BACKGROUND Access to palliative care within healthcare systems of low- and middle-income countries (LMICs) has never been more pronounced than in current times. The Lancet Commission Report (2018) estimates that 80% of global serious health-related suffering (SHS), which demands access to palliative care for its relief, are in LMICs. Cancer is a major contributor to SHS and a rapidly growing burden in LMICs. Similar to many LMICs, cancer is a leading cause of death in India. The North-East Region (NER) of India has a high prevalence of cancer and paucity of services for cancer and palliative care. OBJECTIVES To describe the strategies used to initiate and strengthen palliative care services integrated with the comprehensive cancer care initiatives in the state of Assam in NER. METHODS After an initial assessment of the status of palliative care in the NER, a multipronged strategy was adopted that aligned with the WHO framework recommended for initiating palliative care services. A core team working with a government and private collaborative strategized and activated supportive policies, education, and training and improved access and availability to essential drugs, while implementing the components synchronously within the state. SIGNIFICANCE This project demonstrates an informed regional adaptation of the WHO model. It highlights the strengths of integrating palliative care within cancer care program right from its inception. It emphasizes the sustainability of services activated across public healthcare systems, as compared with the donor- or champion-driven initiatives. The outcome of this project underlines the relevance of this model for LMIC regions with similar health systems and sociocultural and economic contexts.

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In this study, the outcomes of assessments of radon exhalation rates for both mass and surface, radium content and annual effective dose from 45 numbers of geological samples in Tiru Valley Coal Field area are presented. The nuclear track detector LR-115 (II) of bulk etch rate, VB = 4 µm h-1 with a spark counter to archive alpha track density of radon was used to measure radon exhalation rate from the samples and to assess radiological exposure in the coalfield area, which has significant geological characteristics. In this work, the surface exhalation rates for coal, carbonaceous shale and sandstone samples have been estimated to be in the range of 217.4-659.9 mBq m-2 h-1, 234.0-381.1 mBq m-2 h-1 and 337.1-741.4 mBq m-2 h-1, respectively. The mass exhalation rates for coal, carbonaceous shale and sandstone samples varied in the range of 6.5-19.8 mBq kg–1 h-1, 7.0-11.4 mBq kg–1 h-1, and 10.1-22.2 mBq kg–1 h-1, respectively. The radium contents have been found to vary in the range of 6.7-20.3 Bq kg-1, 7.2-11.8 Bq kg-1 and 10.4-22.9 Bq kg-1 for coal, carbonaceous shale and sandstone respectively. The annual effective doses related to the inhalation of radon from the exposure to the samples have been estimated to be in the range of 15.8-47.9 µSv y-1, 17.0-27.7 µSv y-1 and 24.5-53.8 µSv y-1 for coal, carbonaceous shale and sandstone respectively. In this investigation, the lifetime fatality-risks have also been assessed. The values were generally higher in rock samples than in coal. However, the findings have shown that the obtained values are within the internationally accepted recommended values.

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