Response to the Matchim and Aud Article
To the Editor:
I read with interest the recent article entitled "Hospice Care: A Cross-cultural Comparison Between the United States and Thailand" by Matchim and Aud (September 2009). My interest in end-of-life (EOL) care in Thailand stems from a partnership I am involved with between Edgewood College in Madison, WI, and Kaukarun College of Nursing (KCN) in Bangkok, Thailand. On two occasions, I had the opportunity to present on EOL issues while in Bangkok; the first being in January 2006 and the second in May 2008. In January 2006, I presented at the First International Caring for the Caregiver Conference held at KCN. My presentation focused on the history of hospice in the United States. During the May 2008 conference also held at KCN entitled "The Second International Conference: Chronic Illness Across Continents," I presented on symptom management at the end of life. During a third trip to Thailand in July 2007, I cofacilitated a postgraduate palliative care course held at KCN for 1 week and had the opportunity to visit Wat Phrabat Nampu Temple in Lob Puri province. All of these experiences provided me with a global perspective on EOL care.
This article provided a comprehensive historical review and comparison of hospice care in the United States and in Thailand. While this article raised several areas of concern related to accessibility, quality of care, and inadequate or inconsistent policies within each country, it was also noted that there is a need for greater research, professional training, and education related to palliative care issues for both the United States and Thailand. One area that this article did not discuss was the work that the World Health Organization (WHO) is doing in relationship to disseminating information related to EOL care globally. In an attempt to help alleviate suffering at the end of life, the WHO developed a "public health strategy to integrate palliative care into existing healthcare systems."1(p42) This strategy consists of four components: (1) appropriate policies, (2) adequate availability of medications, (3) public education including policy makers, and (4) an implementation plan. The WHO's strategy is a foundational starting place for many countries to develop their own solution to EOL care issues. The WHO's plan allows countries to individualize palliative care programs, taking into account associated costs and cultural issues, and allows autonomy for countries to develop programs appropriate to their healthcare system.2 The Matchim and Aud article led me to believe that the development of palliative care services in Thailand is dependent on individual healthcare organizations deciding what services are to be offered and covered by Thailand's national health insurance program or private insurance companies. I believe, as described above, that the WHO's public health plan for palliative care would help Thailand's governmental policy makers and healthcare workers in developing and implementing a consistent EOL program nationally.
The International Association for Hospice and Palliative Care is another organization that, in response to the WHO's four public health strategies, to help integrate palliative care globally, developed guidelines for aiding countries in developing plans for three of the four strategies. The guidelines were related to use of medications at end of life, development of educational programs for healthcare workers, and a directory of services available to aid in the development plan.3
It is important to remember that access to good EOL care leading to a dignified death should be regarded as a basic human right.4 Hopefully, this article opened the eyes of its readers as to the necessity of providing quality EOL care globally. Thank you for the opportunity to briefly discuss resources available to aid in planning and implementing palliative care programs globally and in Thailand.
Julie Hudziak, RN, MS, OCN
Clinical Instructor
Edgewood College
School of Nursing
Madison, WI
[email protected]
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