21 November 2007 from The New Paper (Singapore)
http://newpaper.asia1.com.sg/news/story/0,4136,148343,00.html
DYING WITH DIGNITY
Hospice care is limited in Vietnam, where S’porean doctors have been fighting for better medical facilities
IT’S where the terminally ill go to die in Hanoi, Vietnam.
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By Genevieve Jiang in Vietnam
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21 November 2007
IT’S where the terminally ill go to die in Hanoi, Vietnam.
It is in these narrow, usually overcrowded wards that doctors and nurses toil to make sure that patients spend their last days with as little pain as possible.
But there are only nine doctors and 14 nurses taking care of up to 70 patients at any one time at the palliative care unit of the National Cancer Hospital.
With only 35 beds, it is not unusual for two or three patients to share a bed, Dr Doan Luc said. He is the head of the unit.
He told The New Paper: ‘It is a situation we would like to improve but can do little about at the moment. We do not have much resources, so we have to do the best we can, with any help that we can get.’
Since 2005, about 90 medical workers in Vietnam have been trained by a team of Singapore doctors and nurses in palliative care.
The hospital is one of only three in Vietnam to have such a unit.
It opened in 2000 as the first one in the country to provide pain relief and care for the terminally ill.
A study by Vietnam’s Ministry of Health last year revealed that more than 250,000 people in the country were living with Aids, while about 150,000 people were diagnosed with cancer each year.
At Hanoi’s National Cancer Hospital, the load on the medical workers is shared by families, who pack hospital corridors to keep watch over their loved ones 24 hours a day, seven days a week.
When The New Paper visited the hospital last week, we saw a display of quiet stoicism amid death and despair.
A husband sat silently next to his sick wife, caressing her hand.
A daughter put her arms around her ailing mother, as she lay next to her on the hospital bed.
In the garden outside the wards, a son and daughter gently massaged their father’s arms with herbs to ease the swelling after an injection.
In another corner of the garden, a stranger listened to a woman and her son pouring out their anxiety about a loved one battling lung cancer for the past five months.
And at the paediatric oncology ward, a mother softly patted the backs of her 4-year-old son and a stranger’s daughter as they retched into a basin she held.
Next to the hospital beds in the wards are makeshift beds that family members had transported from home so that they can camp overnight.
One such caregiver is Mr Pham Ngoc Linh, 30, who has been keeping vigil by his mother’s bedside for the past week.
CARE FALLS ON FAMILY
Mr Pham told The New Paper in halting English: ‘The duty of caring for a sick family member is not supposed to fall on the shoulders of doctors and nurses, but on us.
‘In our culture, we believe only our family should feed us medicine.’
That is why Mr Pham cleans his mother, changes her clothes, gives her medicine, and tenderly massages her limbs and back to ease her pain daily.
He helps turn her every few hours to minimise the chances of her developing bed sores. When she is thirsty, he gently wets her lips with freshly squeezed orange juice.
Mr Pham’s mother, Madam Phan Thi Cuc, 60, has end-stage cancer of the pancreas. She can no longer walk or eat on her own. Even speaking is a struggle.
Doctors have given her, at most, a few weeks to live.
Mr Pham and his family are prepared for the inevitable. He said: ‘We have made funeral arrangements according to her wishes. She will be buried in the village where she was born, in Ha Nam province – about an hour’s drive from Hanoi.’
Mr Pham shares the caregiving duties with his 64-year-old father, Mr Pham Van Tung, and two sisters, aged 31 and 28.
He has taken time off his work in a remittance company indefinitely to do this. He and his father are usually there in the mornings and afternoons, while his sisters take over in the evenings.
Madam Phan’s illness was discovered early last year when she suffered incessant abdominal pains and had severe diarrhoea for several weeks.
In October last year, she had a tumour in her pancreas removed, but her condition didn’t improve. The cancer cells had spread to her blood, Mr Pham said.
After the operation, doctors said she would probably have only six months to live.
But the family refused to give up and gave her traditional medicine, boiling herbs for her every day. Her condition improved, but early this month, she suffered a relapse. She also vomited blood.
Doctors found that her kidneys had failed.
Mr Pham said: ‘Now, every day that she is able to open her eyes is a bonus.
‘We just want her to live the rest of her days as comfortably as possible. We will be by her side, holding her hand when she dies. We want her to die with dignity.’
And he is thankful for what the Singapore team has done.
One of the team’s major contributions was pushing to make morphine more readily available at the hospital.
Madam Phan is given morphine to ease her pain every four hours.
Mr Pham said: ‘Without the drug, I cannot imagine the agony that my mother will have to go through. Now she can die peacefully, with little pain.’
Doctors, nurses not trained
WHEN asked to take the pulse of a patient, the Vietnamese nurse reached for the wrist and held it tentatively.
But she wasn’t wearing a watch. Neither was there a clock in the ward.
When Associate Professor Cynthia Goh first arrived at the National Cancer Hospital in Hanoi more than two years ago, she was surprised at its level of nursing care.
She said: ‘The nurse didn’t know how to take a patient’s pulse. When I asked her what she was doing, she said sheepishly, ‘just pretending’.’
The senior consultant and head of palliative medicine at Singapore’s National Cancer Centre was in Hanoi to train medical workers in palliative care, a branch of medicine aimed at providing pain relief and care for the terminally ill.
Prof Goh said: ‘During our first few visits, we wondered whether we were just wasting our time because our aim was to teach palliative care, not basic nursing. But it all begins with basic nursing so we stuck on. And it was worth it.’
It was 2005 then, and nurses sorted out medicine on straw mats strewn on the hospital floor.
Medical workers didn’t use gloves, masks or gowns when handling chemotherapy drugs.
Patients’ progress were not properly recorded. Doctors did not know how to assess a patient’s level of pain.
And those who had undergone surgery were not given morphine, but aspirin or paracetamol.
Prof Goh said: ‘No one could tell me why the hospital didn’t have stock. But I found out it was a complicated process to get hold of the drug.’
Over the past three years, some 89 Vietnamese doctors and nurses have been trained.
The project, which ended last Friday, was part of the Singapore International Foundation’s Singapore Volunteers Overseas programme, and it received $125,000 in funding from the Asia Pacific Breweries Foundation.