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www.AIDS-HOSPICE.com

Introduction. (traduction française)

This website is designed to assist, and draw on the experience of, those responsible for medical care in an AIDS hospice environment without access to morphine, X-rays or lab exams. People working in such an environment know that in this kind of hospice many patients cannot be considered as "dying patients.”  In practice, we often observe that with only basic treatment and support, "dying patients" will be "revived" for months or years more life. How do patients arrive then at our hospice?  Sometimes apparently "dying patients" may arrive and be treated successfully, but once "revived" they cannot be sent elsewhere because of social/family/cultural/logistical reasons.  Sometimes they arrive "by mistake.”  Sometimes the "collective hysteria" about HIV appears to be the main reason for their arrival at the hospice.  Another reason why patients may come to our hospice to die is the prejudiced or even cruel attitudes in some general hospitals.

Without lab test results, X-rays or comprehensive referral letters from the hospitals that send us patients, we are never really sure about the accuracy of our diagnosis.  Sometimes we "kill" men, women and children if we decide to give only "supportive care", ignoring the fact that an easy and cheap treatment may be available. 
Therefore we believe that for hospices such as ours it is not good medicine or ethical medicine to limit ourselves to exclusively palliative protocols. It is important to mention that, in practice, without morphine (and even with!), the concept of "PALLIATIVE CARE" is not an operational one.  Shall we accept cataclysmic diarrhea, horrible headaches of curable brain diseases or the slow evolution of a curable shortness of breathing just because we have decided that an anti-retroviral therapy is not indicated anymore?  The people who say "YES" are office workers, not health workers..  "Palliative care" should include some curative treatments... and palliative care for dying AIDS patients needs specific protocols for specific situations -- such protocols/diagnosis are the primary subject of this website. We have had to make specific protocols for our needs.  In designing these protocols, we have also had to take into consideration the low level of organization of the ward, the fast turn-over of workers, the scarcity of assistant-nurses and their difficult time-tables... Our protocols also work within the constraints coming from local customs that Westerners do not always understand and that often scare off prospective support from NGO's. 

Sometimes for months on end there is no doctor visiting the ward. The protocols are supposed to be not too complex for clever "assistant-nurses" who have some experience of making ward rounds with a doctor and who are capable of using initiative.

Finally, our protocols are suffering from lack of specific theoretical knowledge.  The site has been created with the purpose of obtaining suggestions and corrections.  The protocols are regularly updated by new finds and/or advice from visitors of the site and/or by specific literature (which is unfortunately very scarce for information on operations without lab tests or X-ray).  More than "moral support," technical remarks, advice and suggestions are welcome.  Please use the e-mail link on the bottom of each page

A note about the drugs:

Some of our protocols use quite expensive drugs: fluconazole, gentamycin, ciprofloxacin... We prioritize these drugs because, more than others, their curative and palliative merits make them cost effective. 
There are some important drugs we are unable to use: morphine, amphotericin, clarythomycin.... These drugs are unavailable for logistical, legal, technical or economic reasons. Any doctor would be able to suggest alternatives to drugs we use in the local context. But a doctor must also consider the local organization, staff training, possibility or not to inject, etc.  The main point of the site is less to suggest treatment than to try to find easy (and cheap) ways to make useful diagnosis for "terminal patients".

ARV?

Since September 2003, we initiated as much as possible "Anti Retro Viral" (ARV) treatment for our patient because Thailand started to produce cheap generics AND accept to assume financial and technical support for compliant patients. We introduced a few pages on the topic, targeting the needs of health workers without hospital facilities.

paul yves wery (M.D.)

Juridical and administrative notes

• "Aids-hospice.com" works without any financial support. There is not any bank account associated with this site, and we have never asked for any donations from any visitors to the site. We mention this because a part of the site has been copied, without permission, onto another internet site. On that website, the stolen pages are associated with the name of an association and a bank account, and they ask for donations." We are shocked that this terrible sort of betrayal of trust has occurred.

• There is no financial contract between the webmaster and Wat Phrabatnamphu (the AIDS hospice). The webmaster offered his services there as a volunteer. After two years of volunteering, enriched by the amazing experience, he started to create this website with the intentions described in the welcome pages of "Aids-Hospice.com." He informed the administration at Wat Phrabatnamphu and they didn't express any objection to the project.

• No photos may be copied without the agreement of the webmaster. The medical photos were ALL take with the agreement of the hospice AND the concerned patients. The photos have been taken so that patients can NEVER be recognized, as the medical ethics dictates for all medical publications. All these photos (unless explicitly stated otherwise), are the full property of the webmaster. For legal and technical reasons the webmaster places the photos on the site only after resampling and irreversible compression (jpg). This avoids any debates concerning ownership; he is the only one who can produce these photos in high resolution and optimal quality. (Note also that the photos on the site are not adapted for printing because they are optimized for internet and monitors).

• In the non-medical section of the site ("virtual visit of hospice"), there are 3 dead children whose identities could (by long and difficult research) be known. They were the friends of the webmaster. He decided to publish these moving photos because they honor these patients, and these photos give to the dead children the power to touch us and to stimulate us to better things... The pure intentions with which he made this decision are his arguments in defense against those who criticize him.