NO. OF DAYS CARED FOR : 191

Aged 14 years, Suchitra was a very sweet young girl. She lived in a thatched hut, which had no electricity, with her mother, an elder brother and elder sister; both daily wage earners. Her father had died of diabetes. When Suchithra developed bone cancer her mother had to stop working, to attend to her daughter's medical needs.

One day, Suchitra fractured her left thigh bone on falling down. Not realizing that it was cancer which caused this injury they promptly went to a local native osteopath, who didn't diagnose the disease. He applied some oil and herbal medicine and put her leg in a cast/bandage. They were asked to return but could not make it to the doctor.  So they themselves opened the dressing and to their shock found that there was a swelling and an ulcer and that the thigh was distorted and bent. Fearing that something serious had happened they rushed to a very large government hospital. She was admitted and investigations done which established the diagnosis as a malignant bone tumor (technically known as Osteogenic Sarcoma). This had caused the fracture, ulcer and the deformity of the thigh. It was too advanced for any curative treatment and so they dressed the ulcer and applied Plaster of Paris support (splint) to prevent further pain and damage at the fracture site. The doctors advised amputation which she refused when she was told that it wouldn't stop the spread of the disease. They sent her home saying that curative treatment was impossible due to the advanced nature of the disease.

That's when DEAN Foundation entered Suchitra's world. For the initial examination, the DEAN Foundation team opened the plaster casts and inspected the limb. There was a huge swelling on the knee and the thigh was bent and deformed. There was an infected ulcer on the front of the knee (2"x2") and another small one nearby. Movement of the leg was very painful. The heel was very tender due to pressure and weight of the leg falling on the heel. The team cleaned and dressed the ulcers with ointment and put back the plastic casts. Her liver was enlarged and palpable. To control her fever, pain and headache, antibiotics, painkillers, (particularly morphine injection and tablets), some steroids and intravenous fluids, anti-emetics and some vitamins were given. Horlicks, fruits, mattress and ice cream were also taken as a special treat. Home visits were made every alternate day. DEAN Foundation also entertained her by taking their pet monkey to play with her. She enjoyed the visits very much. With the support of Rotary Club members a theatre was arranged and few vacant rows reserved for viewing a Tamil movie, something she hadn't done ever since she had become ill. This was followed by a visit to the beach and dinner at a restaurant, all on a stretcher. A few weeks later, Suchitra passed away peacefully.

Keywords: Rural healthcare services, Palliative care, Hospice care, Pediatric Palliative Care, End-of-life care, Symptom management, Holistic support, Emotional counseling, Family training, Patient dignity.