In 1999 Joy Nugent RN RN Traveled to:
The Hospice Association of Sandakan Sabah, East Malaysia
Joy Nugent RN
Director/Principal Consultant, NurseLink Adelaide, Australia
Highlights
A Bereavement Program leader will be appointed, and future bereavement guidelines will include commonalities among religious customs.
Ms Margaret Lieu Nyok Ching, Hospice Association of Sandakan
We were able to create a common Thanksgiving Memorial Service which included Christian, Muslim, Hindu, Sai Baba and Buddhist religions.
Ms Joy Nugent
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Read excerpts from her report
Read full report
Excerpts from her report
I travelled to Sabah, Malaysia to facilitate a course for Bereavement Counsellors. Prior to my arrival, my 120 page Program Guide was photocopied by the Hospice and distributed to individuals with interest in hospice, and to volunteers who had recently completed 18 hours of basic training with the Nurse Coordinator, Margaret Lieu.
All participants could understand English. Participation would have improved had material been translated into the native language. It would helped to have had a local facilitator share anecdotal examples from local experience.
Rituals described by North Borneo Kadazan natives helped me realise that
Westerners can learn much from their traditions. I was told that after a course participant's grandfather died, her grandmother and the children went into the river with special leaves on their heads and submerged themselves. The leaves floated away symbolising the departure of the grandfather's spirit. For Malaysians, grief arises in the context of ritual. Aspects of that ritual promote grief.
Malaysia is a Muslim country with rich, diverse cultures. Be prepared to take off your shoes when entering a Malaysian home. Actions such as pointing must be achieved with a closed fist and with the thumb. Through an exercise designed to create a common Thanksgiving (Memorial) Service which included Christian, Muslim, Hindu, Sai Baba and Buddhist religions, we all became aware of the need to find a common thread such as love and compassion.
On-going regular meetings are planned for the future and a leader for the Bereavement Program will be appointed. Guidelines for bereavement were to be drafted for approval by various religious groups, noting commonalities such as observances on the 7th, 14th, 40th, and 100th day following death. Knowledge of various customs of each ethnic and religious group was crucial to develop these guidelines.
Full Report
Visit to Sabah, East Malaysia, Sept 21st to Oct 11th 1999
Joy Nugent, Adelaide, South Australia
Principal units/services visited
On arrival in Kuala Lumpur, West Malaysia, I was invited to spend several days in Ipoh and to visit the newly established 6 bed Palliative Care Unit in Ipoh's Government Hospital. I was introduced to the two doctors in charge of the unit and also the nurse in charge. They had one in-patient at that time. The Perak Palliative Care Society in Ipoh also supports a community-based service. The headquarters for this operation is situated in the Chinese Maternity Hospital. The chairperson, Dr Boon, introduced me to volunteers and showed me the recent training program they had undertaken. Although the visit was informal the interest and offer of support was appreciated.
From Ipoh I travelled to Tawau in Sabah, East Malaysia, where I was invited to give presentations at the first training opportunity for volunteers on the following topics: Hospice and Palliative Care - background, key elements and definitions, Understanding Loss and Grief, Spiritual and Emotional Pain - caring the healing gift and Effective Communication and Listening Skills. The program also included a Public Forum on cancer. I was asked to present the topic: Rehabilitation of Cancer Patients. A printed copy of the all presentations was given to those present. The 2-Day Introductory Training Course in Palliative Care for Volunteers was jointly organised by the Tawau Hospice Association, The Palliative Care Unit, Tawau Hospital and the Rotary Club of Tawau. The Medical Superintendent Datak Dr. Nagappan attended all the sessions. His hospital staff presented on the following topics: Role of Physiotherapy in Palliative Care, Role of Occupational Therapy in Cancer Medicine, and Role of Medical Welfare Officer in Palliative Care. 120 nurses, doctors and volunteers attended the 2 day training which was held at a recently built school of nursing. As a nurse, I particularly enjoyed the interaction with the Principal Nurse Education and viewing the training skills facilities.
From Tawau, I travelled to Sandakan via Kota Kinnabalu where I met briefly with the Nurse Coordinator from the Palliative Care Unit at Queen Elizabeth Hospital and one of the volunteers. The Palliative Care Unit at the Queen Elizabeth Hospital opened in 1995 was the first unit of its kind in Malaysia and is a leader in providing hospice education. At Sandakan I attended the funeral of a 13 year old Chinese boy who had been cared for by the Hospice volunteer team and was privileged to visit four patients in their homes with the Hospice team.
Details of the main activity of my visit
The main activity of my visit to Sabah Malaysia was to facilitate an Intensive Course for Bereavement Counsellors. This course began with an Opening Ceremony on Saturday afternoon and continued on the Sunday and for 2 hours each week night with Saturday afternoon and Sunday concluding the course. This enabled course participants to attend to their work commitments. It was held in the Hospice Secretariat - a building that had been made available to the Hospice from the Government on a site used for elderly citizens and disabled children. Dr Joseph who is a supportive oncologist from Kuching in Sarawak was invited to open the course and his presence was greatly appreciated by all 30 participants.
Preparatory work for my visit
I was very impressed with the preparatory work that had been done for my visit. I had e-mailed a 120 page Study Guide (Program attached) and this had been photocopied and bound with the title page honouring that the course had been made possible by IAHPC. The course program had been distributed to various Church organisations, those who had shown interest in Hospice and to volunteers who had recently completed 18 hours of basic training with the Nurse Coordinator, Margaret Lieu.
Meals for the course participants were varied and interesting. They provided an important focal point for fellowship. An efficient sound system was in place as was an overhead and slide projector. The Secretariat had been enlarged to accommodate the course participants.
Anticipated lasting results
At the end of the course there were many people who expressed the desire to support the Hospice in some way. The Myers-Briggs Typology was used as a tool to facilitate team building and understanding of the different personalities and generally the team spirit was lifted at the end of the course. On-going regular meetings are planned and a leader for the Bereavement Program is to be appointed.
Guidelines for bereavement were to be drafted at the next committee meeting for approval by the various religious groups and commonalities such as the observances on the 7th 14th 40th and 100th day following death noted. It was agreed that great sensitivity was needed as well as knowledge of the various customs of each ethnical and religious group.
If doing it again, what would I do differently?
While all course participants could understand English, I feel it would be helpful to have notes in their language. Many participants needed to be drawn out and encouraged to participate in the group exercises, and it may have been helpful to have the assistance of a local facilitator to give anecdotal examples from his/her local experience.
Based on my experience, the advice I would give to other Travelling Fellows
Give yourself plenty of time to build a therapeutic trusting relationship. This means appreciating the local food, sights and customs. Remember the significance of gift giving. Be prepared for ceremony and formality and the media. Give yourself time to acclimatise and be prepared to set boundaries on the time you need for yourself. Dressing is mostly formal. Be prepared to take off your shoes when entering a home in Malaysia. Malaysia is a Muslim country and actions such as pointing need to be achieved with a closed fist and with the thumb. Be familiar with the various religions represented in the country and local traditions. Try to validate the people's ways and customs and maintain a non-judgmental attitude.
Was it worth the time, travel and trouble?
Certainly! I found that I appreciated so much of the richness of the diverse cultures. Just the exercise of trying to create a Thanksgiving Service (Memorial Service) which included Christian, Muslim, Hindu, Sai Baba and Buddhist religions made us all aware of the need to find a common thread such as love and compassion.
Some of the rituals described by the Kadazan people (natives of North Borneo) made me realise how much we in the West can learn from their traditions and rituals. For example I was told that when one of the course participant's grandfather died, her grandmother and the children went into the river with special leaves on their heads and as they submerged themselves in the water the leaves floated away symbolising the departure of the grandfather's spirit. For these people grief arises in the context of ritual. Aspects of the ritual promote grief such as the sacred chanting. Food and fire are symbols of transformation.
At the end of the course an Evaluation Form was given to the participants. This form requested an indication of the value of the course with consideration to the Aim and Objectives on a scale of 0 to 5. Also requested was an evaluation of the topics presented and the usefulness of the Study Guide notes. From personal feedback as well as from the Evaluations, course participants valued the course. I certainly valued the time I spent in Sabah and wish to thank IAHPC's sponsors for making it possible.
Intensive Course on Bereavement Counselling
For Hospice Carers
Sandakan Oct 2nd to Oct 10th
Aim
The aim of this interactive experiential course is to raise awareness of the physical, psychological and social process of grief and loss, taking into account different personal, cultural and religious beliefs.
Objectives
At the end of this course participants will have an understanding of the following:
* Responsibilities and personal preparation for the caring role
* Recognition of significant losses and their effect on customary coping skills
* Personal experience of loss and building self-esteem
* Understanding the process of grief within established grief models
* Commonalities and characteristics of different religious frameworks
* Skills for effective communication and counselling
* Development of compassion and empathy in the face of strong feelings
* Special considerations for gender, children, sudden and traumatic death
* Building bridges for contrasting views and honouring individual gifts
* Strategies for healing past hurts - the importance of ceremony and ritual
* Safe environments for debriefing and on-going support
Course format
The course generally is based on personal development and right relationships. It intends to honour the carer's contribution to the delivery of hospice care and to the team in general. Course notes will be provided and form the basic study text. Each session will have the theory of the topic followed by group exercises to reinform the theory. To this end an agreement needs to be reached at the beginning of the course to respect confidentiality.
It is hoped that course participants will make a contribution to each session with sharing their own experiences, beliefs and goals. The sessions are intended to be interactive so that learning is a two way process. I hope to share my knowledge and also to learn new ways and attitudes.
It is also hoped that the group will define and develop its own on-going self-directed education and mechanisms for support.
Submitted by: Joy Nugent RN
