In December 2014, Sheila Payne, Emeritus Professor, International Observatory on End of Life Care, and past president of the EAPC, went to Taiwan to support the development of a new palliative care research network in South East Asia. In Tapei, she took part in the 3rd Building the Collaborative Research Platform and Professional Training Workshop for Cancer Treatment, Hospice/Palliative Care and Bioethics in Southeast Asian countries and took the opportunity to invite some of the delegates to contribute to this special series.
Dr Rojim J Sorrosa, Consultant in Palliative Medicine at the Southern Philippines Medical Center, concludes our special series from South East Asia with a story from the Philippines.
A four-year old female child with neuroblastoma (a cancer of the sympathetic nervous system) was referred to the Palliative and Hospice Care Team of the Southern Philippines Medical Center, a 1,500-bed government-based hospital, which cares mostly for poverty-stricken patients presenting with varied medical conditions, and their families. The patient was already in an advanced stage of her illness and had endured countless unsuccessful chemotherapy sessions and operations. The cancer was persistent, and the child had been experiencing a lot of pain. Sadly, the prognosis and prospects of survival for someone suffering from such an advanced cancer were dismal and so the child was referred to our team for pain control and psychosocial support. Comfort then became the team’s priority goal.
How does a child react physically and emotionally to her illness? We might think that children who are very sick and frail cannot feel psychological pain and are devoid of emotions − but this is not true − just like adults, children go through a rollercoaster ride of emotions. Children who are very sick must be given opportunities to ventilate their feelings.
We gave morphine as the primary drug to control the severe cancer pain. At the same time our team was able to initiate structured play therapy for this child using clay materials. What you see in the picture is the child’s understanding of what her illness is all about. The horns are what caused her body great pain. This figure represents a demon grinning from ear-to-ear every time the child suffers. The experience draws out all her positive energies leaving her helpless and her calm demeanour compromised. She thinks of a sadistic, psychic vampire that sucks the very life from her. This is the child’s artistic impression about her journey as a cancer patient. This is the face of uncontrolled pain from neuroblastoma.
Opioids address severe pain but equally important is that play therapy can help to uncover the context of children’s emotions. The toys are the patients’ words and the play, their conversation. The child was maintained on morphine and was able to stand, walk, talk, laugh, smile, and interact ─ all of which define a good quality of life. The family was counselled and supported with information about the child’s psycho-emotional state.
Controlling physical pain is just the tip of the iceberg. Pain is a multi-dimensional construct − it is both a biological and an emotional event. Comfort does not end with pain medications. Treating pain is addressing the patient’s whole being − an important life lesson that we should all remember.
Links and resources
- Video clip on sand play therapy and excerpts from Dr Barbara Turner’s presentation at International Play Therapy World Congress 2010.
- Hall TM, Kaduson HG, Schaefer CE. Fifteen effective play therapy techniques, Professional Psychology: Research and Practice 2002, Vol 33, No 6, 515-522.
- Davao Palliative and Hospice Care Network (Facebook group)
Note: Dr Sorrosa suggests that the first two resources may be helpful in providing an overview of various play therapy resources though they do not cover the clay techniques used by his team.
More posts in the South East Asia series on the EAPC Blog…
Click here to read about the ‘Cloud-based Platform for Palliative Care at Home’ by Dr Yingwei Wang and ‘Dying at the end of mainland Asia: Palliative care in Singapore’ by Dr Natalie Evans.