Midwives of the soul

Josefina Magno, the doctor acknowledged to have paved the way for the wide acceptance of hospice care in the American health care system, will always remember her brother on his death bed. Journalist and businessman Felix Bautista had already suffered much from cancer. In his last few days in a Makati hospital, his internal systems were shutting down one by one, an almost sure sign of impending death.

The US-trained Magno was thus very much aghast to chance upon two doctors still trying to administer dialysis on the patient who was undeniably dying. Not only was the procedure painful, it was also costly to mechanically cleanse his blood from impurities, a task his kidneys could no longer carry out.

"He was moaning and suffering so much when he could have been spending his last moments just being with his loved ones," she said.

Magno ordered the doctors to stop what were puny efforts to coax the patient back to life.

In lieu of the confusion and panic that usually accompanied death, the deeply- religious Bautista basked in the prayers and farewells of his family. He took his last breath in the deep peace of one who had been prepared for it.

Option

To fully live one’s life, in the face of death and to provide a painless, peaceful and dignified death transition are the goals of hospice care. A widely accepted option for the terminally-ill in theUnited States, the service is just being introduced in the Philippines by Hospice of Manila Empowerment, Inc. HOME’s principals are Susan Reyes, Annette Sumulong and Tessie Escaler. Reyes serves as HOME managing director while Magno serves as president.

"We believe that there is that invaluable opportunity that exists at this critical time for foregiveness to be expressed and relationships mended, a time for thanksgiving and appreciation, and a time where love can be expressed while it can still be appreciated by its recipient, and the resolution of significant issues," said Sumulong.

To make the most of these, HOME makes available social, psychological and spiritual support where needed–services that have earned hospice firms the reputation of being "midwives of the soul."

In addition to the qualitative values, the quantitative economics of hospice care likewise strongly supports the viability of finding a market for this service. In a study conducted by Magno in the US for one of the largest health care providers, as much as 50% could be saved in medical expenses for the terminally ill if the patient were to opt for hospice care in the last stages of life rather than the standards curative courses of treatment associated with tests and the intensive care unit.

"Why cure when a cure is no longer possible?", said Magno. Such savings has led to the inclusion and acceptance of hospice services by the US health care system.

Endorsements

As a product, HOME’s brand of hospice care does not lack for endorsements from clients and their clients’ families such as the Coronel clan of the Cinderella group whom the firm assisted when the clan matriarch recently passed away. Reyes and Escaler themselves became convinced of the need to introduce this service in the Philippines when each experienced the peace and serenity of the death of a loved one with the help of hospice workers in the U.S.

Reyes recalled how she was able to savor the final moments with a significant other primarily because counselors as well as caregivers from the hospice coached her through her fears and concerns down to his very last hour. Their coaching included where to source medical supplies, equipment, and 12-hour duty nurses as well as how to set up a system of care. Because of this kind of assistance, she and the rest of his family were able to honor his wish to die at home rather than in a hospital.

The endorsement of hospice care to the terminally ill, nevertheless, largely hinges on their physicians. In the US, hospice workers, including licensed doctors, begin to play a larger role in the life of the patient when the primary physician assesses that full recovery has become highly unlikely. At this point, he begins to shift from a strategy of cure to that of comfort care. As the illness progresses, more and more palliative care for the comfort of the patient is provided for by the physician in tandem with the hospice team.

25 years behind

In the area of hospice care, the Philippines today is where the US was 25 years ago. Then, most American doctors were reluctant to accept — much less endorse–this service. The resistance stems in large part from a physician’s training and orientation to save and prolong a life. "We still have to make doctors in the Philippines realize that endorsing a patient to a hospice does not mean giving up on him. Rather, it is continuing to care for him on another plane," said Magno.

In business for a year, one of HOME’s long-term goals is to campaign among doctors to fully understand and accept their service. In the short-term, HOME has included complementary lines like elderly care and other nursing services on its menu in an effort to build a critical mass of patients.

Consultancy fees range from P5,000 a week for elderly care all the way up to P17,000 a week for serving the needs of the terminally ill in their last stages of life.

"If there is any business being done from the heart, this is it!", said Sumulong.

And there is little reason to doubt her.