Currently, at least 13 organisations provide 40 hospice-palliative care services, mostly to inpatients. Eight of these organisations are government facilities (tertiary hospitals and cancer centres), one is a private hospital and two are faith-based institutions (Table 1). Alongside these providers a wide range of groups give compassionate care to the dying in Thailand.

Table 1 Palliative care provision in Thailand

Faith-based community facilities

The Camillian Social Centre⁵ in Huay Pong is a charitable institution led by the Catholic priest Giovanni Contarin. Opened in 1996, it was designed as a response to the growing number of people living with HIV/AIDS, particularly in the Rayong province. Referrals are taken from local hospitals. Antiretroviral drugs are available and palliative care is provided to those who need it.

St Clare’s Hospice⁶ was opened by the Christian Franciscan Friars in the grounds of their retreat centre in Lamsai (Phatum Thani province) in 1993. Criteria for admission to the 16-bedded unit are that patients must be poor, homeless and diagnosed with final stage AIDS. Referrals are made by physicians belonging to Medicins sans Frontiere, who also provide medical support.

The Mercy Centre, Bangkok⁷ is a Christian charity run by the Human Development Foundation, a non governmental organisation aimed at providing education, improving family health and welfare, and supporting children and adults living with HIV and AIDS. The hospice opened in 1993 as a final shelter for patients with late-stage AIDS and during the 1990s cared for over 250 patients per year. With the increasing availability of antiretroviral drugs, the hospice has also become a place of respite as patients return to their homes and family.

The Temple of Wat Phrabat Nampu⁸ in the central province of Lob Puri has provided hospice care for people living with HIV and AIDS under the leadership of Chao Khun Phra Udom Prachatorn since 1992. The facility includes living accommodation for families with HIV positive members as well as inpatient facilities for those coming to the end of their life.

Tertiary providers

King Chulalongkorn Memorial Hospital (Bangkok) was built on land owned by the King and named after the then King’s father. Opened in 1914, it is administered jointly by the Thai Red Cross Society. Interest in end of life care gathered momentum in 2003, leading to the establishment of a multidisciplinary committee which was recognised by the hospital administrator in 2005.

Maharaj Nakhon Hospital, Chiang Mai was built in 1939 and designed to expand the services of Chiang Mai Municipal Hospital. Known locally as Suan Dok Hospital, it became known as the Maharaj Nakorn Chiang Mai Hospital in 1983. The hospital consists of several buildings which incorporate 1,800 beds; around 414,000 outpatients and 49,000 inpatients are seen each year.

Ramathibodi School of Nursing was established in 1969 as part of the Faculty of Medicine at Mahidol University, Bangkok. Opened in 1943 under its original name of the University of Medical Sciences, Mahidol University has its origins in Thailand’s first medical school which was founded at the near-by Siriraj Hospital. Siriraj dates back to the late 1880s when the then King Chulalongkorn’s son died of cholera and his father sponsored a hospital which he named ‘Siriraj’.

Srinagarind Hospital, Khon Kaen opened in 1976 as a special project between the governments of Thailand and New Zealand. The Faculty of Medicine is the only medical school in north east Thailand and was established to address the lack of medical personnel throughout the region. Members of the paediatric department have taken a special interest in palliative care and opened a service in 2005.

Songklanagarind Hospital, Hat Yai, was developed under the Third National Economic and Social Development Plan 1972-1976 and aimed to extend provision for medical education in the south. The partially constructed hospital opened with 100 beds in 1982. Importantly, when the Palliative Care Development Committee was formed in 1999, the decision was taken to provide a hospital-wide palliative care service rather than develop a separate ward or unit.

This vision of palliative care as an integrated feature of the hospital’s provision has resonated with those seeking to develop end of life care at Chulalongkorn and Siriraj hospitals - hence the establishment of multidisciplinary committees. Figure 1 shows a draft model of how this concept might be incorporated into the structures and practices of Siriraj Hospital and was used during the formative stage of the group’s deliberations.

Figure 1 Draft palliative care integrated model: Siriraj Hospital, early 2007

A further model (Figure 2), developed by Kittikorn Nilmanat at the faculty of nursing, Prince of Songkla University, served to highlight issues concerning the dying process and those involved with it.

Figure 2 Network of interconnecting experiences and issues surrounding dying (Faculty of Nursing, Prince of Songkla University

Cancer centres

The National Cancer Institute, along with the regional cancer centres, is a government facility that falls under the Ministry of Public Health. A home care programme became established there as a demonstration model in 1998.⁹

The Mahavajiralongkorn Cancer Centre in Phatum Thani province is one of seven regional cancer centres located throughout Thailand. The others include: Chonburi, Lampang, Lop Buri, Surat Thani, Ubon Ratchathani, and Udornthani. The director of Mahavajiralongkorn Cancer Centre, Tanadej Sinthusake, opened a hospice facility there in 1998, initially with 16 beds and a home care service.

Private hospital

Wattanosoth Cancer Hospital is one of four hospitals on the campus of the privately-run Bangkok Hospital Medical Centre.¹⁰ The palliative care unit opened in summer 2007 and extends the work of the former pain unit. The director, anaesthesiologist Laksamee Chanvej, recorded 10 to 15 new patients each month during the four months that the unit was operational. Palliative care is provided for between ten and twenty per cent of patients in two special oncology wards.