The state of palliative care
Excerpted from a speech by Datuk Seri Dr. S. Subramaniam, Minister of Health, at the launch of the new palliative care symbol and palliative care photography exhibition by Hospis Malaysia, Kuala Lumpur, 25 April
Palliative care is an approach that improves the quality of life for patients and families facing the problems associated with life-threatening illnesses. It is a field that has become increasingly important worldwide as the major challenges in healthcare are those of ageing populations and chronic noncommunicable diseases (NCDs).
The WHO estimates that worldwide, some 20 million people need end-of-life palliative care services each year, and about 20 million more are believed to need palliative care in the year before death, giving an annual total of about 40 million people. It is estimated that of these people needing palliative care, around 80 percent live in low- and middle-income countries.
In Malaysia, based on similar estimates of deaths from cancer and the five commonest chronic progressive NCDs, it is estimated that every year, at least 32,000 Malaysians who die require palliative care in the last few months before death.
Palliative care initially focused very much on patients with late-stage, incurable cancer. However, we realize today that the scope of palliative care extends far beyond just patients with incurable cancer and is applicable to many other patients dying from chronic NCDs such as end-stage cardiac failure, end-stage renal disease, neurodegenerative diseases such as multiple sclerosis, Parkinson’s disease, motor neuron disease, severe chronic obstructive pulmonary disease, chronic liver disease and severe dementia. There are also infectious diseases such as HIV/AIDS and drug-resistant tuberculosis where palliative care may also be applicable when cure is no longer possible. So, we can see that the scope of palliative care is very wide and the need for palliative care is evident in almost every medical discipline.
I am told that there are currently 27 registered palliative care NGOs throughout Malaysia providing community services at varying levels and standards of care. At present, almost all community-based palliative care services in Malaysia are provided by nongovernmental organizations (NGOs) and we are indeed grateful to all these NGOs, including Hospis Malaysia, for diligently providing care for patients in the community.
The Ministry of Health (MOH) recognizes the need to support this area of community palliative care as most patients with terminal illnesses spend the majority of their days at home in order to be close to family and friends.
There are six hospitals in Malaysia with specialist palliative care services. There are another 29 MOH hospitals that have palliative care services provided by specialties such as general medicine and surgery. At present, there are only seven trained palliative medicine specialists in the country, and this is far from ideal.
In the UK, the standard norm for palliative medicine specialists is one per 200,000 population. At present, with our population of 30 million, we should have at least 60 specialists to meet a reasonable ratio of one per 500,000 population. So, we definitely do not have enough trained palliative medicine specialists in Malaysia. It is nice to know, however, that we have an active specialists training program, established in 2007. Currently, there are nine trainees in the program. We hope to encourage many more doctors to come forward to serve the nation in this important and noble field.
Palliative care is a fundamental human right. Just because someone is suffering from an incurable and terminal illness, it does not mean they do not have a right to health. All of us, as health professionals, have a responsibility to support and care for patients with palliative care needs.
I know that each and every one of us, as we reach our twilight years, will feel a little more comforted knowing that certain things are in place when our time draws to the inevitable. And although we will also strive to develop more modern facilities in terms of treatment options for cancer and other NCDs, we will recognize that eventually there comes a point when it is not so important to add more days to lives but, more importantly, to add more life to days. This is where palliative care plays a major role.
Today, Hospis Malaysia is launching a new symbol of palliative care so that an identity for palliative care will be created. This symbol will help raise awareness of palliative care nationwide and challenge misconceptions about palliative care.
In addition, there is also a photo exhibition featuring the stories of palliative care recipients, and messages from advocates of palliative care. I would like to congratulate Hospis Malaysia on this initiative, and it is my sincere hope that palliative care services in the country will continue to be further strengthened.
Albert Schweitzer, a German physician, once said, “The purpose of human life is to serve, and to show compassion and the will to help others.” Let me commend all the NGOs involved in this noble endeavor on your compassion for the not so fortunate in our society.