Interest in palliative care in Jordan was initiated by Crown Prince Hassan in 1985. In 1986, through his office, two nurses from the UK charity the Macmillan Cancer Relief (then known as Cancer Relief Macmillan Fund) were commissioned to conduct an assessment of palliative care need in cancer patients in Jordan. Their study highlighted the need, particularly for pain relief and trained professionals. By 1992 a group of concerned health professionals was discussing how to actively set up palliative care services. Rana Hammad, director of Al Malath Foundation describes how, with the continuing support of Prince Hassan – who gave Al Malath an award for starting the first service – the hospice was set up in 1993:

‘ So we started, there was choices for us to make, tough decisions to start in-patient or to start home care. I wanted to start an in-patient because I’m more in control, and because there was no home care, community home care program whatsoever, no community outreach in Jordan, full stop. Nothing, not even paid. Nobody goes to homes, all the patients have to go to hospital whatever are their conditions. So I thought like we will be talking about pain control, we started talking about morphine, and people are about to shoot us because of this. We are talking about empowering patients, quality of life - so we are pioneers in everything. I didn’t want to add another burden of being pioneers also in home care. So I wanted to be in the hospital - the majority wanted home care - and then we had this first phone call from Ann David, who was a lovely British lady, who was our first patient - her husband used to work in the United Nations - and when she became terminal, she decided to die here, at her home here. So should she give us a call, and she said, “Why don’t you start and come and visit me.” So she dragged us, and we started home care. So there has been a sequence of coincidences, of beautiful people who just put us on the right track. It was destined to become, to be.

A second decision that we had to make: should it be a program under the umbrella of Ministry of Health, or a private sector hospice, or a charity hospice. The toughest way was to be a charity organization, because in Jordan, the charity sector is hard to live in. We don’t have resources or income, so it was hard, but for me it was the most suitable thing because it was the only guarantee to eliminate the human bias when it comes to money. So if I want to deal with people, I’ll deal with them regardless of their ability to pay, regardless of, you know, the income they have or the donations they might give or money they might give. Those terminal people - I’ve always had this fear in my heart, my worst nightmare was that I was their last chance and the only choice; there was no other program. From 1993 till 2004, there was no other program in Jordan.

It started with primitive resources, but with huge will we’ve got professionals to help us; volunteers. It started from my home, with the space and one huge table as the office for one year; with wheelchairs, my kids playing on both wheelchairs; meetings of the part-time secretary, “Come and help me while I cook and do some meeting”. So I started home care using a taxi from my home. And the first year, we only took one patient, stayed with that patient, helped, tested the needs; saw what the Jordanian people wanted. And modifying, re-modifying again and again, coming back and forth to the basics again; till that patient dies then we take another patient - we haven’t duplicated two patients at the same time. In 1993-1994, we rented this office, got a car, and added more equipment.’⁴⁷

By 1995 Al Malath had sufficient resources to care for 40 patients – adults and children, over the year. The hospice continues to care for, annually, around this same number of patients.

From the late 1990s the WHO began actively to support the development of further palliative care services, encouraged by the establishment of KHCC as a dedicated oncology hospital and the willingness of oncology unit staff to train at Al Basheer Hospital. Director of nurse training at KHCC, Ahmad Al Khateib describes the development of the first hospital based palliative care service at KHCC:

‘August 2003 we started, there was a one day workshop, sponsored by the WHO and the Ministry of Health, and KHCC participated in that workshop. One of the outcomes was a recommendation to have a National Palliative Care and Pain Relief Initiative Committee in Jordan, with his Excellency the Minister of Health as chairperson and Dr Samir Khlief, director of KHCC, and people who cover all health sectors in Jordan to sit in that committee.

Here at King Hussein Cancer Center, two years ago we started the program of palliative care and pain management at home care. I have to say proudly that the only hospital setting palliative care program in Jordan is King Hussein Cancer Center. Now we’re going to have this hospice unit and we are going to extend it for more. And we have the home care programme; we have trained nurses and trained physicians to run this service.’⁴⁸

The KHCC team was established in September 2004. Team director Dr Amal Bandak, with the nurse manager and the team (including 2 nurses who trained in palliative care with Al-Malath), wrote the guidelines for the in-patient and home care services. The team started with 4 nurses, but has now expanded to a total of 21 nurses in order to develop small teams able to work within the hospital –in the out patient department and the proposed in patient unit - and in the home care service. The team has a part time psychologist and is recruiting more psychologists and social workers. Amal Bandak is keen to develop more educational opportunities for the team professionals; in particular she is setting up links with centres in the USA.

At the Faculty of Nursing at Jordan University of Science and Technology (JUST) in Irbid, the largest city in the north of Jordan, Assistant Professor of Nursing, Dr Suha Omran and her colleagues, are developing palliative care training workshop based at the medical and nursing schools. Currently, the Faculty is offering a unit in oncology nursing for undergraduate nurses included in the medical surgical course. There is also a Master’s program offering a clinical nurse specialist in oncology nursing. The palliative care element is supported by opportunities for student placements at KHCC and Al Malath.⁴⁹