mardi 9 septembre 2014

SPIRITUALITY IN HEALTH CARE: WHAT I LEARNED FROM CANCER PATIENTS

Spirituality in Health Care

Healing versus Curing
Quality vs. Quantity
How many vs. how much
In treating Cancer,
How long is the survival? Rather than how good is the quality of survival?
I will begin with a case history
Many years ago when I was a Fellow in Endocrinology, I was very nearly killed by the negligent medical care given to me at a small private hospital by an incompetent physician. A good friend of mine at that time, Mrs S, saved me by signing me out against medical advice and taking me to the teaching hospital at the middle of the night, where proper attention took care of the metabolic problem.
From that day onwards, she was my sister, since that is what she told the private hospital, when signing me out.
Many years later, she had breast cancer and with careful therapy and follow up, she became free of that disease. Imagine all our sorrow and surprise when a large mass showed up in her left lungs, with metastasis to the nodes in the mediastinal region (sorry to use these medical terms, but just to let you know the seriousness of the problem, in general people with similar problems do not survive beyond 9 months)
She was under the care of a competent Oncologist. But she needed someone else, apart from her oncologist and a very supportive husband, who could translate what is happening in this new world and environment which are full of different symbols and rituals.
I am an Endocrinologist by medical training but soon realized that what I learned at the Hospital and University were not of much use if I wanted to heal the groups of people I was interested in, mainly the Indigenous people of the world. I decided to go back to the University to study Medical Anthropology at the postgraduate level. Fortunately I went to a very good programme in London, England and had some wonderful teachers.
My Medical education had prepared me for a CURE and did not prepare me how to HEAL patients but my anthropological education helped me learn, along with a lot of help from my patients, who in the United States are exclusively American Indian.
I became aware of the Spiritual aspects of the worldview of the patients that can be used in helping them heal. Most chronic conditions cannot be cured but most can be healed.
In our small clinic in an isolated part of an Indian village in Nebraska, we attend to patients, more than just their biomedical needs but also their social, economical, emotional and spiritual needs.
To do that, you cannot rush through seeing a patient and you have to have a team (in the conventional medical sense, a RN, a PA, a Medical Nutritionist; but all interested in contributing equally to each of the above needs of the patients). We can manage comfortably with 10 patients per day, and payments are not part of the picture (all of us are employed by the tribe, full time as well as Consultant basis), we can take enough time to solve the problems of the patients, whatever might be their nature.
So, I was more than curious when a blurb arrived in my email proclaiming: Spiritual needs of Cancer patients important part of Care.
I thought to myself, have they just discovered it? Or as they propagating an already established thought patterns in the ordinary medical practice. Reading the comments it is obvious, that Spirituality is mistaken for Religion and most doctors and nurses don't have a clue about Spirituality and its role in context of health care. Some were indignant, equating Spiritual Care to snake oil or astrology? And these comments were from practising health care professionals!
I teach and do research in Medical Anthropology in Havana, Cuba and have had on-going projects in various countries. During my travels, when asked what I do with myself, I always say I am an anthropologist, never would say I am a doctor. Most people know what a doctor does but majority of the people do not know what an anthropologist does, Indiana Jones? Mummies? Ebola hunting? And usually there is a silence.
On a recent flight to Miami from the Midwest of the country, the person who was loudly talking on the phone, turned around asked me, what is the book you are reading.
Oh! It is a book by Marc Auge on Non Places. Marc Auge is a well-known Anthropologist from France. For the rest of the trip he left me alone.
So I will try to clarify Spirituality in the context of patient care.
Do the patients need it? That question is redundant to me, as I have been attending to their spiritual needs ever since my post graduate studies in Anthropology opened the doors for me to pursue that question.
What is spirituality?
For most people, they would equate with religion but the very first thing I would say that Spirituality and Religion are not the same, in fact you can be spiritual without being Religious and many people are religious without being spiritual.
To give an answer, I would look deep into the American Indian Philosophy, Yogic Philosophy of Patanjali and the Buddhist Philosophy.
Spirituality is your connection with the universe that surrounds you.
American Indians view themselves a part of the natural world that surrounds them, they do not believe that MAN is the supreme creation of the Great Spirit, but one of the creations, thus feeling brotherly feelings towards all living things, animals and plants and birds. They are also well connected to the natural phenomenon, telling themselves that a cold winter is good for the health of themselves and the earth, allowing for renewal.
Mindfulness, which is part of both Yogic and Buddhist philosophies, can help the spiritual side of a person. Being aware of what is happening around you and being fully part of it, would enhance the power of things we pay no attention on a daily basis, such as Breathing and discover the power of Pranayama, the power the proper breathing gives your body and mind and spirit.
Attachment or lack thereof helps the person to understand the context of their lives, disconnect themselves from the past and the future, clear their minds of aversion, not be afraid of change.
All ancient philosophies stress the containment of the Ego and reduce the punishment Ignorance puts on your mind.
Why all this on a note on Health Care?
To be able to give spiritual counselling, the provider, in this case a health care provider has to prepare himself or herself.
As an Indian pointed out to me at the Omaha Indian Reservation: It is a good person that becomes a good doctor, so try to be a good person.
I am extremely fortunate to be living, teaching and studying in the island of Cuba, where the majority of the people are atheists but one encounters spirituality far more commonly than most western countries.
If someone were to ask me, define spirituality for me in one short sentence, I would have to say:
Spirituality is your attempt to come into balance with all aspects of your life.
Thus you can impart that to your patient, a patient with cancer has had a fracture in their wholeness, and you and they can make them come back to that wholeness. The oncologist with their medications and others including some health care providers but also members of the family and friends can help the patient achieve the wholeness.
The Doctor is in a powerful position to learn and offer symbols of  healing which offer comfort to their  patients with cancer. What is symbolic healing? The Oncologist has already selected the best medication or the necessary poison for the patient but can learn or understand other symbols that are very important to the patient.
The faith in your doctor is very important and the doctor should cultivate that fertile ground.
Transacting symbols of importance to the patient, here it would be good to know something social about the patient.
How did Spirituality help my sister cure her cancer and heal herself?
The Oncologist who cared for her, went out of the box of average doctor patient relationship, the special interest shown had powerful effects on my sister.
She is a devout catholic and she gained a lot of comfort from her equally devout husband and the church and its Filipino pastor.
Her children lent their support, more than just the filial piety but devotion.
She has a brother who is Medical Anthropologist who was available day and night for consultation even though he was living in Paris but was present at the beginning of each chemotherapy cycle every 21 days in Miami. The symbolism of these visits were not lost on her and was very healing for her
The powerful medications cured her cancer, but everything else healed her. As I write this, she is free of cancer.
I am not an Oncologist and in my specialty it is very seldom that I encounter patients with such life and death issues but I have learned so much from the illness of my sister that I can incorporate that into taking care of American Indians with chronic metabolic diseases such as Obesity, Diabetes, Hypertension and Kidney diseases.
All patients derive immense relief and satisfaction when their health care provider walks with them along the Spiritual path. The healing power of Spirituality is immense!
this is a good video to watch. A TED talk video by the Buddhist Monk, Mathieu Ricard, a French Molecular Biologist who became a Monk and moved to the Himalayas. He talks about Happiness.