Pain management is so important because it's not so much death itself as the pain experience that most patients fear. "The relief of suffering at end-of-life issues should never be an option for anyone," says Hospis Malaysia deputy medical director Dr Sylvia Mc-Carthy.
"It should be regarded as a human right. It's difficult to manage the psychological aspect if patients are in severe pain and are experiencing other distressing symptoms."
Pain management is one of the key areas of palliative care. Palliative care is the complete philosophy of care that addresses all aspects of a patient's life. It involves any form of medical care or treatment that concentrates on reducing the severity of disease symptoms. The aim is to reduce suffering and to improve the quality of life of people facing serious, complex illnesses such as cancer, pulmonary disorders, renal disease and chronic heart failure.
Dr Mc Carthy says in the vast majority of hospitals, this is an unmet need as dying if often seen as the consequences of a failure to cure rather than a responsibility to care.
"Palliative care should be the right of every patient who's facing a life-limiting illness. We don't use the word 'terminally ill' because it is now recognised that anyone suffering from a life-limiting illness, not just cancer patients, can benefit from palliative care.
"The aim is to create a pain free environment. By providing comfort and relief from pain, Hospis Malaysia hopes to help patients make the most of each month, week or day of their remaining lives.
"It's all about improving quality of life. It's a holistic approach that acknowledges the physical, emotional and spiritual needs of patients. "No one should have to manage pain in isolation. Some patients eventually get better, while others don't. But either way, what we do helps the patient cope. It's about providing good support. It's individualised care."
In dealing with any illness, Dr Mc Carthy says, there's always something that can be done to help a patient. "Before we begin pain management, we prepare a set of questions to better understand what the patient is going through. We ask them things like how the illness has impacted their life? What's the most important to them? What's their biggest problem?"
She says it's important to address these concerns as fear, uncertainty and tension increase an individual's reaction to pain. "After we understand the patient's situation better, we provide support be it medical, phycisally or emotionally. We provide care, company, and activities that help patients find meaning in their experience and achieve realistic goals. Exploring new possibilities in life, no matter how small, make a world of difference when one's time is limited."
Ghauri Aggarwal, the head of the Department of Palliative Medicine at Concorde hospital Sydney, says Australia has known the importance of palliative care for many decades. "Malaysia is still far behind in terms of realising the importance of pain management, but it can't afford to ignore the matter any longer. Malaysia is lucky because it doesn't have to make the same mistakes other countries have already made. It can learn from the others. Malaysia can leap forward to a different growth and development."
"Besides pushing for the palliative care system to be in place in hospitals, the government should make sure it has the resources, space and expertise. Unless you have that, you're not going to go very far."
Can we afford to have this service in every hospital? "I don't see why not. Palliative care should be a separate department attached to the in-patient unit. In Australia, this system is available in every part of the country. Studies have shown usefulness, both in community and hospitals guide to end of life care, especially in making clinical decisions."
"Diseases are complex. It's so important to look at the whole aspect of a patient's life. The biggest thing is awareness of the fact that there's management options available. Get rid or myths attached to hospitals. Some patients don't go because of fear, and some are ignorant. But we need to empower them to make decisions."
When you know something is available, she says, you should go for it. "Unfortunately, even some doctors and nurses are ignorant. Malaysia needs to look at awareness among medical workers and patients.
"But this is an exciting time in Malaysia, as people are becoming more aware of their rights and options. Pain management is the right of every human being. On the part of the patients, there's some ignorance about the medical services available. Many hospitals here already have palliative care services. Anyone who thinks they may need it should ask for it. It's your right."
"But having said that, Malaysia is still far behind in making this a 'must' in all hospitals. This system is mainly available in private hospitals that charge a lot for this type of care."
What if you don't want to go to a hospital?
She says many patients refuse to go to hospitals, but this should not be a hindrance to providing palliative care. "There's many ways of providing care for patients in the comfort of their own home. The government should be looking into increasing experts in this field. "It's not about the fluffy stuff. It's not just about sitting there and holding your hand. There're many useful things that can be done."
People think pain management is about death and dying, she says, but it's also about bringing hope and living with the disease. "Palliative care is not something you should seek at the end of an illness, the earlier you receive palliative care the better. Yes, you have a disease. But how do you live with it? That's the question that everyone should be asking." - NST.
"It should be regarded as a human right. It's difficult to manage the psychological aspect if patients are in severe pain and are experiencing other distressing symptoms."
Pain management is one of the key areas of palliative care. Palliative care is the complete philosophy of care that addresses all aspects of a patient's life. It involves any form of medical care or treatment that concentrates on reducing the severity of disease symptoms. The aim is to reduce suffering and to improve the quality of life of people facing serious, complex illnesses such as cancer, pulmonary disorders, renal disease and chronic heart failure.
Dr Mc Carthy says in the vast majority of hospitals, this is an unmet need as dying if often seen as the consequences of a failure to cure rather than a responsibility to care.
"Palliative care should be the right of every patient who's facing a life-limiting illness. We don't use the word 'terminally ill' because it is now recognised that anyone suffering from a life-limiting illness, not just cancer patients, can benefit from palliative care.
"The aim is to create a pain free environment. By providing comfort and relief from pain, Hospis Malaysia hopes to help patients make the most of each month, week or day of their remaining lives.
"It's all about improving quality of life. It's a holistic approach that acknowledges the physical, emotional and spiritual needs of patients. "No one should have to manage pain in isolation. Some patients eventually get better, while others don't. But either way, what we do helps the patient cope. It's about providing good support. It's individualised care."
In dealing with any illness, Dr Mc Carthy says, there's always something that can be done to help a patient. "Before we begin pain management, we prepare a set of questions to better understand what the patient is going through. We ask them things like how the illness has impacted their life? What's the most important to them? What's their biggest problem?"
She says it's important to address these concerns as fear, uncertainty and tension increase an individual's reaction to pain. "After we understand the patient's situation better, we provide support be it medical, phycisally or emotionally. We provide care, company, and activities that help patients find meaning in their experience and achieve realistic goals. Exploring new possibilities in life, no matter how small, make a world of difference when one's time is limited."
Ghauri Aggarwal, the head of the Department of Palliative Medicine at Concorde hospital Sydney, says Australia has known the importance of palliative care for many decades. "Malaysia is still far behind in terms of realising the importance of pain management, but it can't afford to ignore the matter any longer. Malaysia is lucky because it doesn't have to make the same mistakes other countries have already made. It can learn from the others. Malaysia can leap forward to a different growth and development."
"Besides pushing for the palliative care system to be in place in hospitals, the government should make sure it has the resources, space and expertise. Unless you have that, you're not going to go very far."
Can we afford to have this service in every hospital? "I don't see why not. Palliative care should be a separate department attached to the in-patient unit. In Australia, this system is available in every part of the country. Studies have shown usefulness, both in community and hospitals guide to end of life care, especially in making clinical decisions."
"Diseases are complex. It's so important to look at the whole aspect of a patient's life. The biggest thing is awareness of the fact that there's management options available. Get rid or myths attached to hospitals. Some patients don't go because of fear, and some are ignorant. But we need to empower them to make decisions."
When you know something is available, she says, you should go for it. "Unfortunately, even some doctors and nurses are ignorant. Malaysia needs to look at awareness among medical workers and patients.
"But this is an exciting time in Malaysia, as people are becoming more aware of their rights and options. Pain management is the right of every human being. On the part of the patients, there's some ignorance about the medical services available. Many hospitals here already have palliative care services. Anyone who thinks they may need it should ask for it. It's your right."
"But having said that, Malaysia is still far behind in making this a 'must' in all hospitals. This system is mainly available in private hospitals that charge a lot for this type of care."
What if you don't want to go to a hospital?
She says many patients refuse to go to hospitals, but this should not be a hindrance to providing palliative care. "There's many ways of providing care for patients in the comfort of their own home. The government should be looking into increasing experts in this field. "It's not about the fluffy stuff. It's not just about sitting there and holding your hand. There're many useful things that can be done."
People think pain management is about death and dying, she says, but it's also about bringing hope and living with the disease. "Palliative care is not something you should seek at the end of an illness, the earlier you receive palliative care the better. Yes, you have a disease. But how do you live with it? That's the question that everyone should be asking." - NST.
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