This time, the theme was: ‘Hospice-Palliative Care: New Paradigm to Integral health service’, an integrated conference in correspondence to the latest national health policy that focused on good death and better palliative care.
The conference also acted as a meeting place between policy makers, healthcare providers and volunteers, to share their knowledge and talk about what needs to be done in order to achieve our goals.
Palliative care in national health policy
During the inauguration, Dr Suphan Srithamma, director general of Department of Medical Services, and Dr Pranom Kumtiang, deputy permanent secretary of Ministry of Public Health, emphasised the importance of palliative care, and noted that nowadays there had been more information exchange between policy makers and those who are in the field, making it a very good start.
They also urged the need to change the narcotic law restriction in Thailand in order for patients to have better access to controlled medicines such as morphine.
Dr Kumtiang also gave a summary of the palliative care situation in Thailand.
In 2015, in response to the national health policy, there had been an attempt to initiate a pain and palliative care clinic in each and every hospital in Thailand. Practical guidelines and more training programmes are also being developed by the Department of Medical Service.
As for the goals in 2016, she mentioned the need to:
- extend palliative care services beyond cancer and the elderly to include people with organ failure, HIV and AIDS, TB, as well as dementia
- work towards a seamless service between each region and hospital
- improve networking and capacity building between government sector and NGOs
- improve the home care system; enable better discharge and referral system to send patients back into the community with proper care
- form a palliative care team and unit and founding of pain control unit in regional hospitals; and
- change the narcotic restriction law in Thailand so that patients could have better access to morphine.
Community participation in palliative care
In the afternoon, there were several simultaneous sessions. One of the sessions was about community participation palliative care.
Dr Suresh Kumar, technical advisor at Institute of Palliative Medicine (IPM), Kerala, India, shared his insights, challenges, and key factors that lead to success in Kerala.
This model is helped by the network of community volunteers and the community mentality that palliative care is everybody’s business. Dr Sirichai Namtassanee also shared his experience at his hospital in Kalasin district, Thailand.
Both speakers agreed that the key indicator for success for the sustainable community participation was that it had to be driven by the community itself. The people had to explore issues in their context and worked toward the solutions together along with the help of palliative care professionals.
Improving access to palliative care
The second day was focused on improving access to palliative care and palliative care in urban areas. This has a unique model and differs greatly from palliative care provision in the rest of the country.
Ironically, there has been very little integrated palliative care service in the capital. Most of the time, people had to make several trips between their home and hospital. For that, they need a lot of support from the community and their family. However, most of the people who lived in Bangkok either came from different regions, looking for work, lived alone, or had no carers at all.
There are several primary care units and hospitals that already initiated their palliative care service but they still need a lot of support and integration into the system. A representative from Thammasat University Hospital also mentioned about their hospice which, hopefully, to be opened soon, to support those who need it.
These challenges still linger and need a different model to tackle them.
Access to medications
The last day started with updates of opioid availability from Associate Professor James Cleary, Director of Pain and Policy Studies Group, WHO Collaborating Centre for Pain Policy in Palliative Care.
Dr Cleary said that there needs to be balance between national policy, education and medicine availability. For Thailand, the barriers for better integrated palliative care are: limited formulations of opioids and derivatives, limited procurement, doctors still lacking knowledge on using opioids and also the morphine-phobia mentality, unnecessary paperwork for morphine prescription in most hospitals, and overly stringent narcotic control laws.
There were also more updates about the law on narcotic regulation from Mr Morakot Jaroonwattana, director of Narcotic Revolving Fund, FDA Thailand.
Mr Jaroonwattana noted that there needs to be better access to opioid medications for palliative care, quoting that the statistics clearly showed that there had been an increase in prescriptions of morphine and other opioid derivatives in recent years.
It may take a long while to change the narcotic law but it had to be done because pain control was fundamental for palliative care service.
You can contact the Thai Palliative Care Society to find out more about palliative care in Thailand.