Open source · voice first · palliative care

Palli Sahayak पल्ली सहायक

Ask a palliative-care question out loud, in your own language, from an ordinary phone, and hear a short, careful answer drawn from curated care guidance.

Palli Sahayak in brief: what it does, how it answers, its guard rails and how it extends. Narration is a synthetic voice; the conversation excerpt is fictional.

Watch the full film · 19 min Read the code on GitHub

An ongoing project. Phase-one expert review on synthetic cases; not yet tested with real patients.

Why it matters

The care exists. The answers don't reach the bedside.

Palliative care eases pain, breathlessness and fear for people living with serious illness. Much of it can happen at home, with family and the community health workers who visit, if the people in the room can get a clear answer in a language they speak.

<2 in 100of the more than ten million people in India who need palliative care receive it¹

1M+ASHA workers are the first link to care in rural India, with no standard training in palliative care

22scheduled languages, while most palliative-care guidance is written in English

What it does

A knowledgeable colleague on the phone

Ask by voice

Call a phone number from any phone, send a WhatsApp text or voice note, or talk in the browser. No app to install, no screen to read.

Answers from a curated library

It looks the question up in a small, local library of palliative-care guidance, searched by meaning, and replies in two or three spoken sentences built from what it found. Not the open internet.

Guard rails built in

It never gives specific medicine doses. Danger signs get one answer: call 108 now. When a person is needed, it records a request for a clinician.

What it doesn't do: examine anyone, replace a nurse's or doctor's judgement, or send an ambulance. The person at the bedside stays the decision-maker.

How it works

From a spoken question to a spoken answer

These diagrams describe the code as it stands today in the open-source repository, including the parts that are built but switched off.

Ways inPhone call (no app or mobile data needed) · WhatsApp text or voice note · browser voice
Speech to textIndian-language speech recognition; in the browser, a live voice model
Safety screenRed-flag words, in five languages · a request to talk to a person
Search the libraryLocal, curated palliative-care documents, searched by meaning, across languages
Write the answerA language model drafts two or three short sentences from the passages it found
Check the answerA dose guard removes medicine doses · an evidence badge grades confidence A–E
SpeakThe answer is spoken back in the caller's language

Around it

Clinician reviewAll critical answers, half of the flagged ones and 5% of the rest are queued for clinicians to review; a separate console lets doctors grade answers to test cases

Handoff requestsRecorded for a supervising clinician to follow up

Medication remindersOutbound voice calls, confirmed with a key press

Language layerWhich languages each part hears and speaks is set in configuration

Knowledge-graph checkCross-checks drafted answers against a map of symptoms, medicines and side effects. Built, switched off by default

System architecture. One pipeline serves every way in. Dashed: built, but off by default.

1 · The caller asksout loud, in their language

2 · Speech to text

Red-flag words?yes →no ↓

3 · Asked for a person?if yes, a handoff request is recorded for a clinician

4 · Search the library

5 · Draft a short answeronly from the passages found

6 · Remove any doses · add an evidence badge

7 · Speak the answer

Red-flag words heard

Skip the AI answer

Tell the caller to call 108 nowwith what to do in the meantime

Flag the call as urgentfor clinicians to review

One call, including the emergency path. Red-flag words are listed today for English, Hindi, Bengali, Tamil and Gujarati. Palli Sahayak does not dispatch an ambulance.

Check speech supportRecognition for the language (a speech service or the live voice model), and a voice to answer in. Without one, answers fall back to Hindi speech.
Switch it on in configurationAdd the language code to the speech, live-voice, phone-line and enabled-language lists. No new app, no new code path.
Localise the safety layerRed-flag words, emergency messages and dose-guard wording in the new language.
Clinicians test and approveBefore anyone relies on it.

Punjabi today

Speech recognition and a voice, through the speech service
Not yet in the live voice model; phone calls answer in Hindi
No red-flag words yet

So it isn't ready for use. The library itself needs no translation: search works across languages, and local care guidelines can be added.

How a new language is added. Mostly configuration and clinical review, not new software.

Hear it

Three conversations

Fictional · synthetic demo. These conversations are made up, with no real patients, families or health workers. They are realistic illustrations of how the tool is meant to respond, not clinical advice.

Tamil · a daughter, about her mother · cancer pain and weight loss

Daughterஹலோ… அம்மாவுக்கு… அது வந்து, கேன்சர். கீமோ எல்லாம் ஆறு மாசம் முன்னாடியே முடிஞ்சிடுச்சு, ஆனா இப்போ ராத்திரியானா வலியில அழுறாங்க…(Hello… my mother… um, she has cancer. Chemo and all finished six months back, but now, every night, she cries with pain…)
Palli Sahayakவணக்கம். சொல்லுங்க, கேக்குறேன். இந்த ராத்திரி வலி எத்தனை நாளா இருக்கு?(Hello. Go on, I'm listening. How many days has this night pain been there?)
Daughterஒரு வாரம்… இல்ல, பத்து நாள். முன்னாடி முறுக்கு சுட்டு எல்லாருக்கும் குடுப்பாங்க… இப்போ ஒரு இட்லி கூட வேணாங்கறாங்க, மெலிஞ்சுட்டாங்க.(A week… no, ten days. She used to make murukku for everyone… now she won't even have one idli; she's got so thin.)
Palli Sahayakமுறுக்கு செஞ்சு குடுப்பாங்களா… இப்போ தண்ணி குடிக்கறாங்களா? ராத்திரி தூங்கறாங்களா?(She used to make murukku… Is she drinking water now? Does she sleep at night?)
Daughterதண்ணி கொஞ்சம் குடிக்கறாங்க. தூக்கம்— இல்ல, தூக்கமே இல்ல. தம்பி துபாய்லேர்ந்து டெய்லி போன் பண்றான்…(She drinks a little water. Sleep— no, no sleep at all. My brother keeps calling from Dubai every day…)
Palli Sahayakஇது கஷ்டமான நேரம். நீங்க நல்லா பாத்துக்கறீங்க. டாக்டர் வலிக்கு மருந்து எழுதிக் குடுத்திருக்காங்களா?(This is a hard time. You're looking after her well. Has the doctor prescribed medicine for the pain?)
Daughterஆமா, குடுத்திருக்காங்க. ஆனா… வலி வந்தா மட்டும்தான் குடுக்கறோம், பழகிடும்னு பக்கத்து வீட்டு அக்கா சொன்னாங்க.(Yes, they have. But… we only give it when the pain comes, the lady next door said she'd get used to it.)
Palli Sahayakடாக்டர் சொன்னபடியே குடுங்க. நேரம் குறிச்சிருந்தா, வலி வரும் வரை காத்திருக்காதீங்க. அளவை நீங்களே மாத்தாதீங்க; சந்தேகம் இருந்தா டாக்டர்கிட்ட கேளுங்க.(Give it just as the doctor said. If times are set, don't wait for the pain. Don't change the amount yourself; if you're unsure, ask the doctor.)
Daughterசரி… சரி. சாப்பாடு— கொஞ்சமாவது வற்புறுத்தணுமா?(Okay… okay. Food— should I push her to eat at least a little?)
Palli Sahayakகட்டாயப்படுத்தாதீங்க. அவங்களுக்கு பிடிச்சதை கொஞ்சம் கொஞ்சமா குடுங்க. வாய் வறண்டா, அடிக்கடி கொஞ்சம் தண்ணி குடுங்க.(Don't force her. Give small amounts of what she likes. If her mouth gets dry, give little sips of water often.)
Daughterம்ம்… ஒரு நிமிஷம், இன்னொண்ணு… எப்போ ஹாஸ்பிடலுக்கு கூட்டிட்டுப் போகணும்?(Mm… wait, one more thing… when should I take her to the hospital?)
Palli Sahayakஇன்னைக்கே உங்க நர்ஸ் அல்லது டாக்டர்கிட்ட பேசுங்க. வலி திடீர்னு ரொம்ப அதிகமானா, உடனே 108-க்கு போன் பண்ணுங்க, நர்ஸுக்கும் சொல்லுங்க. நீங்க தனியா இல்ல.(Talk to your nurse or doctor today. If the pain suddenly gets much worse, call 108 for emergency help right away, and tell your nurse too. You're not alone.)

Hindi · an ASHA worker in Uttar Pradesh · two households: cancer pain, then breathlessness

ASHA workerनमस्ते… मैं आशा दीदी बोल रही हूँ। वो… क्या है ना, गाँव में एक कैंसर के मरीज़ हैं, दर्द की बहुत तकलीफ़ है।(Hello… this is the ASHA didi speaking. Um… it's like this, there's a cancer patient in the village, he's really suffering with pain.)
Palli Sahayakनमस्ते दीदी। दर्द कब से है? रात को सो पाते हैं?(Hello, didi. Since when has the pain been there? Can he sleep at night?)
ASHA workerदो हफ़्ते… नहीं, बीस दिन हो गए। रात भर कराहते हैं, खाना भी छोड़ दिया है। आज तो रास्ते में पानी भरा था, बड़ी मुश्किल से पहुँची।(Two weeks… no, twenty days now. He groans all night, and he's stopped eating. The road was flooded today, I barely made it there.)
Palli Sahayakपानी में भी पहुँचीं, बहुत अच्छा किया। डॉक्टर ने दर्द की दवा लिखी है? घरवाले कैसे दे रहे हैं?(You made it through the water, that was good of you. Has a doctor prescribed pain medicine? How is the family giving it?)
ASHA workerलिखी तो है… हम्म, पर घरवाले कभी-कभी ही देते हैं, कहते हैं आदत पड़ जाएगी। और खाना ज़बरदस्ती खिलाते हैं।(It's prescribed… hmm, but the family gives it only now and then, they say he'll get hooked. And they force him to eat.)
Palli Sahayakदवा ठीक वैसे दें जैसे डॉक्टर ने लिखी है, मात्रा खुद न बदलें। आदत की चिंता हो, तो डॉक्टर से बात करें। खाना ज़बरदस्ती नहीं, जो पसंद हो, थोड़ा-थोड़ा।(Give the medicine exactly as the doctor wrote it, and don't change the amount. If they worry about getting hooked, talk to the doctor. No forcing food, just a little of what he likes.)
ASHA workerहाँ हाँ… समझ गई। अच्छा, दूसरे घर में दादाजी हैं, साँस की पुरानी बीमारी, दो कदम में साँस फूल जाती है।(Yes, yes… got it. Okay, in the other house there's a grandfather, an old breathing illness, two steps and he's out of breath.)
Palli Sahayakअभी आराम से बात कर पा रहे हैं? होंठ नीले तो नहीं हैं?(Can he talk comfortably right now? His lips aren't blue?)
ASHA workerबात तो कर रहे हैं… होंठ— रुकिए, देखती हूँ… नहीं, ठीक हैं। बस घबरा जाते हैं।(He's talking… his lips— wait, let me look… no, they're fine. He just panics.)
Palli Sahayakउन्हें सीधा, थोड़ा आगे झुककर बिठाइए। चेहरे की तरफ़ पंखा रखिए। होंठ सिकोड़कर धीरे-धीरे साँस छोड़ें, और दवाएँ वैसे ही लें जैसे लिखी हैं।(Sit him upright, leaning slightly forward. Keep a fan towards his face. Breathe out slowly through pursed lips, and take medicines just as prescribed.)
ASHA workerठीक है… अच्छा सुनिए, डॉक्टर को कब बुलाऊँ? मतलब— कब तक रुकूँ?(Okay… Listen, when should I call the doctor? I mean— how long should I wait?)
Palli Sahayakदोनों परिवार आज ही अपनी नर्स या डॉक्टर से बात करें। होंठ नीले पड़ें, उलझन हो, बोल न पाएँ, या दर्द अचानक बहुत बढ़े, तो तुरंत 108 पर फ़ोन कीजिए, और नर्स को भी बताइए।(Both families should talk to their nurse or doctor today. If lips turn blue, there's confusion, he can't speak, or the pain suddenly gets much worse, call 108 for emergency help right away, and tell the nurse too.)

Punjabi · a patient · breathlessness · a language not yet ready for use

Patientਸਤ ਸ੍ਰੀ ਅਕਾਲ ਜੀ… ਉਹ… ਮੈਨੂੰ ਸਾਹ ਦੀ ਪੁਰਾਣੀ ਬਿਮਾਰੀ ਆ, ਥੋੜ੍ਹਾ ਤੁਰਾਂ ਤਾਂ ਸਾਹ ਚੜ੍ਹ ਜਾਂਦਾ।(Sat Sri Akal ji… um… I've got this old breathing illness, I walk a little and I get breathless.)
Palli Sahayakਸਤ ਸ੍ਰੀ ਅਕਾਲ ਜੀ। ਇਸ ਵੇਲੇ ਆਰਾਮ ਨਾਲ ਗੱਲ ਕਰ ਪਾ ਰਹੇ ਹੋ?(Sat Sri Akal ji. Can you talk comfortably right now?)
Patientਬੈਠਾ ਹਾਂ ਤਾਂ ਠੀਕ ਆ। ਪਰ ਰਾਤ ਨੂੰ… ਘਬਰਾਹਟ ਜਿਹੀ ਹੁੰਦੀ ਆ, ਪੋਤੇ ਦੇ ਪੇਪਰ ਨੇ, ਉਹਨੂੰ ਜਗਾਉਣਾ ਨਹੀਂ ਚਾਹੁੰਦਾ।(Sitting down it's fine. But at night… a sort of panic comes, my grandson has exams, I don't want to wake him.)
Palli Sahayakਪੋਤੇ ਦਾ ਇੰਨਾ ਖ਼ਿਆਲ, ਚੰਗੀ ਗੱਲ ਹੈ। ਕਿੰਨੇ ਦਿਨਾਂ ਤੋਂ ਵਧਿਆ ਹੈ? ਬੁਖ਼ਾਰ ਜਾਂ ਛਾਤੀ ਵਿੱਚ ਦਰਦ ਤਾਂ ਨਹੀਂ?(You think of your grandson, that's kind. For how many days has it been worse? Any fever or chest pain?)
Patientਤਿੰਨ… ਨਹੀਂ, ਚਾਰ ਦਿਨ। ਬੁਖ਼ਾਰ ਨਹੀਂ, ਦਰਦ ਨਹੀਂ। ਬੱਸ ਮੱਝ ਨੂੰ ਪੱਠੇ ਪਾਉਣ ਗਿਆ, ਓਥੇ ਹੀ ਸਾਹ ਚੜ੍ਹ ਗਿਆ।(Three… no, four days. No fever, no pain. I just went to feed the buffalo, and got breathless right there.)
Palli Sahayakਡਾਕਟਰ ਦੀਆਂ ਦਿੱਤੀਆਂ ਦਵਾਈਆਂ ਲੈ ਰਹੇ ਹੋ?(Are you taking the medicines the doctor gave you?)
Patientਹਾਂ ਜੀ, ਲੈਂਦਾ ਹਾਂ… ਪਰ ਕਦੇ-ਕਦੇ— ਸੱਚ ਦੱਸਾਂ ਤਾਂ ਭੁੱਲ ਜਾਂਦਾ ਹਾਂ।(Yes ji, I take them… but sometimes— to tell the truth, I forget.)
Palli Sahayakਦਵਾਈਆਂ ਉਸੇ ਤਰ੍ਹਾਂ ਲਓ ਜਿਵੇਂ ਡਾਕਟਰ ਨੇ ਦੱਸਿਆ ਹੈ। ਮੈਂ ਯਾਦ ਕਰਵਾਉਣ ਲਈ ਫ਼ੋਨ ਕਰ ਸਕਦੀ ਹਾਂ।(Take the medicines just as the doctor said. I can call you to remind you.)
Patientਹਾਂ ਹਾਂ… ਇਹ ਠੀਕ ਆ। ਤੇ ਰਾਤ ਨੂੰ ਘਬਰਾਹਟ ਹੋਵੇ, ਉਦੋਂ ਕੀ ਕਰਾਂ?(Yes, yes… that's good. And at night, when the panic comes, what do I do?)
Palli Sahayakਸਿੱਧੇ, ਥੋੜ੍ਹਾ ਅੱਗੇ ਝੁਕ ਕੇ ਬੈਠੋ। ਮੂੰਹ ਵੱਲ ਪੱਖਾ ਰੱਖੋ, ਤੇ ਬੁੱਲ੍ਹ ਸਿਕੋੜ ਕੇ ਹੌਲੀ-ਹੌਲੀ ਸਾਹ ਛੱਡੋ।(Sit upright, leaning slightly forward. Keep a fan towards your face, and breathe out slowly through pursed lips.)
Patientਠੀਕ ਆ ਜੀ… ਇੱਕ ਮਿੰਟ, ਹੋਰ ਕੁਝ ਪੁੱਛਣਾ ਸੀ… ਹਾਂ, ਹੋਰ ਕੀ ਧਿਆਨ ਰੱਖਾਂ?(Alright ji… one minute, there was something else… yes, what else should I watch for?)
Palli Sahayakਅੱਜ ਹੀ ਆਪਣੀ ਨਰਸ ਜਾਂ ਡਾਕਟਰ ਨਾਲ ਗੱਲ ਕਰੋ। ਬੁੱਲ੍ਹ ਨੀਲੇ ਹੋਣ, ਉਲਝਣ ਹੋਵੇ ਜਾਂ ਬੋਲ ਨਾ ਸਕੋ, ਤਾਂ ਤੁਰੰਤ 108 ਤੇ ਫ਼ੋਨ ਕਰੋ, ਤੇ ਨਰਸ ਨੂੰ ਵੀ ਦੱਸੋ।(Talk to your nurse or doctor today. If your lips turn blue, you feel confused or can't speak, call 108 for emergency help right away, and tell your nurse too.)

Phase one

What doctors said

In the project's first phase, four palliative-care doctors, two from Max Healthcare and two from Pallium India, each reviewed the same 40 made-up cases: 20 of advanced lung cancer and 20 of COPD. Each read one written English answer per case, not the voice and not the other languages: 160 reviews in all.

Mean overall score

7.8 / 10

Would the doctor use the answer? (160 reviews)

954421

use as is with revisions no

All four doctors said yes together for only 3 of 40 cases, and they often disagreed with one another.
In 12 of 40 cases, at least one doctor rated safety 2 out of 5 or lower. Their comments raised concerns about emergency escalation and medication advice.
Good scores on average, with real safety worries in the details. The work continues: flagged answers will be revised.

The full film

Palli Sahayak: a voice in your phone for palliative care

19 minutes: the access gap, how the tool finds an answer, its guard rails, three fictional conversations and the phase-one review. Narration is a synthetic voice.

Open source

Use it, adapt it, help improve it

Palli Sahayak is released under the MIT licence. Anyone can read the code, run it and adapt it for another language, region or care setting.

Read the codegithub.com/inventcures/rag_gci Run it yourselfQuick start in the repository Add a languageWhat it takes, step by step Report an issue or suggest a fixGitHub issues

Acknowledgements

We thank the Gates Foundation and BIRAC (Biotechnology Industry Research Assistance Council, Government of India) for supporting this work under Grand Challenges India.

Clinical partners: Pallium India and Max Healthcare. Team: Dr Anurag Agrawal and Ashish Makani, Ashoka University.

Knaul FM et al. Alleviating the access abyss in palliative care and pain relief. Lancet 2018;391:1391–1454. doi:10.1016/S0140-6736(17)32513-8