According to the Malaysian Hospice Council, the palliative care workforce capacity in 2005 amounted to 403 personnel. Most of these (351, 87%) are volunteers. Among the total of 71 doctors, 65 (92%) are volunteers; among nurses, 70 (72%) of the 97 are volunteers (Table 14). In this scenario, the recruitment and retention of staff pose special problems – illustrated by the fact that the six palliative care doctors are found in just two locations: Drs Devaraj and Lim in Penang; the other four in Kuala Lumpur’s Hospis Malaysia. Finding nurses is often a challenge too. Lyan Shih (Pure Lotus Hospice of Compassion) comments:

Table 14 Malaysia: palliative care workforce capacity, 2003-05

Source: Malaysian Hospice Council

‘In palliative care youngsters do not want to get involved. They cannot see their careers going anywhere; they see it as the end thing. So I contacted all my ex-friends and ex-colleagues who I had worked with as a nurse – the older
ones – and asked them to come and help. They were all very good and came and gave their time and skills. It was very good. They were retired, but could still do what nurses are trained for, and I also had the nurse aides. They were the younger ones and were doing the fetching and carrying and all the heavy manual work, cleaning. The old colleagues, the nurses, came to know the patients, were able to administer the drugs, and I was very, very fortunate like that. But the problem is still there. I find we still have trouble getting really good younger staff.’ ⁹¹

Similar difficulties are to be found at Hospis Malaysia, the country’s largest palliative care provider. Deputy medical director Sylvia McCarthy explains:

‘One of our main challenges is staff – finding people who want to do the work. We are limited by that. Our patient load has increased 20 per cent this year but our nursing staff hasn’t increased. It’s shrunk. It fluctuates so they’re stressed. It’s a very challenging job for nurses here. The nursing profession hasn’t got the status that it maybe has in the UK and nurses are not used to being independent practitioners; but we’re asking them to do that. We’re asking them to go out and see patients, assess patients, communicate with us about what they think the problems are and discuss management with us. Some think it’s wonderful to have that responsibility but I think for others, that’s not what they want to do. And plus, it’s driving around in the community from house to house; it’s being on call and it’s a hard job’ ⁹²

Nurse manager Sharon Dabi tells how the role of the hospice nurse contrasts sharply with that of a hospital nurse:

‘I think it is more than the nurses have experienced in any hospital, because a lot of knowledge is expected by Dr Ednin from us. So it means we should know about the whole physical person: the anatomy and physiology – we should at least know a lot about that; the medication – why you’re starting it and the reason behind it. We are expected to diagnose the patient as well. When we see a patient we are expected to assess a patient from head to toe, and I think nurses in the hospital don’t do that because there are a lot of doctors there. I understand why Dr Ednin wants us to be equipped to go through these questions and to be able to say to the family why things are happening, but it’s a high expectation and it’s stressful. The sight of Dr Ednin puts us under pressure [laughter]. He says he doesn’t believe that, but I think it’s good for us.’⁹³

Ednin Hamzah is aware of the pressures that palliative care delivery places on the staff of Hospis Malaysia and puts these in the context of personal development:

‘I guess I feel that the only limitation to any individual’s progress is mental, it’s how much you want something. I don’t think it’s a case of materialism or how much someone gets paid, it’s really how much you want something: the will to gain knowledge, to be able to develop: self development. And I think I’ve tried to select the kind of people in Hospis Malaysia that have this sort of attitude; they want to do the best for the patient, but within a balance of their own personal as well as professional development. I think they go hand in hand.

‘How I approach this is to look at each individual and plan a structure of where I want them to be in a year’s time, in five year’s time. We talk about this and it’s something that we do together, but I tend to do the pushing. I think that if you talk to each of them, they will probably, hopefully, feel that the way they have been guided has been good for each of them; and I hope they think that this translates into better care for patients and gives palliative care a wonderful name in the community.⁹⁴

Nurse Loi Fui Fen worked at a geriatric centre before joining Hospis Malaysia, with some apprehension, in 2004. She tells how her professional development as a palliative care nurse has raised her self-esteem and the expectations she has of herself:

‘Before I came to Hospis Malaysia, Sharon [Dabi] was already here so I had the chance to come and have a chat. Then, slowly, I feel that this job is very special. I never knew this job is so wonderful. But I didn’t know if I could handle it because Dr Ednin has high expectations. So it was quite stressful at the beginning. But when I saw patients suffering and I could do something to help them, comfort them, I felt all this is very wonderful. I never thought I could do this sort of thing before.

When I came here I was so frightened because my English is not so fluent, and some of the patients spoke very nice English. The stress was there. But slowly, it all came together and my confidence grew. I love this job. I hope one day to go back home and set up palliative care in my home town. I come from a small village and I know in most of our villages there are sufferers, but no-one has heard of palliative care. So if one day I can make it, I think my life will be very good. All these things I never thought of before.⁹⁵