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AROKHAYASARN

Khampramong Temple, Pannanikom District, Sakolnakhon Province


Objectives

  • To understand the holistic palliative care of terminal cancer patients and to shed light on actual care involving various methods to treat patients
  • To treat and offer palliative care to increase immunity of cancer patients at different states and to apply teachings in different religions, particularly Buddhist teachings, to care for patients which enables provision of care than can better reach the spiritual being of patients
  • To learn from direct experience and to gain understanding of problems and obstacles as well as suggestions and comments that may benefit provision of palliative care to these patients

Background of Khampramong Temple

Khampramong Temple, or Don Kham in the past, is situated in Pannanikom District in Sakolnakhon Province. It spans over 300 rais, with a 100-rai water pond included on the plot. The pond was graciously donated by His Majesty the King, and it holds one million cubic meters of water. There is a standardized concrete road to provide transportation in and around the temple. The temple was established on April 8, 1986.

Background of Arokhayasarn

Arokhayasarn is a place of care that has continuously offered palliative care to cancer patients since 2005. At one time, so many local people became sick and sought refuge at the temple, so the temple had to use a pavilion originally built for miscellaneous uses as a patients’ ward. Most of the patients who come here to wait for the last day of their lives are terminal cancer patients who have been rejected from the hospital. Initially, the treatment was aimed to treat the patients’ physical, emotional, and spiritual beings. After that, Pra Ajarn Paponpat Jiradhammo, who is fondly and respectfully called ‘Luang Ta’ by the villagers, introduced a traditional herbal therapy which significantly improved the care outcomes.

At present, the care provided by Arokhayasarn combines alternative therapy, Chinese traditional medicine, and modern Western care. The patients who seek care at Arokhayasarn come from all over the country, and the care outcomes have proved satisfactory to both the patients and their family members. A group of physicians and nurses offer physical, emotional, and spiritual treatments to the patients on a voluntary basis, with Pra Ajarn Paponpat Jiradhammo working as the abbot of the temple who manages the total care system to enable patients from all walks of life to receive holistic care to sustain their lives regardless of their races, religions, genders, or ages. It can be said that the palliative care at Arokhayasarn is now considered appropriate and effective. The palliative care system at Arokhayasarn can be described in detail as follows:

Administrative System

  1. The budget used to provide palliative care to patients at Arokhayasarn comes from direct donations at the temple as well as the donations deposited into the temple’s bank accounts.
  2. Healthcare personnel including physicians, nurses, as well as non-medical volunteers are invited to provide care to terminal cancer patients to ensure continuation of care.
  3. Accommodations are arranged to sufficiently serve the needs of patients, their family members, and volunteers.
  4. Medical supplies including medicines and therapeutic diets for patients, clothes, and bedding are provided for the patients.
  5. Herbs library and nursery are set up as a source of learning and a place for experimentation.
  6. Necessary medical equipment including ultrasound machine, darkfield microscope, etc. is made available.
  7. Coordination with other organizations and agencies is established to conduct activities for patients. For example, Blue World Foundation has sung to the patients and their family members.
  8. Family members of the patients also stay at Arokhayasarn to provide close care to the patients.
  9. Patients and family members take part in mutual activities and help take care of one another through the service provision system.

Service Provision System

  1. Offering palliative care to cancer patients and terminal cancer patients who need care regardless of genders, races, ages, and religions without using force or propaganda and without asking for benefits or profits in return
  2. Using alternative medicines to provide holistic care to patients such as meditation therapy, natural herbal therapy, herbal sauna at the temperature 40-42C, acupuncture, breathing therapy, diet therapy, music therapy, and prayer therapy
  3. Offering daily treatment to cancer patients by a team of modern medical team consisting of physicians, nurses, pharmacists, as well as traditional healers who work on a voluntary basis
  4. Accepting patients at different stages of the disease referred by government and private hospitals with referral letters and medical evidence including x-ray film, results of a computer scan, lab results, surgical records, or results of chemotherapy or radiation treatment to ensure continuation of care

Academic Services

Arokhayasarn is a resource of medical, nursing, and public health research and development for those who are interested. It is also a learning resource to generate a new body of knowledge or expand an existing body of knowledge for students and those interested. In addition, Arokhayasarn is considered a place where organizations, agencies, and individuals interested in terminal care can carry out studies and training. Arokhayasarn has also participated in academic conferences and seminars with the Faculty of Medicine, Chulalongkorn University, Faculty of Nursing, Khon Kaen University, and many other leading educational institutions in Thailand and abroad.

Preparation for Palliative Care at Arokhayasarn

What patients need to bring along

  1. Medical records from the hospital including lab results of blood tests, x-ray films, results of ultrasound tests, results of computer scans (if any)
  2. A pot size 32 for boiled medicines
  3. A can of powdered Isocal supplementary diet
  4. Mouthwash and toothpaste for patients
  5. Food for patients such as brown rice, fresh vegetables, fresh fruits, an electric hot water thermos, an electric rice cooker, and other personal belongings
  6. One to two family caregivers

Remarks: The foods that patients are not allowed to eat include frogs, turtles, eels, soft-shelled turtles, rays, geese, quail’s eggs, uncooked fermented fish, fermented food, seafood, jackfruit, banana, durian, longan, sapodilla, guava, young coconut, coconut milk, and sticky rice.

Care activities

07:00 - 08:00 a.m. Making merits: Patients making merits by offering food to the monks, practicing meditation, doing physical exercise or breathing exercise, and singing songs or using humor therapy
0:800 a.m. Herbal detoxification: Patients boiling herbal medicines as appointed by Luang Ta
09:00 a.m. Patients receiving examinations and prescriptions from doctors or Laung Ta as appointed
Daytime: Personal time for patients and family caregivers
Nighttime: Patients who are strong enough pray together at Arokhayasarn

Problems and Obstacles

  1. The temple still lacks budgets to carry out its provision of palliative care such as budgets for utilities, medical supplies, etc.
  2. The temple is in need of volunteers who can provide continuous care to patients such as physicians, nurses, and psychologists. At present, the patients who receive terminal care at Arokhayasarn are adults or the elderly. Arokhayasarn is currently unable to offer care to children patients as these patients need more specific care due to their own limitations in development or learning which prevent them from receiving comprehensive care at Arokhayasarn, especially when it comes to child psychology.
  3. The referral systems from hospitals are not effective enough to ensure continuation of care.
  4. Arokhayasarn needs a more systematic connection with other palliative care establishments both in and outside the country.
  5. There is a limitation in accommodation, so the patients have to share rooms, which may affect their rest and relaxation.
  6. Some patients do not receive herbal medicines on some days as it is not convenient for them to travel to the temple due to such reasons as distance, darkness, and health problems. Family caregivers should set up a team to take turn going to receive the medicines from Arokhayasarn.
  7. Further research to support use of herbal medicines to treat terminal cancer patients according to accepted standards is still needed.
  8. Different therapeutic techniques including music therapy, meditation therapy, imagination therapy should be researched and implemented to generate acceptance and to establish standard of care.
  9. The palliative care offered at Arokhayasarn, Khampramong Temple, should be more widely publicized to create understanding of natural herbal treatment and to gain more support.

Future Operational Plan

Arokhayasarn aims at becoming a research resource for further development of Thai traditional medicines and alternative therapy. Yannasithidhammaosotbumbud Institute is going to be established for future research.

Benefits and Recommendations

  1. At Arokhayasarn, Khampramong Temple, terminal cancer patients receive holistic palliative care with the use of alternative medicine based on religious principles that emphasize psychosocial and spiritual care. It is not necessary for patients to stay at the temple because religion can be practiced anywhere including the hospital. At present, provision of palliative care has become more concrete. For example, Pediatrics Wards 2D and 3D at Srinakarin Hospital in Khon Kaen Province encourage patients and family caregivers to make merits by offering food to the monks, especially terminal patients. This helps give patients and their family caregivers peace of mind. However, due to overwhelming workload of staff, this aspect of care is not comprehensively offered to all patients. An observation conducted at Arokhayasarn has led to a conclusion that psychosocial and spiritual care is of great significance as good mental health leads to good physical health and satisfaction of patients and family caregivers.
  2. A study of lives, symptoms, and symptom managements of terminal cancer patients in an actual setting in addition to textbooks, documents, or words of mouth regarding terminal care helps shed light on holistic palliative care which can extend lives of the patients, ensure their quality of life, and enable patients to die with dignity and peace of mind.
  3. A study of spiritual well-being is an important type of care. Thus, it should be included in the undergraduate nursing curriculum instead of the graduate nursing curriculum. This is because the number of graduate nursing students is generally small and insufficient to provide palliative care to tend to patients’ spiritual well-being, thus depriving patients of appropriate spiritual care. Nursing students may undergo training at Arokhayasarn to gain clearer insights into palliative care in addition to studying from textbooks in class.
  4. The palliative care which involves patients of all religions and cultures developed by Arokhayasarn should be implemented to offer appropriate care to terminal patients.
  5. If the hospital is not ready for palliative care, data regarding palliative care currently offered by Arokhayasarn should be publicized to enable healthcare staff of the hospital to provide assistance and guidance to terminal patients who may find palliative care a more appropriate alternative for their situation.
  6. At Arokhayasarn, the environment is arranged so as to make patients and family members live in a familiar surrounding. Such care that takes cultural values into consideration can very well respond to the needs of the patients and their family caregivers. This helps put the patients and family caregivers into a better mood, and they become less gloomy or depressed. Furthermore, the patients do not feel that they have to stay away from their own community or society, which increases the effectiveness of care and which should be adopted in hospitals.
  7. Arokhayasarn is suitable as a training place for undergraduate and graduate students to gain more insights into palliative care for terminal patients.
  8. If patients suffer from considerable pain, PCA painkillers may be prescribed together with other forms of alternative therapy to increase the patients’ comfort.
 

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