Everyone has the right to
palliative care, is a
basic human right. No one should have to suffer from avoidable pain or
manageable symptoms. However, only 20 out of 234 countries have effectively integrated palliative care into their healthcare system, the other 42% have no delivery system for palliative care services, and 32% service delivery reaches only a small percentage of the
population. Some 80% of the world’s population lack adequate access
to medication needed for palliative care. In the U.S., hospitals
or nursing home facilities are most common to receive palliative care services;
however, approximately 63%
of hospitals report a palliative care program.
Meanwhile,
palliative care can be defined differently between developed and developing
countries. In the U.S., palliative
care is a specialized medical consist of physicians, nurses, social
workers, and other healthcare professional working together with primary
physicians providing care for patient with cancer, Alzheimer, CHF, COPD, kidney
disease, Parkinson, ALS, HIV/AIDS, and many more. The goal is
relief of symptoms such as pain, constipation, nausea, short of breath, loss of
appetite, insomnia, and depression resulting from disease process or medical
treatments. When patients are able to function at their best possible level;
resulting in improved quality of life and well-being of patients and their
family. Palliative care can and should be delivered at the beginning of
diagnosis along with curative treatment. Why don’t all terminal ill patients
receive palliative care?
In
the Philippines, palliative care provides mostly pain control for cancer
patients whereas hospice has a strong association with dying and support for
the bereaved. The term “hospice” does not mean end-of life care rather “a home,
building or institution for the terminally ill to receive specialized
palliative care regardless of capacity to cure the disease. Contrary to the
U.S. hospice is based on the timeline of 6 months or less to live rather than
the functionality, disability and severity of illness of dying patients;
hospice programs historically were more likely to be an effective method in
relief of suffering during a cancer death but not so for Alzheimer, dementia or
CHF. The challenge of selecting U.S. hospice benefit is giving up curative
medical treatment; therefore, some patients sign on with hospice when they have
exhausted curative treatment or at the end of their rope.
The
challenge is that palliative care and hospice are currently not part of the
government medical insurance program in the Philippines. In 2013, the
country had nearly 106 million in population
with a life expectancy of 72 years. PhilHealth, a government-owned
insurance agency provides universal health coverage, however struggles with
coverage with high unemployment and underemployment and access as more than
half of healthcare facilities are privately-owned. According to The Philippine Department of Health (DOH), by
2010, 62% of population covered by National Health Insurance Program (NHIP) but
only 73% had access to affordable essential drugs in 2009 and 54.3% out of
pocket expenditure for healthcare in 2007. The reality is that
more than 80% of Filipinos cannot afford out of pocket expenses needed for
basic medical care.
Cancer
is the third leading cause of Death in the Philippines. Philippine
Cancer Society (2010) survey indicates that 13% males and 12% female would
have some types of cancer if they live beyond age 75. Breast
cancer is most common cancer followed by cancer of the lung, liver, cervix,
colon, thyroid, rectum, ovary, prostate and non-Hodgkin lymphoma.
Since majority of Philippine families cannot afford out-of-pocket medical
expense for early screening and prevention, the majority of cancer cases were
not diagnosed and treated at an early curable stage. Only 30% of patients
who have been diagnosed with cancer received medical treatments while the 70%
did not return for treatment due to “they are afraid of the diagnosis,
financial problem and a matter of attitude and perception” said Dr.
Saleshe Tracy Anne Fernandex of
Breast Cancer Clinic at the Vicente Sotto Memorial Medical Center (VSMMC) in
Cebu City. As
a result, breast cancer survival rate was the lowest among 15 Asia countries
while 10% male and 7% female of cancer patients would have died before age 75.
There
are 34 organizations, 108 hospice and palliative care services providing a
range of inpatient, outpatient and home care in urban cities. Philippines
consists of 7,107 islands each has their own unique cultural identity and
dialects making logistically difficult to provide services. Most hospice
organizations are providing fee for service and free services in order to serve
the indigent. During the
end-of-life care, Filipino family members are primary caregivers for patients. Senator Marcos Jr. has introduced Senate
Bill 3342, “the
Palliative and End of Life Care Act” to provide benefit of 60 days a year
leave with full pay for immediate family members or relatives who care for a
critically ill. If the bill is passed; all government and private
hospitals and health centers is required to provide palliative care and end of
life services to all patients with life-threatening illness.
There is work to be done in both countries on how to
promote awareness and access to palliative care. Let's start with education
first!
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