Stepping Up End-Of-Life Care In Jakarta

LEFT: Veronica Basuki, chairperson of the Jakarta Cancer Foundation, giving her opening remarks at the launch. RIGHT: Dr Ramaswamy Akhileswaran, who leads the team of specialist volunteers from Singapore.

The Singapore International Foundation is partnering Indonesian non-governmental organisations to equip health-care professionals with the awareness and skills to care for the terminally ill. BY AUDRINA GAN



ith a projected 10,000 new cancer cases annually in Jakarta alone – of which 7,000 cases are expected to be incurable at the point of diagnosis – the need for palliative care services in the Indonesian capital is expected to grow.

The challenge, however, is the lack of certified physicians trained in palliative care. The Indonesian Palliative Society estimates that, in 2012, only 21 physicians in Indonesia had palliative care accreditation. Of these, four were in Jakarta. Further, only two of the 12 public hospitals in the capital have established palliative care units.

To address this shortage, the Singapore International Foundation (SIF) and its Singapore International Volunteers have embarked on a needful and beneficial collaboration with the Jakarta Cancer Foundation (YKI DKI) and Rachel House (RH). This partnership will see Singaporeans and Indonesians working together to raise the capability and capacity of Jakarta’s medical communities to care for its terminally ill.

At the launch of the project in Jakarta on Jan 20, SIF’s Executive Director, Jean Tan, said: “Over the next three years, volunteer palliative care specialists from Singapore will partner with Indonesian medical professionals from all 12 public hospitals in Jakarta and YKI DKI and RH to work with patients who suffer from endstage illnesses.”

The three partners will organise yearly Palliative Care Leadership Roundtable sessions to engage national policy makers and leaders of public health institutions in discussions on policy and management issues. They will also run annual Palliative Care Symposiums, to share their knowledge and experiences with the larger Indonesian health-care community.

Previously, SIF had worked with Rachel House staff on a series of training sessions in Jakarta to improve palliative care standards for terminally ill children. This helped to enhance the staff’s knowledge and clinical skills on in-patient and homecare palliative care services for children.

Lynna Chandra, founder of Rachel House, said at the project’s launch: “SIF’s support from the beginning in 2008 when palliative care was understood by few has been invaluable... We are hopeful that our vision that no child should ever have to die in pain is now within reach.”

The commitment by both countries to work together to improve lives reflects the gotong royong spirit between Singaporeans and Indonesians. It also demonstrates the good that can emerge from sharing resources and expertise in solving common challenges.

The Singapore International Volunteers Specialist Team comprises doctors and palliative care nurses, and will be led by Dr Ramaswamy Akhileswaran. He is one of Singapore’s top palliative care experts and the chief executive officer and medical director of HCA Hospice Care, a charity supporting terminally ill patients.


Dr Akhileswaran and his team are conducting nine three-day workshops over three years for 69 Indonesian medical professionals from the 12 public hospitals, the Jakarta Cancer Foundation, and Rachel House. They will learn how to assess, treat and manage palliative care patients, and communicate effectively with patients and caregivers. They are also expected to pass on what they have learnt to their colleagues.

At the first workshop in February, trainees were introduced to the principles of palliative care and symptom management. They were also taught how to provide nursing care, such as managing sores and dressing wounds, as well as to address the psychosocial issues of patients and caregivers.

Instead of lengthy lectures, most of the training involves small group discussions based on case studies, as well as role-playing sessions. On the second and third day of the workshops, trainees practise what they have learnt on patients, in bedside teaching sessions at the hospital where the training is conducted.

Dr Akhileswaran said: “During these practical training sessions, we see if the trainees do a good examination of the patients and whether they understand and know how to manage the symptoms that they saw in the patients.”


Participants of the first workshop have given positive responses, said Dr Akhileswaran. He added: “At the start of the training session, we asked the trainees what they expected out of the workshop and most of them said they did not know the reason they were there.

“After the training, a lot of them were glad that they had come. Some said the workshop taught them, for the first time, how to break bad news to patients and their families even though they have been practicing medicine for 10 years.”

Reflecting on her experience, one of the trainers , Kahvidah Mayganathan, an Advanced Practice Nurse at HCA Hospice, said that language was an initial challenge. But this was overcome after participants translated for each other. It also helped that most of the trainers are conversant in Malay. She added: “It has been a great experience to work with our Indonesian counterparts in this training programme. Their enthusiasm to learn has made this programme a lot more worthwhile.”

Representatives from the Jakarta Cancer Foundation, Rachel House and the Public Health Offi ce of Jakarta, as well as Singaporeʼs Ambassador to Indonesia Anil Kumar Nayar (second from left), were present at the launch in Jakarta.

The Specialist Team will also compile materials shared during the workshops to help trainees to pass on their newly acquired knowledge and skills to their colleagues.

When the project concludes in 2018, Dr Akhileswaran hopes that the trainees will set aside half a day every week to practise palliative care and train others to do the same. “We also hope that they can help to set up palliative care units at the hospitals,” he said.

As awareness of palliative care deepens in the country, he hopes that district or tertiary hospitals can eventually refer terminally ill patients to community hospitals or to be cared for at home by visiting palliative care specialists.

For the trainers, sharing their expertise with their Indonesian friends has been a rewarding experience. Said Mayganathan: “I have learnt that anything is possible as long as you are determined and focused on achieving the goals.

I gained tremendous satisfaction from knowing that my skills and knowledge can be used to improve the care of patients across borders.”




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