Mark Schubauer, R.N. is a Certified Hospice and Palliative Nurse from Portland, Oregon, U.S. Awarded an IAHPC Traveling Fellowship in April 2015, Mark set off on a memorable journey to China to undertake his three-week fellowship at the Cancer Hospital, Chinese Academy of Medical Sciences (CHCAMS) in Beijing.
I prepared for the trip by reading books and articles and by interviewing people in China and America. My preparations raised many questions and opened up specific lines of inquiry. Being well prepared allowed me to remain flexible throughout the three weeks and, where necessary, to reconfigure didactic content in response to my hosts’ requests.
My experience in China answered some questions but left me with an unslaked thirst for a depth of understanding that could not be achieved in a mere three weeks. Nevertheless, I gathered many impressions. The expansive generosity of my hosts gave me privileged access to 10 different institutions and organizations that are involved in the delivery of health care and education in Beijing. I was guided by talented, highly capable interpreters. The interpreters were not professionally trained translators. Rather, they were young doctors and nurses who possessed a command of written and spoken English suitable to the task. The interpreters seem worthy of the label ‘change agents’ who understand the importance of improving end-of-life care. Through their daily toils and studies in elite hospitals and educational institutions, the change agents directly experience the importance of broadening the awareness and delivery of palliative care in China in order to meet the challenge of caring for an aging population in the era of modern medicine. These are times when the promise of medical technology and innovation in medicine has been realized and many people benefit. These are also times when the unexamined conceit of technology obscures the certain reality of death.
Dozens of people that I met reported conflict over professional and/or personal involvement in overtreatment of terminally ill people driven by implicit and explicit prohibitions that impede or prevent frank, iterative discussions about the burden and benefit of available treatments.
It is worth noting that at every one of the 14 site visits I was involved in, doctors, nurses, and other involved parties asked for direction on how to speak honestly about death in a culture that places less emphasis on respect for patient autonomy and medical indications, and more emphasis on contextual features, especially the legitimate interests of families. On many occasions, I was asked to speak about how to provide emotional and psychological support to patients who were not informed of the nature or severity of their illness, in accordance with family wishes and cultural norms.
My responses to these inquiries were grounded in Kübler-Ross’s Stages of Grief Model. This model received unanimous endorsement as being culturally resonant from the change agents I questioned.
My responses also emphasized the importance of active listening and compassionate presence and there were many opportunities to demonstrate and speak about techniques such as life review, relaxation breathing, and guided visualizations which can be utilized even in the absence of full disclosure of diagnosis and/or prognosis.
The main problems that I encountered were the language barrier and a lack of pre-travel needs assessment. As an immediate solution to these, I reduced the length of programs and reconfigured content for teaching purposes. However, to others who may be embarking on a traveling fellowship I suggest you ask your hosts to translate PowerPoint and other visual tools into the host language before your arrival and also conduct a full pre-travel needs assessment. And in answer to my own question, ‘What would you do differently in the future?’, I would emphasize case studies (over lectures) in didactic settings.
My traveling fellowship gave me a high level of satisfaction in all areas (activities, results, application process, information provided, general). And it’s likely that my two follow-up activities – accepting an invitation to join the Palliative Care Teaching Group at Peking Union Medical College and collaboration with three change agents to publish a journal article – will ensure that I maintain lasting contact with my newfound colleagues.
To find out more about IAHPC’s Traveling Scholarships and Traveling Fellowships, please visit our website. Through these programs we support projects and individuals around the world, especially in developing countries in Africa, Eastern Europe, Asia and Latin America.
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