By Dr Malar Velli Segarmurthy / Dr Nirmala Bhoo-Pathy

While the COVID-19 pandemic has captured the attention of media outlets, governments as well as the general public all over the world, a coexisting pandemic that is responsible for approximately 41 million deaths every year continues to go largely ignored.

Non-communicable diseases (NCDs), which include heart disease, cancer, diabetes, stroke and chronic lung diseases are among the greatest health threats to mankind in recent times, resulting in huge cost that extends beyond health-related sufferings.

These diseases are responsible for almost 70% of all deaths worldwide.

Sadly, about 82% of the 16 million people who die prematurely due to NCDs and their complications are from low- and middle-income countries.

The crux of the matter is that often these deaths occur after long periods of hospitalizations and costly treatments, putting a massive amount of pressure on the already fragile health systems and low-income households.

Malaysia too, is not spared from the impact of the NCD crisis.

In 2016, an estimated 113,400 out of 154,000 deaths in the nation were attributed to complications of NCDs.

The increasing disease burden caused by NCDs calls for an urgent need to focus on chronic care, step down care and community nursing.

The complications of NCDs will result in higher numbers of those dealing without serious health-related sufferings (SHS) requiring palliative care.

Palliative care is a specialized branch of medicine which provides holistic care to people living with serious health issues such as cancer and heart disease.

It focuses on providing relief through medical management of symptoms caused by their illness as well as addressing psychosocial, mental and spiritual needs to improve the quality of life of both the patients themselves and their caregivers.

Most importantly, far from the misconception that palliative care is about death and dying, it is about life and living.

Inequality of access to basic palliative care and common symptom relief is however one of the greatest inequalities and disparities in global healthcare.

In Malaysia, the unmet need for palliative care prevails with a prevalence of 90% (MOH, 2019).

Statistics show that our country will soon become an aging nation within the next decade, hence the need for palliative care will soon become more pressing (MOH, 2019).

Currently, there are only 21 qualified palliative medicine consultants in the country. Most of them are serving in the public sector such as the Ministry of Health and university hospitals, mainly in urban areas.

Given that palliative care services in Malaysia are heavily dependent on large (tertiary level) hospitals and NGOs alone, there is currently a big gap in delivery of community-based palliative care services via both the public and private sectors for populations living in urban and rural areas.

Amidst the inequality in access to palliative care services in the country, it is strongly felt that there is an urgent need to strengthen palliative care services provided in primary care facilities.

Central to this issue is the fact that the COVID-19 pandemic has already strained tertiary care services, disrupting the care of patients dealing with serious health-related sufferings.

The worry is that our health system will soon be overwhelmed if the care of patients who are in need of palliative care services are also left in the hands of the tertiary centers alone.

With the availability of extensive primary care services in Malaysia, the primary care physicians can be roped in to provide palliative care for both symptom management and holistic care focusing on other important factors like psychological and spiritual needs.

Caregiver support and empowerment will also be helpful in reducing the need for repeated admissions or visits to tertiary hospitals.

The primary care doctors in "klinik kesihatan" and general practitioners are the first point of contact to the community. They have a remarkable and meaningful role to play in providing palliative care.

With their knowledge and rapport established with patients and their families, the primary care doctors are indeed in an ideal position to address the complex issues faced by people with serious health-related sufferings, as they will be able to carry out home visits and also communicate and coordinate with other palliative care related health care resources.

The majority of those who need palliative care prefer to spend their lives not in the hospital but in the community among their family and friends. Hence community awareness has a major role in the care of these individuals.

Malaysia has to start taking robust actions to face the impact of NCDs and the country’s aging population from now on.

It will be a timely intervention to decentralize palliative care services mainly to the primary care level, to ease the burdens to the healthcare system as well as to maintain sustainability of this important service.

References:

Gomez, O. C. (2020). Population Ageing, Improving palliative care. October 26, 2020 – November 01, 2020.

MOH, N. M. D. D. (2019). National Palliative Care Policy and Strategic Plan 2019-2030 , Ministry of Health Malaysia.

Mustapha, F. I., Omar, Z. A., Mihat, O., Noh, K. M., Hassan, N., Bakar, R. A., . . . Muhamad, Y. (2014). Addressing non-communicable diseases in Malaysia: an integrative process of systems and community. BMC Public Health, 14(2), 1-6. 

Pandve, H. T., Fernandez, K., Chawla, P. S., & Singru, S. A. (2009). Palliative care – need of awareness in general population. Indian journal of palliative care, 15(2), 162-163. doi:10.4103/0973-1075.58465

WHO. (2018). Integrating palliative care and symptom relief into primary health care: a WHO guide for planners, implementers and managers [internet]. Geneva: World Health Organization; 2018 [cited 2019 Sep 29]. In.

(Dr Malar Velli Segarmurthy, doctor of public health (DrPH) candidate, and Dr Nirmala Bhoo-Pathy, public health medicine specialist and associate professor of epidemiology at the Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya.)