Alex Tang
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Medical Students /Paediatric notes
Overview of the Hospice Movement in Malaysia[1]
The modern hospice movement can be attributed to the pioneering work of Dame Cecily Saunders who in the late forties worked in St.Luke’s Hospice, London as a nurse and social worker and later as a doctor in St. Joseph’s Hospice, London. In 1967 she founded St. Christopher’s Hospice to show that by combining the medieval tradition of compassion with modern medicine it was possible to relieve suffering of terminally ill patients and their families.
In Malaysia, Hospice Home Programmes for patients with incurable cancer began in Kuala Lumpur and Penang in 1992 followed by similar programmes in Kota Kinabalu, Ipoh, Kuching Johor Bahru, Klang, Melaka and a second one in Kuala Lumpur. Awaiting registration are groups in Kota Bahru, Sandakan and Tawau while discussions have begun in Seremban, Alor Setar and Sungai Petani.
Models of Hospice in Malaysia
1. Hospice at Home
All the established hospice groups in Malaysia have begun with the following features:
Ø Hospice care is provided in the home of the patient
Ø There must be a primary carer at home, preferably a relative
Ø It is a free service
Ø Run by volunteer nurses, doctors and lay persons with one of more nurses as staff.
Ø Not a 24 hour programme
Ø Dependent on funding from public
Ø Dependent on hospitals (usually public) to manage when care is no longer possible at home or when the primary carer at home needs respite from caring.
Ø Concerns such as long term volunteer commitment or quality of care, staffing difficulties and funding.
Further these groups vary in their organisational aspects – some are projects of established societies such as the National Cancer Society of Malaysia, others are registered societies or companies registered as charities while one is still a project of a Rotary Club.
Hospis Malaysia was founded in late 1991. It is a charitable NGO and provides palliative care services for a large part of the Klang valley. Services provided are basically homecare, loan of medical aids/equipment, volunteer support services and a bereavement support services. The hospice has a staff of 11 of which the palliative care team consist of a doctor[2] and 5 palliative care nurses. In June 1998, the hospice moved into its own building in Cheras.
2. Palliative Care Unit (PCU)
A Palliative Care Unit was successfully set up in the Queen Elizabeth Hospital in Sabah in January 1995. The advantage of this unit is that a large number of cancer patients will get palliative care as the majority of cancer patients get their treatment in public hospitals. This PCU concept has since been extended to five district hospitals in Sabah and to Kota Tinggi district hospital in Johore.
The objectives of the PCU are:
Ø To provide a specialised short term inpatient unit for the comprehensive care of advanced cancer patients, including good symptom control
Ø To provide day care for procedures that cannot be done at home such as pleural tap.
Ø To provide temporary respite for the primary carer and family.
Ø Training of health professionals in palliative care
Ø To establish standards and quality assurance.
Ø To recruit volunteers for the support of both inpatients and hospice home programme (volunteer support group).
Aside from Sabah, the Ministry of Health has not set up any PCU in the other public hospitals. With the stated Government policies towards corporatisation of public hospitals and health services, there is real concern that palliative care may receive low priority.
3. Institutional Hospice
At present, there are no institutional hospices in Malaysia. Many of the established Hospice groups have realised the need to have a home with beds.
Conclusion
The above brief review showed the great need for more hospice care in this country. The Hospice Movement is still in its infancy in this country.
[1] Information for this overview is from a paper presented by Datuk (Dr) Devaraj, “Hospice Care – Developing Malaysian Models” at the Second MOH-AMM Scientific Meeting, 4-7 November 1998. Datuk (Dr) Devaraj is the Chairman of the Hospice Council of Malaysia and of the National Cancer Society of Malaysia (Penang Branch). Personal communication.
