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Bringing palliative care conversations to Indonesia's aging
Palliative care services are not adequately reimbursed under either private insurance or our universal health coverage, BPJS, leaving those in need to bear the financial burden on their own.
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Abandoned: A Tangerang police officer and local residents evacuate a paralyzed elderly man on April 25, 2023, after he was abandoned by his family on the street. (Antara/Tangerang Police)
I
n my routine practices as a physician providing primary palliative care to patients in their homes, I have observed the struggles faced by my terminally ill patients and their caregivers. I have witnessed the overwhelming weight of the moment of diagnosis, the challenge they face in processing the situation, caregivers losing their jobs to fully commit to long-term care and the difficulty they encounter in understanding and creating a care plan.
Often, driven by recommendations from most physicians to fix the problem quickly and fearing giving up, they may unintentionally choose more aggressive therapies. This sometimes results in them prioritizing the concerns of physicians and extended family members over the actual needs and values of the patient.
This common scenario highlights that the current medical training in Indonesia does not adequately equip general practitioners and specialists with the necessary skills to adopt palliative car into their routines. As a result, patients and caregivers often find themselves unprepared to navigate this distressing scenario.
In caring for the terminally ill, the objective is not always to cure or to fix, but to comprehend the patients’ needs and ensure they receive true comfort and understanding.
Palliative care principles hold the key to solving this challenging dilemma. However, stigma surrounding palliative care often hinders open discussions about this service between physicians and patients. It is crucial to fully understand the difference between hospice and palliative care. Although palliative care evolved from the hospice movement, they are not synonymous.
At its core, palliative care helps patients and caregivers understand the trajectory of the disease and to be informed about what can be done to alleviate suffering by making value-aligned care decisions through advance care planning. Palliative care accounts for the emotional, physical and spiritual needs of the patients while also offering support to caregivers which will significantly ease their load throughout long-term care.
Ideally, this care should be introduced at the early stages of illness, rather than at advanced stages.
