Palliative Care Updates from Samoa

Submitted by: Ms Alice Every

“Palliative Care in Samoa: Everyone, Everywhere”

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 on the 28th & 29th May and co-hosted by the Samoa Cancer Society and the Ministry of Health.

The forum aimed to help progress 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. Over 100 people attended from a range of backgrounds, including health professionals, managers, health non-governmental organisations and patients and family and supporting countries including New Zealand, Australia and Fiji.

At the opening, the Minister of Health Tuitama Dr. Leao Tuitama said that anyone who suffers from a terminal illness deserves to die with dignity and minimal suffering. He assured that the Government is committed to improving the level of palliative care in Samoa.

“Since 2010 there has been discussion within Samoa to develop a coordinated approach to deliver palliative care and since this time there have been various training programmes, workshops and plenty of discussions.”

“The ongoing momentum has meant that now in 2018 there is increased knowledge in the broader health community about what palliative care is.”

He said 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 that have no palliative care services at all, acknowledging that “The need for palliative care has never been greater in Samoa.”

As a result of the forum, a working group will 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.

APHN Mini Interview Series – Professor Myo Nyunt, Myanmar

This interview is the third of the mini-interview series featuring members of the 17th Council of the Asia Pacific Hospice Palliative Care Network (APHN).

This month, we interviewed Professor Myo Nyunt, the appointed council[1] member from Myanmar. Prof Nyunt is the President of the U HlaTun (Hospice) Cancer Foundation.

How did you come to the palliative care field?

It was very unusual for a pathologist by profession to be involved in palliative care. It was sometime in 1994 when Daw Mya Sanda Tun, daughter of U Hla Tun, came to me for unexplained fever for investigation and treatment. I did a venepuncture and 26 parameter haematological test. In the blood film I found that there were some abnormal cells and further investigations including bone marrow examination revealed acute leukaemia/lymphoma. To cut the story short, she ultimately went to London for further management in view of a bone marrow transplant in 1995. Unfortunately, the transplant failed.  U Hla Tun was very grief stricken and decided to build a hospice in Yangon, Myanmar, in 1998. Since then, I have become an executive member and worked in the hospice over the years until today, where I am the current President of the U Hla Tun Hospice Cancer Foundation. I am currently in charge of the medical affairs of the hospice in Yangon and Mandalay. The Mandalay hospice was established in 2003.

Please share with us more about the hospice work.

We have two hospices, one located in Yangon, and the other in Mandalay. We have resident doctors caring for the cancer stricken patients. Our hospices care for cancer patients that are the poorest of the poor and cases that are beyond treatment. When our patients are unable to afford cycles of palliative chemotherapy, radiotherapy, we do cover the costs for some of them to complete their treatment. We also cover the costs for surgery in some cases. However, we are still mainly providing palliative care services. The staff nurses and nursing aids attend to patients’ various needs. Specialists from various disciplines like medicine, surgery, anaesthesiology, OBGY, dental surgery, clerics and social workers also form part of the team and conduct ward rounds on designated days.

What do you think are the current opportunities and challenges in Myanmar in developing palliative care?

The challenges in Myanmar in developing palliative care are considerable, especially due to the availability of oral morphine and morphine syrup. We now have a pharmaceutical factory which is ready to supply the amount needed for hospices. However, specific procedures are not yet available for the purchase and processing of the medicine. In this area work is still work in progress.

We are glad that we have trained staff who have already attended the training of trainers’ course under the Lien Collaborative for Palliative Care project.

How will you hope to see the APHN collaborating with relevant stakeholders in Myanmar?

APHN has a strong presence in Myanmar involving both the public organisations, like Pain Society, and private organisations like the U Hla Tun Hospice Cancer Foundation, Shwe Young Hnin Si Foundation, the Oncology Society and the Myanmar Medical Association.

The APHN representatives have met with the Minister of Health and officials from the Ministry of Health and Sports. They have also given lectures and hands-on training in Naypyidaw, Yangon and Mandalay. Most of the palliative care doctors and nurses in Myanmar are familiar with them.

In terms of policy, I think we do need to raise more awareness on the subject of palliative care and its necessity. We also need to have better community involvement.

If you were to choose a colour to represent your journey in palliative care, what will it be and why?

The colour I chose will be the evening tide (light purplish blue) colour. The colour is often used by hotels. I feel that it is not dull, yet cheerful and peaceful enough, as if the name implies it is set for a “quiet night’s sleep”. Out of so many philanthropic works, I chose to be an APHN Council member because I hope to be a role model for the younger generation of physicians in Myanmar and incite them to continue in this noble work.

[1]The APHN Council consists of 7 members to be appointed by sectors on a rotation to be determined alphabetically according to the name of the sectors (Constitution 12.2a), 7 elected members, and 6 Co-opted member

Hong Kong 2nd Community End-of-Life Care International Conference

The Community End-of-Life Care International Conference will be held on June 20-21, 2018. Sponsored by the Hong Kong Jockey Club Charities Trust, registration is FREE.

Some of the keynote speakers for this conference are Dr. Stephen Connor – Executive Director, Worldwide Hospice Palliative Care Alliance (WHPCA), Prof. Irene Higginson – Professor of Palliative Care and Policy King’s College London; King’s Health Partners, Director, Cicely Saunders Institute, Prof. David Currow – Professor of Palliative Medicine, Faculty of Health, University of Technology Sydney, Prof. Wang Ying Wei –Director General, Health Promotion Administration, Ministry of Health and Welfare, Taiwan

Find out more at the conference website here.

Travel Grants to 23rd Congress of the Japanese Society for Palliative Medicine

Dear friends

The 23rd Congress of the Japanese Society for Palliative Medicine (JSPM) is open for registration. We are pleased to announce that the JSPM 2018 organizing committee will offer travel grants to overseas participants who would like to submit abstracts as International members, traveling from all parts of the world(country,25 or below at this site) to present high quality papers at the meeting. Only one person per abstract (the presenting author) will be considered for the Travel Grant. Funding for travel will not exceed JPY50,000 per grant, and will be limited to 20 members.

For more information on the congress and travel grant, please visit the website http://jspm2018.umin.jp/english/

I will be going and I look forward to seeing you there!

Joyce Chee, APHN Executive

On behalf of Prof Yoshiyuki Kizawa, APHN Council Member and President of the 23rd JSPM

 

 

25th Annual Conference of Indian Association of Palliative Care

25th Silver Jubilee Conference of the Indian Association for Palliative Care will be held in Delhi, India on 23rd – 25th February 2018.

They have lined up a list of expert speakers from the world and the region, including Robert Twycross, Eduardo Bruera, Julia Downing, Ilora Baroness Finlay, Cynthia Goh, Eric L. Krakauer, Fiona Rawlinson and many more!

More details on the conference and their programme can be found at http://www.iapcon2018.com/index.html

 

APHN-Hospis Malaysia Workshop: Grief & Bereavement Care

This 2-day intense workshop on Grief & Bereavement Care concludes our final series of palliative care workshops for the year.

Associate Professor Amy Chow from the University of Hong Kong together with Dr Gilbert Fan from Singapore, will be facilitating the 2-day course which is designed towards a very interactive and engaging experience. This workshop will be immensely valuable to clinicians, psychologists, social workers  and counselors managing palliative care and care of the dying.

Registration submission can be made online at www.hospismalaysia.org/griefandbereavement/ and emailed to education@hospismalaysia.org.

APHN Mini Interview Series – Dr Masanori Mori, Japan

This interview is the second of the mini-interview series featuring members of the 17th Council of the Asia Pacific Hospice Palliative Care Network (APHN).

This month, we interviewed Dr Masanori Mori, one of the Co-opted members[i] of the Council. Dr Mori is a palliative care physician at Seirei Mikatahara General Hospital, located in Hamamatsu city, Shizuoka Prefecture, Japan.

Challenges in clinical practice and unique approaches

I was trained and practice palliative care in oncology for 10 years, during which, I had faced many challenging problems, but there are two distinct situations I encountered which I will like to share.

The first was providing palliative care for adolescent and young adult patients (aged 18 – 39) when I was a fellow, partly because we were in the same generation. We could provide symptom management, but many of them had severe psychosocial & spiritual pain, especially regarding them having to face early, premature death. I remember clearly a patient asking me in front of his family, “What would you do in my shoes?” It got me thinking. What would I do being in my 30s and facing death? I thought there was no right answer to that, so I had some difficulty when faced with such questions.  We had a good patient-physician relationship. I felt like I was asked the question not only as a physician, but as a person. So I shared a part of my life with the patient, and we had some good conversations. I was sharing what my hobby was, which was “Haiku”, a very short form of Japanese poetry. After he passed away, the patient’s family engraved the haiku poetry I wrote for him on his tomb.

I feel that when we are facing such situations where a patient has significant psychosocial distress, what we could do is to sit down near the patient, try to understand where his or her suffering comes from, and adopt a multidisciplinary approach to discuss how best to support the patient.

The second challenge I have faced was, no matter the improvements in palliative medicine, occasionally we still have difficulty in relieving severe symptoms at the end of life. For example, shortness of breath just before death can be quite difficult to manage even with the use of parenteral opioids. We sometimes do palliative sedation to relieve intractable symptoms like refractory shortness of breath. But before its initiation, it can be difficult to say how much palliative treatment is sufficient enough to say “this symptom is indeed refractory”, even with the best evidence and discussions among palliative care experts. Going forward, we need to improve strategies of symptom management at end of life

One unique approach I can share is that recently, there have been some trends to the early integration of oncology and palliative care in Japan. One of such activities is a “two-physician system” for advanced cancer patients; while a patient is receiving anticancer treatment by an oncologist, a palliative care physician within or outside the institution sees the patient as the other main physician, not as a consultant, alongside the oncologist. I feel that this new, collaborative approach allows for a smooth transition to palliative care, lessening the sense of abandonment felt by patients. However, this practice is still in the pilot stage in Japan.

One thing I hope to do during my term on the APHN Council is to contribute in the area of research. For example, I am interested in cross-cultural studies in Asian and Pacific countries to understand similarities and differences in palliative care practices. Such data could help us appreciate the situations of each country, and lay the foundation for future collaboration.

Life and inspiration

My friends and colleagues are usually surprised to know that I am interested in Haiku poetry because it is not very popular among people of my age. (Haiku poetry is usually popular among older people in Japan.) I have 4 kids, so I also enjoy playing with them.

There were many people who inspired me in my life; my dad and mum, my previous and current mentors in US and Japan, and Dr Shigeaki Hinohara who was one of the founders of the APHN. Many of them share similar characteristics in terms of how to view the world, manage challenges, take collaborative actions, and enjoy life. They all have certain aspects which became my inspiration in one way or another.

For example, Dr. Hinohara’s writings and works are very inspirational. I was so inspired by his altruism, perspectives, and medical and social activities that I visited him at St. Luke’s International Hospital 10 years ago when I was a palliative care fellow in Houston. Dr. Hinohara was 95 years old then. It was about 10-15 minutes when we talked; Dr. Hinohara listened to me, and shared his vision of not only launching a graduate medical school but also ceasing wars worldwide. He left the world at the age of 105 but he pioneered in numerous fields in medicine ranging from preventive medicine to end of life care , as well as medical and nursing education. Moreover, Dr. Hinohara contributed to the entire society by publishing a number of million-seller books such as “Living long, living good”, and initiating something very new such as so-called “Smart Senior Association”.

As a new member, I very much look forward to working with you all at APHN!

By: Joyce Chee, APHN Executive
The article first appeared in the APHN newsletter Issue 34.
All information is correct at time of publishing.
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[i] The APHN Council consists of 7 members to be appointed by sectors on a rotation to be determined alphabetically according to the name of the sectors (Constitution 12.2a), 7 elected members, and 6 Co-opted members.

SG Pall eBook

The Lien Centre for Palliative Care (LCPC) is pleased to launch the SG Pall eBook, a mobile- friendly online resource for palliative care tips. This product arose from a  collaboration between LCPC and a group of specialist Palliative Care practitioners from various institutions across Singapore. The  eBook aims to provide quick and  easy access to basic palliative knowledge (through their mobile phones) for  busy healthcare professionals on the go, and is suitable for all care settings.

Access the SG Pall eBook here!

APHN-Hospis Malaysia Workshop: Pain & Symptom Management

One of the objectives of palliative care for patients and their families is to improve their quality of life (QOL). Ensuring good pain and symptoms control for patients with life-limiting illness will help achieve this objective. This three-day workshop deals with aspects of both pharmacological and psychological issues on pain and symptom management so that patients with life-limiting illness are given the opportunity to live out their days with meaning and with as little distress as possible.

Thus, successful pain control requires a multidisciplinary approach to treatment that addresses all aspects of care and suffering. As usual, our workshop concentrates on small group settings and will be most beneficial to healthcare providers working in a palliative or oncology setting, and other related specialties, with a general interest in palliative care.

Registration submission can be made online at www.hospismalaysia.org/painandsymptom/ and emailed to education@hospismalaysia.org.

WHPCD 2017: Health Screening and Information Booths by Singapore Hospice Council

Join the Singapore Hospice Council and their member organisations to celebrate the World Hospice and Palliative Care Day with health screening, information booths and live performances to engage the public to learn about palliative care.

Find out more here.

 

What is your organisation doing for the World Hospice & Palliative Care Day & Voices for Hospices 2017? Let us know in the comments below or email us at aphn@aphn.org!

WHPCD 2017: Patient Get-together by Pallium India

Pallium India will be organising “Thalolam 2017” in conjunction with the World Hospice Palliative Care Day 2017. About 500 participants, including patients with life-limiting diseases and their family patients, will gather on 14 October 2017 for the get-together.

Read more here.

 

What is your organisation doing for the World Hospice & Palliative Care Day & Voices for Hospices 2017? Let us know in the comments below or email us at aphn@aphn.org!

WHPCD 2017: Hospice Film Festival/Book Fair by Hospice Foundation of Taiwan

In conjunction with the WHPCD 2017, Hospice Foundation of Taiwan will be holding a Film Festival featuring ‘Oscar et le Dame rose’, ‘The Fault in Our Stars’ and ‘In His Chart’. There will also be a feature talk by movie director Wu Nien-jen and a book fair focusing on palliative and hospice care.

 

What is your organisation doing for the World Hospice & Palliative Care Day & Voices for Hospices 2017? Let us know in the comments below or email us at aphn@aphn.org!