Shanghai's hospice wards offer terminal patients a better last stop
Shanghai aims to stop terminally ill patients being shunted from one hospital to the next
Ten bedridden terminal cancer patients lie in the dimly lit, quiet hospice ward at the Jingan Temple Community Hospital in Shanghai. Most are cared for by auxiliary workers, who look after a few at a time.
Dong Wenying, 54, usually spends around an hour a day visiting her 81-year-old father-in-law, Gu Zhenping, a lung cancer patient who has been in the ward for three months.
"Our house is small and we don't have enough hands to care for my father-in-law," she said. "This hospice ward helps us a lot and relieves a lot of the burden on my family. Otherwise, we would have to send the old man to a hospital and then be forced to take him out of the hospital every two weeks, like we had to for the past four years.
"My father-in-law was rotated among four hospitals, which agreed to admit him after we begged. The fact is, no hospital in Shanghai is willing to accept terminal cancer patients."
Dong's family is among the few to have benefited from a municipal government project in which 18 community health centres were ordered to open hospice wards last year. Each centre has 10 beds, but that supply falls far short of demand.
Around 36,000 people die of cancer every year in Shanghai, but the city previously had almost no hospice beds. Public hospitals take no interest in those about to die, as there is no money to be made by treating them. So the last stop in most patients' lives is either an intensive care unit or an emergency ward.
Li Shuijing, an official from the Shanghai Health and Family Planning Commission's grass-roots health department, said the hospice ward project was a humanitarian initiative by the municipal government and one that demonstrated that Shanghai was more civilised than other mainland cities. She said the project had arisen in response to enormous public demand.
In March last year, then-Shanghai party secretary Yu Zhengsheng wrote back to secondary school teacher Qin Ling to show his concern for Qin's struggle to seek medical treatment for his father, who had terminal cancer. Qin had written an open letter to Yu, saying that hospitals either "forcibly" discharged his father or did not want to admit him because of his terminal status or because they were full. Yu said the government would try to change the system.
Li said turning existing wards into hospice wards had cost the authorities 27 million yuan (HK$34 million), with most of the funding coming from district governments across Shanghai. Each of the advanced beds in a hospice ward cost 12,000 yuan because they were designed to let patients lie in comfort.
"The ward needs to be decorated in warm colours to create a cheerful environment," she said. "Some community health centres also hang images of God or Buddha near the beds, according to the patients' religion."
Following intensive training, 120 medical staff have been licensed to work in the hospice wards. Some visited hospices in Hong Kong last year on a trip organised by Shanghai's health authorities.
Li said demand was high for Shanghai's current hospice wards, which only admit people whose hukou (residential registration) is in the same district as the ward, and that people had to wait an average of about three weeks before being admitted.
Xu Huiming, director of the Jingan Temple Community Hospital, said that a day in its hospice ward cost a patient 218 yuan, much less than average inpatient costs at a Shanghai hospital. Terminal cancer patients stayed there for an average of 29 days before dying.
He said the health of each applicant was assessed and only those likely to survive for less than two months could be admitted.
Dr Miu Jun, the only doctor on the ward, said that persuading people to give up hope of rescuing their beloved relatives occupied a lot of his time at work.
"Most of my patients' relatives still ask us to try what we can to extend the patients' lives," he said. "But I tell them this will add more pain to the patients. I ask them 'What's your goal? Don't you want your relative to pass away in peace and without so much pain?'"
He said some of his colleagues at the hospital did not understand the concept of hospices because they had been taught in medical colleges that medical personnel should cure illnesses and save people's lives.
Miu said nurses in his ward could become depressed and were under a great deal of pressure when they saw as many as four patients die in a single night.
The municipal government said the next step for Shanghai was to open hospice wards in major hospitals in the next three years. But Li said this would be difficult because the big hospitals were generally reluctant to open hospice wards due to financial concerns and the fact that government funding to support the project was meagre.
Dr Huang Cheng , from the oncology department of a big Jingan district public hospital, said the hospital turned away all terminal cancer patients and he knew that smaller hospitals in Shanghai were also reluctant to take them in.
"The medical insurance authority requires that each bed in public hospitals can't be used by a patient for too long so that medical resources can serve more people," he said. "But terminal cancer patients can stay for weeks or even months."
Huang said doctors could only prescribe drugs for such patients, instead of offering check-ups or chemotherapy, and it was not profitable for his department.
The authorities also plan to develop more palliative care services for terminally ill patients who stay at home rather than in institutions.
Professor Shi Yongxing , a Shanghai-based hospice expert who has researched the subject for more than 10 years, said stay-at-home palliative care would be the best option for most terminal cancer patients in the future, and that it was a good fit with China's traditional "family-centred" culture.
"Many people prefer to die at home, with their family members around them," Shi said.
Miu said the hospice service was not popular at the moment, with only 26 patients in the community having registered for the it, even though there were more than 2,000 residents suffering from cancer.
"I think people will continue with treatment for cancer for as long as they can afford," he said. "People shun talking about death and death education is non-existent in our society."
But Dong said her father-in-law's children had come to accept that the old man would die quite soon.
"My father-in-law should be thankful to spend the last stage of his life staying in this hospice ward, where the doctor and nurses are kind to him and he doesn't need to be shuffled between hospitals," she said.