dying from cancer at home in Thailand

[Lorry]

My experience how ordinary Thais die is pretty similar to what @connda wrote.

They die in agony. All they get is paracetamol tablets.

There has been some improvement recently,  as @Sheryl notes. 

But pain management - even if it is not end-of-life - is a very weak point in Thai healthcare.

[Celsius]

1 hour ago, Lorry said:

My experience how ordinary Thais die is pretty similar to what @connda wrote.

They die in agony. All they get is paracetamol tablets.

There has been some improvement recently,  as @Sheryl notes. 

But pain management - even if it is not end-of-life - is a very weak point in Thai healthcare.

 

I don't understand.  I was in agonizing pain and I really thought I had cancer. I went to the hospital twice and both times almost immediately I was injected with a strong painkiller. I am guessing if you have money they will give you injections. It's not that complicated 

 

 

[Rumpelstilskin]

JK nurse in Pattaya has caring nurses 24x7, wonderful people. 1500 the per diem. The funeral also important and Buddhism has a wonderful and caring tradition. I just went through this process with my mom at home, peaceful and no pain.

 

PEACE will come, in Thailand or UK.

[newbee2022]

15 hours ago, fvw53 said:

I am 82 years old and I live in Thailand since 1987.

Last year during holidays in my home country (EU) a bladder cancer was detected. Since then I have undergone TURBT, cistectomy, radiotherapy but the cancer always came back and now as a last option immunotherapy will be tried.

If this does not work I would prefer to be no longer a burden for the friends where I am now staying and return to Thailand to dy in my own house.

However I do not know if in Thailand there is palliative care at home 

What do Forum members recommend?

 

There are a lot of homes. But also you can hire a nurse 24/7. That is what I intend to do in case (and my wife can't do it anymore)

[Drumbuie]

A friend with cancer was admitted to hospital for " End of Life Care" . That was last year.

 

After some stem cell immunotherapy treatments, there was so much improvement they were able to have a meal in a restaurant just a week or two ago. It's not a cure, but it's definitely improved their quality of life at a very late stage . 

 

 

[Drumbuie]

14 hours ago, connda said:

Nope.  Nor are there any hospices. They don't exist here. And palliative care in hospitals is in the stone-ages, or non-existent. They'll hand you a bottle of Tylenol and wish you good luck. And the palliative care you can obtain will probably be inadequate if you can get it as Thai doctors have two problems.  1) They feel that the pain you experience is your karma and your own fault, and 2) they feel that if they give you adequate amounts of painkillers you'll become an "addict" (heaven forbid).  And they aren't going to give you morphine to take home. It's extremely difficult to obtain except in hospitals and then only under certain conditions. And don't plan to be put on a machine to self-administer morphine based on your pain levels.  They'll ration morphine and they won't care how much pain you are experiencing.   They use to have fentanyl patches, but I'm pretty sure those were discontinued.  See reasons 1 and 2 above.

You're better off staying in your home country.  This is no place to die if you're in pain.  Where do you think wealthy Thais go to die if they have cancer?  They don't stay here.  Check Soapy Massage tycoon and politician Chuwit Kamolvisit.  He left to go die in the UK.  You can't get adequate palliative care here, and you won't get it at all for home use. 

Wishing you the best.  🙏

 

No hospices? Not true. Here's one :-  https://qscbc.org/en/qscbc-foundation/

[The Fugitive]

Several Thai friends and relatives have died of cancer. All were taken care of in their home by relatives. Same as UK, they received 3 daily visits by district nurses. Unlike the UK they also received one daily visit by a doctor in their end of life stage. We have a family friend who is a nurse at our local community Government Hospital who provides end of life care. He tips us off immediately someone we know has died and we go to their house to pay our respects. There are always pain pumps around, electric pressure relieving mattresses and masses of medication and other medical supplies. Never any suggestion that anyone was left to die alone in pain and of suffocation whilst conscious.

[renaissanc]

14 hours ago, connda said:

Go to Switzerland and check out.

 

14 hours ago, connda said:

Go to Switzerland and check out.

In Thailand, if you ask a hospital doctor to do it discreetly, he will (may) help you to die. 

[Lacessit]

6 hours ago, Lorry said:

My experience how ordinary Thais die is pretty similar to what @connda wrote.

They die in agony. All they get is paracetamol tablets.

There has been some improvement recently,  as @Sheryl notes. 

But pain management - even if it is not end-of-life - is a very weak point in Thai healthcare.

I can get unlimited 50 mg Tramadol tablets over the counter at a local pharmacy. Don't even need a prescription.

 

While it is not as powerful as oxycontin, it is a moderately potent opioid analgesic.

 

IMO poor Thais get fobbed off with paracetamol because it's cheaper.

 

 

[Grumpy one]

14 hours ago, steven100 said:

what if you have no family or they don't want you hanging around as they have their own life to run ... ? 

 

14 hours ago, steven100 said:

what if you have no family or they don't want you hanging around as they have their own life to run ... ? 

Quickly spend their inheritance

[Thingamabob]

Palliative care readily available in most parts of Thailand. ,but not for free.

[faraday]

29 minutes ago, Lacessit said:

I can get unlimited 50 mg Tramadol tablets over the counter at a local pharmacy. Don't even need a prescription.

 

While it is not as powerful as oxycontin, it is a moderately potent opioid analgesic.

 

IMO poor Thais get fobbed off with paracetamol because it's cheaper.

 

 

 

Tramadol for injection is also available.

 

I was prescribed this twice by my Orthopaedic doctor.

 

I havr have had a medical career & self-administered it.

 

It was very effective.

 

Doing a muscle injection (IM) is not difficult, at all, but training is needed.

 

Perhaps @Sheryl might give her opinion, please. 

[jayboy]

46 minutes ago, The Fugitive said:

Several Thai friends and relatives have died of cancer. All were taken care of in their home by relatives. Same as UK, they received 3 daily visits by district nurses. Unlike the UK they also received one daily visit by a doctor in their end of life stage. We have a family friend who is a nurse at our local community Government Hospital who provides end of life care. He tips us off immediately someone we know has died and we go to their house to pay our respects. There are always pain pumps around, electric pressure relieving mattresses and masses of medication and other medical supplies. Never any suggestion that anyone was left to die alone in pain and of suffocation whilst conscious.

 

This is also my experience, at least for ordinary Thais at village level.I have personally seen this system in action with my own eyes with the end of life period of my stepmother.

[Jerzy Swirski]

46 minutes ago, Lacessit said:

I can get unlimited 50 mg Tramadol tablets over the counter at a local pharmacy. Don't even need a prescription.

 

 

 

 

 

I concur with this.

Fortunately I don't need it yet, but my doctor has a cabinet full of Tramadol.

It is good to know that it is there if I need it one day

[Moonlover]

46 minutes ago, The Fugitive said:

Several Thai friends and relatives have died of cancer. All were taken care of in their home by relatives. Same as UK, they received 3 daily visits by district nurses. Unlike the UK they also received one daily visit by a doctor in their end of life stage. We have a family friend who is a nurse at our local community Government Hospital who provides end of life care. He tips us off immediately someone we know has died and we go to their house to pay our respects. There are always pain pumps around, electric pressure relieving mattresses and masses of medication and other medical supplies. Never any suggestion that anyone was left to die alone in pain and of suffocation whilst conscious.

This has been my observation as well having lived in a small village for 8 years. I think some contributors here have been a little 'over dramatic' on this issue. It is my understanding that Thais prefer to spend their final days, at home amongst their families and they are never left to die alone.

 

I have also observed that the health services are on hand to deliver what they can from their resources. Two of our elderly relatives, my wife's sister for one have been provided with hospital beds (on loan) to improve their comfort and oxygen and breathing aids are provided. I am not aware of what medication is being administered, but it certainly is not just paracetamol as some have suggested.

[proton]

1 hour ago, Lacessit said:

I can get unlimited 50 mg Tramadol tablets over the counter at a local pharmacy. Don't even need a prescription.

 

While it is not as powerful as oxycontin, it is a moderately potent opioid analgesic.

 

IMO poor Thais get fobbed off with paracetamol because it's cheaper.

 

 

 

Where is that?

[soalbundy]

16 hours ago, connda said:

Nope.  Nor are there any hospices. They don't exist here. And palliative care in hospitals is in the stone-ages, or non-existent. They'll hand you a bottle of Tylenol and wish you good luck. And the palliative care you can obtain will probably be inadequate if you can get it as Thai doctors have two problems.  1) They feel that the pain you experience is your karma and your own fault, and 2) they feel that if they give you adequate amounts of painkillers you'll become an "addict" (heaven forbid).  And they aren't going to give you morphine to take home. It's extremely difficult to obtain except in hospitals and then only under certain conditions. And don't plan to be put on a machine to self-administer morphine based on your pain levels.  They'll ration morphine and they won't care how much pain you are experiencing.   They use to have fentanyl patches, but I'm pretty sure those were discontinued.  See reasons 1 and 2 above.

You're better off staying in your home country.  This is no place to die if you're in pain.  Where do you think wealthy Thais go to die if they have cancer?  They don't stay here.  Check Soapy Massage tycoon and politician Chuwit Kamolvisit.  He left to go die in the UK.  You can't get adequate palliative care here, and you won't get it at all for home use. 

Wishing you the best.  🙏

I don't think this is entirely true, I know of two instances where doctors did regular home visits for terminally ill patients here in Surin province, one for a French guy and the other was a Thai man with cancer, in this case morphine was given to his daughter and she was taught how to ad minister it to her father on a regular basis, he died at home pain free after 5 months of care from his daughter. I believe the government hospital in Surin city has start a palliative department.

[DaRoadrunner]

15 hours ago, connda said:

Go to Switzerland and check out.

That would be euthanasia with Dignitas or Pegasus.

 

Before that you might try researching other treatments such as

https://cancer.stonybrookmedicine.edu/diagnosis-treatment/Immunotherapy

I have no experience of the above. It needs study first.

 

You might also try Chinese Mushrooms. Do some research on shiitake, maitaki and reishi.

[campbell]

yes, there is an excellent home palliative care social enterprise, which I would highly recommend. They provided excellent care to my dying husband earlier this year. Yuen Yen is run by Dr Issarang, who speaks very good English, and who specialises in care for both paediatric and adult  terminal cancer patients. 

their website iws https://yuenyen-se.com/ (use google translate for English version). You can also call the numbers at the attachment.

Wishing you all the best

[faraday]

52 minutes ago, proton said:

 

Where is that?

At bigger Pharmacies

[Lorry]

I am happy to see so many posters with quite positive experiences about palliative care in Thailand.  I haven't seen posts like that in older threads about the same subject.  So things seem really to be improving. 

 

As for @Celsius, no, this is not only about money. 

The availability of pain medication in Thailand is very limited.  Some very common medications are not available in Thailand at all. Others (Fentanyl patches were mentioned) are not easy to get.

[ChipButty]

Somebody told me years ago that Thai's get some heroin, in the north of Thailand get on the Opium, I don't know how true that is, 

[ChipButty]

I knew a guy a few years back now, got himself a carer full time, she was able to live in and he gave her a car, food included, he wasn't that bad and was able to get to hospital when needed, all she had to do was keep the house clean and cook and make sure he took his medicine,

As I said he wasn't that bad or didn't appear to be, but all of a sudden he died one morning, no drama's 

[connda]

2 hours ago, Lacessit said:

I can get unlimited 50 mg Tramadol tablets over the counter at a local pharmacy. Don't even need a prescription.

 

While it is not as powerful as oxycontin, it is a moderately potent opioid analgesic.

 

IMO poor Thais get fobbed off with paracetamol because it's cheaper.

 

 

Tramadol may make you feel better about being in pain, but it does next to nothing to alleviate pain. At end stage cancer the only thing that is going to make a difference are opioids, and not a low efficacy synthetic opioid with SSRI effects. Tram is a better fit for people with depression. 
Doctors giving paracetamol for cancer is inhuman.  The lack of effective palliative care in Thailand is a disgrace.  Thai "leaders" are so worried about morphine "being abused" that, like fentanyl patches, they make the drug difficult to impossible to obtain - then hand you a bottle of paracetamol for end stage cancer.  It borders on sadistic.  A poster above mentioned that drugs like opioid are in short supply.  That is an artificial shortage.  Take fentanyl which is an effective synthetic opioid.  A day doesn't go by where the US isn't slamming China for fentanyl. Fentanyl is cheap to produce and plentiful.  It's rarity in Thailand is a product of leadership which chooses to keep an effective palliative drug out of the hands of cancer patients and those is chronic pain. Again - it is sadistic and inhumane.

[connda]

However - it is good to have discussions like this.  Things may change ever so slowly in Thailand, so discussions like that highlight the changes - good and bad. 

[connda]

2 hours ago, Thingamabob said:

Palliative care readily available in most parts of Thailand. ,but not for free.

Substandard (by Western standards) palliative care readily available in most parts of Thailand.  It's still in the stone-ages and is hampered by Thai elites/leaders aversion to drugs that are effective by using the excuse that those drugs "might be abused" so therefore they must be made difficult to obtain, for example, that's why you can't have morphine drips in a home setting.  You might "abuse" your morphine while your dying.  Heaven forbid.

[PoorSucker]

17 hours ago, connda said:

Not at home they didn't.  You don't have to believe me

My father in-law got a hospital bed at home and nurse came every week.

Small village in north Chiang Mai.

Died from stomach cancer

[PoorSucker]

2 hours ago, proton said:

 

Where is that?

I have shingles right now, no problem getting Tramadol and Codein at pharmacy here in Pattaya.

[Thingamabob]

40 minutes ago, connda said:

Substandard (by Western standards) palliative care readily available in most parts of Thailand.  It's still in the stone-ages and is hampered by Thai elites/leaders aversion to drugs that are effective by using the excuse that those drugs "might be abused" so therefore they must be made difficult to obtain, for example, that's why you can't have morphine drips in a home setting.  You might "abuse" your morphine while your dying.  Heaven forbid.

The nursing side of palliative care in Thailand is as good as, and often better than, can be found in most western countries. Further, the restriction of some medicines for domestic use also applies in many western countries. 

[PoorSucker]

2 hours ago, Jerzy Swirski said:

I concur with this.

Fortunately I don't need it yet, but my doctor has a cabinet full of Tramadol.

It is good to know that it is there if I need it one day

Yes, Tramadol and Codein is aviable at my pharmacy here in Pattaya, have shingles right now so I know.