Regional Reports

Saudi Arabia

Building Capacity for Palliative Care at King Abdulaziz Medical City, Riyadh, Saudi Arabia

The Division of Palliative Care at the King Abdulaziz Medical City (KAMC), the regional center for the National Guard Health Affairs (NGHA) in Riyadh, Saudi Arabia was first established in 2004, concurrent with the development of the Department of Oncology. In 2008, our palliative care team saw 400 new consults and provided ongoing care for patients with late stage cancer in inpatient, outpatient and home settings. Now, the integration of palliative care into all of the healthcare services at KAMC is becoming a top priority.

EPEC-Oncology Workshop

To stimulate further integration, a Scientific Organizing Committee from KAMC invited Dr. Frank D. Ferris, Director of the International Program at the Institute for Palliative Medicine at San Diego Hospice (IPM), and other faculty, to present a three-day Education in Palliative and End-of-Life Care for Oncology (EPEC-Oncology) Workshop October 13-15, 2008 at our Postgraduate Training Center. More than 175 leaders, consultants, nurses and other disciplines from various specialties at KAMC, and different hospitals across Saudi Arabia, participated. The well designed, highly-structured program included 12 plenary and six breakout sessions. An enlightening session on legal and religious issues related to the provision of palliative care in Saudi Arabia was presented by KAMC faculty experts. Extensive interaction took place among participants and faculty during all of the plenary and breakout sessions. Pre- and post-course data was collected to measure the impact and effectiveness of the educational intervention. Participants received continuing education credits for the sessions they attended. Everyone who completed the full program received EPEC-Professional Certification.

Workshop Impact

Already the workshop has had the effect we hoped for. During his opening remarks at the Workshop, Dr. Bandar Al-Knawy, Chief Executive Officer, National Guard Health Affairs said,

“We at National Guard Health Affairs are aware of the great importance and the dire need for palliative care services in our health care system to better serve our patients. Our support and commitment will continue to ensure that palliative care is fully integrated at all levels of care within the National Guard Health Affairs. “

Dr. Abdulrahman Jazieh, Chairman of the Workshop’s Scientific Committee and the KAMC Department of Oncology said,

“I believe this workshop will be a changing experience for many attendees, not only at professional level but also at a personal level. I am very proud I was part of such activity. ”

Here’s what some of the participants said:

“I think it was an enlightening, eye opener experience in which we approached a very sensitive, frightening issue, but were able to work through it, and feel confident in the end that we are better prepared, to manage the difficulties people go through, when they are reaching the end of their life”.

“Excellent Workshop, Brilliant organization and superb faculty, the facilities were outstanding. World class Conference. Well Done.”

“EPEC Workshop like a single candle that opens a new dimension, for a new science in our society and one day, the light of it will reach all humans that they are seeking for it”.

“I am really impressed by this meeting. I was looking for a meeting that concentrates on the patient as a human and as a whole person and I finally found it. I felt very reassured, when I heard all the lectures which concentrated on even the tiny detail”.

Future Direction

The EPEC-Oncology based Workshop appears to have been a highly successful strategy to stimulate the integration of palliative care into KAMC. It planted the seeds for the further development of palliative care knowledge and skills for many of the clinicians at KAMC. It also helped develop a palliative care advocacy group that will facilitate future training, communication and the integration of palliative care across Saudi Arabia.

To achieve the NGHA’s corporate vision to be "the Kingdom of Humanity," expansion of palliative care services is now underway at KAMC, including:

• Development of a standalone Palliative Care Center that will be the Center of Excellence for palliative care education and research, and the first of its kind in the region. It will include 80 beds in inpatients units that provide different levels of care, ambulatory outpatient clinics, and homecare and day care programs.
• Inauguration of a Saudi-based Palliative Medicine Fellowship Program starting in early 2009.

Already, we are beginning to plan for establishing a Palliative Care Education Center to be able to offer more educational opportunities, like the EPEC-oncology based workshops and bed side training to stimulate further palliative care integration throughout the National Guard Health Affairs, and Saudi Arabia.

Omar Shamieh , MD
Director, KAMC EPEC-Oncology Workshop
Consultant, Palliative Care
Department of Oncology
King Abdulaziz Medical City
Riyadh , Saudi Arabia

Asia

Palliative Care in Asia – The Challenges

A new chapter for palliative care in the Asia Pacific begins in 2009. The end of 2008 brought about major changes for the Asia Pacific Hospice Palliative Care Network (APHN). The secretariat has moved from Singapore to Seoul where the current chairman Professor Young Seon Hong resides. Rosalie Shaw is no longer the Executive Director of the APHN having relocated back to Singapore.

There are very distinct challenges affecting the growth of palliative care in Asia. Some countries may be economically developed but resource poor in terms of palliative care. Conversely, there are examples of good palliative care initiatives in developing countries. Life and illness are intertwined in different ways in Asian communities when compared to other regions. A strong individual advocacy approach may work in western societies, but it may not have the desired impact here. The needs of many may seem to be more pertinent here than the needs of one. These differences often translate into difficulties for Asian communities to access and to be integrated into western palliative care type programmes.

There are huge challenges to integrate palliative care in the region. The very principles of palliative care may need to be interpreted within the values of Asian communities. The evidence base that we routinely use is derived from western populations, but it may not be entirely appropriate to our region. Though developing local evidence is important, the need to develop and maintain services in Asia is overwhelming and research is often sacrificed.

Over the years, the APHN has worked to link individuals and services together in the region with the aim to develop a web of contacts. The Biennial Asia Pacific Hospice Palliative Care Conference, to be held on 24 – 27, September in Perth (in conjunction with the 10 th Australian Palliative Care Conference. www.conlog.com.au/palliativecare2009/ ) will help bring together palliative care workers to share and learn together. This is an opportunity to share the commonality and diversity that is the richness of palliative care in the region.