Devi B C R, Tang T S, Corbex M
Department of Radiotherapy and Oncology, Sarawak General Hospital, Sarawak, Malaysia.
Ann Oncol. 2008 Dec;19(12):2061-6. doi: 10.1093/annonc/mdn422. Epub 2008 Jul 17.
The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access.
The establishment of this program, initiated in 1994 by the Department of Radiotherapy of Sarawak General Hospital, consisted of training, empowering nurses, simplifying referral, facilitating access to medication, and increasing awareness among public and health professionals about PC.
The program has been sustainable and cost efficient, serving 936 patients in 2006. The total morphine usage in the program increased from <200 g in 1993 to >1400 g in 2006. The results show that pain medication can be provided even in remote areas with effective organization and empowerment of nurses, who were the most important determinants for the set up of this program. Education of family was also a key aspect.
The authors believe that the experience gained in Sarawak may help other regions with low or middle resources in the set up of their PC program especially for their remote rural population.
在低收入和中等收入国家的偏远地区，很难确保提供姑息治疗（PC）和阿片类药物。我们在此描述砂拉越（婆罗洲岛的马来西亚部分）一个居家护理项目的设立情况，该地区一半人口生活在难以到达的村庄。
这个项目由砂拉越总医院放疗科于1994年发起，其设立包括培训、赋予护士权力、简化转诊流程、便利获取药物，以及提高公众和卫生专业人员对姑息治疗的认识。
该项目具有可持续性且成本效益高，2006年服务了936名患者。该项目中吗啡的总用量从1993年的不足200克增加到2006年的超过1400克。结果表明，通过有效组织和赋予护士权力，即使在偏远地区也能提供止痛药物，护士是该项目设立的最重要决定因素。对家属的教育也是一个关键方面。
作者认为，在砂拉越获得的经验可能有助于其他资源有限的地区建立其姑息治疗项目，特别是为其偏远农村人口建立项目。
