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Asia
Palliative care conference held in Thailand
K.S. Chan ( Hong Kong)
A palliative care conference has become a regular event in a country where palliative care services is well established. However, to organise a conference with the major theme of care for the terminally ill is no easy task. This is especially true for many Asia countries where palliative care is still unpopular among those in the medical field and society.
Thailand, also called Siam until 1939, draws visitors because of its combination of beautiful natural scenery, religious temples, unique cuisine and ruins of ancient kingdoms. From 2nd to 6th February 2004, three hundred local participants will gather for the palliative care conference with the theme "Palliative care: from Principles to Practice in Thailand". The conference is hosted by the Palliative Care Unit of Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University in Hat Yai. Under the enthusiastic leadership of Professor Temsak Phungrassami, a radiation oncologist, palliative care service has been promoted in the Songklanagarind hospital for several years. Moreover, Prof. Ian Maddocks's booklet of palliative care was translated into the Thai language several years ago. From the visions and goals of the conference as described below, one will realize the importance of this conference:
1. To share the experiences in end of life care among health care professionals all over Thailand.
2. To encourage health care professionals to be concerned about palliative care.
3. To establish the direction of the development of palliative care in Thailand.
4. To establish a palliative care network in Thailand with a regional network, such as APHN.
Thailand, a Southeast Asia nation of 517,000 sq km and a population of 65 millions, consists of 75% Thai, 11% Chinese, 3.5% Malay, and also Mon, Khmer, Phuan and Karen minorities. Cancer is now becoming the most common cause of death. Together with accidents and heart diseases, they are the three most common causes of death in Thailand. With the standardized cancer incidence rate of 152.8 per 100,000 in the male population, and 128.5 per 100,000 in the female population, it is conceivable that the need for palliative care services for advanced cancer patients will be enormous.
The National Pain control programme has been included under the National Cancer Control programme. The national pain guidelines are now being actively promoted by The Thai Pain Society (IASP, Thai chapter), of which one of the key leaders is Dr Staporn Leelanuntakit, head of the Anesthesiology Department & Pain clinic of the National cancer Institute of Thailand. The key drugs described in the analgesic ladder of WHO such as codeine, tramadol, morphine syrup, morphine tablets, morphine sustained released tablets, fentanyl patch and adjuvant drugs are mostly available in Thailand. Being a drug under tight legal control, morphine is imported from other countries. The key obstacle for effective pain control is opioid phobia among both health care professionals and the general population.
The health care system in Thailand is well developed and a new "health insurance system for all people" was established two years ago. Every patient has to pay only 30 Thai bahts for each visit, inclusive of all key medical expenses. However, palliative care service is still sparse. Though the existing palliative care system is not well established and structured, there exists many other organizations which take care of terminal peoples both in private and public sections, such as the temples for the HIVs, and small hospitals taking care for the terminally ill. About 2 years ago the first 16-bed hospice with home care service and an outpatient clinic was founded in Mahavajiralongkorn Cancer Center in the central Thailand. Nurses, oncologists, anesthesiologist/pain specialists, social workers, and Buddhist monks are the key personals who are involved in palliative care. Even though there is no designated palliative care specialty ward in Songklanagarind hospital (organizer of the conference), the hospital formed a Palliative Care Development Committee in 1999 headed by Professor Temsak Phungrassami. The vision and mission of this committee is to promulgate palliative care to all regular wards so that it can be put into practice by their personnel.
We sincerely bless this conference with great success, and hope that their visions become a reality.
( The majority of the information for this article was provided by Professor Temsak Phungrassami )
Africa
South Africa
Head, Heart and Healing hands conference.
Dates: 13, 14, 15 November 2003
Reported by Susan Jackson - Trainer, Hospice Witswatersrand
In November this year, a national conference on Palliative Care Training was held in Gauteng/Johannesburg, South Africa and was hosted by MESAB PCI - Medical Education For South African Blacks, Palliative Care Initiative supported by the National Department of Health and the Hospice Palliative Care Association of South Africa. The aim of the conference was to promote access to quality training for all people involved in Palliative Care in South Africa. The conference was attended by a wide spectrum of people including doctors, nurses, social workers, psychologists, clergy, community workers and traditional healers involved in facilitating Palliative Care in their communities.
South Africa, a country of diverse regions, cultures, and economic standards, is fighting the scourge of HIV/AIDS, other chronic diseases, poverty, unemployment, inadequate health facilities, violence and crime. This has a negative socioeconomic impact on the country.
The name of the conference was 'Head, Heart and Healing hands', an appropriate name as it encompasses so many aspects of Palliative Care.
The objectives of the conference were:
· To present and further develop a network of Palliative Care training
· To develop a database of Palliative Care training material in South Africa
· To integrate Palliative Care training within Primary Health Care and all levels of care
· To initiate a process of standardization and accreditation of Palliative Care training
· To provide a framework of evaluation and monitoring of Palliative Care
International and national speakers involved in Palliative Care services shared their views, skills and knowledge with delegates.
Dr Rose Malumba a speaker from the National Department of Health spoke on the necessity of South Africa and the African continent to re-group to assess our quality of care for people with chronic conditions. She spoke of the importance of improving the quality of life for people living with HIV/AIDS, Diabetes, T.B., chronic renal failure and all other chronic diseases. Dr Malumba admitted that Palliative Care had not received the attention it needed in South Africa and said, I quote; " The burden is big but has not been attended to." She spoke of the conference's objectives and emphasized the need for a database and training for Palliative Care and the need to standardize Palliative Care services. Her hope was that out of the track workshops, held at the conference, a framework would be co-coordinated to enhance Palliative Care services in South Africa.
Peggy Harper, the executive director for the Foundation for Hospices in Sub - Saharan Africa, gave an international overview of Palliative Care. She brought wishes from the US for a productive, challenging conference and complemented Hospices in South Africa, stating that they had accomplished a lot in a short space of time. The alarming statistics highlighted the importance of Hospice and Palliative Care in Africa. In 2002 over 6, 500 people died of AIDS daily in Sub Saharan Africa, equivalent to twenty 747 plane's crashing daily.
One of the basic principles of Palliative Care was for patients to live with as little pain as possible. Yet Sub Saharan Africa, including South Africa has a very low use of morphine, this drug is not always readily available and people are dying in pain. In Sub Saharan Africa, there are 11 to 14 million orphans. Household definitions have changed and in many instances young children or Grannies are heading the families with very little available support. The constant hunger, food shortages and poverty are daily challenges for palliative care in Africa. Tragically people are begging for help with their dying on the African continent. There is no one-way to provide care in the face of this HIV/AIDS pandemic.
Her views of our Palliative Care challenges as
· To keep focus on core services
· Work together to increase access for others
· To assure that Hospice and Palliative Care are not compromised
· To have a goal of where we are going in order to determine how to get there.
Joan Marston from the Hospice Palliative Care Association gave an overview of National Palliative Care Training in South Africa .She mentioned the importance of recognizing the common elements in the definition of Palliative Care for both children and adults. Palliative Care must be aimed at relief of suffering, promoting quality of life, offering Holistic Care and recognizing the patient and family as the unit of care while working towards an Interdisciplinary/Multidisciplinary team with pain and symptom control. She emphasized the need to remember and understand that it is everyone's right that Palliative Care continues into the bereavement period and that Training in Palliative Care should be available on all levels.
She read a beautiful poem by Longfellow, which has meaning for us all:
" No man is so poor as to have nothing worth giving
As well might the mountain streams say they have nothing to give
because they are not rivers.
Give what you have to someone - it may be better than you dare to think."
Dr Chrystal Kotzenberg from the National Department of Health gave an apology from the Minister of Health and read out the report from the Minister. She said that Palliative Care should be Person Centered, Holistic, taking into account the cultural beliefs of a person and their family and that training in Palliative Care needs to be standardized and accredited. She mentioned the need to work together and to share knowledge. She said that Government cannot provide Palliative Care alone, the problem being too overwhelming. She recognized the need to establish comprehensive care services and to call on all stakeholders to" start sowing the seeds of caring and improving quality of life for all". Dr. Kotzenberg hoped we would come out of this conference with an idea of how to integrate Palliative Care into other services to form strong networking systems" because as partners we can conquer and win". She stated that the government would give money towards Palliative Care services and that there are allocations in two budgets available which can be utilized for this.
Dr Debbie Norval representing the Hospice Palliative Care Association of South Africa, Director of the Center for Palliative Learning Hospice Witwatersrand and board member of IAHLPC spoke on The Development of South African Pediatric Palliative Care Curriculum'
Her quote "When a child dies, it is always out of season" brought the tragedy closer to home especially when she gave the statistics of children's deaths in Africa. In 2002, there were 610, 000 deaths of children from HIV/AIDS Worldwide, 555, 000 of these occurred in our area. There are 2.8 million children living with HIV/ AIDS in Africa. She highlighted the need for these statistics to be taken into account, and to recognize
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