Strengthening palliative care in Sarawak

In Sarawak, urgent efforts are underway to enhance palliative care services, particularly in rural communities. Collaborative initiatives, including the “Domiciliary Palliative Care Program”, are bridging gaps, and a partnership with the Asia Pacific Hospice Palliative Care Network aims to bring regional expertise.

Urgent Care

There is an urgent need to strengthen palliative care in Sarawak, especially within the rural communities. According to the Sarawak General Hospital’s head of the Palliative Care Unit, Dr Sharon Choo, palliative care is an approach that enhances the quality of life for individuals with life-limiting illnesses, which may be cancer, or non-cancer individuals.

“It also supports families and addresses not only the physical symptoms but the social, psychological and spiritual aspects. This comprehensive care is vital in ensuring that individuals receive the support they need to navigate their healthcare journey with dignity and comfort,” she added.

The World Health Organisation (WHO) is working to support countries in the implementation of the 2014 World Health Assembly (WHA) Resolution 67.19 which urges all member states to strengthen palliative care as a component of comprehensive care throughout the life course.

It states that the provision of palliative care is a moral imperative of health systems and it should be integrated into all levels of health care. The implementation of this resolution is focused on expanding access and strengthening the quality of palliative care services delivered to patients as it recognises that palliative care is fundamental to improving the quality of life, wellbeing, comfort and human dignity for individuals.

Dr Choo also said that in Malaysia, only about 10 per cent of individuals with palliative care needs have access to this service.

Lien Collaborative Scoping Visit to Sarawak.

Lien Collaborative Scoping Visit to Sarawak.

Lien Collaborative Scoping Visit to Sarawak.

“Therefore, there is an urgent need to address this gap in provision and ensure concerted action is taken on expanding access to quality palliative care.”

Meanwhile, Sarawak, which covers a wide geographical area, has a rural population of about 40 per cent.

“Palliative care is mainly accessible in major towns whilst individuals in rural areas have limited access to this service.

“Many Sarawakians stated their preference to be cared for at home if they are unwell and data from a local hospice (Two Tree Lodge Hospice) in Sarawak in 2018 noted that 73 per cent of individuals prefer to pass in the comfort of their own homes. Thus, there is an urgent need to develop a community palliative care service to address this,” said the palliative care physician.

Bridging the gaps

To ensure that palliative care is administered in patients’ chosen location, which is in the community, the Sarawak State Health Department launched the “Domiciliary Palliative Care Program” in Siburan Health Clinic in 2022.

This programme was implemented throughout the state in 2023, and 34 medical clinics received training to offer community palliative care to those in need of such services. Various stakeholders are working together to provide education, training, and enable access to opioids and other essential medications in order to facilitate this.

Sharing further, Dr Choo revealed that there is an ongoing collaboration with the Asia Pacific Hospice Palliative Care Network (APHN) through the signing of a Memorandum of Understanding (MOU) on April 13 between the state, represented by Deputy Premier Datuk Amar Prof Dr Sim Kui Hian and APHN Chairman Dr Ednin Hamzah.

The MOU paved the way for Sarawak’s first palliative care training programme, as part of the three-year commitment programme under Lien Collaborative for Palliative Care is co-developed with APHN.

“This MOU will enable the state to access regional expertise in palliative care, especially through the APHN faculty in providing training and technical assistance to equip healthcare professionals to provide effective palliative care to patients and also to ensure sustainable service.”

“Moreover, the collaborative effort will involve sharing best practices, exchanging information and experiences to address common challenges and importantly, develop strategies and policies to fit the local community in improving palliative care services.”

Signing of the MOU between Sarawak and APHN.

Lien Collaborative in Sarawak.

Dr Choo’s part of the Cynthia Goh Palliative Care Fellowship

As part of the Lien Foundation’s continued efforts, the foundation has recently committed SGD 2 million in funding and launched the Cynthia Goh Palliative Care Fellowship, to identify and groom the next generation of Asian palliative care leaders.

Dr Choo, being the first Palliative Medicine Consultant in the state of Sarawak under the fellowship has played an instrumental role in leading efforts to enable patients in rural communities to have care services including opioids and essential palliative care medications.

“It is a privilege to be part of this prestigious Fellowship. This fellowship will benefit the development of palliative care services in Sarawak as it will be used in enhancing my ability to develop greater knowledge and skills to generate a more effective strategic approach to enhance care with those I work with.”

According to her, there is also the opportunity for networking and collaboration with other fellows from Singapore, India and the Philippines in research, and quality improvement projects and facilitate exchange of ideas and best practices.

“This is also a platform for further coaching and mentoring to ensure the provision of palliative care in Sarawak is of the highest quality and standards,” she added.

About Lien Foundation

Speaking to its Chief Executive Officer Lee Poh Wah, the Lien Foundation champions palliative care which is a counter discipline that takes suffering seriously as a problem to be tackled.

“It is good medicine, as well as embodies the principles and practices of a good clinician.

“When I was at the World Cancer Leaders’ Summit in 2011, what caught my attention was leaders from developing countries requesting palliative care. We decided to start the Lien Collaborative for Palliative Care with APHN in 2012, working closely with Dr Cynthia Goh, as a platform to galvanise members to help develop palliative care capabilities and services in their public healthcare system,” said Lee.

The fellowship offers in-country training of trainers, improving access to essential pain medications, and supporting local policy work and clinical fellowships in established overseas institutions.

With a presence in 10 Asian countries, training over 150 institutions and more than 500 healthcare staff, Lee sees Sarawak as a beacon of hope in palliative care development.

“There is a presence of strong leadership with a clear and compelling vision of the future. The cohesive ecosystem works well with the government and is ready to grow together. I’m also looking forward to seeing how the inaugural leaders from our Fellowship programme, including Dr Choo, pave the way for palliative care in Sarawak and beyond,” he said.