Hospice care remains new to many countries

Posted: Wednesday, January 30, 2002

Last April, largely through the generosity and encouragement of my husband, I had the privilege of attending an international hospice conference in London, England. Physicians, nurses, social workers, and chaplains from 27 countries met to share their knowledge and experiences.

A highlight of our conference came when the founder of the modern hospice movement, Dame Cicely Saunders, spoke individually with each delegate. At 87 years, she still possesses a regal and commanding presence. Saunders told us how the concept was born to her, and how her dream finally materialized with the building of St. Christopher's Hospice, an exquisite facility in the heart of London.

I was amazed to hear how new hospice care is. Though hospice has been active in Juneau for over twenty years, the movement's development remains in its infancy even in some first world countries such as Denmark.

One privilege of my experience came in the opportunity to meet and become friends with hospice professionals from around the globe, each of who came from disparate backgrounds and faced unique challenges.

An Italian physician named Allessandro had recently left his hospital position as an oncologist to become a medical director of a hospice because he saw too many people dying badly.

Flora, a Honduran physician, had founded a cancer clinic in Honduras for indigent women. She described how women diagnosed with cancer are frequently abandoned by their husbands. Her clinic is supported by the government and charity; the United States donates pain medications.

An oncologist from Nigeria described the horror of the AIDS epidemic in his country. The Nigerians do not have the resources to provide pain control for their patients. I was stricken by how horribly sad and wasteful it is that federal law requires us to dispose of our unused narcotics down the toilet.

Vera, a Russian physician who also serves as a director of a hospice facility in a Moscow hospital, suffered chest pains during the conference yet kept returning to share in the discussions. Gila, from Israel, works as the nursing director at an oncology and hematology unit in Tel Aviv, where she wants to start a hospice branch.

The lectures ran twelve hours a day, and despite jet lag, anxiety over lost baggage (all of mine), and insomnia, I found my usually reserved self uncharacteristically verbal. I felt compelled to apologize to a Scottish professor of Ethics for we Americans sounding like we had all the answers.

"Not to worry," he said, "we're used to it."

I also spent four days at the Joseph Weld Hospice in the town of Dorchester as part of a field experience. The facility might as well have been a five star hotel -- its patron is Prince Charles, who visits several times a year. A beautiful building located in a serene, pastoral setting, it houses up to 18 patients. The hospice employs a music therapist, social workers, physical therapists and massage therapists.

Patients come to the Joseph Weld Hospice when they are in need of more intensive care than their families can provide. Though most of the patients are terminally ill, chronically ill patients may make arrangements for a two-week stay annually to provide respite to their caregivers. One to three physicians are on staff at all times. The nurse to patient ratio is two to one (similar to most intensive care units in the United States).

The government provides 20 percent of the Joseph Weld Hospice's funding; the rest comes from charity. In a structure similar to that of Hospice and Home Care of Juneau, a director who answers to a Board of Directors manages Joseph Weld Hospice.

Hospices such as Joseph Weld and St. Christopher's are the norm throughout the United Kingdom. It is amazing and inspiring to realize what is possible when people identify a goal and reach for it. The 14 days I spent in the United Kingdom were exhausting yet exhilarating. It left me with an appreciation of where we are with Hospice in Juneau and gave me a vision of where we can grow.

Mary Kyle is a certified Hospice and palliative care nurse who has been employed with HHCJ for 12 years.

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