Dr Cynthia Goh: "The market is flooded with distance learning courses but where do we send out staff for training?"
Dr Devaraj: "We need information about courses and feedback about deficiencies,"
Ms Ellen Nightingale: "Palliative care programs should pick the right people to send overseas for training. These people must be able to determine what is appropriate for their own cultural setting and be able to teach and become good agents for change when they return home,"
Mrs Nellie Fung: "It is also useful to bring in outside experts to teach. Local tutors can also be used to give workshops of communication and other palliative care skills."
Dr Cynthia Goh: "It would be useful to have a database which collates information about available courses - type of course, purpose, by whom, where, target group, cost, length of course."
Dr Hinohara: "Medicine is a science of uncertainty. A change of attitudes is needed."
Dr Takeda: "Professors in medical schools are very cure orientated. They have no knowledge of palliative care."
Dr Hong: "Palliative care must be introduced into the medical and nursing undergraduate programs. These are the professors of the future."
3 ALLOCATION OF RESOURCES
Three issues were identified - ethics of the allocation of resources, availability of resources, access to resources,
The question was asked as to whether terminally ill people are staying at home because they want to, because of the expense of inpatient care or because they have no place to go?
Ms Joy Brann: "Do we provided 'Rolls Royce' care for a few in an inpatient hospice or do we provide some care for as many as possible at home?"
Dr Rosalie Shaw: "We need to be aware that if most of the family are working, home care may not be the cheapest option."
Dr Hong: "In Korea, where the average length of stay in the inpatient hospice is only 18 days, there is a long waiting list and 80% of patients do not get admitted."
Dr Co-Shi Chantal Chao: "In Taiwan, where are 70 hospice beds, there is also a long waiting list. Ten home care programs care for 1000 patients. However, family members need to work so private nursing aides are hired to care for the patients. In Taiwan, people want to die at home so that they do not become an 'isolated ghost'."
Dr Cynthia Goh: "There are no statistics to indicate whether Singaporeans want to die at home or not. At present 45% of all deaths occur in hospital, 45% at home."
Dr Devaraj: "In Malaysia, 70% of deaths occur outside hospitals."
