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Elizabeth Cheung

Understaffed and undertrained, Hong Kong’s end-of-life care services struggle to meet needs of an ageing population, despite government plans to expand the stretched provisions to cover ­support for those who wish to die at home.
Hong Kong has only 19 ­palliative care specialists – those who focus on providing physical and psychological care to patients suffering from terminal illness – and university training has been criticised by experts.
Last wish: Hong Kong survey reveals most elderly would rather die in hospital than at home
The University of Hong Kong told the Post on Tuesday that medical students would be required to follow terminal patients for a year, to better understand their needs. They may be asked to accompany them to see doctors, visit them at home, or attend their funerals.
It is impossible to lay all the work on those 20 specialists
Dr Michael Sham Mau-kwong, palliative specialist
The proposal of encouraging patients to spend their final moments at home is only part of palliative care services, which are now being studied by the former health minister Professor Yeoh Eng-kiong, as revealed by Hospital Authority chairman John ­Leong Chi-yan in his interview with the Post last week.
Yet, whether the city is prepared to embrace the new proposal is still in question, given insufficient home care medical assistance for the elderly, especially for those living alone.
“It is impossible to lay all the work on those 20 specialists ... what we need is more palliative care training, but not only specialists,” said Dr Michael Sham Mau-kwong, who has worked in palliative care for 30 years, as dying at home also means more doctors to certify deaths and knowledgeable caregivers to take care of patients ­before death.
From cancer to dementia, palliative care could help a huge number of patients suffering from different chronic illnesses.
Sham said the ­discipline remained ­unpopular, despite its establishment as a specialty in Hong Kong 16 years ago.
“There is no private market ... doctors cannot earn much. Only those with great passion would choose it,” said Sham, one of the doctors who introduced the specialty into the city.
Finger on the pulse: hospital chief’s vision for improving Hong Kong’s public health service
Palliative care is not provided in private hospitals, where doctors tend to earn more than in public sector. According to Sham, fewer than 10 trainees choose the specialty every year.
Around 200 nurses are working in public hospitals’ palliative care units and 400 serving in the oncology centres, which also provide the services. This is in contrast to the some 46,000 deaths every year.
“Services are there but not adequate. We don’t have thorough planning now,” Hospital Authority chairman Professor John Leong Chi-yan said.
Revealed: why hospital chief wants to give Hongkongers the option to die peacefully in their own homes
Dr Raymond Woo Kam-wing, a specialist in palliative medicine from the Caritas Medical Centre, recalled the speciality was taught for only a matter of hours during his medical school training.
“Pain management and ways to take care of patients’ psychological needs, such as anxiety and depression, are not focuses of the syllabus,” he said.
A spokesperson from Chinese University said palliative care was “one of the indispensable elements” in the medical curriculum and taught in different subjects across different academic years. Students were required to spend two days to one week in public hospitals acquiring palliative care experience to gain first-hand clinical exposure. Students were also required to study bioethics, which included end-of-life issues.


End-of-life care in Hong Kong severely lacking, doctors warn

Professor John Leong Chi-yan, chairman of the Hospital Authority. Photo: Edward Wong

Last wish: Hong Kong survey reveals most elderly would rather die in hospital than at home

Elderly people in Sham Shui Po would rather die in a hospital. Photo: Sam Tsang

News

Hong Kong

Health & Environment

With only 19 palliative care specialists in the city, priorities and training must change, they say
