The future of palliative care in the Islamic world
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Cancer
in the developing world, of which the Islamic world is a substantial
component, is characterized by far more advanced stages at diagnosis,
fewer allocated resources for prevention and treatment, and higher
incidence than in countries with more developed health systems.1
The
top five cancers in the emerging world are (in descending order)
stomach, lung, liver, breast, and cervix, and in developed countries the
most common cancers are those of the lung, colorectum, breast, stomach,
and prostate.2
In Indonesia, which has an estimated total cancer incidence of about
300,000 cases per year, only 10% are seen in the health care system.3 Similarly, only one cancer unit is available for about 120 million people in Bangladesh.4
Because preventive and curative services for cancer control are
underdeveloped in many Islamic countries, the development of palliative
care services is a more realistic option for most patients in these
countries who have cancer.
The available health care
services in the Islamic world clearly do not meet patients' needs, and
there is little sign that this situation will improve in the foreseeable
future. Even if palliative care development is placed on an Islamic
country's health care agenda, such development might be handicapped by
technical and economic constraints. However, despite this gloomy
picture, there are signs that palliative medicine is beginning to take
off in the Islamic world. For example, the medical use of morphine for
cancer pain control has been steadily increasing during the past few
years in many Islamic countries.5 Once a palliative care program takes root in an Islamic country, it usually grows into a thriving service.3,6,7,8,9,10
SAUDI ARABIA
In
the early 1990s, a group of nurses and physicians at the King Faisal
Specialist Hospital in Riyadh, Saudi Arabia, saw that a huge need
existed to establish palliative care services for patients with advanced
cancer in both the hospital and the community. The group's proposal for
the new service was approved, and within a few years the palliative
care program developed into a comprehensive service. It now has a 10-bed
tertiary care unit, an outpatient clinic, a home care service, an
inpatient consultation service, and an outreach clinic that serves
patients in three other regions in the country. A recent major
development was the establishment of a postgraduate training program
where interested physicians spend two years receiving advanced training
in palliative care.6,7
I was privileged to be the first physician to join this program.
Several other hospitals in Saudi Arabia have recently started to develop
local palliative care programs.
EGYPT
The
Society for the Management of Pain was founded in Egypt in 1980. A
postgraduate training program was subsequently established to equip
physicians with advanced knowledge and skills in pain management.
Parenteral morphine is locally manufactured whereas oral preparations
are imported. One Egyptian experience that could have possible
implications for other Muslim communities is the success that Egypt has
had in training patients' relatives to care for patients in their homes.
A patient's relative is selected as the principal caregiver and is then
given basic teaching on the disease and some tips on patient care at
home. The home caregiver is provided with a booklet that contains a
daily observation sheet, which is completed by the caregiver and
reviewed by the health professionals weekly.8
INDONESIA
Indonesia,
which has the largest population among Islamic countries, started its
palliative care movement in the early 1990s. The establishment of the
National Cancer Committee led to the National Cancer Control Program and
ultimately to the Cancer Pain Relief and Palliative Care Program.3
The movement progressed from the establishment of committees and
organization of scientific conferences to palliative care services that
are provided in pilot health institutions. Although weak opioids had
long been widely available in the country, oral morphine was not
available until 1995, when it started to be used by some referral
hospitals.9
TURKEY
Turkey,
which has a total annual cancer incidence of about 100,000 cases,
started to develop palliative care services 15 years ago. By 1993, the
Turkish Society of Algology (established in 1987) became a regular
chapter of the International Association for the Study of Pain. The
academic activities of the society included publishing a scientific
journal, organizing several conferences, publishing and distributing
relevant booklets, and incorporating palliative care into the curriculum
of medical students. Some medical colleges in Turkey established
postgraduate programs in pain management.10
OTHER ISLAMIC COUNTRIES
Some
forms of palliative care services exist in other countries including
Tunisia, United Arab Emirates, and Pakistan. The scarcity of reports on
palliative care programs in different countries throughout the Islamic
world makes it difficult to evaluate the status of such care.
CONCLUSIONS
Although
the limited resources and the long list of unmet health needs are
factors that could hinder the development of palliative care services in
the Islamic world, it could be argued that such development is more
dependent on genuine commitment than on material resources.11
Other factors might favor a bright future for palliative care in the
Islamic world, namely, the culturally-rooted strong family and community
support given to patients, the great emphasis that Islam places on
caring for the elderly, and the absolute unacceptability of euthanasia
by Muslims.12
The
future of palliative care in the Islamic world is difficult to predict
with any certainty. Whereas the steady progress in palliative care
programs is being made in some countries, the underdevelopment or
complete lack of services in other regions is of great concern.
References
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West J Med. 2002 January; 176(1): 60–61.
PMCID: PMC1071657
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