National Conference of Children's Palliative Care Malaysia conference eProgramme book

The 1st

NATIONAL CONFERENCE OF
CHILDREN'S PALLIATIVE
CARE MALAYSIA 2022

Supporting from the beginning

6 - 8 OCTOBER 2022
Swiss Garden Hotel

Kuala Lumpur Malaysia

Co-organised by: Platinum sponsor:



NCCPCM 2022

OUR
OBJECTIVE

There is a great unmet need for children’s palliative
care in Malaysia. Children with life-limiting illnesses
and their families have a right to palliative care – to
improve their quality of life. The first NCCPCM aims
to raise awareness about children’s palliative care
and to share expertise in providing palliative care for
children among healthcare professionals who work
with children. We hope that this will be the start of
similar conferences on children’s palliative care on a

regular basis, and to keep the spirit of children’s
palliative care going strong.

3

Table of Contents

5 Welcome address
7 Organizing committee
8 Day1-3 program
11 Venue floor plan
12 Meet the speakers
53 Scientific paper abstracts
85 Sponsors

4

Welcome Address by Director
General of Health

Tan Sri Dr Noor Hisham Abdullah

Assalamualaikum and salam hormat,

It is a great honour for me to deliver the opening speech in the 1st National Conference for Children Palliative Care
Malaysia with the theme ‘Supporting from the Beginning’. I would like to thank the organising committee for this golden
opportunity; your willingness to work continuously, despite the current pandemic, is an inspiration to everyone. We are in
the period where difficult choices need to be made for the sake of our future and beyond. The COVID 19 pandemic has
brought anxiety and uncertainty in many aspects to Malaysians. Resources are channelled towards curbing pandemic,
from mass screening, vaccination and supportive treatment. Despite the current focus on addressing the pandemic, we
should not forget the ongoing needs of children who need palliative care.

Paediatric palliative care in Malaysia, certainly, is a new emerging specialty. Without doubt, it needs support from the
hospital, community, and non-governmental organizations. In Malaysia, we have yet to establish key policies towards
children with life limiting illnesses. The need for paediatric palliative care is big, where 29 out of every 10 000 children in
Malaysia need palliative care services. However current service provision is limited to major hospitals and only 3 hospitals
have an established paediatic palliative service. Therefore, more is needed to expand the service provision for paediatric
palliative care.

However, the recent launching of National Palliative Care Strategy in 2019 and the Handbook of Children’s Palliative Care in
2021, I believe the change is at the horizon. Paediatric palliative care can grow through more healthcare personnel training,
advocacy to raise public awareness, education in both healthcare and community setup and partnership with relevant
stakeholders and NGOs. As a new specialty, there are many challenges in front before it becomes an established course.
These challenges include ensuring continuity of trained personnel, developing available infrastructure and community
resources among others. Recognizing paediatric palliative medicine as a subspecialty will promote more interest in this
field and help ensure continuity in trained paediatric palliative paediatricians to serve the children.

One of the Sustainable Developmental Goals (SDGs) is to “Ensure healthy lives and promote well-being for all at all ages”.
Promoting well-being is not only limited to the physical context, but also encompasses the psychological, spiritual and
social context. This is in the focus of paediatric palliative care, to achieve the best possible quality of life in children who are
facing life-limiting or life-threatening illnesses. Our healthcare providers need to be trained on how to help these children.
Therefore, this conference is a great opportunity to improve knowledge and skills of healthcare personnel interested in
paediatric palliative care. This is an excellent example of collaborative partnership between Ministry of Health with the
community and NGOs.

Our government has given its commitment in achieving what SDG aspire with the 2030 agenda. One of it is to promote
physical and mental health and wellbeing, and to extend life expectancy for all, to achieve a universal health coverage and
access to quality health care. We would like to ensure that children with palliative care needs are not left behind. We will
focus on helping the patients and their families to achieve a better outcome. Collaboration with community and NGOs is
the way forward to share resources to work towards a common goal: to ensure that children with palliative care needs are
supported from hospital to community.

Finally, I would like to congratulate and thank MAPPAC for organizing this conference. I hope that this conference will bring
the knowledge and expertise of the speakers to conference participants. I look forward to seeing paediatric palliative care
progress further in Malaysia.

On this note, it is now with great pleasure that I declare the 1st National Conference for Children Palliative Care Malaysia,
officially open. I wish you all a successful meeting.

Thank you.

5

Welcome Address
by NCCPCM
chairperson

Dear Friends and Colleagues,

Welcome to the First National Conference of Paediatric Palliative Care Malaysia(NCCPCM) 2022!

This conference is organised by the Malaysian Association of PaediatricPalliative Care (MAPPAC) in collaboration
with the Ministry of Health, Malaysia.

It is the first national conference on Paediatric Palliative Care in Malaysia. This conference aims to promote a correct
understanding of the Paediatric Palliative Care concept. We hope that it will provide broad learning opportunities for
various partiesinterested in palliative care for children – ranging from practical knowledge, attitude and skills on
essential symptoms management to psychosocial support.

The conference theme: “Supporting from the beginning”, is to remind all of us that palliative care support starts
from diagnosis of life limiting disease for the childrenand their families. This support should extend from
communication needs, symptom management, end of life care until death and bereavement support for family
members.

The programme has been carefully planned to incorporate sharing from local and international experts in children’s
palliative care, voices from volunteers andcaregivers, as well as various categories of healthcare professionals. We
aim to providea balanced view of interprofessional collaborative practice in optimising the quality of life for children
with life-limiting illnesses.

I want to take this opportunity to extend my gratitude to the conferenceorganising committee and the Ministry of
Health members who have been working tirelessly in ensuring the success of this conference. I also hope that the
event will bememorable and enrich your current practice.

I look forward to meeting all of you personally at the First National Conference of Paediatric Palliative Care Malaysia
2022. We welcome you to join the Gala Dinner on the second day of the conference as we build networks with one
another.

Yours sincerely,
Dr. Lee Chee Chan
Organizing Chairman NCCPCM 2022

6

NCCPCM 2022
ORGANISING COMMITTEE

Organizing Chairperson:
Dr Lee Chee Chan

Conference Secretary:
Mr Michael Tan Teow Chye

Conference Treasurer:
Ms Esther Leong Soke Yein

Scientific Committee Chairperson:
Dr Fahisham Taib

Fundraising & Advocacy Chairperson:
Dr Choong Yee Wan

Social Events Chairperson:
Dr Shamini Subramaniam

Logistic Chairperson: 7
Mr Yeoh Seng Huat

Organising commitee members:

Dr Ng Su Fang
Dr Teoh Yen Lin
Dr Sharifah Najwa Syed Mohamad
Dr Nickson Tai Boon Khean
Dr Tan Chai Eng
Dr Hidayah bt Jamil
Dr Rovina Ikesh
Mr Edmund Lee Kim Choy
Ms Lee Sing Chet
Ms Nurhidayah bt Rosli
Ms Kathryn Ong

S C I E N T I F I C P R O G R A M M E Day 1

8

S C I E N T I F I C P R O G R A M M E Day 2

9

S C I E N T I F I C P R O G R A M M E Day 3

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VENUE FLOOR PLAN

Plenary - Grand Hibiscus
Symposium stream A: Hibiscus 2
Symposium stream B: Lotus 3
Symposium stream C: Lotus 2
Poster: Lotus 1
Gala Dinner - Grand Hibiscus

11

International speakers

1 Dr Chong Poh Heng
2 Dr Rever Chak-Ho Li
3 Ms Serene Wong

12

Dr Chong Poh

Heng
MBBS (UM), MRCP (UK), Dip Palliative Care (Edith Cowan), Clin Dip Palliative Medicine
(RACP)

Dr Chong is the Medical Director of HCA Hospice Care, Singapore. It is the largest home hospice service in
Singapore. In 2012, he conceived the first and only community specialist palliative care service for children
called Star PALS, after he completed his advanced training in palliative medicine, which included observerships
at centres of excellence in the US and UK. Presently, he is a visiting consultant at both department of
paediatrics, National University and KK Hospital in Singapore, and vice-chair in the Singapore Hospice Council.
His regional work in CPC involves advocacy, training and research as chair of the Children Palliative Care
Special Interest Group with the Asia Pacific Hospice and Palliative Care Network.

Dr Chong will deliver a plenary session entitled Resources and funding for paediatric palliative care service and
symposium lectures on Prognostication for children with life-limiting conditions, and Advance care plan and goals
of care.

Abstract 1 - Prognostication for children with life-limiting conditions

Despite the uncertainty that exists within clinical practice, prognostication remains a key knowledge and skill
within children palliative care. There are several reasons and implications in relation to this, and some of these
will be explored in detail. Recommendations will be drawn from available evidence, both from adult and
paediatric literature, on how prognostication may be performed in clinical practice. Challenges associated with
this aspect of ultimately inexact science or some even call art will be shared, including case studies from the field.
Finally, empathetic communication that is underpinned by a large dose of hope is critical, as we engage our
clients, whether it is the distressed parent or the dying child at a most difficult time.

Abstract 2 - Resources and funding for paediatric palliative care service

Starting a service often appears challenging when thinking about funding. In reality, what is most critical is clarity
around purpose among all stakeholders, whether for the CPC champion or the policy maker. Clearly, it is not a
job of one person, the foundation or NGO, nor the state or government in isolation. It should ideally start from
the perspective of the end-user, that is, the people we are serving. What might their needs be? Only then can one
assemble the right types and level of resources that would make sense. There have been many guides and policy
papers published. However, context and culture differ. Healthcare systems and funding models are unique to
individual jurisdictions in different countries. Settings are also important, like whether it is the hospital or the
community. Nonetheless, there are commonalities, and these will be shared.

13

Dr Rever Chak-


Ho Li

MBchB (CUHK), MRCPCH (UK), FHKAM (Paed), FHKCPaed, DipPallMed (Cardiff, UK)

Dr Li specialized in Paediatric Haematology/Oncology and was in charge the haem/oncology team in her
hospital. She also has special interest in child protection and palliative care. Dr Li provided palliative care to
cancer children since 1999 with the support of Children’s Cancer Foundation.In 2016, she set up a
multidisciplinary Paediatric Palliative Care Team and extended the service to patients with non-malignant
diseases. The team consisted of paediatricians, nurses, clinical psychologist, social worker, allied health staffs
and Children’s Palliative Care Foundation Home Care nurses. They provided 24/7 care to patients at home and
to special schools. The team was awarded the Outstanding Team of Hospital Authority in 2019. In 2017, Dr Li
and a group of paediatricians, nurses, social workers and parents formed the Hong Kong Society of Children
Palliative Care to promote children palliative care in Hong Kong. Dr Li is the current chairlady of the society.

Dr Li will be delivering a plenary entitled 2-step vs 3-step WHO Pain Ladder: Which one is better? and symposium lectures on
Psychosocial care for the family – the Hong Kong, and Managing symptoms of children with cancer.

Abstract 1: 2-step vs 3-step WHO Pain Ladder: Which one is better?

World Health Organization (WHO) principles of pain management aim at good to excellent pain relief to children with
malignant or non-malignant diseases. Pain control principles: 1. By the clock; 2. By the child; 3.By the appropriate route; 4.By
the analgesic ladder.WHO has moved the analgesic ladder from 3-steps to 2-steps in the latest guideline 2012. Weak opioids
step was eliminated.
- Step 1: Mild pain: Acetaminophen and Ibuprofen (NSAID) are recommended.
- Step 2: Moderate to severe pain: Morphine and other opioids are recommended.
The three-step analgesic ladder recommended the use of codeine as a weak opioid for the treatment of moderate pain, while
the two-step approach considers the use of low doses of strong opioid analgesics for the treatment of moderate pain.Weak
opioid Codeine was not a reliable analgesic as its analgesic effect was produced only through the pathway depending on the
activity of a liver enzyme Cytochrome P450 (CYP) 2D6. A large percentage of children are found to be ‘poor’ or ‘intermediate’
metabolizers for CYP 2D6 and show no (poor metabolizer) or remarkably inefficient (intermediate metabolizers) hepatic
conversion of codeine to morphine. Moreover, Children were reported died after administration of codeine. Tramadol and
other intermediate potency opioids, the evidence of safety and efficacy were not well available.

Abstract 2: Psychosocial care for the family – the Hong Kong scenario

In Hong Kong, there are about 250 children passed away each year. Over 85% of children deaths occurred in government
hospitals. There is no child hospice in Hong Kong. Dying at home has cultural and social obstacles. The psychosocial support
to families of children with life-limited diseases is quite inadequate. It was mostly provided by NGO (Children Palliative Care
Foundation). The over crowed living environment in Hong Kong make it difficult for parent to look after children with complex
medical illnesses at home. Many of these children live in special school hostels.

Abstract 3: Managing symptoms of children with cancer

Study has shown that children with cancer experienced significant distressful symptom during end-of-life care. High degree of
symptom associated suffering included intense pain (visceral pain, bone pain); respiratory symptoms due to pulmonary
infiltration or pleural effusion; GI symptoms of diarrhoea, vomiting, CNS symptoms of seizure and headache, etc. The
psychological burden of children with cancer and their families is sometimes been underestimated. The End-of-life care of
children with cancer has relatively short time frame. A good symptom- control reduces not only the suffering of the child but
also the stress of the family. The events preceding child’s death have significant influence on how the family grieves.

14

Miss Serene

Wong Su Ling

Ms Serene Wong is a paediatric palliative care nurse at HCA Hospice Care, the largest home hospice service
provider in Singapore. She qualified as a Registered Nurse in 2007. Before she became a registered nurse, she
taught children with special needs as a special education teacher for almost a decade. She joined HCA Hospice
Care in July 2013. She soon went on to win the Intermediate and Long Term Care (ILTC) Service Quality Silver
Award in 2016 and later the prestigious Nurses’ Merit Award in 2019. In 2016, she received the coveted Singapore
Health Manpower Development Plan (HMDP) Award to visit Naomi House and Jacksplace in Southampton,
England. She learnt from mentors and other experts there how to provide customised, person-centred and
holistic care within a paediatric inpatient hospice. Apart from nursing, Serene contributed to the respite care
programme in Star PALS as a Medi Minder Coordinator and trainer. She is also passionate in providing integrative
care using complementary therapies. Serene is a Certified Infant Massage Instructor with IAIM and Certified
Pediatric Massage Therapist with Liddlekidz Foundation.

Ms Serene Wong will talk on Supporting Parents After Breaking Bad News, Talking To The Child About Death And
Dying and deliver a plenary lecture on Respite Care Programme.

Abstract 1 - Supporting Parents After Breaking Bad News

The diagnosis of a life-limiting condition in a child shatters dreams and throws families into a whirlwind of
emotions and uncertainties. Through the story of a 4-year-old girl, we will learn how the family transits from a cure-
orientated treatment to a care focusing on comfort and quality of life and how we as palliative care providers can
support parents after the breaking of bad news. We will be tackling some common questions that PPC providers
face, such as “What is our role?” “What can the parents focus on after the breaking of bad news?” “Should the child
be told of the bad news?” “Should parents be the ones breaking the bad news to the child?”.

Abstract 2 - Talking to The Child About Death and Dying

Death is a taboo topic in many cultures. Is it necessary to talk about death with a child diagnosed with a terminal
illness? If so, how do we approach this difficult topic? Through the story of a 4- year-old girl diagnosed with a brain
tumour, we will explore some of these concepts of death and dying in children. In addition, we will also be
discussing age appropriate activities we can do to facilitate the process of living and dying well!

Abstract 3 - Respite Care Programme

Caring for children with life-limiting conditions can be mentally, physically and emotionally exhausting for
caregivers. This session will describe the process of how a respite care programme, called the Medi Minder
service, was developed in Star PALS (a paediatric palliative home care service in HCA Hospice Care), and how this
has benefited our children, their families and even the Medi Minders!

15

Local speakers

1 Datuk Dr Kuan Geok Lan

2 Dr Richard Lim Boon Leong

3 Dr Lee Chee Chan 16 Dr Yang Wai Wai
4 Dr Chong Lee Ai 17 Ms Ee Su Im
5 Dr Fahisham Taib 18 Dr Tan Ru Wei
6 Dr Khoo Teik Beng 19 Assoc. Prof. Dr Erwin Khoo Jia Yuan
7 Dr Susan Pee 20 Dr Nicole Chen Lee Ping
8 Dr Aaron Hiew Wi Han 21 Ms Nurhidayah Rosli
9 Dr Teoh Yen Lin 22 Ms Elaine Teo Chiew Yian
10 Dr Lim Voon Lee 23 Ms June Thow Meei Jiun
11 Asso. Prof Dr Tan Chai Eng 24 Ms Maggie Nur Umairah
12 Dr Ng Su Fang 25 Dr Zubaidah Jamil Osman
13 Dr Felicia Chang 26 Ms Lim Kar Gee
14 Dr Ch’ng Gaik Siew 27 Mr Raymous Wong Choon Yong
15 Dr Shamini Subramaniam 28 Ms Joanne Lau Lee Bin
29 Dr Sujatha Doraimaniackam
30 Mr Chris Ng
31 Ms Lee Voon Yee
32 Mr Teoh Teik Hoong
33 Mr Brandon Ho
34 Ms. Fatimang Ladola
35 Ms Low Mi Yen

16

Datuk Dr Kuan

Geok Lan

MBBS (Singapore) MRCP (London) DCH
(London), FAMM (Paediatrics), FRCP (Edin), Dip Paed Palliative Care
(Cardiff), MSc Paed Palliative Care (Cardiff)

Datuk Dr Kuan Geok Lan has been a paediatrician since 1983 and obtained her fellowship with the College of
Paediatrics, Academy of Medicine Malaysia in 2003, followed by her FRCP (Edinburgh) in 2004. She served in
Ministry of Health Hospitals until 2015 and subsequently joined International Medical University as a clinical
associate professor in paediatrics. Her passion for paediatric palliative care led her to obtain her Diploma and MSc
in Paediatric Palliative Medicine from Cardiff University, Wales in 2012. She has written chapters relevant to
paediatric palliative care for the Paediatric Protocol for Malaysian Hospitals 5 th edition, and Paediatric Palliative
Care Global Perspectives (Springer). She has also presented her research works in paediatric palliative care in
national and regional conferences. She has been a strong advocate for Paediatric Palliative Medicine to be
developed under the Ministry of Health Malaysia and mentored many junior paediatricians to inspire them to
provide paediatric palliative care in their respective hospitals.

Dr. Kuan will be giving a plenary lecture on Paediatric Palliative Care Milestones in Malaysia: An Overview.

Abstract - Paediatric Palliative Care Milestones in Malaysia: An Overview.

Curative Paediatrics in Malaysia with seventeen subspecialities, has advanced by leaps and bounds since the
1920s’ with the arrival of two pioneering British paediatricians, Cicely Williams (1936) and Elaine Field (1949).
Paediatric palliative care (PPC) was recognized as a speciality in USA (AAP ,2000), UK (2003, ACT) and later by the
WHO (2009). However, no structured palliative component exists in our services. The beginnings of PPC in Malaysia
was within the Paediatric department, Melaka when a local framework of care was developed in (2005-2008) for
children in need of PPC; with various strategies that included training, development of a core team that could do
home visiting, as well as
collaborating with the local hospice nurse (Hospice Malacca). This start in Malacca in 2005 gave impetus to further
advocacy work, training, capacity building, research at a national level. In conjunction with the visit (13 th Sept
2012) and advocacy for PPC by the Duchess of Cambridge, Malaysian PPC had its very own royal patron, Tuanku
Raja Zarith Sofia Sultan Idris Shah, consort of the Sultan of Johor. Since 2013, Her Royal Highness has elevated
Johore as a leader in PPC by spearheading the setting up of PPC services in all the hospitals within the state. Many
other developments followed, most significant of which is the support of KKM towards investing in the full
fellowship training of our very first PPC paediatrician. Since Dr Lee Chee Chan’s return on 1.2.2018, there has been
an exponential growth in the critical mass of activists, providers and the various service types which are still taking
shape. The First National Conference of Paediatric Palliative Care Malaysia 2021 (NCCPCM 2021) and the imminent
launch of the National Handbook in Children’s Palliative Care during the conference, are two significant milestones
in the PPC landscape in Malaysia.

17

Dr Richard

Lim Boon Leong

MBBS (UM), MRCP (UK), Dip Palliative Care (Edith
Cowan), Clin Dip Palliative Medicine (RACP)

Dr Richard Lim Boon Leong is the pioneer of palliative medicine in Malaysia. He became a clinical specialist in
Internal Medicine and Palliative Care in Hospital Selayang in 2002 until 2005. Subsequently, he underwent further
training at the Sydney Institute of Palliative Medicine from 2006 to 2007. He has since served as a Consultant
Palliative Medicine Physician and Head of the Palliative Care Unit of Hospital Selayang since 2007 onwards. He is
also a visiting consultant for the National Cancer Institute in Putrajaya from 2014 until 2017.He is currently the
National Advisor for Palliative Medicine for Ministry of Health Malaysia, Vice- Chairman of the Malaysian Hospice
Council and Chairman for subspecialty fellowship training committee in Palliative Medicine. He has contributed
vastly in developing local training programmes for palliative medicine for doctors and, nurses. He also chaired the
development of the local clinical practice guidelines for cancer pain management and published several articles
about palliative medicine in high-impact journals.

Dr Richard Lim will be giving the plenary lecture on Malaysian National Palliative Care Strategy.

Abstract - Malaysian National Palliative Care Strategy

Malaysian National Palliative Care Policy and Strategic Plan 2019-2030 In November 2019, the MOH launched its
first ever National Palliative Care Policy and Strategic Plan which is a roadmap for the development of palliative
care in Malaysia over 10 years. In this policy, the MOH states clearly its commitment to the development of
palliative care in Malaysia with the intention of integrating palliative care into the healthcare system in order to
increase equitable access to palliative care throughout the nation. The theme of the policy is “Providing
Compassionate Care throughout the healthcare system” and aims to take an all of healthcare system approach to
achieving this goal. There are 3 main thrusts to this policy including Equitability, Sustainability and Quality. The
policy is laid upon a foundation of sustainable funding, education and essential medications and looks at
developing services in 3 main areas, hospital based palliative care , community based palliative care and
paediatric palliative care. There are 7 key strategies applied in the plan and these are as follows:
1. Development of palliative care as part of universal health coverage.
2. Ensure all who need palliative care are recognized within the healthcare system where they seek care.
3. Ensure all who have been recognized to need palliative care can access the care and
medications they need within the community they live in.
4. Develop a systematic network for the continuity of palliative care.
5. Create palliative care education programmes for all levels of care.
6. Encourage community participation in provision of palliative care.
7. Establish standards of care based on best practices coupled with principles of good medical practice.

Despite the challenges of the pandemic, palliative care has actually achieved a fair degree of development as the
needs of the pandemic had prompted a greater awareness of the need for palliative care. As we move on in the
endemic phase of COVID-19 we look forward for even more development to provide equitable access to all in
need throughout Malaysia.

18

Dr Lee Chee Chan


MBBS(UM), Master in Paediatric (UM), MRCPCH (UK),
Fellow in Paediatric Palliative Care (London)

Dr Lee has been passionate to provide better care for dying children since his housemanship. He obtained his
specialist qualifications as a paediatrician since 2011 and has been serving Ministry of Health in major and
district hospitals. He underwent a 3-year subspecialty training and fellowship in Paediatric Palliative Medicine in
Malaysia and Royal Marsden Hospital, London in 2017. He started the first paediatric palliative specialist service
in Paediatric Institute, Kuala Lumpur since February 2018. The service is now based in Tunku Azizah Women and
Children’s Hospital Kuala Lumpur and comprises inpatient and outpatient symptom care consultations, home
and school visits, transition care and paediatric chronic pain service, as well as collaboration with community
paediatric palliative care in district hospitals and hospices. He is currently the chairperson for the National
Paediatric Palliative Care Technical Group and leads the Malaysian Association for Paediatric Palliative Care
(MAPPAC) a non-profit NGO to further support the development of paediatric palliative care in Malaysia.

Dr Lee will be giving several symposium lectures including Non-invasive ventilation in PPC and Perinatal palliative
care.

Abstract 1- Non-invasive ventilation in PPC

Non-invasive ventilation (NIV) has an important role in children’s palliative care for two main clinical indications. It
is applicable when, after in-depth discussions with the family members, the managing team have agreed not to
perform cardiopulmonary resuscitation or invasive intubation in child’s best interests. Firstly, NIV can be used to
improve lobar collapse secondary to impaired cough effort, impaired muco-ciliary clearance, pulmonary
aspiration or pneumonia. NIV can improve oxygenation and ventilation with only minor discomfort in these
conditions. Potential symptom improvement and possibility of reversing acute respiratory distress from NIV far
outweighs the mild discomfort from its use. Secondly, NIV is indicated for end-of-life comfort measures to relieve
respiratory distress. Examples of conditions which may benefit from end-of- life NIV are end-stage renal failure
with pulmonary oedema, extensive lung metastases or withdrawal from invasive ventilation support. However,
judicious patient selection, careful symptom monitoring and effective communication with the parents are
required to optimise the benefits of NIV and to avoid harm to the patients.

Abstract 2 - Perinatal palliative care

Parents of an unborn baby diagnosed with a life-limiting disease require support, even from the initial diagnosis 19
during pregnancy. Upon disclosure of bad news, the expectant parents, and their family, face great uncertainty
for their journey ahead. These uncertainties may pose significant psychosocial challenges as the family is unable
to properly prepare for something that is not yet definite. Perinatal palliative care focuses on assessing and
managing anticipatory grief, providing psychosocial support for the family, and preparing an advance neonatal
symptom care plan. Perinatal palliative care also involves managing unpredicted expectations, memory making,
and ensuring support during transition through different levels of care such as the neonatal intensive care unit,
postnatal ward, neonatal ward to community and home. In conclusion, the aim of perinatal palliative care is to
support parents and empower them in the goal-setting process for care and symptom management of their
newborn.

Dr Chong Lee

Ai

MBBS (Adelaide), MMed Paeds (UM), Grad Cert
Palliative Care (Flinders)

Lee Ai is a paediatrician and consultant of the Paediatric Pain and Palliative Care Unit at the Department of
Paediatrics, University Malaya(UM). She received her MBBS from University of Adelaide and M(Paeds) from
University Malaya. Following paediatric oncology training in the UK, she worked at UM for 7 years prior to
pursuing further training in palliative care. She received a Grad Cert (Palliative Care) from Flinders University in
2013. She trained at a community palliative care service (Hospis Malaysia) and at Children’s Hospital at
Westmead, Sydney. She also had clinical attachments in palliative care at Royal Children’s Hospital, Melbourne,
Great Ormond Street, London and Alder Hey Children’s Hospital, Liverpool. She enjoys teaching and is an EPEC
Master Facilitator. She has taught at many palliative care workshops around the country and in Vietnam. She
has published on various aspects of palliative care services in Malaysia. Lee Ai has also developed an interest in
clinical ethics and received a Cert in Paediatric Bioethics from the Children’s Mercy Bioethics Centre, Kansas City
last year. It is her hope that children with a life-limiting illness in Malaysia will always have access to quality
palliative care.

Dr Chong will deliver a plenary lecture on Research changing practices in paediatric palliative care and a
symposium topic on Refractory pain with opioids – what are our options? She will also be a panellist for the
Bioethics Discussion on Truth-telling.

Abstract 1 - Refractory pain with opioids – what are our options?

Pain in children is often ignored and left untreated. Education in pain assessment and use of the various
pharmacological and non-pharmacological therapies are still lacking among health care professionals. Children
with cancer can often develop severe nociceptive pain requiring opioids. This talk will address the options of
when children have pain that is refractory to opioids.

Abstract 2 - Research changing practices in paediatric palliative care

Paediatric palliative care aims to improve quality of life and reduce suffering of both the child and their families.
Understanding the clinical experiences of children and their families will result in research questions. Evidence
based research can then inform to improve clinical practices. However, there are obstacles to research in
relatively small number of children with heterogenous group of serious and life-limiting illnesses. Furthermore,
children are not little adults. In the absence of robust evidence to base paediatric palliative care practice, often
decisions are made based knowledge extrapolated from the studies of adult populations and applied to
children. This needs to be improved and research focusing specifically on children is necessary. Innovative non
RCT methodologies too are able to pose appropriate clinical questions and derive at clinically relevant
outcomes.

20

Dr Fahisham

Taib

MBBCh,BAO (Dublin), DCH (Glasgow), MMedSci
(Galway), FRCPCH (UK), SpecCertPallCare
(Melbourne), Fellow in Paediatric Palliative Care
(Cardiff)

Dr Fahisham Taib is a lecturer in the Department of Paediatrics, Universiti Sains Malaysia. He obtained his
subspecialty qualifications in Paediatric Palliative Care in Australia. He is actively involved in providing paediatric
palliative care in Hospital Universiti Sains Malaysia as well as doing community home visits in Kota Bharu. Dr
Fahisham is also active in research and publication and currently leads Malaysian Paediatric Palliative Care
group in Malaysian Paediatric Association. He is also the Vice-Chairman for Malaysian Association of Paediatric
Palliative Care (MAPPAC).

Dr Fahisham will be giving two symposium lectures, which are How did I start PPC in my Hospital and Using
opioids in children’s palliative care.

Abstract 1 - How did I start PPC in my Hospital

Paediatric Palliative Care (PPC) is a holistic approach to care of children life limiting conditions and their families.
It requires multi-disciplinary team to work together to achieve the same goals. Starting PPC in the hospital vicinity
would depend on opportunity – available resources, multi- team support, and good infrastructure to support
patients and families both in the hospital and community. But it can be done on a smaller scale with collaborative
and partnership with non- governmental organization or other governmental agencies. Working in the university
has allowed me to jumpstart my PPC journey by obtaining a small community engagement grant which then
been used as a stepping- stone to train, collaborate, advocate and create awareness locally. In my set up,
support to the cause is garnered with the Ministry of Health and NGO to increase awareness, train personnel
and promote active participation from domiciliary team. The community team has a very important role to
prepare caregiver, support the patients and navigate resources for local support. Development of PPC can be
achieved with planning and perseverance of the cause. This by no means that one has to depend on local
champion to pursue the dream, because every single healthcare professional is responsible to guard the interest
for the children with life- limiting diseases.

Abstract 2 - Using opioids in children’s palliative care

Opioids often been managed by the pain team in hospital setting. However, managing chronic pain in hospital 21
and community settings requires one to master the understanding of opioid use, disease pathophysiology and
skills to assess, change and optimize opioid treatment. In developing nations, there is lack of options and even
the availability of the drug. Physicians should develop the art of use of opioids in many chronic debilitating
conditions because these children survive until late teens. Opioids has also potential to be used in other than
pain indication and this has potential role in managing symptom such as dyspnoea or end of life phase. The
lecture focuses on the basic understanding, route, and indications of the opioids, extrapolating some evidences
for our use.

Dr Khoo Teik

Beng

MBBS (UM), MMed Paediatrics (UKM)

Dr Khoo Teik Beng is a practicing consultant paediatric neurologist in the Department of Paediatrics, Tunku
Azizah Women and Children’s Hospital, Kuala Lumpur. He has been serving as a paediatrician since 1996 in
various Ministry of Health hospitals. He completed his clinical fellowship in Paediatric Neurology and
Neurodisability at the Royal Hospital for Sick Children, Edinburgh, United Kingdom in 2002. Upon his return, he
has served in Tunku Azizah Women and Children’s Hospital. He is also an Exco member and Scientific Chair for
the Asia-Oceanian Child Neurology Association (AOCNA) and an associate editor for Neurology Asia journal. He
has also published many articles in various journals.

Dr Khoo Teik Beng will be speaking on the symposium topic of Care for children with severe neurological
impairment.

Abstract - Care for children with severe neurological impairment

Children with severe neurological impairment includes quadriplegic cerebral palsy, some neurogenetic and
neurometabolic disorders, some neuromuscular disorders, severe epileptic encephalopathies, post hypoxic-
ischaemic encephalopathy and post-traumatic brain injury. Among the common symptoms that could lead to
severe distress in these children and their families are intercurrent illnesses, pain and distressing symptoms,
spasticity and dystonia, seizures, swallowing and feeding problems, constipation, severe drooling, chronic sleep
problem and musculoskeletal complications. Pain behaviour in these children could result from multiple factors
and require quantification using simple scale such as the FLACC behavioural pain score. It could also guide the
clinician on the appropriate treatment strategies; some of them require multimodal approach. Growth failure is
common in these children. However, we need to be realistic about their growth potential as well as taking
consideration the parental priorities. Gastrointestinal symptoms such as severe drooling, swallowing
incoordination, gastroesophageal reflux and chronic constipation should be managed appropriately to reduce
the caregiver’s burden. In recent years, hip surveillance and treatment have become part of the holistic
management for children with severe cerebral palsy and will be further elaborated.

For this group of patients, the quality of life of the caregivers especially their mothers that is often crucial in the
child-caregiver unit is equally important and may be an appropriate target for medical intervention and
psychosocial support. Although the life expectancy of children with severe neurological impairment has

mproved over the years, the trajectories in most of them remain unpredictable. Hence, provision of
neuropalliative care often remains the key focus in the overall management. In recent years, advances of new
genetic therapies of some genetic disorders like spinal muscular atrophy and neuronal ceroid lipofuscinosis has
effectively change the disease trajectories and clinicians and families need to reconcile with the issues of access
and cost of these expensive treatments in resource-limited countries.

22

Dr Susan Pee


MBBS (UM), FRCPCH (UK)

Dr Susan Pee is currently practicing as a paediatric nephrologist in Hospital Sultan Ismail Johor Bahru. She
graduated with a Bachelor of Medicine & Bachelor of Surgery from University Malaya and later obtained her
Membership of the Royal College of Paediatrician United Kingdom. She is a MRCPCH examiner for Malaysia
circuit after obtaining her FRCPCH. She is the one of the authors for paediatric nephrology chapters in the 4th
edition of the Malaysian Renal Replacement Therapy CPG as well as 4thEdition of Paediatric Protocols for
Malaysian Hospitals. She is also the honorary lecturer of Newcastle Medical University in Nusajaya. She was
involved in the setting up of the paediatric palliative care unit in Hospital Sultan Ismail in 2013.

Dr Susan Pee will be speaking on Managing symptoms for children with renal failure.
Abstract - Managing symptoms for children with renal failure
End-stage renal disease (ESRD) in children is not common, with an incidence of about 10 per million paediatric
population. In the vast majority of children with ESRD, the decision to proceed to renal replacement therapy
(RRT), which may include dialysis and/or renal transplantation, is an obvious “yes” as these modalities are
essential to sustain life.
At the present time there are an increasing number of children in nephrology programs who survive with
multiple organ impairments, but with a limited life expectancy, and are reaching ESRD or chronic kidney disease
stage 5 (CKD 5). It is important to evaluate the potential harms and benefits of RRT for such patients as it is a
physician’s primary obligation to first do no harm.
Providing early palliative care as an integral part of the kidney supportive care devised by the nephrology care
team is both necessary and feasible for patients with CKD. As a minimum, a specialized palliative care team
should be involved in patients with multiple comorbidities, in conservative treatment scenarios and in acute life-
threatening complications.
An ethical decision-making framework for the appropriate choice of conservative care or renal replacement
therapy in infants and children with ESRD will be discussed to help determine if the burdens of dialysis would
outweigh the benefits for a particular patient and family.Some common end of life symptoms management in
ESRD will also be discussed. The patient’s renal function must be considered when selecting a drug and when
determining the dosage.

23

Dr Aaron

Hiew Wi Han

MMD(UKM), MRCP (UK)

Dr Aaron Hiew graduated with a Doctor in Medicine degree from University Kebangsaan Malaysia. After
graduation, he gained his experienced working in the medical department before obtaining his MRCP (UK) in
2010. He subsequently completed his Fellowship in Palliative Medicine Ministry of Health Malaysia and is now
practising as a Palliative Medicine Specialist, Department of Medicine, Hospital Kuala Lumpur. Dr Aaron has a
keen interest in the aspect of education and improving the skills and knowledge of healthcare workers. He is
involved as a trainer for the Advanced Diploma programme for Palliative care in the Ministry of Health Training
Institute and an active committee member of the National Palliative Care taskforce groups.

Dr Aaron Hiew will be speaking on Transition from Children to Adult Services and Active Listening Skill

Abstract 1- Transition from Children to Adult Services

With an increasing number of young people surviving with life limiting or life-threatening conditions into
adulthood, understanding their palliative care needs during this transition period and into adult services is very
important. This is a time that is fraught with many uncertainties especially when they are trying to navigate
through a new service. Challenges to this transition can arise from ways. From the original paediatric service to
the patient themselves, up to adult service that is supposed to receive them. Understanding these barriers is
the first step to aiding the transition process. Only then can steps be taken to ensure that this transition is a
success.

Abstract 2: Active Listening Skill

Assuming that just because you can hear you can listen is like assuming that just because you can see you can
read. - Tony Alessandra

Hearing and listening though many would think are the same, are actually very very different.
Hearing is physiological. If we are born with hearing, then we hear. It takes no effort. It just happens.

Listening on the other hand is an active activity. It requires not only our ears, but our eyes, our minds and heart.
So what do we know of it? What can we do to cultivate it?

24

Dr Teoh Yen

Lin

MD(USM), MMed (Paediatrics)

Dr. Teoh Yen Lin graduated from USM medical school in 2003. She obtained her Master in Medicine
(Paediatrics) UKM in 2011 and was trained at Penang General Hospital and UKM Medical Centre. In 2015, she
started her General Paediatrics and Child Health fellowship. She did her clinical attachment with Hospis
Malaysia and Paediatric Palliative Care Unit in Starship Children Hospital, Auckland in 2017. She is currently
working in Hospital Seberang Jaya (HSJ) and has started paediatric palliative care (PPC) service in Penang since
Nov 2017. She has organized Paediatric Palliative Care Workshops in Penang in 2018 and 2019. PPC service
provided in HSJ are mainly in-patient consultations, out-patient clinics, bereavement clinics, as well as home visit
and medical equipment support. The service is 7/24 with phone contact during emergency for the caregivers.

Dr Teoh will be speaking on the topic Introduction of paediatric palliative care to medical professionals and
parents and Caregivers’ burden and competency during the transition

Abstract 1 - Introduction of paediatric palliative care to medical professionals and parents

The World Health Organization (WHO) defines palliative care as: The active total care of the child’s body, mind
and spirit, and also involves giving support to the family. Beginning when illness is diagnosed and continues
regardless of whether or not a child receives treatment directed at the disease. Requiring healthcare providers
to evaluate and alleviate a child’s physical, psychosocial and social distress. Incorporating a broad
interdisciplinary approach that included the family and makes use of available community resources; it can be
successfully implemented even if resources are limited. Being provided in tertiary care facilities, in community
health and hospice centers, and in children’s homes.

The introduction of palliative care can be done in three different approaches: An added dimension to care,
Movement from curative to palliative care, and Transition to hospice or community care. Partnership between
the patient, family and health care providers, along with a multidisciplinary health care team are important in
providing comfort care and ensuring a good quality of life to patient along the disease trajectory.

Abstract 2 - Caregivers’ burden and competency during the transition

Family caregivers play an important role in supporting their children with life-threatening or life-limiting

conditions, especially for home and transition care. Their needs and competencies need to be acknowledged, to

capacitate them in looking after their children, to decrease their burden and decrease the number of hospital

readmissions. Introduce the use of Zarit Burden Interview (ZBI) questionnaire in assessing the burden of

caregivers in paediatric palliative care. The ZBI consists of 22 items rated on a 5-point Likert scale ranging from

0 to 4, which cover 5 dimensions: general tension, isolation, disappointment, emotional involvement and

environment. The questionnaire can be used to assess the important aspects for caregivers, such as health,

mental wellbeing, personal relationships, physical overload, social support, finances and home environment. It

can be administered by an interviewer or self-administered, and takes about 10-15 min to complete. The

information from the questionnaire can be used to design series of training and education programme to

improve competency of caregivers. 25

Dr Lim Voon

Lee

MD (USM), MRCPCH (UK)

Dr Lim is a General Paediatrician currently serving in Penang General Hospital. She obtained her membership in
pediatric in year 2010 and subsequently obtained her fellowship in General Paediatrics and Child Health in year
2018. During her training in her Child Health fellowship, she had a year of exposure in paediatrics palliative
medicine under Hospis Malaysia as well as Brisbane Children Hospital, Australia. Hand in hand with her service
as a General Paediatrician, she incorporated palliative care management in children that are in needs of the
service. She is one of the contributors for the National Handbook of Children’s Palliative Care. She is also
actively involved as speaker in paediatric palliative courses mainly in northern region.

Dr Lim will be delivering a symposium lecture on Transition from Hospital to Home.

Abstract: Transition from Hospital to Home

Most families wish to care for their children with life limiting illness and life threatening illness at home as much
as possible. The benefit of being at home include familiar environment, freedom to have extended family to visit
as well as more privacy.

However, some of the parental concerns include their ability to cope with the management of distressing
symptoms at home and the availability of support in the community . Thus a well planned transition pathway
from hospital to home is very important. A smooth transition will ensure both the child and parents are well care
for in their home . A well planned transition pathway also plays a role in ascertain that there are good and clear
communications in the care of the child between the team in hospital with the community teams.

This session will briefly introduce the important components of transition care in Malaysia.

26

Assoc. Prof. Dr

Tan Chai Eng

MD(UKM), MMed(Family Medicine)(UKM)

Assoc Prof Dr Tan Chai Eng is a Family Medicine Consultant and lecturer with UKM since 2011. She teaches
palliative care to UKM undergraduate medical students and family medicine postgraduates. Her area of interest
is in caregiver support and home care. Currently she is pursuing her PhD in Health Education and
Communication. She has been actively contributing to MAPPAC through various activities including volunteer
training and education and is one of the trainers for the National Training Programme for Paediatric Palliative
Providers. She hopes that she can inspire her students to learn about palliative care and to empower caregivers
to provide care for their children.

Dr Tan Chai Eng will be giving a symposium lecture on PPC in healthcare professions education.
Abstract - PPC in healthcare professions education
Awareness regarding children’s palliative care is still low among healthcare professionals. Healthcare professions
education is important to instil awareness about paediatric palliative care (PPC). Various core competencies are
required for healthcare workers to provide PPC, according to the levels of PPC service. Currently, PPC education
for healthcare workers in Malaysia span across formal and informal education. The National Training Programme
for Paediatric Palliative Providers is one such programme being held in various hospitals in Malaysia. The current
session will share about how to design PPC education for healthcare professionals using instructional design
model. PPC education is important but can be challenging to deliver due to diverse learner backgrounds and
needs. However, it is an effort that must go on to ensure HCP are ready and equipped to provide PPC service.

27

Dr Ng Su

Fang

MBBS(IMU), MRCPCH (UK)

Dr Ng Su Fang is a general paediatrician serving in Sabah Women and Children’s Hospital. She earned her MBBS
in International Medical University in 2005 and obtained her MRCPCH in 2014. She started leading the paediatric
palliative care team in Sabah Women and Children’s hospital in 2015. She works closely with local home care
team and NGOs to deliver palliative care to the sick children in Sabah. She has successfully run two PPC
workshop in her hospital to create awareness among healthcare workers and volunteers in 2017 and 2018. She
is involved in PPC taskforce committee since 2018 and is currently a committee member of MAPPAC, Malaysian
Association of Paediatric Palliative Care. With PPC as her area of focus, Dr. Ng Su Fang just finished her
subspecialist training in general paediatrics and child health in August 2022. Her objective is to keep developing
her PPC knowledge and abilities so she can contribute more to the growth of PPC in Malaysia.

Dr Ng will be sharing her knowledge on Assessing pain in children and Home extubation – preparation,
challenges and practicality.

Abstract 1 – Assessing pain in children

It's important to recognise and treat child pain. Untreated pain not only has detrimental short-term effects but
also serious long-term effects. An essential component of pain management is pain assessment. A thorough
assessment of pain will help the medical practitioner to decide on the right therapy of pain. The QUESTT
technique is simple and aids in both subjective and objective identification of children's pain.

Abstract 2 - Home extubation – preparation, challenges and practicality

Some of the children who are admitted to intensive care units (ICUs) for invasive and curative therapy cannot be
cured or have their physiological derangement restored to an acceptable level. In these situations, continuing
futile artificial ventilation will merely lengthen an agonising death. Invasive therapy has traditionally been withheld
for ICU patients, who instead get end-of-life care and die there. A small number of institutions reported
compassionate extubation, also known as palliative extubation, in which life-sustaining therapy is discontinued
outside of the intensive care unit, such as at home or in hospices. It is done to stop mechanical ventilation and
withdraw the tube, which lessens suffering and prevents the death from being prolonged.

To facilitate home extubation, careful planning and communication with families and medical personnel are
crucial. A thorough checklist that includes all five phases of home extubation will help ensure that all problems
have been solved and that all necessary arrangements have been made for the patient, family, and home care
team to experience a seamless transition. These five phases of home extubation are (i) introduction of
withdrawal, (ii) pre transfer preparation, (iii) extubation, (iv) post extubation care and (v) post death care. In these
situations, early involvement of the paediatric palliative care team is recommended. Plans must be announced
and put into action as soon as the decision to withdraw is taken.

28

Dr Felicia

Chang

MBBS (Kasturba), Grad Cert Palliative Care (Flinder)

Dr. Felicia Chang has more than 16 years of extensive experience in Palliative Care having served in Ministry of
Health and 2 local hospices. Since August 2015, she started serving as an independent palliative care doctor
where she continues to serve the range of needs of patients needing palliative care in their homes. She joined
Beacon International Specialist Centre in Aug 2017 to provide palliative care for cancer and non-cancer patients
while continuing her work in the community visiting those in need of good palliative care service. She works
closely with general practitioners to provide palliative care in areas that do not have hospices or palliative care
services. She is actively involved in teaching and training and one of the board of directors with Medical
Practitioners Coalition Association of Malaysia (MPCAM) and Malaysian Association of Paediatric Palliative Care
(MAPPAC). Dr Chang’s area of interest and passion is in palliative care for children. She has won several awards
for her contribution and work in palliative care and various other volunteer services for the poor and needy in
Malaysia.

Dr Felicia Chang will speak on End-of-life symptom management.

Abstract – End-of-life symptom management

In a world that has the latest technology and medical advancement, a child’s death is almost unacceptable for
most people even for the medical faculty. With the hope that new medications and machines prolong life, we
push for more treatment even if the treatments offer very little hope for recovery. Parents and doctors try
relentlessly for miracle even as the little one is suffering and dying. Family dynamic, unrealistic hope, doctors who
refuse to accept defeat added to the complexity as a child is dying. But in the simple mind of a child, their need to
play, sing, and to spend time with siblings or family is often overlooked because the adults are too busy chasing
after cure.

When parents, health care providers, and caregivers finally have to face the end- of –life journey, they must deal
with both physical aspect of dying and the emotions that are attached to it. Managing the physical symptoms well
and keeping the child comfortable help parents to learn to accept the finality of life and in doing so helps to
create memories during those last days that eventually will bring solace to them.
End-of-life symptom management will cover some of the more common physical symptoms approaching death.
The speaker will also touch on some needs that have more emotional attachment to it, for example, hydration
and nutrition to a dying child and how we can support parents when we need to make some very difficult
decision to withhold fluid and food.

The speaker hopes that this session will help healthcare providers and parents to be more prepared when the
child faces the final moments of life.

29

Dr Ch’ng Gaik

Siew

MD (UKM), MRCPCH (UK)

Dr Ch’ng Gaik Siew is a consultant clinical geneticist and currently heads the Department of Genetics, Penang
Hospital, which serves as the Northern regional centre for inherited metabolic diseases and genetic disorders in
Malaysia. She completed her Clinical Genetics Fellowship programme in Kuala Lumpur Hospital (HKL), the
national centre for genetic-metabolic services and spent the last year of training at the Institute of Human
Genetics, International Centre for Life, Newcastle-upon-Tyne, UK. Upon returning home, she served in HKL for 8
years and led the cancer genetic service in the Ministry of Health besides running other genetic and metabolic
services including combined specialties and specialized clinics focusing on cancer genetics, dysmorphology,
neurogenetic/neuromuscular, genetic-palliative and rare disorders. She has keen interest in mindfulness-based
therapies and their clinical application in supporting caregivers and patients with life-limiting illnesses. She also
promotes and empowers parent support/patient advocacy groups for rare genetic disorders which provide
important resources for families, genetic counsellors and medical/clinical genetic professionals.

Dr Ch’ng will talk on Supporting Caregivers Of Children With Metabolic And Genetic Disorders.

Abstract - Supporting Caregivers Of Children With Metabolic And Genetic Disorders.

The non-cancer group of children with life-limiting conditions (LLCs) who need palliative care include genetic
conditions or metabolic diseases, and data on this population are sparse. Genetic disorders are mistakenly
thought to be rare, hence labelled as ’rare disorders’ (RDs), estimated 7000 RDs worldwide. Collectively it affects 1
in 10 people, half of them are children and a third of them will not live beyond 5 years old. 35% of deaths occur
before one year of age and 65% of RDs is classified as serious and debilitating, associated with chronic pain and
occur before 2 years of age. Many end-of-life issues faced by those with life-limiting genetic disorders may be
common and unique to each.

The key aspect of end of life in genetic diseases is due to its heterogeneity with uncertain course of trajectory.
Pertinent factors which pose serious psychosocial issues for patients and families are foreknowledge of the
disease and its prognosis, potential for prenatal diagnosis, parental guilt regarding transmission, and rapidly
expanding understanding of genetics that influences treatment options and end-of-life decisions.
Understanding the challenging palliative care needs for caregivers/parents and how they cope prepare us in
formulating solutions to offer assistance. Increasing societal awareness through continuous education for both
public and health care providers through constant support and empowerment of patient advocacy groups are
paramount. The lack of inclusiveness and dearth of support for caregivers’ stress, spiritual and mental well-being
and grief management can be daunting. It is very necessary to balance hope regarding genetic advances with the
realities of genetic diagnosis and a more seamless approach needed to palliative care, that avoids unnecessary
conflicts between palliative care and life-prolonging.

30

Dr Shamini

Subramaniam

MD(CSMU), MMED Paeds (HUSM)

Dr. Shamini is a General Paediatrician currently serving in Hospital Teluk Intan. She has been having special
interest in children with special needs, hence serving in a few NGOs as a volunteer since a medical student. As
she was pursuing her postgraduate training, she has developed interest to serve children and family with
palliative needs and is keen to pursue subspeciality training in Paediatric Palliative Care.

Dr Shamini will talk about Identifying paediatric palliative care needs.

Abstract: Identifying paediatric palliative care needs

How do I identify which child needs Paediatric Palliative care and when is the right time to refer has been
challenging and needs regular clinical assessment involving multidisciplinary discussion while taking into
consideration the needs of child and family with palliative needs. Paediatric Palliative care can be incorporated
right from diagnosis in anticipation of life limiting conditions along with curative management.

31

Dr Yang Wai

Wai

BSc (UPM), M. Clin Psy (UKM), PhD (Melbourne)

Dr Yang Wai Wai began her clinical psychology training in the Paediatric Department of Universiti Kebangsaan
Malaysia Medical Centre (UKMMC) in 2003 and joined as a lecturer since 2006. She holds a BSc in Human
Development and Master of Clinical Psychology from UPM and UKM respectively. In 2018, she completed her
PhD at University of Melbourne, Australia exploring the use of emotion-focused parenting for parents of
children with chronic illness. While in Melbourne, she also trained at the Royal Children’s Hospital Psychology
Department and Victorian Paediatric Rehabilitation Services as part of her Master of Psychology (Clinical Child
Specialization). Currently Dr Yang has a broad-based clinical practice in assessments and interventions for
neurodevelopmental disabilities and mental health problems, as well as health-related thinking, behaviours and
emotions, in children and adolescents, as well as their parents.

Dr Yang will be sharing on two symposium topics: Siblings – Never Leave Me Out and Dealing with
Fear and Anxiety in Children.

Abstract 1 - Siblings – Never Leave Me Out

Families often focus on the sick child while their siblings tend to be forgotten or neglected. Parents may have
uncertainties and concerns about how to talk to and involve siblings about the diagnosis or life-limiting nature
of the illness, as well as difficulty supporting and caring for them at the same time. How siblings respond and
cope are greatly influenced by their age, developmental stage, personality as well as family, religious and cultural
influences in their lives. The unique bond and relationship that siblings share with each other means that their
perspectives and experiences are different from their parents and may impact the sick child and themselves in
many ways and for a
long time to come.

Abstract 2 - Dealing with Fear and Anxiety in Children

Fear and anxiety are part of normal psychological responses for both children and adult especially in situations
with high uncertainties or threat to existence. It plays an evolutionary role in the adaptation and survival of the
species. The developing nature of children means that they have a different capacity for understanding and
communicating about their thoughts and feelings. At the same time, they may utilize or require different coping
strategies.

32

Ms Ee Su Im


Dip Occupational Therapy, BSc(Hons) Applied
Rehabilitation (Occupational Therapy) (Teesside),
MMSc (UM)

Ms Ee Su Im is a senior occupational therapist with Tunku Azizah Women and Children’s Hospital, Kuala Lumpur.
She had previously worked in Hospital Permai, Johor since 1996 and Paediatric Institute, Hospital Kuala Lumpur
since 1998. She has contributed to two national clinical practice guidelines for the Ministry of Health for Autism
and
ADHD. She has also published and presented papers relevant to her field.

Ms Ee will be sharing about Occupational therapy role in facilitating participation in daily activities.

Abstract - Occupational therapy role in facilitating participation in daily activities

Occupational therapy practitioners play an important role in paediatric palliative care teams which enable people
to participate in daily activities to the best of their ability despite their condition, illness progression, activity
limitations or participation restrictions. Of primary importance, occupational therapy interventions help to target
a person’s ability to complete their self-care tasks such as showering, toileting and dressing; or their capacity to
transfer and move from A to B. Functional transfer seems to be a critical component in the domain of everyday
life for palliative
clients, especially those with mobility disabilities to participate in their chosen activities (e.g. increased
participation in self-care activities). A functional transfer is a method of moving a patient from one surface to
another, where the patient is capable of helping with the transfer and is able to bear weight on at least one of his
or her legs to perform basic daily activities. Without appropriate assistance, immobile individuals are
unnecessarily confined to their beds during their waking hours.

One of the most difficult skills to practice as a caregiver is transfer patient during daily activities. Common places
functional transfers occur: onto/off toilet, into/out of bed, into/out of a wheelchair, into/out of a chair, into/out of
a shower chair, and into/out of a car. There are different methods of transfer which can be used depending on
the extent of the patient’s mobility: stand-pivot, stand-step, sliding, bent-pivot, dependent and mechanical lift.
Helpful
equipment for transfers include sliding boards, walkers, grab bars, trapeze bars and various types of lifts. Patient
transfers are common ways that health care professionals and patient caregivers sustain injuries. It is important
to know proper transfer techniques to protect yourself, so that you can continue providing the best care possible
to your patient.

33

Dr Tan Ru

Wei

MBBS (IMU), MRCPCH(UK), Paediatrics Bioethics
(USA)

Dr Tan Ru Wei, currently working as the Resident Consultant Paediatrician in Columbia Asia Hospital -Klang. A MBBS
graduate from IMU in 2007, he went on to serve as a Houseman and Medical Officer in Hospital Melaka. He
received his MRCPCH qualification in 2016 while serving in Hospital Serdang. He then went to Hospital Sultanah
Nora Ismail, Batu Pahat. While there, he enrolled himself in the Certificate Program in Pediatric Bioethics, organized
by the Children’s Mercy Bioethics Center, Kansas City and completed the studies in 2018. Throughout his career he
had been actively involved in the advocating and providing paediatrics palliative care service. Apart from organizing
and providing the service in all the hospitals that he worked in before, he also served in different organizations
dedicated to PPC such as the KKM’s Task Force for the Development of PPC in Malaysia, and MAPPAC.

Dr Tan Ru Wei will be the Chairperson on Bioethics Discussion on Truth Telling.

Assoc. Prof. Dr
Erwin Khoo Jia Yuan

FRCPCH

Associated Professor Dr Erwin J. Khoo is a Consultant Paediatrician at International Medical University, a Director at
Baby and Beyond Child Specialist Clinic and the Executive Council Member of the College of Paediatrics, Academy of
Medicine of Malaysia. He was appointed the Medical Editor for NewParents, HealthToday, a print publication that
empower parents to improve child health outcomes by facilitating knowledge exchange and better decision-
making. Dr Khoo received the Young Investigator Award from the Perinatal Society of Malaysia in 2015. Till date, he
has over 20 publications and has given over 30 national and international scientific presentations. He is a keen
bioethicist and educationist. He now supervises postgraduate PhD and Masters students and is an elected
examiner for postgraduate paediatric trainees, while teaching undergraduate medical students. In 2019, Dr Erwin
Khoo was elected to Fellowship of the Royal College of Paediatrics and Child Health (United Kingdom) by the
authority of Her Majesty and Her Privy Council in recognition of his attainment of a high standard of education and
training and of his commitment to the health and welfare of children.

Dr Erwin will be one of the panellists for the Bioethics Discussion on Truth-Telling.

34

Dr Nicole Chen

Lee Ping

BCouns (UM), MCouns (UM), PhD Couns (UM), K.B., P.A.

Dr. Nicole Chen Lee Ping has been working as a counsellor and trainer since 2001 and have served in different
counselling settings in non-governmental organisations, educational institutions, and private counselling
centres. She is also a registered counsellor under the Board of Counsellors of Malaysia. After received a series
of specialised training which included Emotional Focused Couple Therapy and Family therapy training and
Nicole starts to be focused on supporting couples and families. She is currently a senior lecturer at International
Medical University and has more than 12 years of tertiary teaching experiences. She has published several
journal articles and has presented at national and international conferences. Her current research interests are
couple & family therapy, in human resilience, psychological healing, and women's issues. Since 2019,
she has been an active board member of the Malaysian Marriage and Family Therapy Association (MyMFT) and
has been appointed as the President of MyMFT (2021 – 2023).

Dr Nicole Chen will be presenting on the lecture entitled Family resilience in times of stress and transition.
Abstract - Family resilience in times of stress and transition
When any parent is caring for a sick child and expecting to prepare for the death of a child of any age is a
profound, difficult, and painful experience. The effects not only the child and the caregiver but the entire family
system. Many aspects will influence how couples and families cope with the experience. It often depends on
the background of the parents and other family members; the mechanisms for coping can vary from very
positive to very negative. In this session, Dr Nicole Chen will introduce the concept of Family Resilience in times
of stress and
transition and get to know how medical, healthcare and mental health practitioners can provide the support
needed from the discovery of illness to caregiving to the aftermath of the loss of the child.

35

Ms Nurhidayah

Rosli

Bpharm(hons) UKM

Ms Nurhidayah Rosli is a patient service-oriented pharmacist with 10 years working experience. She has a strong
background in clinical pharmacology and patient medication therapy management. She was a clinical pharmacist
in the Oncology Ward of Hospital Kuala Lumpur for 5 years. Currently, she is working as a senior pharmacist in
the outpatient pharmacy of Tunku Azizah Women and Children’s Hospital and also providing her expertise in
paediatric palliative care.

Ms Nurhidayah will talk about Medication Management.

Abstract - Medication management

Pediatric Palliative care is specialized medical care for people living with a serious illness. Palliative care focuses on
providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the child
and the family. Palliative care is appropriate at any age and at any stage of an illness. It is appropriate for neonates,
infants, children, adolescents, and young adults, and it can be provided along with treatment meant to cure. In
order to improve patient quality of life is by providing relief from the symptoms and stress of the illness. There are
two types of symptoms management, non pharmacological and pharmacological. Pharmacological treatment
means by using medications. Medications include prescribed medications, over the counter drugs and
complementary and alternative medicines such as vitamins, herbs and natural medicines.

Most palliative patient use more than one medication for their treatment. Use of an increased number of
medications is often associated with poor adherence, higher incidence of adverse drug reactions, sub optimal
prescribing and high health care costs. Medication management is the process of overseeing the medications
prescribed for a patient. Therefore medications management are vital to ensure they are taken properly and
achieving therapeutic outcome and reduce risk of medication error.The process includes initial and ongoing
medication review to address safety and adherence concerns, reduce adverse drug events, educate patients, and
engage patients and their caregivers. When implemented effectively, it is effectively reduce costs and improve care
for the patients.

36

Ms Elaine Teo

Chiew Yian


B.Nursing(Hons) (IMU), RN

Ms Elaine is a Palliative Care Practitioner, graduated from IMU with a Bachelor of Nursing (Hons). Her career in
palliative care started with Hospis Malaysia back in 2013 and she has continued her journey with ASSISS Palliative
Services (APS) from 2017 till date. ASSISS Palliative Services is under the umbrella of Assunta Integrated Social
Services (ASSISS). With their mission and vision of providing healthcare services to the poor, Elaine’s hope is to be
able to reach out to more patients living in the outskirts of the city and to continue promoting and providing
palliative care in our community. Being actively involved in clinical and operational tasks of APS alongside
teaching/training responsibilities in the Assunta College of Nursing as well as MAPPAC, Ms Elaine is pursuing her
Master of Counselling and looks forward to opportunities for continued growth and change in palliative care.

Ms Elaine will be sharing her experiences on My journey in community palliative care and Use of Syringe Driver.

Abstract 1 - My journey in community palliative care
“Just because my path is different, it doesn’t mean I’m lost.”
Everybody has their own story; everybody has their own journey. Some reveal it while others conceal it but to take
a different path, you have to believe it before you see it.

Abstract 2 – Use of Syringe Driver
A syringe driver is no stranger to symptom control and care at home especially towards the end of life. It is used to
deliver a continuous infusion of medications subcutaneously and this session will be Syringe Drivers 101.

Ms June Thow
Meei Jiun

B.Nursing(Hons) (IMU), RN

Ms June Thow has been working as a community palliative care nurse for 5 years with several NGOs. She has a
keen interest in teaching and research related to palliative care with the hope to expand knowledge and
awareness about palliative care in Malaysia. Upon graduation in 2013, she joined Hospis Malaysia and provided
care for patients requiring palliative care in their homes. Her experience with Hospis Malaysia allowed her to
develop valuable clinical skills as well as teaching others about palliative care nursing. In 2018, she joined Assunta
Integrated Social Services (ASSISS) Palliative Services where she contributes in nursing care, teaching, as well as
administrative responsibilities. She is also a trainer for the MAPPAC Volunteer Training Programme. Ms June is one
of the contributors to the Handbook of Children’s Palliative Care.

Ms June will talk about Wound Management.

Abstract - Wound management

Wounds such as pressure sores and fungating tumors are common among children in the palliative care setting

for various reasons and affect the patient’s quality of life. Hence, good wound care is essential to reduce pain and

other complications. Although some general principles of wound care apply to most wounds, the differences in the

wound etiology and the physiology of the skin in the child population cause the approach to wound management

for children to differ from adults. This session will cover the principles of wound care and the managment of

wounds commonly seen in the paediatric palliative care setting. 37

Ms Maggie

Nur Umairah

Diploma in Nursing (KKSP), Advance Diploma in
Palliative Care (ILKKM Ipoh)

Multilingual paediatric nurse with 7-year experiences in paediatrics nursing in multidiscipline ward including burn
unit, intensive care, neuro science, cardiology, general medicine. Currently, doing sub-specialty in paediatrics
palliative care. A caring, enthusiastic, well-motivated and confident professional who has a comprehensive
understanding of how to deliver high quality paediatric care to adult patients. She have extensive experience of
working with children of all ages and who suffer from many different conditions. Also, the passion to succeed, a
proven track record of achievement and knows exactly what it takes to make a difference. As a lifelong learner,
she did everything possible to keep up to date with the latest developments in paediatric care, hygiene and the
general profession. Right now, she is looking for more experiences and knowledge even chances in palliative care
which will allow her to develop individually and professionally.

Ms. Maggie will be giving a symposium lecture on Experience from the Advance Diploma in Palliative Nursing.

Abstract - Experience from the Advance Diploma in Palliative Nursing

Paediatric patients diagnosed with various diseases like cancer, neurological disorders and even rare disease like
genetic metabolic disorders require not only physical control of disease but also they need psychological
reassurance, social and spiritual support in coming to terms with their disease. Nurses working in the specialized
area play a significant role in the care these children. They must be knowledgeable, skilled and sensitive to the
needs of these patients and their families in order to provide active, holistic care. Nursing is the largest regulated
health professional workforce providing care in all clinical settings. Yet any nurses have received little or no
education about palliative care. Describes the role and responsibilities of advanced-practice nurses in palliative
care and nursing’s initiative in promoting high-quality care through the educational preparation of these nurses.

38

Dr Zubaidah

Jamil Osman

MA (UKM), PhD (Melbourne)

Dr Zubaidah Jamil Osman obtained her doctoral degree in Clinical Psychology from the University of Melbourne
in 2003. Her main area of interest is Chronic Pain Management – focusing on the psychosocial issues
experienced by patients as consequences of their persistent pain. She has been appointed as a Visiting
Consultant Psychologist in Hospital Selayang since 2006, where she works closely with the Pain Management
Team. She conducts psychological assessment on chronic pain patients and Pain Management Program
(MENANG), a self-help, psychoeducational, group-based programme using cognitive behavioural principles in
helping the patients to cope and manage their pain in a more holistic and effective manner, addressing
important issues such as depression, anxiety, cognitive distortions, self-image and interpersonal relationship with
others. She is actively involved in the education of pain management from non-pharmacological perspective to
other allied health professionals in Malaysia. Currently she is an Associate Professor in Clinical Psychology with
Cyberjaya University-College of Medical Sciences.

Dr Zubaidah will be giving a symposium lecture on Cognitive behavioural therapy for pain management.

Abstract - Cognitive Behavioral Therapy for Pain Management

Pain in children has not been widely studied and often being most misunderstood, under diagnosed, and under
treated/untreated medical problems. Pain is defined as a sensation involving both physical and emotional
experience perceived and processed by the brain; and it is a regarded as a health problem as well. Each child has
different pain perception, and the meaning of pain is also different from child to child. The goal of treatment is to
decrease the intensity of pain and make the child feel better. For acute pain, this goal is often met successfully.
But chronic pain, i.e., pain lasting for at least three months or more; it has a different effect on the nervous
system and needs to be treated differently. Perhaps it is one of the most difficult challenges professionally. This
session will discuss non-pharmacological approaches that we can employ in helping children to manage their
pain better. A case study will be illustrated, presenting different ways of managing the case involving a multi-
disciplinary team. This include engaging parents by educating and managing their own anxiety, cognitive
behavioural techniques aiming at getting the children to go back to school and socialise with their friends,
continue their hobbies as well as engaging in sports activities. All this will be done in a gradual manner, guiding
the children to manage their pain-related cognition that provokes anxiety and continue to focus on reduce
disabilities and improving their functioning.

39

Ms Lim Kar

Gee

BA Music Therapy, MA Music Therapy, Music Therapy
Board Certification (CBMT)

Lim Kar Gee, MAMT, MT-BC, is a music therapist registered with the Certification Board of Music Therapists
(CBMT), USA. She holds a Master of Arts in music therapy from St. Mary-of-the-Woods College, Indiana and a
Bachelor of Arts in music therapy from University of Miami, Florida. She also obtained Music and Imagery
trainings from Anna Maria College, USA. With over 20 years of experience in music therapy, Kar Gee currently
works with adults suffering from stroke and traumatic brain injury at SOCSO rehabilitation centre in Malacca.
Besides, she also works with psychological challenges and those who are seeking for personal growth at Enrich
Counselling and Therapy Centre in Selangor. Previously, Kar Gee worked mainly with children with cancer at
Universiti Malaya Medical Centre and children with special needs. Kar Gee was a part-time lecturer in Taylor’s
University, Universiti Kebangsaan Malaysia, University Putra Malaysia, and New Era College. As one of the
pioneers in music therapy profession in Malaysia, Kar Gee is often invited to conduct workshops, seminars, and
trainings at conferences. She was also invited by Ai FM (a local radio station) regularly as a guest speaker.
Internationally, Kar Gee worked as a music therapy practicum supervisor and a guest lecturer in Central
Conservatory of Music in Beijing, China.

Ms Lim will be sharing in a symposium on Music Therapy for Pain Management.

Abstract - Music Therapy for Pain Management

Music therapy is a clinical use of music interventions conducted by a qualified music therapist to help individuals
in accomplishing goals in physical and/or mental health. Music as a medium, may be used as a distraction or a
guide for concentration, to facilitate relaxation process while reducing both anxiety and stress, so as to alleviate
pain and discomfort.

40

Mr Raymous

Wong Choon Yong

Mr Raymous Wong is an art therapist with many years of working experience in private practise with children and
adults. He is a registered art therapist with Taiwan Art Therapy Association (TATA) and has served in welfare
organisations in Taiwan and Malaysia. He also has 15 years of experience as an Art Director / Branding Designer.
His expertise includes art therapy for special children and adolescents, body emotions exploration, grief and loss
support, self-awareness and self-care process-oriented art. He also co-authors “From encounter to healing : The
Art of Self Care “ (2019)

Mr. Raymous Wong will present Communication through art.
Abstract - Communication through art
The therapeutic essence of art can be traced back to the prehistoric times. In cave painting, they use pictures to
describe what they see and hear, or use symbolic images to express their awe or belief in the mystery of nature
and the universe, so as to explore their relationship with the environment at that time, and find the meaning of
existence and the power of life. Therefore, the paintings in the cave, hieroglyphs, pottery and symbols on
clothing are all used to express people’s exploration and thinking of life, as well as to promote their
communication. Back to the society today, art making has been used as a treatment method, a symbolic,
nonverbal communication medium between patients and therapists. Especially when children are in the
developmental stages and their language ability is still developing, it may be difficult for them to use language to
express. When the ability of language expression fails, art therapy which is easy and brings pleasure through
painting and sculpture will be useful, and the effect may be more efficient
than that of verbal therapy.
There is a saying: a picture worth a thousand words, that’s because art can get ideas across using a different kind
of vocabulary. Some people respond better to visual images than words. For example, the usage of colors, lines,
o images to express the inner emotions and stories of a case. Children who may not be able to articulate
thoughts, sensations, emotions or perceptions, it makes sense that children pursue different means of
communication, especially when words aren’t effective, art expression is a form of non-verbal communication.

41

Joanne Lau Lee

Bin

Joanne Lau graduated from China Conservatory of Music, Beijing with a bachelor’s degree in Music Therapy. She
was certified as a practicing music therapist by Chinese Professional Music Therapist Association (CPMTA) in
2017 and is now a member of Malaysia Music Therapy Association (MMTA). She also underwent training in music
therapy for palliative care and geriatric hospice care. Since 2018, she conducts group music therapy at multiple
schools of special education. She also conducts one-to-one therapy sessions at two music centres. In 2019,
Joanne carried out her first workshop titled “How music therapy helps cancer patients to release stress, pain and
insomnia” in
Kuching, Sarawak. Since early 2020, she has started providing music therapy services for Paediatric Palliative
Care Unit at Hospital Kuala Lumpur.

Joanne Lau will talk on Communication Through Music.
Abstract - Communication Through Music
Joanne Lau will introduce you to the world of music therapy within this 25 minutes. You will spend most of the
time experiencing music therapy activity that she designed. The theme of her music activity will only be
announced on the event day. You can expect playing with different music instruments and collaborating with
group members with the ways of music e.g. rhythm, singing, body percussion and etc. which could be used for
communication.

42

Dr Sujatha

Doraimaniackam

MBBS (Kasturba), MPH (UM), MSOH (UM)

Dr Sujatha has more than 20 years of extensive experience in various fields under the Ministry of Health in
leading, strategizing, developing, implementing and reviewing occupational and safety health management plans,
occupational health and safety plans. This includes preparing, implementing plans, strategies for the safe and
suitable disposal of medical waste. She also involves in advising on and enforcing legislation, implementing
prevention programmes and strategies for communicable diseases and food safety. From 2017 onward, she has
been actively promoting wellness programme in collaboration with Osai Foundation. She was involved with the
Little Theatre Chennai which has been invited to perform in Malaysia to raise funds for the Child and adolescent
Unit, Department of Psychiatry and to conduct workshop for hospital clowning and drama workshop. This
focuses on helping children overcome the stress of schoolwork through high quality theatre productions and
creative workshops.

Dr Sujatha will be giving a symposium lecture on Creative drama intervention.

Abstract - Creative drama intervention

Therapeutic intervention began with drama in an interactive, creative process which will be used in a variety of
settings. The use of theatre techniques is to facilitate personal growth and promote mental health. This field is
expanded to allow many forms of theatrical interventions as therapy including role play, theatre games, mime,
puppetry and other improvisational techniques. This workshop improves verbal and non-verbal communication,
social and interpersonal skills and impulse control. It is not just a treatment but as an economically viable and
valuable preventive intervention.

43

Chris Ng


BA (English Literature) (UM), MA (Theatre and
Drama) (Manoa), Cert Expressive Arts
Therapies (Australia), Dip Practice Based Play
Therapy (UK), Dip Skills-based Competency in
Drama Therapy, Dip Neuro Dramatic Play.

Chris Ng is an educator, a trainer and a play therapist. He works primarily in the area of education, child
empowerment and healing. He has worked in the area of HIV/AIDS and Child Protection. He has developed
projects
and trained for the Malaysian AIDS Council, UNICEF, Selangor Welfare Council, Childline Malaysia and national
cancer Society. He focuses on the area of training child advocates, parents on positive parenting, mental well-
being for adults and children as well as developing programmes via the creative arts. After more than 20 years of
NGO-based work, Chris returned to full time work firstly as the Artistic Director of Pusat Kreatif Kanak-kanak
Tuanku Bainun (2015 – 2016) and then as the Artistic Director/ Head of School of Hijau Educare Sdn. Bhd (2016 –
2018). Chris holds a Masters in Arts (Theatre and Drama) from the University of Hawaii at Manoa, a Bachelors of
Arts (English Literature) from the University of Malaya, a Certificate in Expressive Arts Therapy from the Institute
of Expressive Therapies, Australia, a Diploma in Practice Based Play Therapy from Canterbury Christchurch
University, UK and the Diploma in Skills-based Competency in Dramatherapy. He has also completed the course
work for the Diploma in Neuro Dramatic Play.

Mr. Chris Ng will deliver Communication through play therapy.

Abstract - Communication through play therapy

In the midst of a pandemic, we learn a new catchphrase - “a new normal” which we grudgingly adjust our lives to
comply. Many resist. Then we have a child diagnosed with a serious illness. What then is his new normal? How
does he cope with multiple and prolonged treatments, hospitalization, disruption to life as he knew it, the slow or
sudden deterioration of his physical abilities and sometimes the dark shadow of death? We play because play
remains the most natural medium for a child to communicate his understanding of the world he lives. It allows
him opportunities to talk about his life as he experiences it albeit via metaphors. Play allows him a control over
his life in which reality does not. Play helps the child makes sense of his situation and the circumstances he is in
and helps him externalise his frustration, his fears and his feelings. While not all children with terminal illnesses
need play therapy, but they do need play that is the foundation of play therapy. The added therapeutic value
helps towards normalizing life in the new normal and contributing to their emotional well-being. Above all, the
stories they tell through play reinforce the importance of play.

44

Ms Lee Voon

Yee

M. Clin Psy (UKM), Postgraduate Cert Therapeutic
Play, MSCP, PTI

Ms Lee Voon Yee is a clinical psychologist serving at UKM Medical Centre and Dr Yeoh and Dr Hazli’s Specialist
Clinic. She worked in Child & Adolescent Psychiatry unit, UKM Medical Centre from 2012 to 2019. She
obtained her Master of Clinical Psychology from the National University of Malaysia in 2011 and Bachelor
Degree
in Psychology from UCSI, Malaysia in 2007. She just completed her Postgraduate Certificate in Therapeutic Play
in 2018. Voon Yee has been working with many children and adolescents on a broad range of
neurodevelopmental, behavioural and emotional issues, such as ADHD, depression, anxiety, trauma, grief and
others. From 2007-2009, she worked as a coordinator in Kasih Hospice, Petaling Jaya. She provided emotional
and social support to individuals who suffered from terminal diseases, their families and the organization’s
volunteers as well. Her own journey of love and loss experiences nurtures her interest and passion in grief and
trauma works. She has been offering psychotherapy, such as Behavioural Therapy, Expressive Art techniques
and others to individual, parents and families. Voon Yee is a member of the Malaysian Society of Clinical
Psychology (MSCP) and Therapy International (PTI, UK).

Ms Lee will talk on Dealing with grief and bereavement.

Abstract – Dealing with grief and bereavement

Change and loss is unavoidable in life. We all go through such periods in our lives, for example, starting a new
job and losing a relationship. Sometimes, change brings along stress when it is associated with unpleasant
events such as losing our loved ones. It is very hard to say goodbye to someone we care about. Grief is a natural
response to loss and it is an individual experience; there are no standardized coping strategies. Grief often
seems overwhelming, the tears, sadness, and pain make mourning an exhausting process. As we work through
these difficulties feelings, healing begins. Since grieving a loss is inevitable, there are many constructive ways for
us to express and cope with it; and eventually we will pick up the skills and move on with life. This session
highlights the following:

1) Understands the complexities of the grief and loss process.
2) Highlights the psychological needs of the grieving person and the health care professionals.
3) Offers strategies to help children and adults cope with the death of their loved ones and work through their
grief in meaningful ways. For instance, journal writing, create a loving memories box and etc.
4) Recognizes our own personal fears and anxieties and be aware of 3 golden rules for self-care.

Last but not least, self-care is an essential component of everyday life. Research suggests that the more we
practise self-care, the more confident, creative and productive we are in dealing with daily challenges. Thus,
virtuous mental, emotional and physical health facilitates the healing process.

45

Mr Teoh Teik

Hoong

Mr Teoh is a career journalist by profession having spent more than 30 years in the field of journalism and
environmental conservation. He is now the owner and managing editor of Subang Jaya’s Community
Newspaper – SJECHO. Back in 2007, Teoh combined his efforts with like-minded individuals to set up the
Children’s Wish Society of Malaysia, a national charity that focuses on fulfilling wishes of terminally ill children
across the country. As a founding member, Teoh has shouldered many positions and roles in the society; the
last being as Vice-President before taking over the reins as its President. Juggling between full-time
employments and managing CWS Malaysia, he admits that at times he finds that coordinating efforts to race
against time to fulfill wishes seems to be more of his full-time commitment.

Mr Teoh will talk about Wish Fulfillment.
Abstract - Wish Fulfilment
FULFILLING wishes for ailing children across the country is a race against time for the Children’s Wish Society of
Malaysia. The society is totally run by members of a board consisting of volunteers and it has no full-time staff.
The board consists of several medical practitioners in palliative care who serves as medical advisors; and
volunteers who are spread out across the country.CWS Malaysia fundraises to finance its wish fulfillment
mission. Over the years, the society organised an annual Jom Durian event (touted to be the biggest charity
durian fest in the country) tofundraise for its work. Fundamentally, the society’s success in fulfilling more than
1,500 cases since its inception is attributed to the good partnership with doctors and nurses in government
hospitals across the country. Working hand-in-hand with medical practitioners in hospitals, the society plays its
part when deserving cases come to its attention. Racing against time for end-of-life patients, CWS tries its best
to fulfill wish within a minimum of 24-hours from receiving the case. In our brief session, we will present a quick
video of our work over the years.

46

Mr Brandon Ho


CMT, IACT (USA), Certified Clinical Hypnotherapist
ACHE (USA)

Brandon Ho founded Ultimate Training Sdn Bhd and Ultimate Performers Sdn Bhd. He specialises in personal
development and language training. He formulates and conducts programmes for working adults as well as
students. His clients come from diverse backgrounds and countries. Using concepts of NLP and Hypnotherapy,
Brandon has created high- impact programmes that not only educate the participants but also to inspire them
to be the best that they can be. Brandon is a Practising Member of AHPM (Association of Hypnotherapy
Practitioners, Malaysia), the peak body for hypnotherapist and other mind science practitioner in Malaysia. He
also conducts training workshops in his centres in Sunway and Dataran Mentari.

Brandon Ho will be sharing on Hypnotherapy for Pain Management and Hypnotherapy for Grief Support.

Abstract 1 - Hypnotherapy for Pain Management

Pain is real and can greatly affect the quality of life of the person suffering from it. Imagine facing the pain alone
and feel if as it consumes the person, physically and mentally. Besides medication, is there any other options?
The mind is a powerful tool and has not been fully utilized. If pain comes and goes, does it mean that it is
absent, or is the mind distracted that it doesn’t feel it. Many have reported that pain subsides when the person
is focused on other things. The mind has the capacity to do this and hypnosis can help the person manage pain.
Hypnosis is not about making a person not feel pain, but rather help to manage the fear and anxiety a person
feel related to that pain. It also relaxes the person while redirecting attention away from the sensation of pain.
To achieve this, hypno-analgesia, relaxation techniques, mental imagery for disassociation can be used, either
on its one or in combination. This talk will focus on: what is hypnosis and what it is not, how it helps manage
pain, who benefits from hypnotherapy for pain management, self – hypnosis, self hypnosis can be taught to
anyone who wants to use the power of their mind to have more control over their pain or just for relaxation
from the stress they face.

Abstract 2 - Hypnotherapy for Grief Support

.Grief is a natural process and symptoms may vary from person to person. When faces with the loss of a love
one, the journey can be filled with sadness, regret, shame, blame, anger and many other emotions. The process
can be long, lonely and painful, but it is a normal and necessary process. How can we help someone in grief. We
can provide comfort and support but is this enough to help the person go through the process and recover
from grief? Hypnotherapy helps to manage grief by allowing the person to see the reason behind their grief and
give a new meaning to what there are feeling. We cannot change what happened but we can definitely help
change the thought process around the experience. By accessing the subconscious mind, the person can revisit
the memories to gain insight into the experience and learn appropriate ways to deal with it. Hypnotherapy helps
the person to access the subconscious and reprogramme how the person deal with the loss move forward in a
more positive way.

This talk will look into: 1) what is grief? 2) How hypnotherapy work in grief management? 3) Simple techniques to
calm the mind

47

Ms. Fatimang

Ladola

Fatimang Ladola obtained her qualification in human development from the Universiti Putra Malaysia.
Subsequently she received her continuing education in medical social work from Universiti Kebangsaan
Malaysia in 2008. She is a senior medical social worker at the Department of Medical Social Work at the
University Malaya Medical Centre (UMMC). She is already 24 years with UMMC, serving in various departments
including Medicine, Primary Care Medicine, Orthopaedic, Obstetrics & Gynaecology and Paediatrics.
Having worked in the medical social field for many years, she has acquired an extensive knowledge on issues
related to the medical social particularly on children and their families facing chronic, complex and/or life-
threatening conditions. She also teaches part time at the Department of Administration and Justice, Faculty of
Arts and Social Sciences, University of Malaya.

Ms. Fatimang will be giving symposium lectures on Medical social worker’s role in psychosocial support and
Psychosocial needs assessment by medical social worker.

Abstract 1 - Psychosocial needs assessment by medical social worker

Children and their families with life limiting and/or life-threatening illness can experience extreme psychosocial
issues and challenges, including depression, anger, and anxiety, intense physical pain or discomfort, financial
strain, social isolation; and family conflict. For these reasons, a worker’s participation is not an easy task and
can only be done by individuals with high attentive and caring characteristics. Social workers are specially
trained professionals to guide patients and families in navigating the many challenges and pitfalls as well as
advocates and bring depth of knowledge about available resources. The social workers understand patients’
treatment plans and more importantly understand patients’ and families’ needs in the aspects of physical,
affective, social, cognitive and spiritual. Social workers work well in multidisciplinary team because they
understand and complement each other’s roles. This paper will share the experiences of social workers in
fulfilling responsibilities in handling palliative cases at UMMC including conducting psychosocial assessments,
coordinating care, providing counselling and psychotherapy, intervening in client crisis situations, and
educating patients and families about their treatment plan and the available resources and
support systems.

Abstract 2 - Medical social worker’s role in psychosocial support
Palliative care aims to give a better quality in a patient’s life. However, many aspects of needs and impact of
life-limiting disease conditions may not be noticed and dealt with, thereby giving rise to a more complex
situation than the disease condition itself. It affects not just the patient but also family members and other
caregivers, producing great degrees of psychosocial distress. Assessment plays important role to help social
worker understands the situation that a client is dealing with. Effective assessment is an inclusive process that
is ecological, scientific and artistic, sensitive to client/system diversity and an ongoing source of feedback. The
ecological perspective helps social worker do complete assessment possible into the many interrelated factors
associated with any particular client. It is also associated with the five dimensions of human development
(physical, affective, cognitive, spiritual, and social). Instead of considering only problems, a social worker helps
identify client’s unique set of developmental strengths and limitations, in which client experiences most or
minimal confident, success and enjoyment. This paper aims to review elements of effective psychosocial needs
assessment by medical social worker in this field to achieve better practice.

48

Ms Low Mi

Yen

Ms Low Mi Yen is one of Malaysia’s foremost proponents of the application of psychology and mindfulness for
individual, couple, family, workplace and community. She has more than 25 years of experiences in clinical
psychology and workplace behavioural health and productivity through Employee Assistance Program (EAP)
which
she pioneered in Malaysia, 1999 at Motorola and written 2 articles on EAP Development in Malaysia for an
international publication. Since 2005, Miyen is in private setting providing EAP, corporate training, leadership
coaching, change and transition management, crisis intervention, psychotherapy, psychological assessment,
lecturing and supervision. She has delivered more than 1000 programs over the years for a wide range of
organizations in Malaysia, Singapore, Philippines, Taiwan and Hong Kong. Miyen has professional membership
in Malaysian Society of Clinical Psychology (MSCP) and Employee Assistance Professionals Association (EAPA);
currently a board member of Asia Pacific Employee Assistance Roundtable (APEAR) and Vice-President of
Malaysia Association for Mindfulness Practice and Research (MMPR). In recent years, Miyen focuses on
enhancing wellness, self- resiliency, managing challenging relationships, stress and burnout among working
population. Over the years, her work has been featured by various local newspapers, magazines, TV and radio
including being a regular
guest for 4 years on Bella NTV7.

Ms Low Mi Yen will talk about Compassion Fatigue, Burnout and Self Care.

Abstract - Compassion Fatigue, Burnout and Self Care

Compassion fatigue and burnout are considered occupational hazards for most of us attending this conference
- palliative care and medical professionals, mental health professionals including family caregivers whose “job” is
providing full-time care for a loved one, thus also susceptible. Why? Because most of us are very loving, caring
and compassionate toward others but not towards ourselves. The research data from Dr Kristin Neff, co-
founder of Mindful Self-Compassion and Dr Marissa Knox, University of Texas (2016) has shown that 78% of
people are more compassionate towards others, only 6% are more compassion to self than others and 16% are
compassionate to self and others equally. This imbalance can have negative impact to one’s psychological well-
being especially “losing self” (lack of self-care and self-compassion). Thus learning how to “Love others without
losing yourself” have become critical life skills for us to learn especially when we understand the complication of
compassion fatigue and burnout. Compassion Fatigue is when someone who regularly hears/witnesses very
difficult and traumatic stories begin to lose their ability to feel empathy for their clients, loved ones and co-
workers. The symptoms presenting either behaviourally, emotionally, relationally, physically and spiritually and
sometimes compassion fatigue is misdiagnosed as depression. Where else, is the extreme end of compassion
fatigue is burnout, defined as a prolonged response to chronic emotional and interpersonal stressors on the
job, and is defined by the three dimensions of exhaustion (overwhelming exhaustion), cynicism (cynicism and
detachment), and inefficacy (a sense of ineffectiveness and lack of accomplishment). Saakvitne and Pearlman
(1996) identified four areas important for prevention of compassion fatigue and burnout - professional,
agency/organization, personal and general coping strategies. In this brief presentation, we will focus on personal
strategies - developing early warning system for self, cultivating self-care and self-compassion in our life.

49

Parents/patient

1 Ms Yap Sook Yee
2 Mr. Muhammad Ashnawi Azmi
3 Pn Suriyati Mahat
4 Puan Lini Ismadi

50