This is a guest blog post from Colgate University student Michelle Van Veen, who
has spent the last 4 months in Kenya (through the MSID study abroad program), where she worked with a hospice team. I am thrilled that she has taken this opportunity to reflect on her experiences.
How does one begin to talk about working at a hospice in rural Kenya? When Professor Loe asked me to write a blog post for her, I struggled with this question. So, I decided to share an experience that has affected and taught me the most: a story that brings together a wide range of topics I encountered including family, spirituality, poverty, illness, mental well being, hospice care, and cultural sensitivity.
First, I feel that I must start off by giving some background information. I am a double major in Psychology and Women’s Studies at Colgate University. I went to Kenya last semester for my study abroad experience and was given the opportunity to work at the hospice while I was there. A hospice provides palliative (holistic) care that addresses the physical, spiritual, social, and psychological needs of people living with terminal illnesses. I was assigned to the hospice so that I could learn about the psychological aspect of living with cancer in rural Kenya.
On a typical day, I would accompany a nurse on a home visit. We would conduct these home visits to dispense medication, provide psychological counseling to the patient and their families, assist with any other medial needs, pray for the patient’s wellbeing, and offer social or legal advice. Each patient and their family had their own story and even though all of the patients I saw were unified under the label “cancer patient,” they all lived with different realities.
On this particular day we went to visit a patient who lived in absolute poverty. His wife had died, his children abandoned him (for unknown reasons), his house was falling apart, and he was bed ridden with esophagus cancer. A neighbor came to cook him food once a day, but otherwise this man was alone and helpless. However, while we were there, things started to look better (in my eyes). His sister had come to convince her brother to live with her and her family in another town where she could take care of him. But, much to my amazement, the man refused. The nurse later explained to me why this man was being stubborn and refusing the care of his sister. Apparently when the patient’s sister got married, a dowry wasn’t given. This man believed that he would be cursed if he went to live with his married sister because it would be seen as if he were the dowry price (if I understood the nurse correctly). Thus, the fear of being cursed was stronger than his fear of living his last few months alone. When I heard about this, I was initially shocked which turned into frustration because I couldn’t even begin to understand his reasoning. But, the nurse reminded me that we have to respect the patient’s wishes because psychological pain can rival physical pain in many instances of those living with terminal illnesses. I agreed, but still didn’t understand.
The next day I learned that after we had left, the sister had successfully convinced her brother to come live with her. However, on the way to his sister’s house, the patient took a turn for the worse and instead they took him to the hospital. Later that night, he passed away. When I heard about this, my jaw literally dropped and I couldn’t believe it. To some it may look as if he was in fact cursed. But, what I learned from the experience was the importance of culturally sensitive psychology and respecting people’s wishes. Do I think he would have died on the particular day if his sister or we hadn’t visited him? Probably not. He was sick, but I thought he still had a few months left in him.
This man’s story made me realize that while symptom management needs to be the first thing addressed and taken care of, mental health is equally important. Morphine can take away the physical pain in most instances, but we don’t have a miracle drug that can take care of the psychological pain of the patient or their family. Thus, we will never know what would have happened if the man had stayed home rather than gone with this sister. But, learning from his story, I do know that we need to continue placing an emphasis on mental health that accounts for all our differences (including cultural): a lesson that applies to not only Kenya, but the United States as well.