Adapted from the Chairman’s Message in Berita Hospis, Jan 2004 with permission from the CEO/Medical Director of Hospis Malaysia, Dr Ednin Hamzah (Photos courtesy of Hospis Malaysia)

alliative Care and hospices have a long history, hundreds of years, no less. From its early origin as shelters for travelers to its well-documented concept of care for the dying, it has evolved and adapted to care for those that truly matter - our patients. Hospices such as Our Lady's Hospice in Dublin opened in 1879 and St Joseph's Hospice in London in 1905 inspired many other hospices at the turn of the last century.

In 1967, St Christopher's Hospice was founded in London due in no small measure to the pioneering work of Dame Cicely Saunders. From its days where compassion and attention to care were the bedrock of hospice care, medical knowledge and skill were now added ingredients. In the years that followed, Palliative Care units, symptom control teams and paediatric and HIV based units were established. The publication of the World Health Organisation guidelines on Cancer Pain Relief in 1986 and their definition of Palliative Care in 1990 further strengthened the place of Palliative Care within our healthcare programmes.

Palliative Care is now available in many parts of the world. It exists in many forms in numerous countries and perhaps in ways that may be appropriate for that setting. In countries such as the United Kingdom, Australia, United States and many others, Palliative Care has become an acceptable aspect of healthcare and an integral part of their community. There are numerous models of Palliative Care, from inpatient units, independent hospices, specialist homecare support and mobile Palliative Care teams, to disease specific services.

From providing care to dying cancer patients, Palliative Care is now seen as a preventative and supportive structure in the care of patients at earlier stages of not only cancer but also many other chronic illnesses. This is reflected in the new definition by WHO. Palliative Care is established in the medical curriculum of many countries producing professors in Palliative Care. At the same time, Acts of Law are enacted in Parliament dealing with issues involving Palliative Care. In short, Palliative Care is slowly changing from a prognosis-based specialty to one that provides care to all who need it.

In the less developed countries, Palliative Care exists at a different level. Here, Palliative Care could also be seen as providing basic shelter and needs. Where medication and investigations are scarce or not available, good clinical skills, communication and counselling within ethical guidelines provide whatever care is possible. In such communities, many aspects of Palliative Care depend on volunteers, availability of training and education as well as medical and community resources.

What is then the position of Palliative Care in Malaysia? Palliative Care was initiated here in 1991 and it is available mainly in the larger towns. The number of cancer patients diagnosed in 2002 according to the National Cancer Registry was over 30,000 which may well be an underestimation. Added to the burden of illnesses such as AIDS, chronic illnesses and organ failures, the potential population that may benefit from Palliative Care is enormous.

Occasionally we come across remarks such as 'Why does Hospis Malaysia need to exist? Isn't it duplicating what other cancer organisations do? Or even 'Why should you require donations to care for the dying when you can concentrate on curing?'

Many of us in our lifetime will have to deal with issues of sickness, life and death. In doing so, we may ask ourselves, 'How do we know what to do?' 'What medications should we use and how do we get it?' 'Is this safe to eat?' 'I don't know how to deal with this. He is in so much pain, what can I do? What is the right thing to do? He is asking so many questions that I can't answer, what can I say?' and many other questions.

Where can we seek the answers to these difficult questions? For us working in Palliative Care, these are indeed very common questions. Palliative Care provides us with the knowledge to assess, manage and deal with all manner of issues in caring for those with advanced diseases. And it does so with care, compassion and dignity.

All Hospis Malaysia staff is given training and education to provide professional Palliative Care. Perhaps the excellence in their care is reflected in the number of patients referred to Hospis Malaysia and the continuous requests that they get to assist in training others.

Hospis Malaysia provides Palliative Care to over nearly a thousand families each year. They provide Palliative Care education to four universities. Yet they do so as a charity without financial assistance from the Ministry of Health. The Ministry of Health, despite setting up Palliative Care units in many hospitals, has yet to really address the needs of our community. Hospis Malaysia however, does NOT duplicate the efforts of other NGOs in promoting cancer awareness but works hand-in-hand with them.

 

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Last Updated:
Tuesday, 04 January 2005