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Essence of Palliative Care Part 2

The recent re-launching of palliative care ward - at Sarawak General Hospital - on 4th December 2016 by Datuk Dr. Sim Kui Hian

THE MODERN DAY CONCEPT of Palliative Care was first introduced by Dame Cecily Saunders in the United Kingdom some 50 years ago. The World Health Organisation (WHO) defines palliative care as “an approach to improve the quality of life of patients facing fatal illness and their families, through the prevention and relief of suffering by means of early identification, assessment and treatment of pain and other problems whether physical, psychosocial and spiritual.”

Rather than focusing on dying, palliative care focuses on living and living well – now. As Dame Cecily Saunders herself so eloquently said “The care of the dying demands all that we can do to enable patients to live until they die”.

Research has shown, and our own experiences have confirmed this time and again - that people with serious illness have priorities besides simply prolonging their lives. Surveys find that their top concerns include avoiding suffering, healing relationships with family and friends, not being a burden on others, and achieving a sense that their life is complete. The difference between standard medical care and palliative care is not about treating versus doing nothing but, as Dr Atul Gawande so aptly pointed out in his international bestseller book “Being Mortal”, the difference is in the priorities. Palliative care actively deploys professionals in their fields, be they medical staff such as doctors, nurses, counselors, but also chaplains and lay volunteers to help and support patients with advanced cancer and other chronic fatal illness and their families so that they can live until they die and to do so with dignity. Indeed, the wisdom of Hippocrates, the father of modern medicine, some two thousand years ago, is still very much applicable in medicine and palliative care today - “Cure sometimes, treat often, comfort always”

WHO cancer control guide 2007 stressed that Palliative Care is an urgent humanitarian need worldwide for people with cancer and other chronic fatal diseases. And Palliative care is particularly needed in places where a high proportion of patients present in advanced stages and

there is little chance of cure.  Despite significant improvement and advancement in cancer care in the state over the last decade or so, this is still very much true of Sarawak.

Yet there have been enormous barriers to the development of palliative care in this beloved land of ours despite ever increasing needs. Lack of awareness as well as misunderstanding of the essence of palliative care, cultural barriers, logistics issues, limited funding and shortage of trained healthcare personnel are some of the glaring challenges.  

Hearteningly, there has been no shortage of effort to initiate and promote palliative care services in Sarawak despite the obvious challenges. Recognizing the rising urgent palliative care needs in Sarawak over the last 2 decades, many NGOs, started by various individuals and groups in our local community, have risen to answer the call to create awareness and bridge the gap in palliative care service delivery. NGOs such as Kuching Palliative care (under the umbrella of National Cancer Society, Sarawak branch), Miri Palliative Care association, Sarawak Hospice Society and Kuching Life Care Society have been working unceasingly over the years preparing the groundwork and laying a firm foundation for palliative care in Sarawak. So much so that when Two Tree Lodge home care team first embarked on our own hospice journey in August 2016, our work was made so much easier and rewarding because of the teamwork and support of our fellow workers and collaborators in the field.

The recent re-launching of palliative care ward - an 8-bed inpatient ward at the radiotherapy and oncology unit at Sarawak General Hospital - on 4th December 2016 was a remarkable and memorable day for all of us doctors, nurses, volunteers and administrators present that day.  It solidified our commitment to develop and advance much-needed palliative care services in Kuching and Sarawak and celebrated the forging of strong collaborative ties between the government agencies and NGOs needed for the work, so that together we can make a concerted effort to tear down the barriers and march on to develop and advance palliative care throughout Sarawak.

We do not have all the solutions of course, and there is still so much work to be done. It is our dream that palliative care and hospice services can be so well established in our state and country that patients and families can benefit from palliative care much earlier without the need to call for help.

For 2017, Let’s make a recurring resolution to use our collective wisdom & compassion as a community to make a difference in our beautiful homeland of Sarawak.

Reference:1. PA Singer, DK Martin and M Kelner, “Quality End of Life Care: Patients’ Perspectives”, Journal of the American Medical Association 281 (1999): 163-682. KE Steinhauser et al “Factors considered important at the end of Life by patients, family, physicians and other care providers”, Journal of the American Medical Association 284 (2000): 24763. A Gawande “Being Mortal”, Profile Books Ltd 20144. Cancer control: Palliative care. WHO guide for effective programs 2007

Dr Winnie Ling- a proud Sarawakian, is a part time visiting consultant Medical Oncologist at Normah Specialist Medical Centre. Together with her Sister Lily, a counselor and a team of close knit like minded barnyard friends, Dr Ling founded NGO Two Tree Lodge Kuching Hospice on 1st October 2014, in the quest to help develop and expand much needed palliative care & hospice care services in Kuching & Sarawak.

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