2011; Volume 12, No 04, April


15th Anniversary Issue

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Message from the Chair and Executive Director

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Regional Reports: Thailand, Bangladesh, UK and US

Palliative Care Book of the Month and Other Reviews

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Regional Reports

A Journey with Chivantarak — a Travelling Hospice Foundation in Thailand —

Hospice work and Ancient practices

We wake up in the middle of the night. The monsoon rains flooded the land during the day and some of the roads had turned into rivers. The traffic is bogged down in one meter of water, but this doesn’t frighten the Thai bus driver or the twelve experienced voluntary workers of Chivantarak. This night the bus is travelling 700 km north from the capital city of Bangkok to the province of Roi Ed where we will first visit a Buddhist monastery that provides AIDS sufferers with accommodation, medical treatment and spiritual care.

At the beginning of the journey, Dr Mano, President of the Hospice Foundation of Thailand, laughingly said, "It is only two days, but we will all be exhausted afterwards”. He is a man who is very familiar with the vulnerability of life and the great authority of death since his early childhood. His father was a surgeon; he himself is a trained medical doctor who spent half of his life as a Buddhist monk and scholar until he set aside his robe to offer his knowledge and skills to the social development of his country and to those in need.

We arrived far behind schedule; there is no point in thinking about sleep. After breakfasting with voluntary workers from the region, we travel in a minibus into the surrounding countryside. There is little talk, everybody prepares themselves for their meeting with seriously ill patients. I am told "The secret of a good hospice carer is that she is a master in self-care." Chainat, a pharmacologist and deputy secretary of the foundation, suddenly tunes up his mouth organ and we all join in song. A dignified matron of a large hospital sits next to me – she quietly takes my hand. The Thai women hardly leave me – a stranger – untouched all day long. I lose my reticence and start to understand the "secret" of this group.

The Chivantarak Volunteers at Roi-Ed-Hospital

After an extensive ceremony in the monastery, offered by a gracious Abbot, we take paths that lead over rose colored soil to a modest wooden building in an idyllic setting. Approximately 25 people live here and are waiting for us – children, adolescents, and adults. They are all sitting in the traditional position on the long side of the large room: serious faces — some look frightened. Maybe they don’t expect good news because AIDS patients in Thailand are occasionally excluded from society, but they can feel safe here. Today is different, they will meet a group that has managed to win their trust. Chainat deliberately sits amongst the people as Dr Mano begins to speak. He tells an allegorical story of confidence and hope and talks empathetically about the overwhelming, yet conquerable, feeling of being a victim. They are guided by his mellifluous voice as he delivers a meditation of deep religious significance which leads them into their bodies. White light is imagined to slowly float through their nostrils into the middle of their body to become embedded like a second soul-body. This enables the experienced person to transcend suffering and pain – even while passing towards, through, death. The government fosters this special technique of meditation as a form of alternative medicine. The practice goes back to an old practice of Thai forest monks. Today, monks also provide chanting services while herbalist doctors occasionally dispense herbal medications.

The Chivantarak group is full of cheer. They have come here to infuse sufferers with a sense, and spirit, of joy – a means of preventing them from deteriorating into isolation. Pure joy fills the whole room along with music and dance. A young woman jumps to her feet like a small child in front of me, she removes her solemn face mask, shows me her smile, and quickly gives me her hand – it is she, a sick person, who pulls me into a joyful dance.

People living with HIV/ADS dancing after the meditation; on the right Dr Mano

The next day we arrive at Roi-Ed-Hospital which is dedicated to treating cancer patients. I experience another impressive program offered to patients and staff that to a large extent consists of a mix of traditional religious and cultural practices.

Basic medical information is also provided along with instructions on how to develop a positive lifestyle. There are panel discussions, dance, films, meditation, questions and answers, and more. Voluntary workers speak candidly about their former cancer. Those celebrating an October birthday share a serenade, some cake and presents; and a lot of laughter. A Thai English teacher, who is a visitor like me, says, "Even when we are sad, we smile. That’s the way we are!"

For a European, this journey offered me a unique opportunity to witness the transforming effects of medical and spiritual skills provided in a culturally sensitive manner that support those who until now had little hope for the future.

Katja Fiedler-Löffelholz lives in Frankfurt a.M./Germany and is a teacher and author.

The Hospice Foundation of Thailand is supported by state aid and public donations. Its task is to help ill and dying people, find volunteers and inform the lay public and professionals in the country about the opportunities offered by palliative and end-of-life care. The medical care in the monastery is provided by registered doctors from the region and the care is covered by public health insurance. In the case of the socially vulnerable AIDS sufferers, the monks and associated lay people offer hospice care as well.

The headquarters of Chivantarak are in Bangkok where an international conference of the Asia Pacific Hospice Palliative Care Network, APHN, will take place in 2013.

From Bangladesh

The 2nd International Conference on Public Health and Palliative Care took place in Dhaka, the capital of Bangladesh on 21st to 23rd January, 2011. The theme of the conference was ‘Compassionate Care for the Incurably Ill’. There were three hundred and thirty participants including those from India, Pakistan, Australia, Canada and United Kingdom. A pre-conference workshop was offered on 20th January, titled ‘Developing a Palliative Care programme for Bangladesh’. About forty local participants were joined by senior faculty members of the university and representatives from the ministry of Social Welfare.


Dignitaries and speakers unanimously embraced the need for appropriate, accessible and affordable palliative care programs for the country. The President of the country formally unveiled the foundation stone of the newly developing Centre for Palliative Care at the medical university.


Most of the local deliberations focused on basic palliative care issues whereas the papers from abroad detailed the public health approach to palliative care. The topics of discussions were diverse in nature reflecting local and international expectations and experiences ― a mix of pondering, aspirations and the reality on the ground that exists both locally and globally. The conference deliberations promoted curiosity and interest. Basic clinical issues such as pain management and symptom management were also discussed. Delegates shared their experiences in their home care support programmes and they heard about a spiritual support model developed for the Australian aboriginal community. A South Indian team came up with an exceptionally successful model of community participation in the area of palliative care in their region.

The conference was unique and occurred at a time when palliative care has begun to find its place in the health care system of Bangladesh. The conference not only helped raise the spirits of those who are engaged in this field in Bangladesh, but also increased local awareness. The public health approach to this relatively new topic was most timely as we contemplate its future direction. In a broader sense, the public health issues have probably been underrated at the expense of fulfilling local needs and understanding.

In conclusion, this first international conference on palliative care and public health in Bangladesh was a milestone in the first five year history of our endeavors and hopefully will inspire ongoing program development in the country.

Dr. Nezam Uddin Ahmed Ahmed
Professor and Project Co-ordinator, Palliative Care Service
Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh

From the UK - NHS Evidence - supportive and palliative care

Keeping UP with the Palliative Care Literature – from the National Health Service,

Dear all,

Each month there is a wide range of new items added to the NHS Evidence specialist collection on supportive and palliative care.  From last month’s list of entries, Dr Jason Boland has selected those which may be of particular interest (see below). 

Users who cannot easily access the web links below from their email software should access the full list via the link near the top of the home page: http://www.library.nhs.uk/palliative/  
or See the full lists of new records added each month

Best wishes,

Richard Stevens, Project Manager, NHS Evidence - supportive and palliative care

NHS Evidence - supportive and palliative care

Mar 2011 Bulletin



Cochrane Database of Systematic Reviews

Dr Richard Stevens, Research Associate,
University of Sheffield, Academic Unit of Supportive Care,
Sykes House, Little Common Lane, Sheffield, South Yorkshire, S11 9NE, UK
Email: [email protected]

From the US

Harford, Joe B. Breast-cancer early detection in low-income and middle-income countries: do what you can versus one size fits all.

Lancet Oncology 2011 ; 12 (3) 306 – 312.

Dear Colleagues,

I am providing a link (below) to a paper of mine that was just published in Lancet Oncology. It addresses the issue of what to do regarding breast cancer in low resource settings. There is a fair amount of "pressure" on policy makers to institute organized breast cancer screening via mammography. Much less attention is being paid to the women with symptoms including those that are diagnosed very late in the disease process. One point of the article is that resources might better be used to deal with women who HAVE breast cancer rather than screening the whole population, the overwhelming majority of whom do NOT have breast cancer. One place where resources are scarce is in palliative care services. I hope the paper will be of help to you since all of us are striving to do what we can with what we have.


Joe B Harford

 Dr Joe B Harford, Office of International Affairs National Cancer Institute
Bethesda, MD 20892, USA

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