Easing the pain over matters of life and death

Today is World Hospice and Palliative Care Day, held on the second Saturday of October each year. The Straits Times recently visited Taiwan, which emerged top in Asia in a global ranking for end-of-life care. Priscilla Goy reports from Taiwan
The Straits Times, 11 Oct 2014

IN TAIWAN, people from all walks of life, including taxi drivers and hairdressers, voluntarily attend sessions to learn how to care for terminally ill patients.

High school students also attend classes as part of their curriculum to learn about the dignity of life and death.

The comfort level of the general Taiwanese public in dealing with the often-taboo topic of death is one reason that Taiwan was ranked top in Asia in the 2010 Quality of Death Index produced by the Economist Intelligence Unit.

It was ranked 14th out of 40, four positions above Singapore.

Professor Chao Co-shi, hailed by Taiwanese media as the island's first palliative care expert, said in Mandarin: "I felt that the quality standard of our palliative care can't be better than Singapore's or Japan's.

"Then I studied the indicators, one of which is public awareness. I agree that Taiwan fares better than Singapore in that aspect."

A recent study trip to Taiwan sponsored by the Lien Foundation found that thousands attend workshops in palliative care there each year. Doctors and academics work closely with organisations, the media and even TV celebrities to run workshops and raise awareness.

One of the main organisations promoting awareness of palliative care is the Catholic Sanipax Socio-Medical Service and Education Foundation.

Since 1999, 35,000 people have attended its seminars, or about 2,000 each year.

"We've had taxi drivers, engineers, the boss of a hair salon, even a nine-year-old kid," said director Eva Wang.

In an intensive one-day course, they learn massage skills, how to communicate and empathise with patients, and legislation regarding palliative care.

Palliative care volunteer James Chang, 57, learnt to talk to patients about the element of choice.

"I tell them that they can decide for themselves how they want to go - in a way that minimises suffering or otherwise," he said.

The Buddhist Lotus Hospice Care Foundation also set up an academy in 2005 to offer systematic training for volunteers.

Lien Foundation chief executive Lee Poh Wah said that there was much to learn from Taiwan.

"Their faith-based organisations are strong community mobilisers able to recruit... retirees and housewives, regardless of their religious affiliation, as advocates," he said.

Education about death and palliative care is also extensively conducted in schools and health-care institutions, he added.

"Such grassroots initiatives have helped to normalise discussion about end-of-life matters."

In Singapore, while welfare groups work to raise public awareness, a 2012 report on a national strategy for palliative care found that a "concerted effort is needed across the health-care and community sector" to raise awareness.

The heightened awareness in Taiwan has also led to strong volunteer involvement in hospital palliative care wards.

Almost 40 per cent of the cancer patients who died in Taiwan received palliative care last year, up from about 18 per cent a decade ago.

In Singapore last year, about 30 per cent of people who died received palliative care.

In the top three hospitals with palliative care wards in Taiwan, the number of volunteers exceeded the number of beds.

In Singapore, Tan Tock Seng Hospital is the only restructured hospital with a palliative care ward of 13 beds.

It has a team of only around 10 volunteers.

The rest of the palliative care beds are mostly in hospices, with Dover Park Hospice being the largest player.

It has 300 volunteers and 50 hospice beds but, unlike Taiwan where volunteers are full-time, hospices in Singapore see volunteers who come for shorter and less frequent periods of time.

Experts note that the strong focus on palliative care in Taiwan has benefited patients and their families.

Said Ms Lin Ling, 29, a Taiwanese whose mother received palliative care: "The staff and volunteers at the hospital here have helped me emotionally. They not only take care of the patients, but also their family members left behind as well."