Late in 1994, I went to my home country, the Philippines, to see for myself how hospice/palliative care can be introduced into a developing country where the majority of the people are poor. There is hardly any health insurance, and there s no financial assistance from the national government for the care of the terminally ill.

Working with the Philippine Cancer Society and the Philippine Department of Health, I was able to give talks on hospice/palliative care to many groups, both government and private, hospitals, medical and nursing schools, church gatherings,

 Rotary clubs and other civic organizations. The Secretary of Health authorized a 3-day Conference on Hospice/Palliative Care where rural and provincial health officers and nurses from all over the country participated. The conference was funded in part by several pharmaceutical companies.

Based on the principle enunciated by the International Hospice Institute College (IHIC), that  hospice/palliative care in developing countries cannot be patterned after the models in more affluent countries, various groups developed hospice/palliative care programs in their communities responding to their  unique needs  and their financial capabilities.

Today, there are several such models in operation in Metro Manila and two adjacent provinces, all of which are replicable in communities with several needs and economic resources. Among these are :

The Philippine Cancer Society Hospice Home Care Program. This is funded by the Philippine Charity Sweepstakes Office (PCSO) which is a quasi government agency. It has a small team of nurses and a part-time Medical Director (Dr. Katherine Krings). House calls are made to patients using motor vehicles provided by the PCSO.

The University of the Philippines/Los Baños Hospice Home Care Program. This is a community-based hospice home care program which provides free services to terminally ill patients. Its success has depended on a dedicated group of volunteers, most of whom highly educated retired faculty members of the University of the Philippines/Los Baños. It has a paid Medical Director and a Clinical Nurse Coordinator. Funds are provided by gifts from its Board of Directors and the Madre de Amor Foundation which undertakes fundraising activities. Los Baños is a province adjacent to Metro Manila.

The Makati Medical Center Hospice Home Care Program. This is a hospital-based Hospice Home Care Program which has a paid staff composed of a part-time medical director, nurse, social worker, chaplain and a large group of trained volunteers. It is strictly for the indigent patients of the hospital.

The Saint Joseph Family Hospice. This is a Parish-based Hospice Home Care program which is a private non-profit organization established in a community composed of people coming from various socio-economic backgrounds. The Parish (Catholic) will provide the volunteers the referrals of terminally ill patients from the parish community. Saint Joseph Family Hospice will provide the training of volunteers as well as the organizational and administrative aspects (including paid staff) of the program. Funds will be raised from private donations. Those who cannot afford to pay will be provided with services.

The ASIAN Institute of Health Care. This is an In-patient Hospice and Nursing Home facility of twenty beds. It is also a Center for Training for Nurses and other health care providers. St. Joseph Family Hospice will use this as an In-patient facility for those patients who need In-patient care.

The Guagua National College Hospice Foundation. This is a Community College-based Hospice Home Care Program in a province adjacent to Manila. It is unique in the sense that it utilizes all the resources that are available in the municipality, both government and private; recruits personnel from the various agencies; and provides them with training in hospice/palliative care so they can serve as volunteers.

A province-wide Convention on Hospice/Palliative Care was held recently with the Vice President of the Philippines as guest of honour. The governor and vice governor of the province as well as the congressmen, mayors, municipal health officers and nurses were present. A half day course on hospice/palliative care was given after lunch. The goal is to have hospice care provided in all municipalities of the province so that eventually, the province itself can serve as a model for all the 78 provinces of the Philippines.

The Philippines is today where the United States was in terms of hospice care in 1978. Filipinos are natural health care givers and the extended Philippine families provide many caregivers who just need training in hospice/palliative care.