Reflections on palliative care in Shenyang, China

Categories: Education.

Palliative care appears to be a developing area of medicine in China. A recent article in the Lancet described palliative care in urban areas of China, and highlighted some of the issues surrounding provision of palliative care in China.

In the article it is argued that: “Education about death and palliative care is imperative for Chinese people, including doctors, patients, and the general population, since Chinese people do not usually talk about their own death or discuss death with family members who are diagnosed with terminal diseases. Such education might bring peace to dying patients and allow them to be willing to die at home with professional assistance from the organisation of palliative care” (Xing et al., 2013).

Teaching spiritual care

My husband taught approximately 20 people – doctors, nurses, social workers, psychologists and volunteers at a local HIV project, as well as professors of social care. I was able to contribute to the teaching by describing the role of the GP in providing palliative care in Scotland.

Core elements of the spiritual care programme were based on spiritual care matters, person centred care (5 must do’s); shaping bereavement care; value based reflective practice (VBRP); asset based spiritual care; and health promoting palliative care.

Interesting features of the teaching sessions were the balance between theory and practice, professional wisdom, and the use of Envision cards to facilitate communication across cultures.

Home and hospital visits

In addition to teaching, we had the opportunity to visit patients at home. The patients were among the poorest members of society and were getting their healthcare provided free, thanks to the generosity of a local charity.

Although the patients were very poor, what struck me was the cleanliness of their homes. Often in Scotland I visit deprived homes, and some of these are very dirty. The patients and their families were very welcoming and all took great pride in offering us fruit and bottled water.

We also managed to speak to two inpatients in the palliative care ward and their families.

During our visit, I observed that personal care is provided by the family. If there is no family to care for the patient, then the patient cannot be admitted. The family is also responsible for feeding the patient.

The cost of a bed in the palliative care unit is £2.60 for the basic room or £10 a night for the most expensive. This is for the room only, not the medical costs.

Doctors in China don’t appear to take bloods or insert cannulas etc. This is the responsibility of the nurses.

In the rehabilitation unit there were large sports hall sized rooms filled with patients with a variety of conditions, from CVA to fractures to brain injury, all receiving individual physiotherapy, but again the family were expected to help. There is no curtaining off, so privacy is not possible.

On the floor below was an exercise gym and play area catered for children born with cerebral palsy, who were all day visitors.

When a family member becomes ill it is expected that their child will give up work to care for the parent. We met a terminally ill man who himself was a doctor. His daughter had been the director of a company in another city but she gave up her job to care for her father.

Education and healthy behaviour

Education is very important in China. Even the poorest patients we visited at home had a child who had studied to Master’s level.

We saw very few obese people. Although we ate a huge amount of food whilst in Shenyang due to the generous hospitality of our hosts, the food was mostly healthy with a lot of fresh fruit vegetables fish. All the meals were very colourful due to the variety of ingredients.

In all the public parks we visited we saw people openly exercising either individually or in small groups, often doing yoga style exercises or using public gym equipment in the parks. On one occasion we saw an elderly couple, the wife was in a wheel chair and her husband helped her out of the chair to use the leg press and back stretching machines.

Continued links

In his trip report, my husband made a recommendation to strengthen the relationships between himself and those in Shenyang interested in spiritual care in palliative care. As a result of this, he hosted Dr Wang, from the Shengjing Hospital of the China Medical University at Ayrshire hospice. We hope that both groups will continue to benefit from sharing our learning and experience in the years to come.

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