Thursday, May 5, 2011

Esther Luo, Ho Chi Minh City, Viet Nam, Developing a Strategic Plan for Sustainability in Palliative Care in Vietnam

Blog 3 In addition to visiting home care patients and facilitating small group discussions on palliative care topics, one of the most exciting events was the development of a strategic plan making palliative home care program sustainable. We utilized the SWOT analysis (strengths, weaknesses, opportunities, and threats) to evaluate our palliative home care initiative. We divided into smaller groups for the SWOT analysis. Our Vietnamese clinicians astutely identified the challenges for sustainable palliative care including securing adequate funding resources, providing further palliative care training to doctors and nurses, and policy advocacy, opioid availability, and implementation.
Funding sources for international palliative medicine is not easy. In 2008, the Open Society Institute conducted a study to identify national and international palliative care funders that support hospice and palliative care activities in Africa, Central, Southern and Eastern Asia, Central and Eastern Europe, the Commonwealth of Independent States;, Latin America and Caribbean, and the Middle East. Of the 354 donors identified, 21% are active donors in Central, Southern and Eastern Asia.
Training palliative care doctors had already began in cities of Vietnam including Ho Chi Minh City and Hanoi. As I mentioned earlier, Dr. Eric Krakauer had already trained many local Vietnamese physicians and nurses on palliative care topics. In addition, two physicians were selected as international palliative care fellows at the International Palliative Care Program in San Diego in the recent years.

The Ministry of Health began its palliative care initiative in 2005 and conducted a rapid situation analysis of the need for palliative care for patients with cancer and HIV/AIDS. Based on these data, the Vietnam palliative care initiative was planned based on the WHO's public health strategy for national palliative care program development. Efforts to make opioids such as morphine available in Vietnam resulted in collaboration with the International Pain Policy Fellowship Program at the University of Wisconsin, a workshop in opioid policy in 2007 in Hanoi. Within one year of the workshop, the Vietnamese Ministry of Health liberalized opioid prescribing regulations that reflected international standards. Despite the current progress, cancer hospitals like the one we visited continue to face shortages of consistent opioid supplies.

Lastly, implementation of a sustainable palliative care internationally is challenging. However, the palliative care program already implemented in Ho Chi Minh City's Cancer Hospital is an example of the possibility of sustainable palliative care. With available resources, dedicated faculty (both American and Vietnamese), and enthusiastic learners and the support of the hospital administration and ministry of health, we are beginning to see the results of years of hard work. From no palliative care, to a dedicated inpatient palliative care unit, to a home care program, and dedicated fellowship training, I believe palliative care will become sustainable in the Cancer hospital in Ho Chi Minh City!

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