WayForwardForHospiceInMalaysia_DrRanjitOommen
-
Upload
malaysianhospicecouncil6240 -
Category
Documents
-
view
221 -
download
0
Transcript of WayForwardForHospiceInMalaysia_DrRanjitOommen
-
8/14/2019 WayForwardForHospiceInMalaysia_DrRanjitOommen
1/7
WAY FORWARDWAY FORWARD
FOR HOSPICEFOR HOSPICE
ININ
MALAYSIAMALAYSIA
RanjitRanjit MathewMathew OommenOommen
Hospice Movement started inHospice Movement started in
the early 90the early 90ss
1992 Home programs by1992 Home programs by HospisHospis MalaysiaMalaysia
andand PenangPenang Cancer SocietyCancer Society
1993 Hospice at home program,1993 Hospice at home program,KotaKota KinabaluKinabalu
1994 Hospice Malacca and1994 Hospice Malacca and KuchingKuching CancerCancer
carecare
Since then 24 services have mushroomedSince then 24 services have mushroomed
20012001 RumahRumah HospiceHospice PenangPenang
Ministry of HealthMinistry of Health
1995 Palliative Care Unit ,Kota1995 Palliative Care Unit ,Kota
KinabaluKinabalu
Since then more then 20 units andSince then more then 20 units and
numerous support teams set up innumerous support teams set up in
MOH HospitalsMOH Hospitals
20022002 SelayangSelayang HospitalHospital
100 beds available currently/ need for100 beds available currently/ need for
1000 beds1000 beds
99thth Malaysia Plan targets to put up 6Malaysia Plan targets to put up 6
regional Palliative Careregional Palliative Care CentresCentres..
Career structure availableCareer structure available
Clinical guidelines for the practice ofClinical guidelines for the practice of
Palliative care being drawn upPalliative care being drawn up
Post basic nursing course in PalliativePost basic nursing course in Palliative
Care Nursing is being developed.Care Nursing is being developed.
HospisHospis Malaysia with over 350 to400 patients inMalaysia with over 350 to400 patients in
the community at any one time, with 4 doctors,9the community at any one time, with 4 doctors,9
Palliative Care Nurses, Occupational therapist,Palliative Care Nurses, Occupational therapist,
pharmacist and supporting staff has establishedpharmacist and supporting staff has established
the largest home care program and trainingthe largest home care program and training
facility in the country.facility in the country.
Provides foundation course and many otherProvides foundation course and many other
courses through out the year.courses through out the year.
In the process of building an educationalIn the process of building an educational
centrecentre
International recognitionInternational recognition
Increased collaboration for research andIncreased collaboration for research and
other facilitiesother facilities
-
8/14/2019 WayForwardForHospiceInMalaysia_DrRanjitOommen
2/7
RumahRumah HospisHospis and theand the PenangPenang CancerCancer
Society Home Care Program providesSociety Home Care Program provides
seamless care in the private sector.seamless care in the private sector.
Has been instrumental in helping to set upHas been instrumental in helping to set up
home programs in the rest of the countryhome programs in the rest of the country
Has continued to provide training and isHas continued to provide training and is
there ever ready to help others to develop.there ever ready to help others to develop.
KK provides seamless care, a veryKK provides seamless care, a very
successful collaboration between an NGOsuccessful collaboration between an NGO
and MOHand MOH
Can be considered a model unitCan be considered a model unitIntroduced the concept of PCU to theIntroduced the concept of PCU to the
MOH and provided initial training to rest ofMOH and provided initial training to rest of
the country planning to set upthe country planning to set up PCUPCUss
Palliative Care in MedicalPalliative Care in Medical
SchoolsSchoolsPalliative Care has been introduced toPalliative Care has been introduced to
medical students in themedical students in the KlangKlang valley,valley,
PenangPenang, Kota, Kota KinablauKinablau etc Not given theetc Not given the
priority it should get considering the factpriority it should get considering the fact
that to be a good doctor the onethat to be a good doctor the one specialityspeciality
a young doctor needs to know is Palliativea young doctor needs to know is Palliative
Care MedicineCare Medicine
No post graduate degree or DiplomasNo post graduate degree or Diplomas
availableavailable
Palliative care is an approach that improvesPalliative care is an approach that improves
the quality of life of patients and their familiesthe quality of life of patients and their families
facing the problem associated with lifefacing the problem associated with life--
threatening illness , through the prevention andthreatening illness , through the prevention and
relief of suffering by means of early identificationrelief of suffering by means of early identification
and impeccable assessment and treatment of painand impeccable assessment and treatment of pain
and other problems, physical, psychosocial andand other problems, physical, psychosocial and
spiritualspiritual
WHO 2002WHO 2002
Palliative care cannot be confined toPalliative care cannot be confined tocancercancer
It is not only for the urban population.It is not only for the urban population.
It cannot be provided in patchesIt cannot be provided in patches
Why should those dying and sufferingWhy should those dying and suffering
just because they do not have cancerjust because they do not have cancer
be denied the proven benefit ofbe denied the proven benefit of
palliative care?palliative care?
The effectiveness of pain and symptomThe effectiveness of pain and symptom
control has been established over 30 years.control has been established over 30 years.
When clinical guidelines on pain control areWhen clinical guidelines on pain control are
followed 70 to 90% of patients withfollowed 70 to 90% of patients with
advanced cancer gain adequate pain reliefadvanced cancer gain adequate pain relief
Good communication results in improvementGood communication results in improvement
in psychological health and better control ofin psychological health and better control of
symptoms.symptoms.
-
8/14/2019 WayForwardForHospiceInMalaysia_DrRanjitOommen
3/7
There is also preliminary evidence forThere is also preliminary evidence for
the application of models of Palliativethe application of models of Palliative
Care for people with other illness.Care for people with other illness.
A substantial body of opinionA substantial body of opinion
recognizes that this model of care nowrecognizes that this model of care nowneeds to be adapted for other patientsneeds to be adapted for other patients
on the basis of need rather thenon the basis of need rather then
diagnosis or prognosisdiagnosis or prognosis
In general the opinion now is thatIn general the opinion now is that
Palliative Care for older people mustPalliative Care for older people must
be included within health servicebe included within health service
planning at national level. Policyplanning at national level. Policymakers need to ensure that palliativemakers need to ensure that palliative
care is integral to the work of all healthcare is integral to the work of all health
services and is not seen just as anservices and is not seen just as an
add on extraadd on extra..
In UK BaronessIn UK Baroness IlloraIllora FinlayFinlay got through a Palliativegot through a Palliative
Care Bill on 23Care Bill on 23rdrd for Febfor Feb07 which called for equity of07 which called for equity of
access to palliative care for all patients.access to palliative care for all patients.
This bill addresses the issue of:This bill addresses the issue of:
*Inequity of access to Palliative Care*Inequity of access to Palliative Care
*Patchy spread of Palliative Care*Patchy spread of Palliative Care
The PC bill hopes to address this with strategicThe PC bill hopes to address this with strategic
planning and sustainable funding. To make sure thatplanning and sustainable funding. To make sure that
there is public accountability for how vulnerablethere is public accountability for how vulnerable
patients get the care they need to be able to livepatients get the care they need to be able to liverather then wait to dierather then wait to die..
Two documents brought out byTwo documents brought out by
WHOWHO
Active aging :a policy framework 2003 andActive aging :a policy framework 2003 and
Palliative care solid facts 2004Palliative care solid facts 2004
These documents clearly bring out someThese documents clearly bring out some
facts which need to be taken intofacts which need to be taken intoconsiderationconsideration
The knowledge and experience gainedThe knowledge and experience gained
through Palliative Care must be integratedthrough Palliative Care must be integratedinto every day clinical practice.into every day clinical practice.
Community surveys consistently find thatCommunity surveys consistently find that
pain is an important symptom in around onepain is an important symptom in around one
third of the older people. Older people withthird of the older people. Older people with
dementia are a particular risk of poor paindementia are a particular risk of poor pain
controlcontrol
A BMJ poll acknowledges theA BMJ poll acknowledges the
importance of Palliative Care for nonimportance of Palliative Care for non
malignant diseases.malignant diseases.
More then 40,000 people voted on lineMore then 40,000 people voted on line
and a large majority voted forand a large majority voted for
palliative care for all at end of lifepalliative care for all at end of life..
-
8/14/2019 WayForwardForHospiceInMalaysia_DrRanjitOommen
4/7
Palliative care Australia :Palliative care Australia :
Priorities for the 2008Priorities for the 2008--09 budget.09 budget.
Health care and other services do notHealth care and other services do not
always perform well for people whoalways perform well for people whoare dying. People with terminalare dying. People with terminal
condition often facecondition often face crippling financialcrippling financial
burdens as a consequence of theirburdens as a consequence of their
terminal conditionterminal condition..
KeralaKerala Government in India announcedGovernment in India announcedPalliative Care PolicyPalliative Care Policy
The government ofThe government ofKeralaKerala announced itsannounced itsPalliative Care Policy and thus becomesPalliative Care Policy and thus becomes
the first government in the developingthe first government in the developingworld to officially declare a Palliativeworld to officially declare a PalliativeCare policy. The government hopes toCare policy. The government hopes todevelop community based palliate caredevelop community based palliate careservice with effective communityservice with effective communityparticipationparticipation
Direction of Palliative CareDirection of Palliative Care
We all dieWe all die --the right of every man to diethe right of every man to die
peacefullypeacefully
To be able to live rather then wait to dieTo be able to live rather then wait to die
No longer the responsibility of NGONo longer the responsibility of NGOss
The benefits of Palliative Care have beenThe benefits of Palliative Care have been
provenproven
THE WAY FORWARDTHE WAY FORWARD
Palliative Care has to be integrated intoPalliative Care has to be integrated into
the mainstream medicine and it has to bethe mainstream medicine and it has to be
a part of the health care system anda part of the health care system and
deliverydelivery
NGONGOs can only be supportives can only be supportive
Delivery of Palliative Care is theDelivery of Palliative Care is the
responsibility of the MOH. Supportingresponsibility of the MOH. SupportingNGONGOs must be adequately supported ands must be adequately supported and
fundedfunded
Training modules have to beTraining modules have to be
developed at various levels.developed at various levels.
Even now it is possible to use existingEven now it is possible to use existing
facilities in Hospice Malaysia ,facilities in Hospice Malaysia ,PenangPenang
etc to train people at all levels. Everyetc to train people at all levels. Every
health care facility must have somehealth care facility must have some
one trained in basic palliative careone trained in basic palliative care
Delivery of Palliative careDelivery of Palliative care aa
modelmodel
All patients to be channeled through PCUAll patients to be channeled through PCU
Pain and symptom control/family conferencePain and symptom control/family conference
all to be done in PCU before discharge toall to be done in PCU before discharge to
districts or home programdistricts or home program
Liaise with trained personnel at district levelLiaise with trained personnel at district level
Work with family physiciansWork with family physicians
Tele medicine may be usefulTele medicine may be useful
-
8/14/2019 WayForwardForHospiceInMalaysia_DrRanjitOommen
5/7
PCU should have a person in chargePCU should have a person in charge
to follow up patients referred out fromto follow up patients referred out from
PCUPCU
Provide regular training to a doctorProvide regular training to a doctorand nurse from all districtand nurse from all district
hospitals/family physicians and theirhospitals/family physicians and their
teamsteams
PCU should be accountablePCU should be accountable
A supportive palliative care environmentA supportive palliative care environment
does not necessarily mean the constantdoes not necessarily mean the constant
availability of professional people. Onlyavailability of professional people. Only
supervision and occasional consultationsupervision and occasional consultation
is required when the whole supportis required when the whole support
system works well. This support systemsystem works well. This support system
needs well trained nurses andneeds well trained nurses and carerscarers
experienced in Palliative Care. Theseexperienced in Palliative Care. These
people are the front line for providingpeople are the front line for providing
Palliative care at homePalliative care at home
STRATEGY TO TRAINSTRATEGY TO TRAIN
SPEICALISTSSPEICALISTSKK ExperienceKK Experience
Attempt to introduce PC as a PGAttempt to introduce PC as a PG
training program at UMS in vaintraining program at UMS in vain
Doctors who got interested in PC haveDoctors who got interested in PC have
fallen by the sidefallen by the side
Doctor who started PC in KK nowDoctor who started PC in KK now
heads Palliative Care Service inheads Palliative Care Service inBrisbaneBrisbane
Palliative Care has to be separate fromPalliative Care has to be separate from
Oncology or any form of curative medicineOncology or any form of curative medicine
Palliative Care cannot be taken for granted.Palliative Care cannot be taken for granted.
It is a philosophy that has to develop on its ownIt is a philosophy that has to develop on its own
and allowed to bloom by itself not under theand allowed to bloom by itself not under the
shadow of Oncology or any other specialty.shadow of Oncology or any other specialty.
The effect of Palliative Chemo on survival isThe effect of Palliative Chemo on survival ismodestmodest
Generally accepted guidelines about offering ofGenerally accepted guidelines about offering ofpalliative chemo are lackingpalliative chemo are lacking
The wish of the a patient to be treated plays aThe wish of the a patient to be treated plays arolerole
A SYSTEMATIC COUNSELING PROCEDUREA SYSTEMATIC COUNSELING PROCEDUREMAY BE NEEDED TO PREPARE PATIENTMAY BE NEEDED TO PREPARE PATIENTAND FAMILY FOR DECISION MAKINGAND FAMILY FOR DECISION MAKING
* Finances have to be balanced* Finances have to be balanced
Palliative Care calls for investing inPalliative Care calls for investing in
personnelpersonnel
*The benefits far out weigh the*The benefits far out weigh the
investmentinvestment
* It will be money well spent. It will* It will be money well spent. It will
reduce suffering across the board.reduce suffering across the board.
-
8/14/2019 WayForwardForHospiceInMalaysia_DrRanjitOommen
6/7
WE HAVE TO ACT FASTWE HAVE TO ACT FAST
We need to lobby with the Health Minister, theWe need to lobby with the Health Minister, the
MOH, the cabinet and all in powerMOH, the cabinet and all in power
Those involved have to be to be passionateThose involved have to be to be passionate
We need to be smart, statistics and proof has to beWe need to be smart, statistics and proof has to beprovided, quote WHO other countriesprovided, quote WHO other countries
We need to educate the peopleWe need to educate the people
The elderly and those with incurable diseases mustThe elderly and those with incurable diseases must
be made aware of their rightsbe made aware of their rights
Unfortunately the dead do not speak aboutUnfortunately the dead do not speak about
the benefits they have had fromthe benefits they have had from
Palliative CarePalliative Care
People requiring Palliative Care are on thePeople requiring Palliative Care are on the
increase. Our population is aging.increase. Our population is aging.
Why at the beginning of the 21Why at the beginning of the 21stst century, docentury, do
we need a grass root movement to help uswe need a grass root movement to help us
learn something as basically human as howlearn something as basically human as how
to die?to die?
We need to relearn death because of theWe need to relearn death because of the
excellent job done by the MOH people todayexcellent job done by the MOH people today
die in a different way from our forbears: Wedie in a different way from our forbears: We
tend to die older, from different causes andtend to die older, from different causes and
in different environment.in different environment.The Health System has to adapt to thisThe Health System has to adapt to this
changechange
In 1900 people died at home surrounded byIn 1900 people died at home surrounded by
family ,physicians routinely comforted thefamily ,physicians routinely comforted the
dying and their families.dying and their families.
In the past century medical and pubic healthIn the past century medical and pubic health
advances have almost doubled the averageadvances have almost doubled the average
life expectancy.life expectancy.
People who die in old age now tend toPeople who die in old age now tend to
experience a long period of functionalexperience a long period of functional
decline before death, thus require intensivedecline before death, thus require intensive
care giving and well coordinated medicalcare giving and well coordinated medicaland palliative care.and palliative care.
On the world hospice scene are we are getting leftOn the world hospice scene are we are getting leftbehind? Other developing countries are fast catching upbehind? Other developing countries are fast catching upand moving forward at a much faster rate.and moving forward at a much faster rate.
We need to move into fast gearWe need to move into fast gear
We need to have a visionWe need to have a vision
To make Palliative Care accessible to all Malaysians whoTo make Palliative Care accessible to all Malaysians whorequire itrequire it
It was DrIt was DrKhashiwagiKhashiwagi who rightly saidwho rightly said
regardless of the differences in the conceptregardless of the differences in the conceptof death, socio economic and religiousof death, socio economic and religiousbackgrounds and medical and nursingbackgrounds and medical and nursing
situations a common hope for all people allsituations a common hope for all people allover the world is to die peacefully. Thereforeover the world is to die peacefully. Therefore
the need for Palliative Care Services inthe need for Palliative Care Services inevery part of the world is a considerationevery part of the world is a considerationthat reaches beyond the boundaries ofthat reaches beyond the boundaries of
countries and nationalitiescountries and nationalities
-
8/14/2019 WayForwardForHospiceInMalaysia_DrRanjitOommen
7/7
We need to have targets toWe need to have targets to
achieveachieve
Set target datesSet target dates
To cover all cancer patients by 2013To cover all cancer patients by 2013
All people requiring Palliative Care byAll people requiring Palliative Care by20202020
Work together to achieve these targetsWork together to achieve these targets--
All those involved the MOH and NGOAll those involved the MOH and NGOss
In Palliative care we are patient , we listen,In Palliative care we are patient , we listen,
we never argue our cause. It is watchfulwe never argue our cause. It is watchful
waiting and symptom controlwaiting and symptom control
This approach will not work in introducingThis approach will not work in introducingPalliative Care into this country. May bePalliative Care into this country. May be
this is why we have not been successfulthis is why we have not been successful
The Hospice philosophy has come to stayThe Hospice philosophy has come to stay
The pioneers have done their part inThe pioneers have done their part in
establishing the Hospice Philosophy andestablishing the Hospice Philosophy and
proved to the country the difference it canproved to the country the difference it can
make to people who are sufferingmake to people who are suffering
The bottom to top approach has worked soThe bottom to top approach has worked so
farfar
Now it has to be the top to bottom approachNow it has to be the top to bottom approach
We have to try and make Palliative CareWe have to try and make Palliative Care
become a government policybecome a government policy
A part of mainstream medicineA part of mainstream medicine
An important part of the delivery of healthAn important part of the delivery of health
carecare
Working together with the existing NGOWorking together with the existing NGOs wes we
can prove that we are truly a nation thatcan prove that we are truly a nation that
carescares
If we act now the MOH working with all theIf we act now the MOH working with all theNGONGOS we can set target and achieve them.S we can set target and achieve them.
Palliative Care for all incurable cancer byPalliative Care for all incurable cancer by
20132013
Palliative Care for all those requiring itPalliative Care for all those requiring it atleastatleast
by 2020by 2020
Only then can we call ourselves a caringOnly then can we call ourselves a caring
nation a developed nationnation a developed nation
THANK YOU