Hospice Movement started in
the early 90’
WAY FORWARD
FOR HOSPICE
IN
MALAYSIA
Ranjit Mathew Oommen
Ministry of Health
1995 Palliative Care Unit ,Kota
Kinabalu
Since then more then 20 units and
numerous support teams set up in
MOH Hospitals
2002 Selayang Hospital
100 beds available currently/ need for
1000 beds
Hospis Malaysia with over 350 to400 patients in
the community at any one time, with 4 doctors,9
Palliative Care Nurses, Occupational therapist,
pharmacist and supporting staff has established
the largest home care program and training
facility in the country.
Provides foundation course and many other
courses through out the year.
8th Malaysian Hospice Congress 13-15 June 2008/RMO
90’s
1992 Home programs by Hospis Malaysia
and Penang Cancer Society
1993 Hospice at home program,
Kota Kinabalu
1994 Hospice Malacca and Kuching Cancer
care
Since then 24 services have mushroomed
2001 Rumah Hospice Penang
9th Malaysia Plan targets to put up 6
regional Palliative Care Centres.
Centres.
Career structure available
Clinical guidelines for the practice of
Palliative care being drawn up
Post basic nursing course in Palliative
Care Nursing is being developed.
In the process of building an educational
centre
International recognition
Increased collaboration for research and
other facilities

Rumah Hospis and the Penang Cancer
Society Home Care Program provides
seamless care in the private sector.
Has been instrumental in helping to set up
home programs in the rest of the country
Has continued to provide training and is
there ever ready to help others to develop.
Palliative Care in Medical
Schools
Palliative Care has been introduced to
medical students in the Klang valley,
Penang,
Penang, Kota Kinablau etc Not given the
priority it should get considering the fact
that to be a good doctor the one speciality
a young doctor needs to know is Palliative
Care Medicine
No post graduate degree or Diplomas’
Diplomas’
available
Palliative care cannot be confined to
cancer
It is not only for the urban population.
It cannot be provided in patches
Why should those dying and suffering
just because they do not have cancer
be denied the proven benefit of
palliative care?
8th Malaysian Hospice Congress 13-15 June 2008/RMO
KK provides seamless care, a very
successful collaboration between an NGO
and MOH
Can be considered a model unit
Introduced the concept of PCU to the
MOH and provided initial training to rest of
the country planning to set up PCU’
PCU’s
“Palliative care is an approach that improves
the quality of life of patients and their families
facing the problem associated with life-
life-
threatening illness , through the prevention and
relief of suffering by means of early identification
and impeccable assessment and treatment of pain
and other problems, physical, psychosocial and
spiritual”
spiritual”
WHO 2002
The effectiveness of pain and symptom
control has been established over 30 years.
When clinical guidelines on pain control are
followed 70 to 90% of patients with
advanced cancer gain adequate pain relief
Good communication results in improvement
in psychological health and better control of
symptoms.
 There is also preliminary evidence for
the application of models of Palliative
Care for people with other illness.
A substantial body of opinion
recognizes that this model of care now
needs to be adapted for other patients
on the basis of need rather then
diagnosis or prognosis
In general the opinion now is that
Palliative Care for older people must
be included within health service
planning at national level. Policy
makers need to ensure that palliative
care is integral to the work of all health
services and is not seen just as an
“add on extra”
extra”.

In UK Baroness Illora Finlay got through a Palliative

Care Bill on 23rd for Feb’
Feb’07 which called for equity of
Two documents brought out by
access to palliative care for all patients.
This bill addresses the issue of:
WHO
*Inequity of access to Palliative Care
*Patchy spread of Palliative Care
Active aging :a policy framework 2003 and
The PC bill hopes to address this with strategic
planning and sustainable funding. To make sure that
Palliative care solid facts 2004
there is public accountability for how vulnerable These documents clearly bring out some
patients get the care they need to be able to live
facts which need to be taken into
rather then wait to die.
consideration

The knowledge and experience gained

through Palliative Care must be integrated
into every day clinical practice.
Community surveys consistently find that
pain is an important symptom in around one
third of the older people. Older people with
dementia are a particular risk of poor pain
control
A BMJ poll acknowledges the
importance of Palliative Care for non
malignant diseases.
More then 40,000 people voted on line
and a large majority voted for
“palliative care for all at end of life”
life”.

8th Malaysian Hospice Congress 13-15 June 2008/RMO

 Palliative care Australia :
Priorities for the 2008-
2008-09 budget.
Health care and other services do not
always perform well for people who
are dying. People with terminal
condition often face “crippling financial
burdens as a consequence of their
terminal condition”
condition”.
Direction of Palliative Care
We all die -the right of every man to die
peacefully
To be able to live rather then wait to die
No longer the responsibility of NGO’
NGO’s
The benefits of Palliative Care have been
proven
Training modules have to be
developed at various levels.
Even now it is possible to use existing
facilities in Hospice Malaysia ,Penang
,Penang
etc to train people at all levels. Every
health care facility must have some
one trained in basic palliative care
8th Malaysian Hospice Congress 13-15 June 2008/RMO
Kerala Government in India announced
Palliative Care Policy
The government of Kerala announced its
Palliative Care Policy and thus becomes
the first government in the developing
world to officially declare a Palliative
Care policy. The government hopes to
develop community based palliate care
service with effective community
participation
THE WAY FORWARD
Palliative Care has to be integrated into
the mainstream medicine and it has to be
a part of the health care system and
delivery
NGO’
NGO’s can only be supportive
Delivery of Palliative Care is the
responsibility of the MOH. Supporting
NGO’
NGO’s must be adequately supported and
funded
Delivery of Palliative care – a
model
All patients to be channeled through PCU
Pain and symptom control/family conference
all to be done in PCU before discharge to
districts or home program
Liaise with trained personnel at district level
Work with family physicians
Tele medicine may be useful

PCU should have a person in charge
to follow up patients referred out from
PCU
Provide regular training to a doctor
and nurse from all district
hospitals/family physicians and their
teams
PCU should be accountable
STRATEGY TO TRAIN
SPEICALISTS
KK Experience
Attempt to introduce PC as a PG
training program at UMS in vain
Doctors who got interested in PC have
fallen by the side
Doctor who started PC in KK now
heads Palliative Care Service in
Brisbane
The effect of Palliative Chemo on survival is
modest
Generally accepted guidelines about offering of
palliative chemo are lacking
The wish of the a patient to be treated plays a
role
A SYSTEMATIC COUNSELING PROCEDURE
MAY BE NEEDED TO PREPARE PATIENT
AND FAMILY FOR DECISION MAKING
8th Malaysian Hospice Congress 13-15 June 2008/RMO
“A supportive palliative care environment
does not necessarily mean the constant
availability of professional people. Only
supervision and occasional consultation
is required when the whole support
system works well. This support system
needs well trained nurses and carers
experienced in Palliative Care. These
people are the front line for providing
Palliative care at home”
home”
Palliative Care has to be separate from
Oncology or any form of curative medicine
Palliative Care cannot be taken for granted.
It is a philosophy that has to develop on its own
and allowed to bloom by itself not under the
shadow of Oncology or any other specialty.
* Finances have to be balanced
Palliative Care calls for investing in
personnel
*The benefits far out weigh the
investment
* It will be money well spent. It will
reduce suffering across the board.
 WE HAVE TO ACT FAST
We need to lobby with the Health Minister, the
MOH, the cabinet and all in power
Those involved have to be to be passionate
We need to be smart, statistics and proof has to be
provided, quote WHO other countries
We need to educate the people
The elderly and those with incurable diseases must
be made aware of their rights
Why at the beginning of the 21st century, do
we need a grass root movement to help us
learn something as basically human as how
to die?
We need to relearn death because of the
excellent job done by the MOH people today
die in a different way from our forbears: We
tend to die older, from different causes and
in different environment.
The Health System has to adapt to this
change
On the world hospice scene are we are getting left
behind? Other developing countries are fast catching up
and moving forward at a much faster rate.
We need to move into fast gear
We need to have a vision
“To make Palliative Care accessible to all Malaysians who
require it”
it”
8th Malaysian Hospice Congress 13-15 June 2008/RMO
Unfortunately the dead do not speak about
the benefits they have had from
Palliative Care
People requiring Palliative Care are on the
increase. Our population is aging.
In 1900 people died at home surrounded by
family ,physicians routinely comforted the
dying and their families.
In the past century medical and pubic health
advances have almost doubled the average
life expectancy.
People who die in old age now tend to
experience a long period of functional
decline before death, thus require intensive
care giving and well coordinated medical
and palliative care.
It was Dr Khashiwagi who rightly said
“regardless of the differences in the concept
of death, socio economic and religious
backgrounds and medical and nursing
situations a common hope for all people all
over the world is to die peacefully. Therefore
the need for Palliative Care Services in
every part of the world is a consideration
that reaches beyond the boundaries of
countries and nationalities”
nationalities”
 We need to have targets to
achieve
In Palliative care we are patient , we listen,
Set target dates we never argue our cause. It is watchful
waiting and symptom control
To cover all cancer patients by 2013
This approach will not work in introducing
All people requiring Palliative Care by
Palliative Care into this country. May be
2020
this is why we have not been successful
Work together to achieve these targets-
targets-
All those involved the MOH and NGO’NGO’s

Now it has to be the top to bottom approach

The Hospice philosophy has come to stay
The pioneers have done their part in
establishing the Hospice Philosophy and
proved to the country the difference it can
make to people who are suffering
The bottom to top approach has worked so
far
We have to try and make Palliative Care
become a government policy
A part of mainstream medicine
An important part of the delivery of health
care
Working together with the existing NGO’
NGO’s we
can prove that we are truly a nation that
cares

If we act now the MOH working with all the

NGO’
NGO’S we can set target and achieve them.
Palliative Care for all incurable cancer by
2013
Palliative Care for all those requiring it atleast
by 2020

Only then can we call ourselves a caring

nation a developed nation
THANK YOU

8th Malaysian Hospice Congress 13-15 June 2008/RMO