Palliative care needs do not stop at a border. Across the Asia Pacific, many people live and work far from home, and when illness advances, many of them wish to return to their families for their final weeks. Making that journey safe, supported and dignified takes more than a plane ticket. It takes clinicians who can hand over care to one another.
In February 2026, we at Asia Pacific Hospice Palliative Care Network (APHN) had the privilege of helping make one such handover possible. Tan Tock Seng Hospital (TTSH) in Singapore wrote to us about a patient from the Philippines, from Cagayan Valley, Cauayan City, Luzon, who was planning to return home the following Wednesday. They asked whether we knew of any doctors in the hospitals there whom they could contact directly.
We reached out to our contacts in the Philippines and were recommended Dr Alizza Love Velasco. We shared her contact details with Dr Lynn Wiryasaputra at TTSH. What followed is told here in the words of the two doctors who cared for Mdm A, first from Singapore and then from the Philippines.
From Singapore: Dr Lynn Wiryasaputra, Tan Tock Seng Hospital
Mdm A was a Filipina working and living with her husband in Singapore for more than a decade. She was diagnosed with metastatic thymic carcinoma in late 2024 and underwent multiple lines of systemic treatment.
Mdm A initially responded well to a course of palliative radiotherapy to her chest wall for pain control in August 2025. However, by end 2025, she unfortunately developed worsening complex cancer pain, requiring multiple continuous palliative infusions for adequate pain control. She was eventually rotated to oral methadone tablets.
By early 2026, Mdm A voiced her preference for best supportive care due to her increasing lethargy and symptom burden. She also expressed a strong desire to return to her hometown in Cauayan City to spend her final weeks with her large family.
As her TTSH palliative care team was concerned about her potential need for continuous subcutaneous infusions, we reached out to our colleagues in the Asia Pacific Hospice Palliative Care Network, who promptly linked us up with Dr Velasco of Cagayan Valley Medical Center. The TTSH team emailed Dr Velasco, who responded promptly and kindly arranged to follow up with Mdm A’s care in the Philippines.
To the Philippines: Dr Alizza Love F. Velasco, Cagayan Valley Medical Center
I am Dr Alizza Love F. Velasco, a Hospice and Palliative Care Specialist practicing in the province. I finished my training in Family and Community Medicine, and subspecialty training in Hospice and Palliative Medicine, at the University of the Philippines–Philippine General Hospital (UP-PGH). After my training, I went home to the province and established the Residency Training Program of the Department of Family and Community Medicine at the Cagayan Valley Medical Center in Tuguegarao, Cagayan, while introducing hospice and palliative care in the Region. At present, hospice and palliative care services are offered under the Department of Family and Community Medicine.
For the first time, I received an international patient referral. The Philippine Society of Hospice and Palliative Medicine (PSHPM) initially contacted me to verify my area of practice and contact information. Shortly after, I received an official email endorsing the case of Mdm A. I responded and gave my mobile number so her family could easily reach me upon their arrival in the province.
On February 27, 2026, I received an SMS from Mdm A informing me that they had arrived from Singapore. The following day, I visited Mdm A and met her and her son. We established an initial rapport, and she expressed immense comfort and happiness about being back home to spend time with her family. During this visit, I re-introduced the concept of hospice and palliative care. I managed expectations by explaining that our local resources are limited compared to other countries and awareness of palliative care remains low, even among medical professionals.
We scheduled the next visit after two weeks, but I assured them my lines were always open for questions or emergencies. This proved vital when, while I was attending an out-of-town convention, Mdm A’s son called me early in the morning. He had taken his mother to the Emergency Room due to severe shortness of breath, and they were being advised to admit her to the ICU, which Mdm A refused. I spoke directly with the ER physician to explain her condition, our palliative approach, and her established goals of care. The doctor understood the situation completely. Instead of the ICU, she was admitted to a regular room where they managed the pleural effusion that was causing her difficulty in breathing.
Mdm A was discharged after a week. I instructed her son to contact me immediately during any future hospital visits so I could align with the on-duty physicians. Because they lived a two-and-a-half-hour drive away, most of our subsequent consultations took place via SMS. Fortunately, she had been provided a six-month supply of all essential medications when she left Singapore.
By my next in-person visit, Mdm A’s condition had noticeably deteriorated. She firmly expressed that she no longer wanted hospital admissions and wished to remain at home. Since her three sisters were present alongside her son, I conducted a family meeting to discuss her declining health, goals of care, and advance directives. Gently, I advised them that it was time to say their final goodbyes. I also spoke with her son’s family in the US, urging them to call. Incredibly, they were able to fly back to the Philippines a few weeks after Mdm A arrived and spend precious time with her. Two days later, I received a call informing me that Mdm A had passed away peacefully, surrounded by her loved ones.
This experience beautifully underscores how seamless continuity of care benefits patients and their loved ones. Mdm A’s family was genuinely amazed to learn that her doctors in Singapore had proactively endorsed her case to me before she even departed. Her sisters were incredibly grateful, comforted by the fact that after a lifetime of working hard overseas, she received such a well-coordinated and dignified transition of care back home.
Furthermore, this international medical referral highlighted the significant gaps in providing hospice and palliative care services to Overseas Filipino Workers (OFWs) who choose to return home to spend their remaining days with family. Currently, there is a severe shortage of hospice and palliative medicine specialists in the Philippines, leaving many regions completely underserved. While it is unclear how widely international referral and endorsement networks are used by palliative specialists globally, formalising this collaboration is vital. Establishing seamless overseas medical referral systems would not only help us reach more OFWs in need of specialised end-of-life care but also raise crucial awareness about the availability of these essential services in our country.
Most importantly, this case showed how continuity of care can transcend borders. The collaboration between physicians provided holistic care to the patient and her family, ensuring Mdm A’s wishes were honoured and comfort was maintained until the end.
Why this matters across the Asia Pacific
Mdm A’s story began with a single email and a short timeline. It worked because two clinical teams were willing to talk to each other directly, and because someone could connect them quickly. The result was a patient who died at home, as she wished, with her family around her, and a family who saw first-hand what coordinated care looks like.
It is also a reminder of how many people across our region live and work outside their home countries, and how many may one day wish to return. Wherever a patient comes from, and wherever they wish to go, they deserve access to palliative care.
APHN: your bridge across the region
APHN is a regional network operating across the Asia Pacific region, and connecting people is at the heart of what we do. In this case, we were able to move from a hospital’s urgent request to a named, willing colleague in a matter of days, because of the relationships our members and partners have built across the region.
We would like to be that point of contact for you too. If you are:
- a clinician with a patient who wishes to return to another country in the Asia Pacific and need a palliative care colleague on the receiving end,
- a palliative care specialist willing to receive international referrals and be listed as a contact in your region, or
- an organisation interested in building referral and endorsement pathways across borders,
please reach out to us. Tell us where your patient is going, and we will do our best to connect you with the right person.
Contact APHN: aphn@aphn.org or WhatsApp us: +65 6235 5166
Our thanks go to Dr Lynn Wiryasaputra and the palliative care team at Tan Tock Seng Hospital, to Dr Alizza Love F. Velasco, and to the Philippine Society of Hospice and Palliative Medicine (PSHPM), for showing what care without borders can look like.
Written by Dr Lynn Wiryasaputra (Tan Tock Seng Hospital, Singapore), Dr Alizza Love F. Velasco (Cagayan Valley Medical Center, Philippines) and the Asia Pacific Hospice Palliative Care Network (APHN)
