For years Siriporn* has worked as a hospice volunteer at Wat Khampramong, which offers palliative care for terminally-ill patients, suffering mostly from cancer. This is one of the few places dedicated to tending patients who are turning the final corners of their lives, and Siriporn's main job is to help them through the inevitable as comfortably as possible.
''Having a chance to get involved with other's death gives me an added purpose to my live. It's very fulfilling,'' nursing professor Siriporn said.
Siriporn and her students visit the temple many times a year to offer patients nursing care services and recreation activities, mostly comic relief to help alleviate their emotional pain.
They never miss engaging them in friendly conversation.
''At the temple, we are able to provide services that we cannot offer at a hospital,'' she said ''We let the patients get a simple workout. We read to them, and our students sing and entertain them. All these activities make them smile and be happy.
''We spend time listening to their needs and try to ensure their needs are met in the best possible way. Many don't want anything but somebody to be there for them and hold their hand to the end.''
Phra Paponpatchara Pibanpaknitee (Ciradhammho Bhikkhu), the abbot of Wat Khampramong, says that the temple offers holistic care that combines alternative therapy, Chinese traditional medicine and modern Western medicine, as well as basic medical services to patients who are in the final stages of a serious illness. It also provides emotional support and spiritual needs to them and their families. All these services are given by a caring, compassionate hospice team that include volunteering physicians, nurses, social workers, palliative medicine experts and monks. Patients and their family members stay in a tranquil place that is much homier than a hospital.
''We look after the patients as a whole person,'' said Phra Paponpatchara, who is also president of the Aphinyana Arokhayasala Foundation. ''We are not intending to speed up or prolong the dying process. We aim to relieve their pain and other symptoms in order to improve the quality of life.
''We want them to stay as comfortably as possible in a relaxed, homey environment with their families and friends. We provide services and care at no cost.''
Unexpectedly, Siriporn has had deal with similar situations in her personal life, as well. Her brother was infected with hepatitis C, which advanced to liver cancer last year.
''The progression of the disease came as a complete shock to all of us. It's sooner than expected,'' Siriporn recalled.
Siriporn didn't allow her brother to talk to his doctor. She herself chose to tell him that he has a tumour in the liver, but not untreatable cancer.
''Well, we didn't want to keep his condition under wraps,'' she said. ''It's difficult for us to accept that he has cancer but it's more difficult to tell him that he's in his last stages.''
Siriporn said her family decided to invite her brother to visit Wat Khampramong where the secret to his condition was revealed.
''He had a talk with a liver cancer patient. And he looked more relaxed so we decided to tell him everything,'' she said.
''He's brave. He doesn't want to receive chemotherapy in a hospital. Instead, he desires to receive care offered by the temple and have a peaceful ending. And we accept his decision.''
Bart Gruzalski, co-manager and faculty of Limerick Insight Meditation Centre in Ireland, who participated in a seminar on grief management last month in Bangkok, noted that it's best for everyone involved to tell a terminally ill patient that they are going to die.
''If the patients want to know, let them know. A lot of people don't like doing this. It's understandable,'' said Gruzalski, a professor emeritus in philosophy.
''Physicians for example, should let the patients know that their illness is serious. Tell them the truth as gently as possible. Also be straightforward and clear as possible; avoid using sophisticated medical terminology.''
By doing this, terminally-ill patients are able to complete their goodbyes and unfinished tasks or business as far as they can and go through the grieving and dying process. Being open also gives family members and friends a moment to tell them that they love them and remember good times and forgive old conflicts.
Siriporn told Life that her brother feels happy staying at the temple where he can talk to patients who share the same feelings and are supportive throughout the dying process. But staying at home stressed him out.
''We go to visit him every week. He told me he likes praying and listening to dhamma lessons that help him keep calm,'' she said ''We've become closer. We witness what is typically a very private moment. We think he made the right decision,'' she said
Many patients with life-threatening illnesses shift from usual medical treatments in which doctors strive to cure the disease in a hospital to receive palliative care at a hospice where they can spend their last months in a serene way.
However, there is only a handful of hospice centres in Thailand while palliative care services that focus on enhancing the quality of life of patients during the difficult moment and supporting their families are still inactive.
''Palliative care is a gap in Thai medical services,'' said Assoc Prof Srivieng Pairojkul, director, Palliative Care Unit, Srinagarind Hospital, Faculty of Medicine of Khon Kaen University.
''Some doctors and nurses don't know how to deal with patients with terminal illnesses in a proper manner.''
Prof Srivieng, who is also president of the Thai Palliative Care Society, noted that palliative care is not on the curriculum of medical and nursing schools here and there is no official training centre.
The good news is that Mahidol University has a plan to develop a fully integrated centre for palliative care for terminally-ill patients and the ageing population on a 100 rai plot located at Hua Hin, Prachuap Kiri Khan. It's expected to be the country's largest centre for palliative care.
To fill the gap in Thai medical services and fulfill the goal of the university's plan, Prof Srivieng suggested including palliative care in medical and nursing educational programmes. Also, adding care services to the national health scheme would be another important step forward.
''The country is entering the 'ageing society'. And there is an alarming number of patients with chronic diseases, including cancer, heart disease, kidney disease and Aids. So these are urgent agendas.'' she said.
How to offer comfort after a loss
Be genuine in communication with the bereaved when offering support.
Say: ''I'm not sure what to say, but I want you to know I care, tell me what I can do for you.''
Avoid saying: ''I know how you feel.'' One can never know how another person feels. Instead, you should ask your friend to tell you how she feels.
''It's part of God's plan.'' This statement can anger most people in grief, and they may respond: ''What plan? Nobody told me about the plan.''
Houses set in a relaxed, homely environment for patients at Wat Khampramong let them stay in peace and feel at ease.
About the author
- Writer: Sukhumaporn Laiyok