The Big Healthcare: Hospice care in China falls far short of demand

World
Europe

Dying, even after living a happy life, can be frightening, lonely, and often undignified. Doctor Li Songtang knows it all too well. He opened China's first palliative center in Beijing 30 years ago - a time when end-of-life care was mostly viewed as a surrender to death.

"How's everybody?"

Doctor Li calls this patient his "valentine"- a 62-year old who suffers from dementia, and believes she's carrying his twins.

DR. LI SONGTANG FOUNDER, SONGTANG HOSPICE "This granny wasn't able to get pregnant when she was young, and that was her biggest regret. Now she feels happy thinking she's expecting twins. A little white lie brings her comfort."

A short walk away, a nursery for the newborns. This 9-month-old has a terminal brain disease. He's simply too young to know what's to come. The nurses, however, want to make whatever time these babies have as rich and loving as possible. Over the years, Doctor Li's team have cared for over 40,000 patients, young and old.

DONG WEI NURSE, SONGTANG HOSPICE "It takes more than medical supplies to alleviate the physical pain for dying, but also the comforts of companionship and emotional support."

And for those with religious beliefs, a unique service is provided for spiritual guidance.

MASTER JIMIAO YOUSHENG TEMPLE "People fear death because they don't know where they are going after dying. It's fear of the unknown, and we help them to find answers."

Mock funerals are even occasionally being held for volunteer Buddhists to practice prayers and help the dying. For the believers, death is made less threatening, and seen as a new beginning for the afterlife.

LI QIUYUAN BEIJING In a country where 7 million people die each year, China's hospice care is desperately under-resourced. And after more than 30 years of the one-child policy, it's projected that people over the age of 60 will make up more than 30% of the population by 2050. This means we are going to see more Chinese in need of significant amounts of daily care, and a smaller pool of younger relatives able to provide it.

So what, then, has prevented China's hospice services from growing more quickly?

TAN JUNWEN PATIENT'S DAUGHTER "When my mother first moved in this hospice center 6 years ago, my brother and I were ashamed of ourselves. We even kept it a secret from our friends and neighbors, fearing that we'll be judged."

In a culture that emphasizes children's responsibility to support their elders, giving up on curative treatment, is viewed as disgraceful, and a disregard for filial piety. Death itself is also taboo in the Chinese culture. Anything associated with it, is said to bring ill fortune.

DR. LI SONGTANG, FOUNDER SONGTANG HOSPICE "We were forced to move 7 times during the past 30 years, and finally moved to the outskirts of the city. Residents nearby often thought we were a hospital for the dying, and could bring calamity to their lives."

A lack of professionalism has also been hindering hospice care's growth in China, given how it draws from multiple disciplines, from medicine and nursing to philosophy and psychology. Earlier this year, the country's top health authority finally released a set of standards for palliative care: such facilities should be equipped with at least 50 beds, and there should be at least one doctor, four nurses, and 12 caregivers for every 10 beds. But there's no mention of government support，which Doctor Li thinks is desperately needed.

DR. LI SONGTANG FOUNDER, SONGTANG HOSPICE "The national health security system does not generally provide any government subsidies for palliative care, making it difficult for individuals to fund their own care."

And when asked how China's healthcare can move forward.

DR. LI SONGTANG FOUNDER, SONGTANG HOSPICE "Too many medical resources are now being wasted on patients' end-of-life stage. My proposal to the government is that doctors should clearly identify when patients enter their end-of-life stage, and stop curative treatment that has become futile and could only cause more physical and emotional suffering. This could save up to at least 36% of the country's medical resources. Only then could Chinese have the chance to truly enjoy universal healthcare." LI QIUYUAN, CGTN, BEIJING.

ROBERT NAGILA NAIROBI, KENYA "That was my colleague on the challenges of Hospice care in China. In many parts of Africa though, just getting access to health care is a challenge. My next report tackles Africa's approach to its numerous challenges in healthcare sector."

Africa is confronting the world's most dramatic public health crisis, according to the World Health Organization.

ROBERT NAGILA NAIROBI, KENYA "With an estimated population of over 1.2 billon people, 83 % living in rural areas have no access to health care. Africa suffers a myriad of healthcare challenges. At the very centre of this are financial resources."

MERCY KORIR DOCTOR "The biggest challenge which most African countries face is financial resources in the health sector."

In 2001, African Union member states. Pledged to allocate at least 15% of their budgets, to their health sectors. A decade later, while 26 countries had increased their allocations, only one African country had achieved the 15% target.

NELLY BOSIRE, HEALTHCARE REGULATOR KENYA "It's only Rwanda that has actually met this and even surpassed this."

MERCY KORIR DOCTOR "The thinking was that 15% would be enough to cater towards providing services, include taking care of the human resources component, which requires a lot of resources, provide supplies and commodities and putting up the actual infrastructure."

The ebola virus that swept across parts of West Africa exposed the continent's weak healthcare systems. In countries like Guinea and Nigeria where more resources had been allocated to the health sector, they were more effective in containing the virus. In sharp contrast, countries with almost non-existent healthcare infrastructure were decimated by the virus. According to data from Afri-dev health and social development agency, in 2014, Liberia had 51 doctors to serve the country's 4.2 million people. While Sierra Leone had 136 doctors for a population of six million people. Other challenges facing the continent are a lack of infrastructure, lack of adequate trained healthcare personnel, corruption.

NELLY BOSIRE, HEALTHCARE REGULATOR KENYA We need to clean up our systems, cut down on wastage, once we minimize the wastage then we do adequate budgeting because it won't make sense to pump more money into a leaking sieve. If we are able to handle our financial Management around healthcare, that is an immediate need and it is something that systems are already in place, it just needs implementation.

But it is not all doom and gloom. There HAVE been vast improvements. According to the WHO, in 2015, more than 12 million HIV positive Africans were on ant-retrovirals compared to 100,000 in 2003. Of the 42 malaria-endemic countries, 33 have adopted artemisinin-based combination therapy, the most effective antimalarial medicines available today.

Most countries are also making good progress on preventable childhood illness. Polio is close to eradication, while measles deaths have declined drastically in the last decade. But a lot more still needs to be done. Of the 20 countries with the highest maternal mortality ratios worldwide, 19 are in Africa.

NELLY BOSIRE, HEALTHCARE REGULATOR KENYA "Lack of awareness of how important it is to seek health, becomes our first problem. Because that aspect is still failing it means primary healthcare overall then begins to fail, because it is targeted more towards prevention, towards continued care of chronic illnesses so that they don't complicate. That aspect in africa is very poorly developed."

ROBERT NAGILA NAIROBI, KENYA "Then there is the strain on African health systems imposed by the high burden of life-threatening communicable diseases, which could be largely avoided by meeting basic sanitation needs."

But it is an increase in non-communicable diseases such as hypertension and coronary heart disease that may prove more worrying. And for all these challenges, more funding, research and training are required. RN.