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By Reynaldo L. Nambayan III, MD  (IAHPC Member)

The Makati Medical Center Hospice Program is one of the projects of Dr. Raul G. Fores, the Medical Director of the hospital. Makati Medical Center is a premiere tertiary hospital in the Philippines with over 700-bed capacity. It boasts of some of the most modern equipment and technology to be found in Philippine health care.
Dr. Raul G. Fores was a personal friend of Dr. Josefina Magno. During a visit by Dr. J. Magno to his office in early 1994, Dr. Fores realized the importance of hospice care. He then spearheaded a conference on hospice care among the medical staff with Dr. J. Magno as speaker. He also put together salaried nurses and social workers to make a hospice team. The objective then was to create a team that would do home care for charity patients of the hospital.
In April of 1994, the nurses recruited me as volunteer physician to help them assess and manage their hospice patients. At that time, I was a resident physician in training for Internal Medicine. I had no knowledge of hospice, but since the nurses promised to orient me, I readily obliged to do the volunteer work while I continued with my residency training. I visited the patients in their houses with the nurses at least once a week during my free time doing whatever I felt the patient needed.
In November of 1995, we requested to visit the Caritas Christi Hospice in Kew, Victoria (Melbourne, Australia) where they allowed me to do a preceptorial in hospice care for one month. There, I learned more about pain and symptom control management and the value of social workers, clergies and volunteers in hospice.
When I returned to the Philippines, we set our vision and mission for our hospice. Our vision is a terminally ill patient should be at peace with the Creator. Our mission: To develop a service system focused on administering holistic care to terminally ill patients and for them to achieve the best quality of life; To affirm life while recognizing death as a natural eventuality through comprehensive, competent and interdisciplinary service to the terminally ill and; To make the society aware, and involved, in the issues and care of a terminal or life threatening illness, death and dying.
After my graduation from residency training in Internal Medicine in December of 1995, our hospital allowed me in to continue my work in hospice, not as a volunteer physician, but as the head of our hospice team.
As the new head of the hospice team, I was able to convince many of my colleagues and friends to help identify patients who are terminal and who needs hospice care. The number of patients referred to our service began to rise from a meager 10 patients in 1994 to nearly a hundred in 1996. We opened the hospice service to non-cancer patients as well.
As the number of patients referred to us continues to rise, our small team of 2 nurses, 1 social worker and myself as a doctor, began to feel the inadequacy of our staff to render the holistic care we wanted to bring to our patients. In the summer of 1997, we organized a volunteer training seminar and were able to recruit 30 volunteers. All of us meet together in groups, or as a whole, once a week to discuss the plans for our patients. Now we are able to give a more holistic care not only to our patients but also to their families.
By the year 2000, we have been receiving about 150 to 200 referrals a year, 60% of whom are cancer patients while the rest suffered from stroke, renal failure and other illnesses
There are more patients needing hospice care, unfortunately we have to limit our service only to a geographic area comprising of the whole Makati City. Until the present, we still do not have our own transportation to use in our home visits. We have to share with the rest of the transportation needs of the hospital and since our program is a charity program. We are sometimes bumped off because the vehicle is needed by another departments of the hospital (especially revenue generating sections).
The hospices in the Philippines are presently trying to come together in order to develop a good referral system where all geographic areas may be served. February 17th of this year, we launched the National Hospice Palliative Care Coordinating Council of the Philippines with this objective in mind as well as the promotion, development and dissemination of information on hospice in the Philippines.
We hope that we can network with other hospices around the world so that we can exchange information in the promotion and development of hospice.
Reynaldo L. Nambayan III, MD  (IAHPC Member)
Medical Officer in Charge of Hospice
Makati Medical Center

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