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Monday, October 23, 2006 

Hospice care in Singapore

The Assisi Home and Hospice is situated within the grounds of Mount Alvernia Hospital, off Thomson Road. You'll be forgiven if you've missed the hospital completely as it is built atop a small hill and mostly hidden from view from the main road.

The restricted visibility of the hospital and the Assisi Home somewhat reflects the state of awareness towards hospice palliative care in Singapore. A recent survery showed that hardly a third of the local population were aware of the existence of hospice care even though about 70% of patients suffering from terminal illnesses are dying without undergoing hospice palliative care in Singapore.

Organizations like the Singapore Hospice Council aim to promote awareness and synergy amongst the various hospice resources in Singapore. The council seeks to coordinate hospice activities and enhance the level of hospice care through the establishment of training programs to provide healthcare workers, volunteers and doctors with the necessary skills to work effectively with patients.

So, what is hospice care? The mission statement of of the Assisi Home captures the essence of it through a simple definiton, "to maximise patients’ quality of life, right up to their natural end". The home admits patients in one of three categories.
  • Respite care
    To give home care givers an opportunity rest and recover, these patients are admitted temporarily.

  • Sympton relief
    Patients suffering from pain and stress are admitted under this category. When relieved of their symptons, these patients are discharged.

  • Terminal care
    End of life patients are admitted when it is deemed that they have about 3 months of life expectancy remaining. The majority of warded patients at the Assisi Hospice fall into this category.

My visit to the Assisi Home began with a glimpse of life in the wards. Doctors and counselling staff make their rounds in the morning, checking up on patients and determining the course of treatment for the day. Here, a counseller speaks to a patient regarding the progress of her illness.

Statistically, 30% of admitted patients end up being discharged, the remainder will live out their last days within the confines of the hospice.

In recent years, there have been a greater number of children stricken with cancer and to address that need, a children's centre was set up in the Assisi Home. The centre caters to children between the ages of 4 to 15 and provides a number of activities to support the needs of these young cancer patients and those who are in remission.

Such children are confined to their homes while recovering from their illness and oftentimes miss out on a lot of schoolwork. The centre runs several educational programmes to help the children catch up with missed lessons and to also help them with the transition of returning to their schools.

It's not all work and no fun for the kids, a multi-sensory room equipped with various activities provide the fun factor for the children.

A day care centre for adults operate from Mondays to Fridays. It runs several programmes catering to the needs of adult patients which include recreational therapy, emotional and psychological support and, pastoral care amongst several others.

I experienced several poignant moments during home visits where I accompanied Home Care nurses on their rounds to patients located all over Singapore. Some patients choose to remain in their homes where the surroundings are familiar and their families closeby as they live out their last days.

Home Care nurses tend to interact with their charges on a more personal and informal level, and operate almost independently. There were several occasions where the nurses had to determine the best course of action on their own when faced with a difficult situation with a patient. It's no wonder that only the more experienced nurses are trained to be Home Care nurses.

A typical check up includes recording of blood pressure. This old gentleman of 94 years kept recounting the time he learnt of the Assisi home and could not stop singing praises about his Home Care nurse.

One of the more distressing cases I experienced was this severely handicapped girl who was hardly a meter tall, she did not look a day over 10 but her actual age was 17. A Home Care nurse changes her head bandage before arranging for admission to a hospital to treat her infected sores.

Treated to a display of the family album during a home care visit.

The most touching moment of my time spent working on this project occurred at the Tampines home of this old lady as she lay in bed dying of cancer. Her fear of passing on commonly reflects the emotions felt by many other end of life patients. She reminded me of the basic need to have family and loved ones around when the time comes to move on, no one ever wants to die alone.

If you feel moved to want to do something more, there are many volunteer opportunities at the Assisi Hospice as well as the other hospice agencies in Singapore. A good place to start would be the Singapore Hospice Council where one can get an idea of what hospice care is all about and who to refer to regarding queries on hospice services and volunteer opportunities.

Very touching pictures. Thanks for once again sharing a glismpe of a life that a lot of us may not know...

hey, like nitrox said, touching shots and story. wes

Thanks for your photos. They were honest yet sympathetic.

Am a first-time visitor to your blog. Read it from end to start. Bravo!

I am pursuing a similar interest in the form of photojournalism and am very inspired by your work. Have learnt quite a bit looking at your pictures and hope to learn more from you in future. =)

Thanks for your comments everyone.

bliz - really, it's a matter of checking out the many good works that are out there and figuring out what and how you want to go about shooting a project. good luck!

Great photos, and brilliant writing. Keep posting..

thanks for your blog here. am looking to volunteer this year. :)

hi, its really gd n meaningful pics that u have captured..its so nice..i m a nurse doing palliative care too in spore..its a meaningful n fulfilling job..calling all nurses n volunteer..its a choice u can made to make a difference in someones' life till the last moment..Live Life to the Fullest...God Bless All!!

thank u so much - touching n insightful, i teared one bit.

im a local nurse into onco nursing n reading up on palliative care. ;]

I agree. There is no doubt about the efficiency of hospice care. They strive to provide quality health care administered in a compassionate environment.

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