For Healthy, Lives and Promote Well Being For Childhood Cancer, Saraburi Hospital, Thailand
Saburi Hospital

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Cancer is currently the leading cause of non-communicable disease related death of children in high and middle income countries, it is threatening to overtake infectious disease as the leading cause of mortality in children . The cause of most childhood cancer is still unknown. Recent studies linked 5% of all cancer in children with an inherited genetic mutation (which can be passed from parents to their children). Childhood cancer is curable with early diagnosis. Proper treatment, care and support for their families can minimize the catastrophic cost of cancer treatment Childhood cancer treatment pushes families deeper into poverty, due to catastrophic costs of treatment, loss of income and treatment related costs ( e.g. travel to health facilitate , regular monitoring test ), Childhood cancer survivors remain at risk of late effects, complication and premature death as they age. Children who are treated for brain tumors, bone cancer, and Hodgkin’s Lymphoma and anyone who received radiation treatment to their chest , abdomen or pelvis have the highest risk of serious late effects, including secondary cancer, hearing loss and congestive heart failure . Saraburi Hospital is one Excellence Center responsible for a population of 5,389,111 people in Saraburi province and neighboring provinces. They provide care for childhood cancer patients with 900 -1000 visits per year. Most of the patients are low income and cannot afford travel to the hospital. Every child deserves a chance to fight cancer and our goal is to help kids with cancer to survive and thrive to live long productive and meaningful lives

B. Strategic Approach

 2. What was the solution?
Safe, timely and quality childhood cancer treatment is a human right. Mobilization support for fast tracking the development of innovative treatment and target therapies that are less toxic advocated for government support for long term follow up care of survival. Let’s make their voice heard by working together to make vital childhood cancer programs and services available.

 3. How did the initiative solve the problem and improve people’s lives?
Saraburi Hospital has realized and envisioned the creation of activities to respond to child cancer. Saraburi Hospital has joined with the people who use the service along with public and private organizations in Saraburi province to prepare the care plan which is divided into early, middle, end. Children are not little adults, childhood cancer is different from adult cancer and needs to be treated differently .Childhood cancer strikes infants, children and adolescents alike . We have advocated the need for children diagnosed with childhood cancer to receive the specific treatment they need and for specialized hospital units and a multidisciplinary team for child cancer care. Multidisciplinary team practice about children care in cancer patients in the early time and question the patients and their relatives about the satisfaction levels and encourage activities like this constantly for the benefit of patients, families and the caring participants in all professions. In the middle time, there are more caring network bringing the results to practice with patients and families. The name of this team is “Tender Loving Care Team”. Moreover, the Executive Committee of Saraburi Hospital has partnered with the Office of Public Health and found that if we can bring these activities into all areas of Saraburi, it will be continuing and successful by patients and relatives needs in the end stage. To build “Tender Loving Care Team” that will rely on the knowledge, understanding, attention, love, kindness, etc. To prepare using the doctrine is easy to understand, practice and prove the results in happiness creating by ourselves. Then we will apply to work with patients and relatives and this method is universal to use in all regions. The patients and their relatives can feel the sincerity, willingness, kindness and generousity by themselves. Then the team can also be linked to a network outside the hospital to have more success by receiving to support from the Peer Volunteer Club, the Local organization; Province and Sub-District.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Sufficiency economy is the name given in Thailand to a development approach attributed to the late King HM Bhumipol Adulyadej. Application of Sufficiency economy to the service model of care network used by local party organization, structure and Multidisciplinary team provide child cancer and care for the patients in the end-stage both in the hospitals and the network so they receive holistic care. There is the child cancer care development to link the network by the achievement of the objectives of the patients, relatives, and the caregiver teams. Then we have established “Tender Loving Care Team” in Saraburi Hospitals consisting of physicians, hospitals, nurses, pharmacists, social workers and related professionals on their dealings and expanded to 160 places in the service network. There are the organizations of equipment banks in all hospitals to supply to people who use them at home and to use in the hospital thoroughly. In addition, staff teams and volunteers have been developed the within the network continuously, as well as getting help from a source of care at all times which is defined channels such as direct-dial phones involved internet online system.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The Executive Committee of Saraburi Hospital has partnered with the Office of Public Health and found that we can bring these activities into all areas of Saraburi and neighboring provinces. In addition, staff team and volunteers has been developed the childhood cancer care to patients within the network continuously. Children and adolescents can survive cancer with early diagnosis . Proper treatment, care and support for their families to minimize the catastrophic cost of cancer treatment . Define core team in charge of the relevant departments, such as doctors, pharmacists, social workers. Development of the transmission network. The patient returned to the client / community / home system information to be passed. Monitoring and evaluation of ongoing care. Caring for the spiritual, emotional, social collaboration with a psychiatrist. Spiritual assessment in children and activities to meet the needs of patients, supported by volunteer / volunteer in recreational activities such as storytelling, so that children feel loved. Organized gatherings for family participation in care. Living very close to normal life.
 6. How was the strategy implemented and what resources were mobilized?
The knowledge development and the activities to be used in the childhood cancer needs to use the management budget. So both are in the public and private sectors, the patients and relatives prepare a project proposal to the Bureau of National Health Insurance Organizations, Saraburi Hospital, Saraburi Health Office, Foundations and the Professional Networks. The support and donations from the faithful are able to perform these activities have continued. Moreover, more training and capacity are given not only to personnel who provide care but we added to the volunteers, patients and relatives also in order to understand and fulfill their roles more efficiently. The activities development is focused on the practitioners to understand, be happy in working unconditionally, and the patients can get maximum benefit. Furthermore there is also a connection to care completely and the development of activities emphasize the practitioners understanding and have the pleasure of working with the most sensitive conditions. It can meet the needs of each patient and it builds understanding to satisfy both users and service providers sensibly. The principles of religion have been applied to use in patients and relatives with belief and faith. The effective communication, skills, experience, knowledge, identity is important in the implementation of activities. The importance of the care that the success factors that will continue to the patients so the activities empower love and mind to the patients and caregivers, including nurses, the health care manager of families to engage in the exchange and learn to understand. This was received with satisfaction of the activities more than 90%, and the results are ensuring, understanding and finding solutions together each patient appropriately. Moreover, the staff acquired knowledge and skills to identify the differences in individuals.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The core team including the director of Saraburi Hospital was responsible for the project design with a multidisciplinary approach to establish guidelines for patient care co-counsel. Foster care and meet the needs of patients with common problems and complications to support the ongoing care, including hospitals in neighboring provinces that have been passed on to patients and their relatives to gain knowledge. The experience and skills to make patients and their relatives to accept the changes, both physically and mentally able to care for themselves with a better quality of life. When a child is sick with cancer, most of the family was always there with their child. There may be a limited time thus, each dedicated time especially for children who are sick. If the child is the only child of the family, time was not affected much. In families with a younger brother or sister, time will be more of an issue. Often to help with all aspects such as the spiritual care, food and medical equipment was donated to the hospital to be used for the benefit of patients. Social, economic and psychological support travel expenses, costs while in the hospital and food essentials such as milk, feeding tubes. There are groups to help parents childhood cancer knowledge as a consultant.

 8. What were the most successful outputs and why was the initiative effective?
Survival rates for some rare cancer are still very low, even in high -income countries. More children die from cancer in low – and middle – income countries compared to high income countries . Survival rates in low – and middle – income countries can be as low as 10% .While in high -income countries, survival rates for the most common cancer is at an average of 84 %. In Saraburi Hospital, there are 900 - 1000 visits per year, who are received cancer care including the physical, mental, emotional, social and spiritual care. There are 95% of patients receiving care from families. The overall survival rates were 68.5% in 2014 and this increased to 70.4% and 72.8% in 2015 and 2016 respectively. Our overall objective is to ensure support for the care and cure of children with cancer everywhere. This affects the quality of life of patients. This research aims to study the quality of life and the relationship between demographic factors. Socio-economic factors and the health and quality of life. We studied 200 children with cancer aged 6-12 years, who were treated at Saraburi Hospital. The study found that quality of life of childhood cancer, the overall quality of life was good and that quality of life satisfaction was at a very good level. Self-concept, body function as well as the social and economic level was well. Demographic factors such as sex, age, education were not related to the quality of life, social and economic factors that were associated with quality of life, including the education of parents, family income, knowledge of maternal care, and relationships in school. The overall health and function of the body were related to quality of life and length of illness. The results of this study found that there are suggestions that the care team should study the demographic factors, economic, social aspects of patients and their families. It should provide knowledge about the disease and treatment options for patients, to care for child cancer.

 9. What were the main obstacles encountered and how were they overcome?
Childhood cancer in this region often occurs in poor families with little economic security. Quality of life is not equal to others and poverty continues to cause instability in the economy, compounded by lack of educational opportunities. Healthcare as a result, the mental health of the person causing disillusionment and despair followed. The lack of distribution of health personnel, the distribution of tertiary hospitals are much higher in some areas such as Bangkok, while more rural areas provide much more limited services. The number of health workers, especially doctors, dentists, pharmacists, nurses, staff and other professionals are inadequate. To accommodate the increasing number of public health issues more potential employees are also limited in dealing with health problems and require cooperation from other sectors and communities. A working group try to study the issue and provide appropriate assistant as the basis was established advocating government support for the long term follow-up care of patients. Families and parents of kids with cancer are an untapped valuable resource. Let’s engage and involve them more in the care of children and adolescents with cancer and in assisting their families. We can provide support and scale up research for childhood cancer. Speak out and stand up against all forms of discrimination towards survivors and help them to build better future

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Saraburi Hospital has a system of childhood cancer care and end stage care and is linked to community hospitals such as the district hospitals .It obtains support from government organizations such as the provincial administrative organization. It can provide equipment for supportive care at home and distribution centers can be established in every hospital in Saraburi province. In the private sector, we work together to improve knowledge, promote exchange and link care to be beneficial for the patients and their relatives. There are the systems of childhood cancer care in a total of 30 network hospitals and 145 local hospitals, as a result people can get access to services, quality and more. The patients and relatives can recognize the correct information for making to use the decisions; the treatment plan in advance and preparing the family to maintain their specific needs. They can be helped from government organizations where are the part of care such as the local organizations, other health officials, the nearest hospital and the provincial hospitals. So the patients are taken care with dignity including the patients that need emergency care and have a chronic disease. The providers who are the public health officials numbering approximately 2000 personnel, have developed the knowledge of child cancer care and distributed this to various parts of the province. The leaders of each district hospital focuses on the happiness building and learning by themselves until it becomes a sustainable activity. Focused on building fun and self - learning activities, so it becomes a way of life with which can be passed to the body and speech. The patients, relatives and people around them can feel the love, kindness, gentleness and sincerity thoroughly. The health officials link in various activities that are appropriate in context to each family. In addition, the patients can pour out their hearts and the relatives will be able to meet their needs. In addition, the staff are happy to work and take it to learn in the real life. They can use their experiences and skills to care appropriately and create happiness in their social life.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
A driven health care system that is humanized health care for patients suffering from the disease that threatens the body and heal the human heart. If this were to work, patients would be happier, and be able to experience the more effective health care. Focused on patients, doctors, nurses, multidisciplinary volunteers, all health services, pay special attention to the suffering of patients and families. Suffering physical pain, fear can be mitigated by the love, mind and spirit, even when in the final moments on this world.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
“I felt very discouraged, hopeless, as if the ground beneath me were collapsing. I began to mourn as if my little daughter died. " said a mother when she learned that her daughter had cancer. Childhood cancer severely impacts on every member of the family without exception. When diagnosed with cancer the children would have to undergo surgery as well as chemotherapy or radiation treatment, which can cause undesirable side effects. For parents, it affects the mind and causes fear, sadness, guilt, anger, and accept the truth, medical personnel compassionately help parents and the patient to cope with this traumatic experience. A fact which could help build support as well as explain some of the expected side effects. This information may help alleviate suffering. For the parents who have children with cancer, it may help encourage others.

Contact Information

Institution Name:   Saburi Hospital
Institution Type:   Government Department  
Contact Person:   Banyong Meeniran
Title:   Assistance Secretary General  
Telephone/ Fax:   +6636211008
Institution's / Project's Website:  
Address:   Saraburi,Thetsaban 4 Rd, Tambon Pak Prieo, Amphoe Mueang Saraburi,
Postal Code:   18000
City:   Amphoe Mueang
State/Province:   Saraburi

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