Die-logues to raise awareness


Die-logues to raise awareness

Dr Norhisham bin Main shares about his palliative care career and offers insight into how we can open up die-logues among healthcare professionals and the Malay community.

Dr Norhisham bin Main is the Head of Division & Senior Consultant, Division of Supportive Care & Palliative Medicine, Department of Medicine at Ng Teng Fong General Hospital. He also serves as the current Vice-Chairman of the Chapter of Palliative Medicine Physicians (2022- 2024) of the Singapore College of Physicians. Dr Norhisham is also President of the Muslim Healthcare Professionals Association, dedicated to building a network of healthcare professionals who practice medicine guided by Islamic principles.

Dr Norhisham has supported Singapore Hospice Council (SHC) as a council member from 2016-2022 and continues to offer his time and expertise as a valued consultant to the organisation. With more than 10 years of experience in the palliative field, Dr Norhisham has intimate knowledge of the growth of palliative care in Singapore. This past January, Dr Norhisham graciously volunteered his time to conduct a session of Palliative Care 101 at An-Nur Mosque.

Dr Norhisham bin Main conducting a session of Palliative Care 101 at An-Nur Mosque

What does Live Well, Leave Well mean to you?

To me, Live Well, Leave Well is very much about living life to the fullest, where one enjoys the various facets of life. Health allows us to pursue our dreams and do what is important to us. Health allows me to connect with others, build relationships, learn and play. Being healthy is not about physical health alone. It includes being spiritually, mentally, and emotionally healthy too.

What inspired you to join this field?

I had the opportunity to work with Professor Pang Weng Sun and Dr James Low years ago. They not only showed me how to care for the elderly in good health but also how to care for them when they were deteriorating and dying. The palliative and hospice nurses were most inspiring in their passion, devotion, and love, to support and care for their patients. Importantly, they made seemingly difficult tasks simple and doable while putting the patient at the centre of it all.

Why do you think conducting community outreach programmes such as SHC Palliative Care 101 course is important?

Most of our patients live in the community. There is so much that our community has been doing and could potentially do. During the pandemic, our community rallied to help others so willingly. With such outreach programmes, we can enable and empower them even more so that they can achieve more for the benefit of patients in the community.

What aspects of palliative care are most misunderstood or underrepresented in the Malay community?

The common myth that palliative care is only about end-of-life care and dying is also found in the Malay community. It does not help that healthcare professionals tend to label palliative care as care that only starts when there are no treatment options or when treatment is withdrawn. We know today that palliative care can and should be provided alongside active curative treatment. Active treatment focuses on cure and return to health while palliative care focuses on symptom control so patients can go through treatments without too much significant loss in quality of life.

To what extent is the patient’s religious or spiritual beliefs considered during their care?

Religious and spiritual beliefs can shape treatment preferences and influence decisions. It is a potential source of strength and resilience that helps patients and their families cope with what may be a difficult journey in illness.

Share a memorable incident with us.

A family chose to withhold information from a patient. When I saw the patient, he hinted that he was aware that he had a serious illness and that he was deteriorating. He shared that his wife for whom he was a caregiver was a priority for him. He also wanted his children to know that he was glad that they have stepped up to care for her in his illness. He understood that they did it out of their own fears and their love for him in not wanting to upset him. He did not hold it against them and shared his love for them. Unfortunately, he deteriorated that same night and died the next morning. His family heard that he had passed a message to me for them. I shared what he told me and assured them that he still loved them. They acknowledged his love for them.

Has the level of awareness of palliative care increased over the years?

Yes, though it can still be improved. There are myths and fallacies; however, more people are aware of and seek resources on palliative care. There are those in need of palliative care in Singapore who do not know how to access it, so it is important that we have resources in the community for this. SHC’s Palliative Care 101 programme aims to increase these community resources for palliative care.

To what extent are healthcare professionals more comfortable talking about death and dying?

Not all healthcare professionals are comfortable with dying and death itself, let alone talking about it. Our experiences with dying and death and our attitudes towards death vary at different stages in life.

How can more people be made comfortable talking about death and dying in Singapore?

It helps to talk to a loved one, an elder or a faith leader when we find the topic of death and dying difficult. A safe space to talk about it without being judged is important; therefore, choosing someone we trust matters too.

What advice do you have for them?

I would advise them to reflect and examine what makes it difficult or fearful. One should also think about times when they have seen others have a good peaceful death and how it was possible. End-of-life conversations may be difficult but having open conversations on it helps us to understand more, allows us to know what a seriously ill person wants, and strengthens bonds through open honest conversations.

What do you hope to see in the palliative care sector in the next 10 years?

I hope to see palliative care become more accessible and seamless, so that those who need it can receive it.

Photo: Singapore Hospice Council

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