Sarawak, one of the fifteen states in Malaysia, is situated at the northern part of the island of Borneo, with a size of 48,000 sq. miles. It has a population of 1.9 million people of various ethnic groups. Kuching is its capital city with a population of 510,000 people. Other towns included Sibu, with a population of 308,000; Miri, a population of 276,000, Bintulu, a population of 127,000 and Sri Aman with a population of 196,000. Other smaller townships are interspersed in various parts of Sarawak, with the smaller settlements having a population of less than a thousand people (See attached map). The number of new cancer cases have risen over the last years and last year there were 1012 new cases registered in the Department of Radiotherapy and Oncology , Sarawak General Hospital, the only Government Oncology Department in Sarawak. The most common cancers that we see here are the nasopharyngeal cancers, which have remained the commonest for the past 14 years. Lung, breast and cervical cancers follow this. About 70% of these cancers present in quite an advanced stage of disease. Hence the intent of treatment is often palliative in nature.

The development of palliative care in Sarawak ( referred to as Hospice Service in this part of the world) started in Kuching in 1995 by the Department of Radiotherapy and Oncology, Sarawak General Hospital. As the concept of Palliative Care was quite new here, the first and foremost task was to create awareness among the professionals especially doctors and nurses. Often the attitude of most medical professional is that it is a waste of time. We began this arduous task in 1995 by training the team involved in the work and also began accepting referrals of terminal cancer cases which other departments had difficulty in managing. With recurrent training, which is still ongoing, we have been able to create sufficient awareness among the staff in the hospital who has seen the positive impact of palliative care on the patients and the families. This has led to a greater enthusiasm and demand. The interest generated has led to further training creating a greater outreach to meet the demand of this service. To further enhance the availability of service especially in the rural areas, the community health personnel with their greater mobility are also involved in providing the service. To date, we have been able to train a total of 350 medical personnel, which consists of doctors, nurses, volunteers, and community based health personnel.

In 1997, Ministry of Health in Malaysia adopted the policy of having one Palliative Care Unit (PCU) in each Malaysian State. The PCU in each state has the task of setting up Palliative Care Team in every hospital in the state; thus ensuring better access to the palliative care service.

The aims of the program which is now running together with Sarawak Hospice Society are to be able to train all staff in the various government hospitals so that continuity of care can be provided even in the most remote areas of Sarawak, where accessibility in the jungle is often only possible by foot and it can be for as long as several days. Under this system, health care professionals making home visits form part of the team who extend the service to patient's home and they liase with the palliative care unit or the palliative care team when help or advice is required.

As for the public in Sarawak, it is a totally new concept, and the Sarawak Hospice Society has been actively participating in public education via the various forms of the media like radio talk shows articles in the local newspapers and by exhibitions. It is hope that with continued awareness through training of professionals and public education, the concept and philosophy of palliative care will be more widely accepted and we will be able to create a greater public awareness about " dying with dignity" and a good quality of life for the terminally ill cancer patients in Sarawak.

Prepared by: Dr. Tang Tieng Swee
Chairman, Sarawak Hospice Society
Email: hosawak@hotmail.com

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