Mrs Nelly Fung: "It is difficult to die at home in Hong Kong because apartments are so small and because these must be a post mortem examination if the death occurs at home. However, in Hong Kong, there are 20 palliative care home care nurses who provide home care for those on the waiting lists for hospices."
Dr Sunaryadi Tejawinata: "In Surabaya, palliative care home care has been provided since 1995."
4 DRUG AVAILABILITY
The question was asked at to whether there was any evidence that herbs had ever cured cancer. Most hospice workers are concerned about the high cost charged for some traditional remedies and are aware of the conflict within patients' families over the giving of these remedies.
Dr Co-Shi Chantal Chao: "There are two units in Taiwan which are doing active research into the efficacy of traditional Chinse medicines and one hospice is using acupuncture, herbs and traditional Chinese medicine as well as western medicine. Some traditional medicines are known to be harmful; some cause renal failure, some contain arsenic and mercury."
Dr Sunaryadi Tejawinata: "We can say to our patients: 'Please tell us what you are taking. If it is having a bad effect, we will ask you to stop."'
Dr Kashiwagi: "The bookshops are full of propaganda about such remedies."
Dr Cynthia Goh: "WHO is strongly in favour of traditional medicines. However, in Asia, the market for traditional medicines is much larger than in the West. The people are being exploited. Perhaps this Network could develop a directory of harmful traditional medicines. The concern of individual hospices is to decide how much endorsement is to be given to such remedies. For example, do we endorse aromatherapy? Or if a patient has a nasogastric tube and the family want us to give Chinese herbs, do we teach the family how to give tube feeds so they can administer the herbs themselves in a safe manner?"
Discussion about the availability of morphine:
Morphine is now available in most countries but cost, lack of knowledge about its use and fear of addiction are still major barriers.
Dr Catherine Krings: "In the Philippines, morphine is restricted to hospitals and is only released to doctors known to that hospital."
Dr Cynthia Goh: "In Singapore there is not a problem of getting morphine into the country. But there are still barriers to getting morphine to patients at home. Most retail pharmacies do not stock oral morphine mixture and subsidised slow release tablets morphine are only available at government polyclinics."
Dr Takeda: "In Japan, doctors do not like to prescribe morphine for patients at home."
Dr Devaraj: "Pharmacies in Malaysia refuse to carry liquid morphine although they will stock slow release morphine tablets. Furthermore, 50% of doctors in Malaysia are general practitioners who know very little about morphine."
Dr Takeda: "Education is the only way to overcome these barriers."
