Abstract
The care of people with life-limiting illnesses is one aspect of health care. Nevertheless, it is intimately interconnected to all other areas of health. Good examples in the Asia-Pacific include serious infectious diseases such as tuberculosis, malaria and HIV/AIDS and the rising toll of smoking-related malignancies. The prevention, diagnosis, and treatment of these illnesses may well segue into another focus of care when the patient deteriorates, symptoms escalate, and death approaches. The preparedness of any health system to deal with that situation is a critical test. To what extent are health professionals trained in meticulous symptom management, do they have the capacity to support patients and their families both physically and psychosocially, and, ultimately, are they equipped to participate in the care of the dying?
Palliative care is a discipline that rose up to respond to these needs in a systematic manner. Unfortunately, in many areas around the world, palliative care is either not practiced formally or is practiced with varying degrees of expertise. In the last decade the Asia-Pacific region has seen considerable expansions of this discipline. Many, although not all countries in the region have health professionals formally working in palliative care. Within countries there are areas of significant activity and access to services and other areas with little or no services. The Asia Pacific Hospice Network (APHN) was established in 2001 to promote, organize, and represent the discipline of hospice and palliative care throughout the region. In July 2011 it hosted its ninth conference in Penang, Malaysia. The network has strong links to the International Association of Hospice and Palliative Care (IAHPC) and the World Wide Palliative Care Alliance (WPCA). A significant and unique gathering was held in Perth, Australia in September 2009. Entitled “Together: Cultural Connections for End of Life Care” it was a combined conference of Palliative Care Australia, APHN, and WPCA.
In Australia, Australasian Palliative Link International (APLI) was founded in 1996. Its objectives have been to develop and foster links between palliative care providers and organizations in Australia and New Zealand and the Asia-Pacific region. It has sought to raise awareness of the needs of new palliative care services and the need for further development of the discipline in the region. In addition, it has sought to provide a forum for the exchange of information and ideas among providers of palliative care in the region. Particular links have developed over the past 15 years with Indian palliative care colleagues. In 2010, APLI embarked on a collaboration with Pallium India called Project Hamrahi. This project involves a mentorship program between India and Australia. Specifically, it will link an Australian doctor/nurse team with an Indian team to build capacity and peer support. “Hamrahi” is a Hindi term meaning “fellow travellers,” and a principal objective of the project will be to engage all practitioners in mutual learning and support.
In addition, members of APLI have been involved in teaching health professionals in Malaysia, China, Nepal, Bangladesh, Vietnam, and the Democratic Republic of the Congo and in fostering the development of palliative care in Timor Leste and Sri Lanka.
Awareness-raising activities include a website, triannual newsletters, forums, and workshops, often in conjunction with national palliative care conferences in Australia and New Zealand. Capacity-building activities include sponsorship of overseas doctors to attend Australian palliative care conferences and to observe palliative care practice in Australia.
Much work remains. Although the economic capacities of many nations in the region have substantially improved, large-scale poverty still exists. Dr. David Roy, Director of Care for Bioethics, Montreal, once asked a challenging question: “How do the poorest of the poor die? Do we really want to know? That knowledge could be very disturbing, loaded as it might well be with imperatives for action. It could also be accusatory knowledge if those of us ‘in the know’ do nothing to mobilize lethargic ministries, governments, health care institutions and professional schools to develop and organize the services the poorest of the poor need.” 1
In conclusion, the fostering and development of palliative care throughout the Asia-Pacific region remains a critical priority. Levels of capacity, access to essential medicines, and resources vary greatly. Imaginative links among health professionals across borders to support, mutually encourage, and, where possible, mentor colleagues is at once both practical and encouraging. In our increasingly interconnected world these alliances will continue to mature the vital discipline of palliative care. The patients and families of this region deserve nothing less.