Easing the pain at the end

So strong is the leaning among health-care professionals towards treatment and prevention that palliative care is often seen as a poor cousin. In essence, the management of dying through symptom relief and tending to emotional needs, it is work suited to few personality types.

There is not much investment by private hospital groups and little training time allotted to end-of-life management in Singapore's medical schools. All of 46 doctors are trained in this medical sub-speciality out of the 11,000 doctors in practice. As for nurses, fewer than 700 out of 36,000 are trained in such care.

In another astonishing survey finding, three-quarters of doctors and half of nurses said they did not know enough about hospice palliative care. For a country with a health-care system that ranks among the best in the developed world, the gap in professional care for the terminally ill is a deficiency that cries out to be fixed, as the ageing rate is accelerating.

The scope for remedial intervention by the Health Ministry is huge and the challenges are no less daunting. The ministry estimates that 10,000 people will require such care by 2020. As for care facilities like hospices, nursing homes and public hospitals with dedicated departments, the numbers are just too small. Besides institutional care, home-care services for the terminally ill need to be ramped up as surveys have consistently shown a cultural predilection among Asian people to die at home. At present, 5,000 people receive home care each year.

Health Minister Gan Kim Yong set out an impressive plan at a palliative care conference last week to address known shortcomings. Quality of care, adequacy of access to facilities and patient affordability were discussed. State funding support will be an important part of the development plan. But even with adequate funding to build the number of care establishments needed, the personnel shortfall cannot be solved with money alone. A Lien Foundation survey laid bare the problem: Shortage of staff, insufficient training, lack of information about palliative care.

An aversion towards caring for the dying is difficult to overcome - anywhere. Doctors and nurses polled by the foundation were unanimous in acknowledging the importance of palliative care at this stage in Singapore social progress but the commitment shown was revealing. Only 15 doctors are training in palliative medicine. If the launch of a graduate diploma course in the discipline announced by the ministry is not matched by the enrolment rate, MOH will have to start looking abroad to get the people it needs to fulfil a mission that will not wait.