In 1999 Dr Vilnis Sosars Traveled to:
Shenyang Railway General Hospital
Shenyang, China

Dr Vilnis Sosars
Head of the Palliative Care Unit at the Latvian Oncological Centre in Riga, Latvia

Highlights

Dr Sosars was able to find comparable words to explain palliative care so that we could dialogue about it. We will do what we can to change the existing medical system.

Chinese Medical Staff

My visit was the impetus for the creation of a volunteer program to support the local hospice.

Dr Vilnis Sosars

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Excerpts from his report

"After arriving in Beijing, I spent time refining teaching materials with the help of a nurse and a translator. I wanted to ensure that lectures were culturally sensitive and that presentations reflected awareness of Chinese perceptions. To make the materials more understandable, transparencies were prepared, written in both Chinese and English. These explained terms and definitions such as ‘palliative’, ‘hospice’, ‘bereavement’, ‘euthanasia’, and others.

Shenyang is the fourth largest city in China, population: 5 500 000. My lectures at the Shenyang Railway General Hospital emphasized team aspects of palliative care and stressed WHO standards. The discussions that followed the presentations indicated great interest. In one session, there were 300 questions raised by the Chinese medical specialists, covering every aspect of palliative care.

The most complicated aspect of these presentations was developing adequate explanations of important concepts such as home care and spiritual needs. More than 50% of Chinese are unbelievers. Many found it difficult to understand the meaning of spirituality or spiritual needs, and it was even hard to find a comparable Chinese word for chaplain.

The Chinese philosophy in palliative care states that patients can remain in hospital up to six months or even more. This model is more expensive and there is a great need for home care to be extended in China.

After Shenyang, I visited the Song Tang Hospice which opened in Beijing in 1990. It is not a State institution and the families of its residents and public donations provide the funding. Each of the 150 patients had a caregiver-volunteer nearby, 24 hours a day. The staff had a very kind attitude towards patients, witnessed by their smiles.

I am certain that palliative care will slowly be implemented in the Chinese medical institutions which I visited. Palliative care is better accepted in hospitals, and the medical professionals can do much to transform the existing system which is similar to the previous Soviet medical system in many respects.

Full Report

Travelling Fellowship Report:

Dr. Vilnis Sosars,
Head of the Palliative Care Unit
Latvian Oncological Centre, May 1999. Latvian Oncological Centre, 4
Hippocrates St., Riga, LV 1079, Latvia

INTRODUCTION

IAHPC supported my travel from Riga, Latvia to the busy metropolitan city of Beijing, China, where I'd been invited to teach palliative care to medical specialists and Red Cross administrators. I later visited and lectured at Shenyang Railway General Hospital in Shenyang, the 4th largest city in China. Upon my return to Beijing, I visited Song Tang Hospice, established there in 1990.

BEIJING

Upon arrival, I refined delivery of lecture and teaching material. I eagerly learned my Chinese hosts' views on palliative care matters. My interpreter helped sort lecture material, suggested that I have all material prepared on transparencies and advised that I include exact definitions in both English and Chinese. Longman Concise Nurses' Dictionary (English-Chinese) included definitions of "palliative", "hospice", "bereavement", "euthanasia". etc.

Adequate time for discussion was planned. I counted 300 questions raised by Chinese specialists during one "medical" discussion with staff. Topics ranged from inquiries about palliative care methods, medicines and dosages, to discussions of attitudes towards euthanasia, chemotherapy, home care issues, and the role of insurance companies in palliative care. We discussed current Chinese attitudes towards traditional medicine and acupuncture. We reviewed WHO standards. I also entertained questions about symptom control in specific patients. For example, a doctor told me that he hesitated to increase a morphine dosage for a cancer patient with extreme pain because he feared patient addiction and he wondered what he should do.

SHENYANG

When I arrived at Shenyang, the fourth largest city in China, I worked with several other translators who wrote Chinese characters directly on transparencies. This was time consuming and often the translations of upcoming lectures were not completed until very late the night before I was to present them.

Lectures and discussions at the Shenyang Railway General Hospital covered all aspects of palliative care: medical, psychological/emotional, social and spiritual. I stressed the importance of each hospice team member's role: physician, nurse, home counselor, and chaplain.

I presented an analysis of psychological and social aspects of palliative care after we'd discussed medical components. I then emphasized the bereavement concept. The most complicated segment of my presentation was explaining home care and spiritual aspects of palliative care, since more than 50% of Chinese inhabitants do not believe in God. It was hard to even find an appropriate word for chaplain. I finally discovered "mushi" in the Comprehensive Russian-Chinese Dictionary. The term "mushi" is explained as meaning "priest", or "svjashchennik" in Russian. It was hard for my listeners to understand why "mushi" is needed in palliative care or hospital. There was often a tendency to refer to spiritual concerns as psychological problems.

I participated in a TV interview while in Shenyang, answering many questions about palliative care, its meaning and my attitude opposing euthanasia. It was a challenge to answer all of the questions which were raised since these topics are frequently discussed in contradictory ways in the Latvian mass media. I stressed that good palliative care which includes all aspects of human life is the best prophylaxis of euthanasia (E), or medically assisted suicide (MAP). I believe that E and MAP requests are indicators of

inappropriate care for humans who suffer. A patient may plead for euthanasia or medically assisted suicide because of insufficient pain and other symptom control, or there may be social, psychological or emotional problems which are not being adequately addressed.

In my practice, I have found that unbelievers raise questions about the meaning of life, death, suffering. They wonder what will happen when life ends. The famous Hungarian pastor Tichomer Toth once said that "the believers are like birds. They can sit on a dry branch and if it breaks they can always fly away."

As I do at home in Latvia, I emphasized here in China, that everyone, regardless of faith status, must be accepted into palliative care if they have a progressive, incurable disease such as cancer, AIDS, heart, lung, or kidney failures. There are doctors who prefer not to be bothered by "difficult" patients. Latvian patients have told me that palliative care patients who request that their family doctors provide euthanasia there must often pay up to $US 2,000. In such cases, euthanasia can be viewed as "dirty business". For me, it also raises questions about the value of life. Hitler and Stalin cynically demonstrated this with statements such as: "is a man, is a problem. No man, no problem." Oncologists and Palliative Care specialists worldwide describe euthanasia as a "slippery slope."

BEIJING SONG TANG HOSPICE

Throughout my entire stay in China, I was pleasantly surprised to find I could communicate with older Chinese physicians who could also speak Russian, as do I. I was especially pleased to meet and talk extensively with an older professor at the Beijing Song Tang Hospital who cried when we talked about the Soviet Union and earlier times in Russia. I spent some time visiting at Song Tang Hospice, a pioneer Beijing hospice which is directed by Dr. Li Wei. One of the early Chinese hospices opened in 1990 and has cared for over 5,000 patients since then. Care is provided by a staff of doctors, nurses, and live-in attendants dedicated to keeping the 150 residents as comfortable as possible. Song Tang Hospice is not a state institute. Families of residents and public donations provide funding. The hospice was very unique from the social care point of view because each of patients had a caregiver-volunteer nearby for 24 hours. Patients who are able to do some work are asked to do this, e.g. feed the birds.

THE FUTURE OF PALLIATIVE CARE IN CHINA

Currently, Chinese patients are concentrated in institutions such as hospitals or hospices. It would be more efficient and economical if home care were extended in China since it is less expensive to be cared for at home. Unfortunately, Chinese palliative care policies permit patients to remain in hospital up to six months or even more. This would be unnecessary if home care were available.

The entire Chinese medical system is still very centralized and dependent on government authorities. I did find, however, that Chinese specialists are sensitive towards and interested in knowledge developed elsewhere. The Chinese with whom I met, wished to develop and maintain good contacts with the USA. This was one dinner toast of a Chinese hospital leader: "to the USA, the most developed country, and to China, the most developing country." It is obvious that Chinese specialists need to study new technologies and learn more about palliative care. More intensive educational programs are needed to bring the palliative care message to the many regions of mainland China. Public awareness could be targeted to universities. There are about 100 universities just in Beijing. Chinese medical workers raised another very serious question. Many were interested in exploring whether Chinese hospice units could join some common network of palliative care either in Europe or in USA.

THANKS

I wish to thank IAHPC for the grant to cover necessary expenses and especially Dr. Elizabeth B. Michael for her assistance in making the necessary arrangements. Special thanks are also due to the leader of the Shenyang Railway General Hospital and Song Tang Hospice in Beijing.

Yours sincerely and with thanks,

Dr Vilnis Sosars

Submitted by: Dr Vilnis Sosars