In 2000 Ms Mary Lou Hathaway RN BSN
Traveled to:
Kyrgyz Researh Institute of Oncology and Radiology Bishkek, Kyrgyzstan

Ms Mary Lou Hathaway RN BSN Kansas City Hospice, Kansas, USA

Highlights

Since pain medication is very difficult to obtain, the relaxation techniques are very beneficial both for the staff, patients, and their families.

Galina Sergeeva, Kyrgyzstan

The people of Kyrgyzstan have big hearts and bright minds. I hope that the pleasure they experienced following the relaxation exercises will be helpful to them in their work and to their patients who have little access to pain relieving medications.

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Report

Eighteen months ago the name "Bishkek, Kyrgyzstan" sent me scurrying to search a world atlas, as I was about to host a physician and nurse from that world region in Kansas City. This initial host experience began an unexpected professional friendship.

I traveled to Kyrgyzstan in September 1999. There I found health care workers eager to learn more about palliative care and I was invited to return again. A Travelling Fellowship grant from IAHPC was arranged and I returned to Kyrgyzstan for the second time in October 2000.

Kyrgyzs nurses wished to increase their skills as well as their status in the medical community. My background in hospice and pain management seemed to fit the needs of hospice staff in Kyrgyzstan. I had spent 10 years working with chronic pain patients, and knew the benefit of regularly practiced relaxation training. This was the skill I went to teach.

Kyrgyzstan became an independent central Asian nation early in the 1990s, after having been part of the USSR since the early 1900s. The Kyrgyz take great pride in their ancient and successful culture. Early culture was nomadic, herding sheep and cattle while living in beautifully designed yurts.

Urbanization is a reality. Some computers and email are now available. There is no longer free health care. Health care insurance has recently become available though it is still distrusted by many citizens. Health care is paid for "out of pocket" and is quite unaffordable for the majority. Nurses’ value in health care is vastly underrated and they work for "miserable wages". There is almost no access to narcotics for pain relief, and proper equipment is lacking.

Present health care developed as a technically based system. Cultural belief strongly holds that patients should not know their diagnosis, particularly as their disease worsens. Patients in weakened condition will not admit their fears or needs.

Some nurses and physicians envisioned a more humane, compassionate health care system. What better place to start than hospice? How did events unfold here?

A patient with advanced disease, whose family could no longer care for her, was left in the garden on the grounds of the hospital. And thus the hospice unit at the Oncology Institute in Bishkek began. The Institute staff took her in, and cared for her until she died. They recognized the community’s need for such a place and dedicated a unit to specialized care of patients with advanced disease. This unit has blossomed into a busy palliative care unit under the direction of nurses and physicians. Much has been accomplished in one year under difficult conditions.

The newly painted unit is attractive, and large windows and plants make the rooms quite pleasant. Volunteers visit with patients and write letters for them. Chaplains counsel patients. Social work students will soon train on the hospice unit. Nursing students serve a rotation there. Patients come and go, spending as much time at home as possible.

During a two-week period in October, I taught at the hospice in the Oncology Institute in Bishkek, at two other developing hospices, and held classes at four other hospitals. The 3-4 hour course was offered at seven locations. Eighty-two nurses participated and practiced teaching autogenic relaxation, diaphragmatic breathing and body scanning.

Nurses with whom I worked, are assigned to burn units, surgery, medical units, outpatient clinics and rehabilitation units. Their enthusiasm for learning relaxation techniques was quite different from my teaching experiences in the United States, where nurses rely heavily on pain medications and tranquilizers to relieve symptoms.

"Natural" and "Alternative" techniques are integrated into medical care in Kyrgyzstan much more than in the US. Nutrition, exercise, rest, herbal remedies, mineral baths, massage, acupuncture are all part of the treatment of patients. Relaxation training was an additional skill for the nurses and physiatrists to practice. They had not learned this in their basic training. Fortunately, nurses can teach it to patients without a doctor's order and no equipment is required. It is a technique that builds trust and a sense of caring.

PROFESSIONAL RECOMMENDATIONS

Nurses are very interested in collaborating with other countries. I believe it would be beneficial for a palliative care physician to collaborate regarding pain management, barriers to narcotic use, ethics, and communication with patients regarding diagnosis. A visit by a social worker to determine psychosocial needs and interventions would help. Nurses are needed to demonstrate the palliative care philosophy. Collaboration with funding organizations such as Soros Foundation and Carelift International is needed. I believe that Methadone would be a good alternative medication in this setting given the patient’s limited ability to pay for medications. Good teaching would be needed to introduce this medication for pain control. Support for families and home care needs to be developed. There does not appear to be a bereavement component at this time. The librarian at the Oncology Institute, Galina Sergeeva (email: ahonco@elcat.kg) must be supported in her work. She is an excellent resource for Internet communication and interpretation. She is exceedingly dedicated and a good net worker and organizer.

I cannot express adequately the reception that I received from the nurses. The preparation for my coming was very thorough. Every class proceeded like clockwork with maximum attendance. Travel arrangements and accommodations were adequate, despite lack of water in some areas and no heat. Krygyzs generosity with food is renowned. I should like to return again to continue my relationship with the nurses and physicians. It is amazing how much a visit means to these people who struggle daily to improve their future. It was a privilege and an honor to be of service to these wonderful caregivers.

A BIT ABOUT KYRGYZSTAN BEAUTY

The scenery in Kyrgyzstan is truly awesome. 20,000-foot mountains, the Tian Shan range, surround the country and separate it from China. I visited the remote city of Karakol, which is on Lake Issyk-Kul, a very deep lake that is slightly salty and never freezes. It has been a spa for centuries and has attracted people from distant places. It is now open for private use.

Osh, a 3000-year-old city in the Fergana Valley, was a special highlight. Osh was once a trading center on the Silk Road. At the center of this vast city is Suleyman (Solomon) Mountain, a holy pilgrimage site for Muslims. Climbing the mountain, in the evening, looking over the city, at sunset with a monk chanting the evening prayers, was an experience I will treasure for the rest of my life. Osh is very different from Bishkek, calmer and more characteristic of the Kyrgyz and Uzbek culture. People here are not particularly interested in being "westernized". They are more interested in becoming part of the global culture while maintaining their identity.

Submitted by: Ms Mary Lou Hathaway RN BSN