SINGAPORE - Palliative care expert Cynthia Goh is familiar with the word no.
She has had her fair share of rebuffs, brush-offs and cold shoulders in the 20-something years of setting up hospice and palliative care in Singapore.
But that did not stop Professor Goh, a faculty member of the Duke-NUS Graduate Medical School and the Yong Loo Lin School of Medicine at the National University of Singapore.
She has spent the last few decades trying to make sure that everyone who needs palliative care receives it.
Experts estimate that by 2020, more than 10,000 people a year here will need palliative care. But according to the Singapore Hospice Council, currently, there are only eight facilities here, serving 5,000 people a year.
But her efforts are slowly starting to pay off.
The Health Ministry announced in March that it will set aside almost $150 million to improve care standards at community hospitals, nursing homes and hospices in the next five years.
Prof Goh recalled the long, hard struggle to make palliative care a part of the medical landscape. In 1986, Prof Goh first approached the Health Ministry to start a programme in elderly care and helping people to die.
There was no call or need for such services in Singapore, she was told.
But she did not give up.
She volunteered her services, treating the dying at a small 16-bed ward at St Joseph's Home for the Elderly, then located in Jurong.
She was joined by Dr Anne Merriman, another like-minded doctor.
"We had nothing - Anne being a geriatrician and I am an internist. We used to hit the books, read articles. We used to also ring people in London to say, 'How do you control this pain?'"
"We really had to do it hands-on and the patients were our teachers, telling us how to control their symptoms, how to use the drugs for their pain," said Prof Goh.
Then the big break came.
When Dr Tetsuo Kashiwagi, the father of hospice care in Japan, visited St Joseph's Home in 1986, a reporter followed.
This resulted in a single-column piece in what was then section 2 of The Straits Times, entitled In Singapore, A Place To Die Peacefully, in the same year.
For such a small story, the response was overwhelming. The paper received 144 responses which had heartbreaking stories, asking to die in dignity or wishing that they had known of the home run by the Canossian nuns.
Got the ball rolling
That got the ball rolling.
Prof Goh and a group of like-minded doctors, nurses and lay volunteers got themselves affiliated to the Singapore Cancer Society and started home hospice services.
The number of patients and families grew from 70 in the first year to 170 in the second and to 500 by the third.
With a donation of $120,000 over three years from Cheng-Kim Loke Foundation, the group managed to hire a nurse and sent her abroad to train as a nurse coordinator.
Needing to move things along at a much faster pace, Prof Goh said the group of 30 had a "clandestine meeting" one night at her home to discuss a breakaway from the Cancer Society. It did, and became the Hospice Care Association.
"This really was the first organisation that was built specifically for hospice and it came from this little group of volunteers. That was the year 1989," she said.
Though the services were beginning to be organised, people had still to be won over. She recalls the storm of protests in 1992 from students and management at the Singapore Polytechnic at the news that Dover Park Hospice could be sited near them.
They succeeded in getting the hospice relocated. It's now in Jalan Tan Tock Seng.
But that did not dampen her drive and enthusiasm, steadily campaigning for more recognition and funds.
In 1995, the Singapore Hospice Council, an umbrella body that incorporates all voluntary organisations that provide hospice and palliative care, was formed and registered.
Today, its members have grown from the initial five to eight.
Prof Goh and her group were also instrumental in getting Palliative Medicine recognised in Singapore in 2006 as a medical subspecialty in line with the UK and Australia.
Although traditionally, in medicine, success is synonymous with cure, for Prof Goh, the measure of success is when her team helped in a good death, free of pain.
"What is a good way to die? People talk about peace, slipping away in one's sleep is not a bad way to die. "Having no pain is very, very important for those with end-stage diseases and providing palliative care is all about that," she said.
This article was first published in.