Dying at home: The experience of four villages in northeast Thailand

In Thailand, increasing numbers of people are expected to die at home as the HIV/AIDS epidemic progresses, but there is little information about the issues surrounding death and dying. This study, conducted in 1994, used qualitative methods to describe the health care patterns, diagnosis, treatment and care of terminally ill people in four rural villages in Khon Kaen Province. The study population included caregivers, biomedical workers, traditional healers and Buddhist monks. Although patients died of cholangiocarcinoma and chronic disease other than HIV/AIDS, the study provides a general model for the home care of terminally ill people in Northeast Thailand. In a context of rapid social and economic change, traditional caregiving roles have altered and biomedical theories replace beliefs about the causation and treatment of disease. Traditional healers and monks are now consulted only if biomedicine does not provide a cure.  The health system and its referral systems are poorly understood by village people. Once a diagnosis of terminal disease is made, people are discharged to die at home, where care is provided in a traditional way, with ample psychosocial care from family and community, but few inputs from the health service. Pain control, medical aids, financial help and caregiver support are not available. Traditional healers are consulted during end-stage illness for diagnosis, treatment and palliative care.