I was first involved in the APHN-Lien Collaborative for Palliative Care in Sarawak, as part of the APHN Team on a scoping visit to Kuching, in August 2022.
Much background work had already been done by the APHN Chair, Dr Ednin Hamzah, Dr Sharon Choo the APHN Medical Lead for Sarawak, and a dedicated group of Sarawak Palliative Care proponents. Representatives of the palliative care community in Sarawak had applied for the state to be considered for a Lien Collaborative project early in 2022.
This culminated in a meeting with the Deputy Premier for Sarawak, Dr. Sim, the Directors of Sarawak General Hospital, Sibu Hospital, Two Tree Lodge Hospice and the CEO of Kuching Life Care, and APHN Chair, team members and the CEO of Lien Foundation. There was great enthusiasm shown by all, and an official MOU was later signed on behalf of the Sarawak Government by the Deputy Premier in April 2023. The Model of Care was to be community-focused and based, led by staff from many Community Health Clinics across Sarawak. This model allows a greater access to palliative care for the Sarawak community, since in common with worldwide practice most palliative care is delivered in community settings, not in hospitals.
The first training Module for District Health Clinic Medical Officers, Nurses and Allied Health team medical assistants in Palliative Care was held in Kuching in (?)May 2023. I was not part of this initial Module but reports from my APHN colleagues were that the Group were so enthusiastic and keen to learn!
I was a Volunteer Faculty Member for Module 2, on October 9-13, 2023. We had a faculty group of doctors and nurses, led by Dr Sharon Choo, and Dr Ednin Hamzah. It was great to work with the 50 Sarawak doctors and nurses and Medical Assistants -to see their enthusiasm for learning, so that they could provide good palliative care for their patients across Sarawak-a very large state, with a scattered population of 3 million, presenting so many challenges! I was particularly struck by the geographical difficulties facing teams caring for patients in remote locations, many hours by road and/or boat from the District Health Clinics. In such areas, internet and phone connections may not be available either. Not all the smaller, more distant clinics have medical staff-so, education of senior nursing staff is a key component of the training. The interactions with so many people were great; the faculty were so well-looked after by the local personnel, and much great food and dialogue was had by all of us! I absolutely commend Dr Sharon Choo, the Palliative Care physician at Sarawak General Hospital, for her impeccable and detailed organisation of all the activities -particularly the clinical bedside teaching at SGH.
I was really delighted to be invited to return for Module 3, March 4-8.2023, as a full Faculty Member. The faculty had a few changes, now including the expertise of another one of the senior Nurses from Dr Hamzah’s Team in Kuala Lumpur. It was so great to see everyone again-and to be able to see the clear progress that all have made in the implementation of their skills and knowledge gained from the first 2 Modules. From conversations and small group discussions over the week, it is evident that they are all able to apply the knowledge gained at the Training Workshops, to their interactions with patients and families. They are clearly making such a real difference to patient outcomes. From being able to prescribe doses of analgesics, and managing a gamut of physical symptoms, to their improved knowledge of the application of communication skills training-very impressive progress has been made.
Dr Choo has implemented a Palliative Care Formulary of Essential Medicines for Palliative care for the state, ensuring appropriate medications are available to all. She has worked tirelessly to be available to Workshop participants as a source of expert advice in matters where people are requiring further guidance.
The Palliative Care Ward at SGH, under her Directorship, is great to see, and well-integrated with Cancer Services at the Hospital. She has an excellent team of senior nurses, some of whom are also Faculty Members, providing additional masterclass education for all Workshop participants-the sessions on Wound care and Stoma care were particularly well-received!
It was an absolute privilege to be able to share Palliative Care knowledge and teaching with the group! Again-the dinners and activities were greatly enjoyed. The Sarawak hospitality is outstanding.
I look forward to returning for the 4th Module in August 2024-to be focused on some further fine-tuning of abilities, and looking at more complicated scenarios, as well as setting up the participants to themselves provide training in Palliative Care for other clinic staff: they are to become the trainers, themselves. Palliative Care in Sarawak is proceeding in such a positive direction, and it is wonderful to contribute.
Written by:
Dr Jan Maree Davis FRACP FAChPM
APHN-Lien Collaborative Faculty Member
Senior Staff Specialist Palliative Medicine
St George Hospital; Calvary Hospital Sydney, Australia