Hailing from a Dylan Thomas-like diminutive, unassuming, “ugly, lovely” former coal mining village in South Wales, UK – whose inhabitants routinely greet friends and strangers alike with a warm, embracing “Morning!” couched in a melodious Welsh lilt – I could be more readily forgiven for small-town parochialism than any meaningful participation in a global dialogue.
But we live in an era where paradigm-like advances in ICT – social networks, video conferencing, Skype and the ubiquitous internet – and air travel mean that which was once distant and burdened by time constraints is now neither. Our traditionally relatively isolated existence is no longer; we are integral citizens of the burgeoning, interconnected global village. People, their customs and cultures are ever more tangible, impacting upon our everyday lives as never before. I, as do we all, need to be not only aware of this changing, contracting landscape but actively engage with it, too.
And yet often we do not. Genuinely understanding ‘the other’ is a process many do not wish to contemplate. Watching events unfurl in far-off international lands through the comforting, reassuring prism of a CNN window is, of course, much easier to manage, intellectually and emotionally. We observe passively, convinced that we are cognisant of the looming worldwide village that somehow lies ‘out there’, in some indeterminate place in space. We do not engage with what that world could offer us, its insights garnered from human stories and experiences that can add value to our interpretation, understanding, and appreciation of our own world, as well as nurture a meaningful empathy for the lives and beliefs of others.
Palliative and spiritual care
Palliative and spiritual care are cases in point. In the US palliative care services are at the forefront of provision globally in terms of its bio-medical understanding of advanced, progressive illnesses and access to the technology capable of addressing them in the early phases of the diseases’ trajectories. Spiritual care, whilst not embedded in palliative care as it should be currently, plays a central role in numerous hospitals, with many services administered by Board-certified chaplains.
But neither can claim to be the unquestionable font of all relevant knowledge in their fields. Patients seen today reflect much more diverse socio-demographic, ethnic and cultural backgrounds than ever – and will continue to do so as the global village becomes more evident.
Worshipping at the feet of the gods of medical technology when cure is an unrealistic option is misplaced; understanding human needs at times of potentially great distress and how they can be addressed effectively before death is imperative. Identifying the humanity in all of us and understanding what that is comprised of among ‘the other’ is critical in this respect.
And this receptivity may indeed be foisted upon us. In the US, for example, one of six projected changes to healthcare provision is the deinstitutionalisation of acute care services (1). Now I am not contending that US health providers, including chaplains, will learn anything new regarding, for example, digital medicine technologies from a home-based care team in rural Africa. But how, for example, US professionals deal with this new landscape, providing meaningful engagement and therapeutic support as part of functional, multi-disciplinary teams to those located over a geographically dispersed setting, could benefit from insights gleaned from those countries where community-based models of care provision exist.
Put simply, we need to adjust our collective focus, look to the horizon rather than our doorstep, and open our eyes to the world that lies beyond whatever signpost stands at the end of our streets. We need to be willing and eager to learn from others, be receptive to their experiences and approaches to life and healthcare, and not consider ourselves the custodian of knowledge per se but simply the caretaker of minutiae insights that can be augmented by those from others.
Three key works
In this regard, and in 2014 alone, there have been three notable publications indicating a growing momentum for a global appreciation of spirituality in the health sector.
First, an edited compilation by Yale University’s Mark Lazenby et al (2) highlights perfectly the rich, layered and nuanced understanding of death and end-of-life care from multiple spiritual traditions, academic and provider perspectives and geographies, from the US to Africa.
Second are the deliberations undertaken at two conferences: Creating More Compassionate Systems of Care (held in November 2012) and On Improving the Spiritual Dimension of Whole Person Care: The Transformational Role of Compassion, Love and Forgiveness in Health Care (January 2013) (3). As part of the latter meeting, attended by 41 participants from multiple economically developed and developing nations, an international definition of spirituality was agreed that was supplemented by a consensus need for a global spiritual care agenda whose areas included clinical care, education policy/advocacy, and research, among others.
Third, and as a starting point in developing a research platform to begin to implement this worldwide agenda, the establishment by respondents from 87 countries of internationally agreed research priorities for spiritual care in palliative care among clinicians and researchers. (4) These included: (i) development and evaluation of conversation models and overcoming barriers to spiritual care in staff attitudes; (ii) screening and assessment, and; (iii) development and evaluation of spiritual care interventions and determining the effectiveness of spiritual care.
Seeing with new eyes
Of course, it is not guaranteed that diversity of experience results in enhanced understanding. To continue the opthamological analogy – those with a tunnel vision of life will see only a narrow depiction of it, irrespective of their immediate surroundings. But I am reminded of the quote by Marcel Proust, the French novelist, who observed “the real voyage of discovery consists not in seeing new lands but in seeing with new eyes”. We should ensure those eyes aren’t myopic.
Richard A. Powell MA, MSc, is a consultant to the HealthCare Chaplaincy Network and living in Nairobi, Kenya
PO Box 459-00621, Village Market, Nairobi, Kenya
Skype: tony.powell3639 T: +254 (0)725 709 104
This post first appeared in PlainViews, a publication of HealthCare Chaplaincy Network and we are grateful for permission to reproduce it here.
1. Emanuel E. Reinventing American health care: how the Affordable Care Act will improve our terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error prone system. New York: PublicAffairs, 2014.
2. Lazenby M, McCorkle, R, Sulmas DP. (eds.) Safe passage: a global spiritual sourcebook for care at the end of life. New York: Oxford University Press, 2014.
3. Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: reaching national and international consensus. Journal of Palliative Medicine 2014; 17: 642-656.
4. Selman L, Young T, Vermandere M, Stirling I, Leget C; Research Subgroup of the European Association for Palliative Care Spiritual Care Taskforce. Research priorities in spiritual care: an international survey of palliative care researchers and clinicians. Journal of Pain and Symptom Management 2014 Mar 27. pii: S0885-3924(14)00047-5. doi: 10.1016/j.jpainsymman.2013.10.020. [Epub ahead of print]