Area of Focus: Eldercare
Partnership agency: Singapore Hospice Council
Conceptualised & Initiated by Lien Foundation
Hospice does not refer to a particular place or venue. Rather, it is a concept of care comprising comprehensive programmes designed for patients and families facing life-threatening illness. Also known as palliative care, hospice may be given in a patient’s home, at an independent in-patient institution, a hospice day-care centre, palliative care clinic or hospital ward.
Twenty-two doctors, predominantly foreigners, manage the care of 3,700 patients through 35,000 visits¹ – this works out to a ratio of 1:168. This is the shocking reality of the hospice doctor-patient ratio in Singapore.
With a rapidly aging population, Singapore is a facing a critical shortage of doctors in hospice. Between April 2004 and March 2005, for example, eight doctors struggled to manage the home-based care of some 3,700 terminally-ill patients. Amongst them, they made a total of 36,000 visits. The situation has improved, albeit marginally, over the past year or so, as a handful of foreign doctors added to the provision of palliative care.
Former contractor CC Lee suffers from high blood pressure, diabetes and lung cancer. His wife, his sole relation, has passed on. Now single, ill and alone, he passes his days shuffling around his government-subsidised flat – often too weak to leave the house. Despite the confinement, Lee will tell you that his daily routine is (happily) interrupted by twice-weekly visits from medical workers as part of his hospice homecare programme.
“They give me free medical checkups and medicine, and ask me if there is pain. They want to know what I do every day – whether I take my medicine, have enough to eat, what TV programmes I enjoy, and who comes to visit me,” says Lee. “The doctors and nurses all take very good care of me.”
Lee is one of some 4,000 terminally-ill patients in Singapore who benefits from hospice in the familiar environment of home. In spite of his ailments, he is usually in good spirits as his aches and pains are kept in check, and he looks forward to the visits of his “good friends” – social workers and volunteers who befriend home-bound residents like him.
Hospice medical personnel provide an essential need to society. So why the lack in numbers?
Dr Cynthia Goh, head of palliative medicine at the National Cancer Centre of
Singapore, shed some light in an article in the Today newspaper². She says
that whilst there are doctors who have expressed interest in this field of practice,
they face huge obstacles ranging from lack of recognition to an ambiguous career
path and limited local accreditation of specialists.
Doctors who wish to specialise in palliative care have to enrol in overseas courses
overseas as there are no local ones available. Whilst their peers know exactly
what await them after three years of professional study, doctors who pursue hospice
studies are none the wiser despite expending time, effort and great personal
expense.
Alluding to the nation’s greying populace, Dr Goh estimates that about 65 per cent of the population will need hospice in the future, up from the current 20 per cent. Clearly, there is an urgent need to re-shape the perception and state of palliative care.
And things are beginning to change.
In April 2006, the Lien Foundation, in partnership with the Singapore Hospice Council (SHC), created and launched the first-ever doctors’ and nurses’ palliative care fellowships and scholarships in Singapore.
In a S$2 million effort, part of which goes towards awareness building for the oft-misunderstood idea of hospice, the Foundation is staying true to its role as catalyst – to ignite action to deal with gaps and unmet needs in society.
The scholarships fellowships from the Foundation will train 10 local doctors,
20 local nurses, and 20 doctors from Singapore and the Asia-Pacific region over
a period of five years.
The public awareness building campaign aims to increase people’s awareness of hospice palliative care and end-of-life issues, and to face them without trepidation or stigma. With a shrinking family size, the younger generation will face a growing load of caring for the elderly and the terminally ill. These care-givers are a focal point of the campaign as hospice is not only for the dying, but also for the living.
The SHC-Lien Foundation project is managed by a committee represented by various SHC members. The public awareness campaign has attracted participation from partners like Ogilvy & Mather (Advertising), fine art photographer, Wee Kheng-Li and Singapore film director, Royston Tan.
The campaign will introduce a toll free hotline for the public and special website on hospice care, as well as an islandwide mobile photo exhibition and TV, radio and outdoor advertisements. In October, the campaign will launch a month of activities starting with the World Hospice and Palliative Care Day on October 7, followed by a book festival, art exhibition and public talks.
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