2018; Volume 19, No 10, October
Around the World
Palliative care progress reports
We at IAHPC know that advocating for, and implementing, palliative care programs is challenging, uphill work. This is why we love to celebrate your successes that inspire our readers, who can learn from your experience. This section focuses on the successes and challenges of your regional, national, and local palliative care programs. We encourage readers to send write-ups (no more than 500 words), with photos or short videos, here for consideration.
Pediatric palliative care in Malaysia, an image from Moonshine Movies’ 2016 feature on palliative care, Life Asked Death. (Photo courtesy of Moonshine Movies)
Palliative Care Advances in the Asia Pacific Region
The September issue of the journal Pain has published an article by Cynthia R. Goh and Sze-Yi Lee titled, ‘Education in pain and palliative care in the low- and middle-income countries of the Asia Pacific region.’ The Asia Pacific Hospital Palliative Care Network recently published a synopsis of the article’s advances, including links to the appropriate sections of the text:
- PC services started in Yangon General Hospital & Mandalay General Hospital
- Prior to 2013 no oral morphine was available; now, immediate-release oral morphine (10 mg tablets, and 5 mg in 5 mL oral morphine syrup) are produced by the main government-owned pharmaceutical factory
- PC service started at the National Cancer Institute, Maharagama
- Trainees from the project started several charitable community PC services
- More outlets supply oral morphine; prescriptions for patients being discharged increased from a 7-day to a 30-day supply
- In 2017 a Graduate Diploma in PC was established
- In 2015, Palliative Medicine was recognized as a medical specialty
- Immediate-release 10 mg oral morphine tablets, sustained-release 15 mg oral morphine tablets, and oral morphine syrup preparations are now available at 3 institutions involved in the training program and in several pharmacies
Lessons from the Lien Collaborative for Palliative Care
- Establish good relations with potential champions
- Listen to cultural concerns
- Engage with drug regulators, pharmacists, and others to get the medications to the patients
- For sustainability, a national policy for the development of PC is required, with recognition of palliative medicine as a specialty
Progress in pain medicine
Status of pain as a specialty in Southeast Asia
- 2000s Malaysia: a 3-year subspecialty training program was established at 5 Ministry of Health hospitals
- In 2008, Thailand recognized it as a subspecialty of anesthesia
- Presently in Singapore, it is not recognized as a subspecialty
- Presently in the Philippines, it is not recognized as a specialty
Palliative Care in Samoa: Everyone, everywhere
A group photo taken at the 2018 Samoa Palliative Care Forum.
The importance of palliative care to improve the quality of life of patients and their families was one of the messages behind the 2018 Samoa Palliative Care Forum, held in May, that was cohosted by the Samoa Cancer Society and Samoa Ministry of Health.
The forum’s goal was to help further the development of a coordinated approach to delivering palliative care within Samoa by creating a platform to hear perspectives from all aspects of service provision, and to look at strengths and opportunities. More than 100 people attended from a range of backgrounds, including health professionals, managers, health NGOs, patients, family members, and supporting countries including New Zealand, Australia, and Fiji.
In his opening remarks, Minister of Health, Dr. Leao Tuitama said that anyone who suffers from a terminal illness deserves to die with dignity and minimal suffering, and he assured those present that the government is committed to improving the level of palliative care in Samoa.
‘Since 2010 there have been discussions within Samoa to develop a coordinated approach to deliver palliative care and since this time there have been various training programs, workshops and a great deal of discussions,’ he said. ‘The ongoing momentum has meant that now, in 2018, there is increased knowledge in the broader health community about what palliative care is.’
Dr. Tuitama said that it is regarded as a blessing that Samoans tend to their sick elders with so much pride; however, Samoa was one of the 42% of countries identified as having no palliative care services at all. He acknowledged that ‘the need for palliative care has never been greater in Samoa.’
As a result of the forum, a working group is to be established to begin the important work of developing and implementing National Palliative Care Guidelines for Samoa and integrating them into the existing health system.
Uganda Commission Releases 9 Recommendations for Palliative Care
In June, the Uganda Human Rights Commission released its 20th Annual Report to Parliament. The report includes a section on the Rights to Palliative Care, informed by the Commission’s monitoring of palliative care services throughout 2017.
The Palliative Care Association of Uganda participated by sensitizing Commission staff, helping to develop monitoring tools, and consulting on the findings, which comprise Chapter 2 of the Report.
The Commission made nine recommendations. Five involve action by the Uganda Ministry of Health:
- Expedite the passing of the National Palliative Care Policy to streamline the provision and regulation of palliative care in Uganda.
- Institute clear monitoring and evaluation strategies for palliative health care services.
- Consider reinstating the legal instrument allowing specially trained nurses to prescribe morphine.
- Strengthen national district coordination mechanisms for the provision of palliative care services.
- Ensure that the proposed National Health Insurance Scheme covers palliative care.
The rest are:
- The Ministry of Finance, Planning, and Economic Development should consider increasing the budgetary allocations to the Health Ministry for palliative care services.
- Implement the various United Nations resolutions on provision of palliative care.
- Scale up training of palliative care human resources.
- Integrate palliative health care service professionals into the mainstream public service structure.
‘This report is a great piece of documentation to support the advocacy work in Uganda,’ says Mark D. Mwesiga, Programs Manager of the Palliative Care Association of Uganda. ‘We are in touch with the Commission in the next steps of following up on recommendations made.’