows:

 Cardinal Ivan Dias : Patron Trustee

 Dr.L.J.de Souza : Managing Trustee
 Sr.Ancy Kottuppalli : Administrator/Trustee
 Mrs. Carmen de Souza : Trustee
 Dr.Satyavati Sirsat: Trustee

MEMBERS

 Dr.Sateesh R. Gupte
 Mr. Anil K. Nehru

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  Mr.Walter Saldanha
 Mr.Jamshed Kanga
 Mr.Homi Ayrton
 Mr.Rapheal Donald
 Air Marshal Denzil Keelor
 Mr.Julio Ribeiro

New Delhi hospice centre staffing:

 2 Doctors
 v7 Nurses
 20 Helping Aids
 Class 4 Employees
 Volunteers
 Counselors
 Rehabilitators
 Clergy

NGO UNDER WHICH IS FUNCTIONING

The Shanti Avedna Sadan is entirely a non-governmental voluntary organization, run by a
Charitable Trust.

The Shanti Avedna Sadan Trust is a Charitable Trust , registered under the Societies Registration
Act of 1860 No.BOM 173/78 G.B.B.S.D and the Bombay Public Trusts Act 1950, No.F-4862
(Bom) of 1978.

OTHER BRANCHES
The main Branch is in Mumbai, situated in Bandra, with Branches in Delhi, near Safdarjung
Hospital, and another Branch in Goa, in the village of Loutulim.

CAPACITY
 The main Branch in Mumbai, with the new extension can accomodate upto 100
inpatients, in five patient wards of 10 beds each and fifty patients in double-bedded
rooms.
 The Branch in Delhi has a capacity of 40 beds, with one floor for the males and one for
the females.
 The Branch in Goa is in a village setting, with small wards and rooms to accommodate
upto 20 patients.

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The Shanti Avedna Sadan is a service organization where absolutely no charges are levied.
Hence, there are no private rooms in any of the Branches. The patients are always encouraged to
be in the wards, as they can be looked after better and never remain lonely. The single rooms are
not given on request, but are allotted by the nursing staff according to the needs of the patients.
Each bed in the ward in all the Branches, however, can be curtained off for individual privacy
and comfort when needed. Further, in Mumbai, each bed has a beautiful serene view of the
Arabian Sea. Also, all the wards and rooms are well lit and ventilated.

CARE GIVEN
The care given is to make the patient as symptom free and comfortable as is possible. The needs
of a terminally ill patient are many: medical, nursing, mental, social, spiritual and financial. The
care given, therefore is with a team effort, each member of the team looking after the needs of
the patient in his or her specialty. The team consists of doctors, nurses counselors, volunteers and
spiritual advisors, to offer “total: care to the patient.

CANCER TREATMENT GIVEN

No specific treatment for the Cancer is given, as all this has already been exhausted before the
patient is admitted. Besides, there are no infrastructure facilities for Cancer treatment, and hence
it would be unfair to any patient who can still benefit from Cancer treatment, even for palliation,
to be admitted in the Sadan.

EXTRAORDINARY LIFE MAINTAINING MEASURES USED

Our goal is to “Add life to days, and not days to life”. A terminally ill patient who has no hope
for recovery, will not benefit from any extraordinary life maintaining measures, like a respirator,
intravenous drips or alimentation, blood transfusions, etc. These measures make the patient more
uncomfortable and miserable and uselessly prolong suffering. They are hence strictly avoided.

NEED FOR AN INTENSIVE CARE UNIT

It follows that if extra-ordinary life maintaining measures are not contemplated, then the ICU is
the very last place a terminally ill patient should be placed in. Instead, they should be in their
own bed, surrounded by the family and friends, and the discomfort of unnecessary supportive
measures.

SYMPTOMATIC CARE

The relief of distressing symptoms is the primary goal of palliative care. Once the patient is free
from symptos, especially severe pain and other distressing symptoms of Cancer like breathing
difficulty, nausea and vomiting, cough, sleeplessness etc., he/she becomes a different person and
can then attend to their other needs. Symptomatic care is therefore individualized to the needs of

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each patient with all the necessary medication needed, to make him or her as comfortable as
possible.

PAIN CONTROLLING MEASURES

Pain is first evaluated to detect its cause, site and intensity. It is then graded as mild, moderate or
severe, and accordingly treated. Mild pain is treated with mild analgesics like NSAIDS and
others, moderate pain is treated with mild opiates like Codeine and severe pain is managed with
strong opiates like Morphine. The pain medication is preferably given orally wherever possible,
by the clock – every four hours for a cumulative effect, and constantly monitored as per needs of
the patient so that he/she remains totally pain free.

Opiates

Opiates are obtained from the poppy plant and are the best drugs to control severe pain. The
main drug used is Morphine, which is best used in the oral form, whenever possible. The dose is
gradually increased till the patient becomes pain free. It is also continued with other supportive
drug groups, which help to reduce the dosage and increase the response.

Side effects of Morphine

What Morphine is initially given, there may be some nausea, drowsiness, and disorientation.
These are transient side effects which are controlled with medication and pass away once the
patient gets used to the Morphine. The main side effect of all opiates is constipation. This has to
be anticipated by giving the necessary laxatives and mechanical bowel cleaning, when opiates
are started so that it does not become a difficult problem.

MYTHS REGARDING OPIATES

There are several myths regarding opiates:

1. It is addictive. Opiates are not addictive when used for pain relief.

2. It makes one a zombie. We have patients on large doses, who are alert and active as ever,
doing everything.

3. Large doses are given. The dose is given per the need. Large doses, even up to several
thousand milligrams can be tolerated because the patient develops an increasing tolerance to the
drug which a normal individual does not have.

Complimentary medicine

There are medications and compounds which have not shown a definite response in the treatment
of Cancer. Some of them have shown some beneficial response in some cases. We intend to us
some of these selected compounds for better palliation of the advanced Cancer patients.

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Holistic medicine

Every human being is a complex fusion of body, mind and soul. Holistic medicine means
treating the patient in all these aspects to give complete care.

Alternate medicine permitted in the Sadan

Alternate systems of medicine like Ayrvedic, Homepathic, Unani, Herbal etc, are often practiced
in our country. We do not permit these systems to be used by outside doctors in the Sadan,
simply because we do not know how they would react with our own medications. We therefore
advise the patient who would like to try these methods, to do it at home or elsewhere, and come
to us when they have finished with them.

The main goal of the treatment

The first goal is to make the patient free of pain and distressing symptoms. Once this is achieved,
we then help them to come to terms with their disease and impending death, so that they accept
the same and are then at peace with themselves, their families and their God.

REFERRALS
Any patient who has advanced Cancer is entitled to this care. It is important however, that all
possible useful treatment for the Cancer has already been given, and the patient will not benefit
from any such further treatment, even for palliation. Our doctors very carefully screen the patient
to confirm this, before admission. Preference for admission is given to those cases with severe
distressing symptoms and the poor and desititute. All admissions are made irrespective of any
caste or creed.

QUERIES ASKED BY STUDENTS

1. From where do the patients come?

Ans. Most patients are sent from the Cancer hospitals or the general hospitals, not only in
Mumbai, but from all over India. Some also come from private hospitals, or are sent by general
practitioners. Many are also brought by religious and social workers.

2. How are the patients referred?

Ans. We request that a special referral form be filled in by the referring hospital doctor. This is
important for us, as it states the diagnosis of the patient and all the treatment given to the patient.
This information is necessary for us to plan further treatment and care. The referral forms are
available at most referring institutions or can easily be obtained from the Sadan, at no cost.

3. Can the patient come directly?

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Ans. Yes, the patient an come directly also. However, they must bring all records of treatment
given. These are evaluated by our doctors, who then fill the necessary referral form, if the patient
is suitable for admission in the Sadan. We prefer, however, that referral forms are filled by the
referring hospitals or doctors.

4. When is it best to bring a patient?

Ans. Once a decision has been taken that no further active Cancer treatment is possible, the
patient should be brought sooner than later, especially if there are severe distressing symptoms.
This gives us a chance to relieve their symptoms in time and make them more comfortable. It is
of little use to bring gasping patients in their last moments, as there is very little that we can do to
help tem at that stage. It is much better to keep them at home, if the end is almost imminent. It is
more beneficial to bring the patients earlier then later.

5. Can a patient go home after admission?

Ans. Most certainly the patient can go home whenever he/she want to and the family is willing to
look after them. In fact, once the patient is pain and symptom free, we encourage our patients to
go home, and almost 20% of our inmates do so.

6. Can a discharged patient come back?

Ans. Yes, the patient can always come back to the Sadan, if the symptoms or discomfort
increases, or the family finds it difficult to look after them at home.

7. What are the undertakings to be given on admission?

Ans. The person who admits the patient must give celear information of the address and
telephone contacts of the patient. These are important for the staff to contact the family in case
the patient is serious or expires. An undertaking is also taken that the family understands the care
given at the Sadan and accepts the same. In case of destitute cases, an undertaking is taken from
the patient whenever possible, to do the last funeral rites also. This avoids the problem of
handing them over to the police authorities as unclaimed bodies. Whenever necessary the Sadan
performs the last rites for the patient as per his/her religion at our own cost.

8. Are there any charges to be paid at Shanti Avedna Sadan?

Ans. There are no charges whatsoever to be paid either for admission or for any are of service
given at the Shanti Avedna Sadan. There is also no need for any recommendations as all suitable

9. Who gives the Nursing Care?

Ans. The nursing care, which is the most important is given by trained and qualified members of
the nursing order of the Holy Cross Sisters, with much love and devotion. They form the “Heart”
of the Sadan. They are helped by paramedical nursing aides, in all three Branches.

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 10. Who gives the Medical Care?

Ans. The day-to-day Medical Care is given by specially trained doctors in palliative care, in all
our Branches.

visiting groups.

11. What happens when the patient passes away?

Ans. When the patient passes away, the relatives are informed, if they are not already there. The
deceased is washed and dressed and laid in the prayer room for any last rites to be done
according to each religion. The deceased is then given over to the family, with a death certificate
for burial or cremation as desired.

12. From where do the funds come?

All our funds come through voluntary donations from individuals and organizations only. No
grants or maintenance costs are received from any government agency

13. What are the Support Systems available?

Ans. In addition to the main care of our inmates, we also have the following support systems:

A) Out Patient Dept (OPD)

This is mainly for patients who have been discharged from the Sadan and need follow-up
treatment on their medication. Our house doctor is available for the same every afternoon as
required.

B) Day Care Services

This is for patients who would like to stay at home, but like to come in for day care attention
when needed. All necessary care is given on a day care basis.

C) Home Services

We do not have a home care service, but closely liase with other NGOs like ‘Caring Hearts’,
Cancer Patients Aides Association, V-Care etc., who support these services and coordinate with
the Sadan.

14. How does one become a volunteer?

Ans. Our volunteers form a very important part of the support system. To become a volunteer,
the individual must send us a brief personal resume, and fill a questionnaire. These are studied by
our committee to see the suitability of the individual to be a volunteer. If found suitable, the

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application is kept on the waitlist and the person is invited, as soon s there is a vacancy or a
special need arises.

OVERALL OBSERVATION
 The patients are given various relaxation and recreational facilities, such as games, T.V.,
visits to the garden, outings etc.
 They also have an occupational therapist, which teaches and supports occupational therapy to
keep the patients occupied.
 The patient are often visited by groups that entertain them. All major festivals like Diwali,
Christmas, etc are celebrated to bring joy into their lives.
 They, however, strictly do not permit spiritual indoctrination of any kind by visiting groups.
 When the patient passes away, the relatives are informed, if they are not already there. The
deceased is washed and dressed and laid in the prayer room for any last rites to be done
according to each religion.
 The deceased is then given over to the family, with a death certificate for burial or cremation
as desired.
 The funeral rites are as per each person’s religion. When there is no family, the Sadan
undertakes to perform the last rites as needed.

CHALLENGES EXPERIENCED
 Limited time was given to us for visit.

LESSONS LEARNED
 I have learned how to organize a field visit.
 Learned how to take permission from the authority for visit
 Learned how to guide students to the way to the field visit
 Hospice performs very crucial role in providing care to terminally ill patients
 The importance of this initiative in making this hospice centre in our country.
 We have learned that how this organization is working.
 We have learned that it is not just a working organization but it is service to mankind

RECCOMENDATIONS
 I would like to recommend to people to have a visit so that they can be greatful to god
for health and they can learn from selfless love from the staff serving here.

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  We can recommend to any patient who has advanced Cancer is entitled to this care. It is
important however, that all possible useful treatment for the Cancer has already been
given, and the patient will not benefit from any such further treatment, even for
palliation.
 Preference for admission is given to those cases with severe distressing symptoms and
the poor and desititute. All admissions are made irrespective of any caste or creed.

CONCLUSION
 By the means of the visit to Hospice centre I have learned how to organize a visit, the
process of seeking permission from the respective authority, how to make a letter for
taking permission for visit and formulating the objectives of the visit and properly
guiding the students to reach the centreon time. It was a great learning experience as we
came to know about the functioning of the centre, management structure, funding,
admission process, patient care services, care of patient with incurable stage of cancer
and providing and fulfilling their needs at the end of their life. The staff works 24x7, 365
days selflessly for the patients. Providing the patient calm and peaceful, dignified death
keeping in mind their religious beliefs and preferences. I would like to thank sister Tabita
for her warm welcome and taking out time for addressing us and providing us with the
information about the Sadan. I also want to thank Ms. Tarika Sharma organizing faculty
and Dr. Mini George for guiding me to conduct the visit with great success.

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