by Inzle Jarred Santos
During the month of May, we celebrate the National Volunteerism Month by looking into institutions where volunteers abound – as with the case of Madre de Amor Hospice Foundation (MdAHF) in Los Baños.
Covering 23 towns in Laguna, MdAHF is a non-stock, non-profit institution providing community-based hospice and palliative care service. It caters to an average of 40 patients a month for free.
The institution’s passion to serve is inspiring—and so is its story.
The inspiration behind the hospice
It is in times of grief when we are either broken to pieces or made stronger. When 14-year-old Sarah Katrina Adriano died of nasopharyngeal cancer in 1994, her parents, Lourdes and Fermin Adriano, were stricken with grief at her untimely demise.
However, Sarah’s death paved the way for a new chapter in palliative care in the Philippines, providing terminally ill patients with care up to their final hours.
It was through the Adrianos and Dr. Josefina Magno that the Madre de Amor Hospice Foundation, the country’s first community-based hospice program was established. Magno, a specialist on palliative care and fresh from her stint in the United States specializing in hospice programs, met the Adrianos by chance at one of her seminars on palliative care in 1994 at Manila. The Adrianos then went on to co-found the hospice in honor of their eldest child, in the hopes of providing assistance to those who are terminally ill.
Established during the year of Sarah’s death, Madre de Amor Hospice has since then been providing free pain management therapy for patients diagnosed with terminal diseases. According to administrative staff Gina Cabrera, the hospice offers six services: pain and symptom control, [care of] psychosocial aspects, lending of medical equipment, training of volunteers, and day care.
As defined by the World Health Organization (WHO), palliative care is“an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”
Simply put, it is the practice of helping terminally ill patients cope through the stress and trauma of going through an ordeal both physical and emotional.
Supportive care is for ambulatory patients, or those who are able to move from one place to another without assistance. Day care is the same, but is also a “diversionary” tactic to out the minds of the ill off their disease. The hospice also loans out medical equipment such as oxygen tanks, hospital beds, and wheelchairs.
Most cases admitted are cancer, but the services the hospice offers are also available for other illnesses such as end stage renal diseases such as but not limited to dialysis patients.
The foundation is located at the university town of Los Baños, just a tricycle ride away from the University of the Philippines at Los Baños (UPLB) campus. Though not strictly limited to Los Baños residents, most of the foundation’s patients are from the barangays of the town. Some of their patients have come from the surrounding towns of Bay, Sta. Maria, and Calamba.
21 years as a volunteer
Aragones, or “Tita Alice” as she prefers to be called, has been a volunteer at the hospice for 21 years. After her husband, a UPLB professor, died due to complications from diabetes, she found herself wanting to volunteer for work at the Madre de Amor. “Bilang alam ko yung pinagdadaanan ng isang may kamag-anak na may sakit, naisip ko, ‘kahit makatulong sana ako’”.
“Mahirap maging volunteer,” she begins, “pero if you have the heart, hindi ka mapapagod.”Recounting the story of Sarah made her reminisce on her own experiences on being a volunteer.
“Ang ginagawa namin, binibisita namin sa kabahayan yung mga may sakit, papaliguan, [at]lilinisan. Kung saan saan ako nakakaabot, minsan tangay tangay ko pa yung anak ko.
Volunteers in the hospice are taught on how to care for patients who have special needs. Usually through workshops, volunteers are also taught on how to deal with emotional aspects of being terminally ill. A mother of seven children herself, Tita Alice says that volunteering is something that is not for the weak of heart. Putting emphasis on emotional maturity, she says that the most trying times are when she sees the warning signs of death in her patients. “Usually pag malapit nang mamatay, alam mo na yun eh: nanghihina, naghahallucinate na. Madalas nang tulog… yung iba, balisa na lang.”
Tita Alice admits that most of the work in volunteering comes not from administering pain medications, or making their rounds on the houses of the patients. The challenge, she says, lies mostly with the emotional aspects of the work.
According to Tita Alice, it is hard not to form attachments to patients as a volunteer. “Madalas kasi kahit yung mga pamilya nila, napapagod din o kaya naman, walang oras mag-alaga sa may sakit.”She also says that they are somewhat the family of the patients. “Kami na lang yung nangungumusta,” she says.
“Madalas naming pag usapan kung paano yung buhay [ng pasyente] dati.”Recalling the case of a spinster diagnosed with breast cancer whom she cared for, she says “dun ko lang naisip, ang hirap pala pag walang pamilya.”
She also notes how most of the patients she has served for throughout the years would eventually find themselves being closer to the Lord. Given this, she feels that, to a certain extent, her volunteer work is a fulfillment of being the Lord’s stewards. “Kami ang naghahanda ng kaluluwa para magbalik loob sa Diyos,”she adds. “Ang iniisip din ng mga tao, pag hospice, mamamatay na,” she says. “Hindi naman sa ganoon, katunayan meron kaming mga cancer survivors na volunteers [na ngayon],”she adds.
She shares the story of a fellow volunteer Tess Gonzales, who is a cancer survivor. According to Tita Alice, Gonzales used to be a teacher at the nearby Maquiling School, Inc. After her bout with cancer, Gonzales has since been an active volunteer at the hospice.
According to Cabrera who sees herself an accountant and social worker by profession, “the work is its own reward. “…nakakapagod talaga, it’s also emotionally exhausting.”. In spite of this, Cabrera still finds herself drawn to the hospice. “Kasi kung tutuusin, if you want to go corporate, ang daming trabaho dyan,”she says.
Palliative care in the Philippines
In the context of hospice care, the Philippines has been described as in its early stages of palliative care development. Although there is definitely the presence of palliative care, it is only in isolated groups. In Southeast Asia, only Singapore has successfully introduced palliative care into its healthcare system. According to Ayda Nambayan, a registered nurse and a consultant on palliative care and oncology at the Makati City Medical Center, some challenges seen in the effectivity of palliative care include education and lack of adequate government support. There is also lack of proper training on part of volunteers and specializations of qualified palliative healthcare providers.
Cabrera laments the state of palliative and hospice care in the country. “Sana mas may government support,”she says. “Yung sa ibang bansa grabe ang supporta ng government,”she adds, citing the case of the Taiwan delegation, which they have encountered during a summit on palliative care in the Philippines last 2012. “Sila pa dumating, talagang grupo. Yung amin eh executive director lang, kasi sariling gastos,”she said.
A 2008 country report by Lancaster University of the United Kingdom lists 34 organizations which provide a wide array of palliative care services in the Philippines. In this, the Madre de Amor Hospice is listed as offering home care, day care, and psychosocial support.
According to Cabrera, the main problems that the hospice faces are on volunteers and funding. In the recent months, few volunteers have shown up for volunteer workshops that the hospice hosts every month. “Nitong nakaraan nga, nag one-on-one kami kasi iisa lang yung pumunta”.According to her, the hospice has adjusted its once two-day workshop into two hours just to make volunteer work more appealing to volunteers.
In recruiting volunteers, Cabrera says that preferably, they should be young. However, looking at their 52 strong volunteer demographic, she says that it is the seniors that are more active because they are usually retirees with plenty of spare time. “Yung iba nga sa meeting lang every first Friday of the month ko na lang nakikita,” says Tita Alice, who is also one of three Perfect Attendance Awardees at the hospice. However, Cabrera understands. Also a mother herself, Cabrera says that to serve others, one must first sustain his/herself.
They also discourage people who have recently lost a loved one to cancer or any other disease because of their emotional fragility. Citing Tita Alice as an exception, Cabrera says that they cannot afford to reintroduce their volunteers into something traumatizing. “That’s why hindi talaga naming tinatanggap”.
Funding and donors
While the Madre de Amor Hospice has its fair share of donors, with some being corporate entities, funding is still a problem. “Katunayan we just had a project sa isang UPLB group, yung sa HIV/AIDS? Break even lang yung kita, pero we’re still happy kasi we got to inform some people tungkol sa Madre de Amor Hospice and HIV/AIDS,” says Cabrera.
The hospice also sells some merchandise done by some patients to help add to the hospice’s funds. “We have our morphine from the Department of Health (DOH),” says Cabrera. In partnership with Hospice Philippines, the hospice has been supplied with morphine, an aneasthetic drug used to relieve pain as part of their pain management therapy, since 1996. Starting with the death of a 14-year-old girl way back in 1994, the collective efforts of the Adrianos, Dr. Magno, and the men and women behind the Madre de Amor Hospice have helped shaped the hospice from its humble beginnings to a fixture in the Philippine hospice scene. Being internationally recognized as one of the pioneer palliative care centers in Philippines, the hospice has served as the final refuge for the terminally ill.
Individuals interested to become volunteers may visit http://www.hospice.org.ph for more information.