On my third year of Family Medicine Residency training, I was given the option to undergo a 2-month rotation in the University of the Philippines-Philippine General Hospital (UP-PGH), Department of Family and Community Medicine (DFCM). The budget skimping, the Manila traffic, the dialect change and being alone (and getting lost) in a big city could not deter me; for I was bent on learning what I can from the country’s top university and training hospital.
I had many learning points in the other sections of DFCM (Wellness, and Community Medicine) but I was most excited of the three-week Supportive Palliative and Hospice Care (SHPC) rotation.The “newness” of the subspecialty intrigued me. My understanding of it was so limited- taking care of the dying, home visits, doing something when many say there is nothing available. I wanted to find out if this is the type of medicine that could have been the best option for my Mom who had late-stage cervical cancer.
And yes I did find out. If I had known it before, if somebody could have told us, Palliative Care would have made my Mom’s last days more comfortable and dignified.
As I was finishing my Residency training, I have come to realize that on many patient encounters - the long-staying Lola in Room 337, the mestizo Lolo, whose children are all living abroad and is being taken cared of by his longtime “yaya”, the mother of three adolescent children who has brain tumor, the repeated admissions of an elderly COPD patient, the dyspneic mother who had metastatic breast cancer to the lung, the advanced hepatic cancer middle-aged father with encephalopathy, the school-aged child with leukemia,the little babies in the nursery born of multiple congenital anomalies); Palliative Care would have made a big difference among these patients’ lives and in their families.
I was therefore delighted that Silliman University Medical Center Foundation, Inc (SUMCFI) has given me the chance to undergo the one-year post-residency training in Supportive Hospice and Palliative Medicine at UP-PGH, the only fellowship training program for Palliative care in the country. In the absence of any other academic specialist programs in the country, it is the national academic center of the medical specialty field in the Philippines.
The SHPM Program
It was this year(2011), when the Section underwent a name modification to Supportive Hospice and Palliative Medicine (SHPM), as a specialty field and to make it more consistent with the international designation of the discipline. The term Supportive Hospice and Palliative Care (SHPC) could then be appropriately used to refer to the clinical practice. The goal is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies, and is not limited to cancer cases, but all other serious illnesses.1
The fellowship training involves weekly case management meetings and didactic sessions with service meetings for research and training. There is the prospect of interacting and teaching the rotating Family Medicine residents (1 month each for Junior and Senior Rotations) and fourth-year medical students (2 weeks) through the case and journal reports, and grand rounds. Weekly multi-disciplinary conferences are also being attended in cooperation with the other subspecialties such as medical oncology, surgery, radiation oncology, rehabilitation medicine, psychiatry, dietary and the social services.The clinical care includes the in-patient and out-patient care and consultation services and the community home and hospice care services.2
The total in-patient referrals in a month can reach to as much as 80-90 patients. However, this number is still below the estimated number of patients who need SHPC in the 1,500 bed UP-PGH, since the delivery of care is still hindered by limited awareness, resources and support. Approximately 80 outpatient clients are seen per month. The program holds out-patient clinics at the SHPM Center at the Outpatient Building. There is also an extension clinic at the Cancer Institute (CI) of UP-PGH to make care more accessible to patients with cancer, especially those being seen by other oncological services. There are approximately 40 patients, living within the 5-kilometer radius of PGH, who are enrolled in the Home Care program. The Community outreach services include service-oriented activities with nearby partners such as Madre de Amor in Laguna and Missionary Sisters of Charity in Tondo, Manila.
Other Related Activities
Along with four other fellows (3 are graduates of the UP-PGH and 1 is from Ospital ng Maynila), we were able to participate in different activities and events in various capacities that help promote the different avenues of cancer awareness, bereavement care as an essential component of palliative care, international hospice week celebration, palliative care awareness and education.
Every third week of January, the National Cancer Consciousness Week is being celebrated. In UP-PGH, the celebration was spearheaded by the Cancer Institute and the different subspecialties. Activities included a parade in and around the hospital premises, an entertainment program, various symposia and a drawing contest for the pediatric cancer patients.
We became involved with the Philippine Cancer Society as volunteers through the encouragement of our consultant, Dr. Rachael Marie B. Rosario, who is the Executive Director.
Last July, a bereavement program was organized as an annual activity called “PAGGUNITA.” This is a necessary service for the families whose loved ones have died under the care of the SHPM. Psychosupportive care and counseling were provided especially for those identified with complicated bereavement. One of our consultants, Dr. Agnes Bausa-Claudio, is seen here sharing her personal experience. Part of the activity was an exercise on guided imagery.
The World Hospice and Palliative Care Week Celebration on October 4-7, 2011 was a big event. It was an event that showcased the importance of hospice and palliative care as a model for quality, expert and compassionate care for those with life-threatening and life-limiting illness like cancer, and end-stage heart or kidney disease. The activity was announced during the Flag Ceremony, continued with a parade inside the UP-PGH premisesand an entertainment followed. The culminating activity was the Hospice Summit wherein lectures were given on topics such as pain and other symptom control, care of the dying and care for those with cancer and non-cancer illnesses. The event was well attended by nurses, social workers, students and physicians from other specialties.
A pose with the PGH Director, Dr. Jose Gonzales and the Section Head, Dr. Manuel Medina, Jr, Dr. Rachael Marie B. Rosario, and Hospice Nurse Luningning Siarez.
Almost Done
A year of SHPM fellowship training is about to end but it does not mean that I should relax. There is so much work to be done. My SHPM mentors have always reminded me that the practice of palliative and hospice care will not be easy; obstacles abound but the passion remains to strive for “improving the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”3
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The SHPM Fellows of 2011: (from right to left) Jeromel Lapitan, M.D., Aliza Macaraya-Pangaibat, M.D., Djhoanna Aguirre-Pedro, M.D. Rowena Marie T. Samares, M.D., Barbara Amity Flores, M.D. |
References:
1. SHPM Service Document (SVC 04202011-1). SHPM Clinical Services: Guide and Summary of Operations (2011)
2. SHPM Academic Document 122010-1
3. Definition of Palliative care by the World Health Organization. http://www.who.int/cancer/palliative/definition/en/
