Continuing our new series about palliative care in the context of humanitarian crisis. In the coming weeks we look at the implications of providing palliative care and bereavement care for migrants, refugees and people who have fled war-torn countries and places of conflict and how the hospice and palliative care community can offer appropriate support.
Today, we hear from Lukas Radbruch, Derya Bozdag and Michaela Hesse, in the Department of Palliative Medicine at University Hospital Bonn, Germany.
Living in peaceful and prosperous Germany, how do the civil war and the ensuing humanitarian crisis in Syria affect a palliative care team?
With nearly one million refugees streaming across Europe and into Germany in 2015, you could hardly escape the news. The culture of welcoming, open arms, but also increasing resentment later, permeated the media. And there were more subtle issues. For example, when one of the hospitals where I (Lukas) work did the x-ray checks for newly arrived refugees, we suddenly had to deal with infectious diseases such as tuberculosis in young people. Before this, we had been familiar with these conditions only in the very sick or frail elderly.
Or when a container camp for refugees was built very close to our home and I noticed that, as liberal as we all seemed on the outside in our neighbourhood, there were some deep down prejudices.
The enormous suffering and the stories of hope and despair that are behind each refugee became clear when a young man aged 31 was admitted to our palliative care unit. He was from Syria, and had recently been diagnosed with gastric cancer. The whole family had shared their resources to send him to Germany quickly so that he would have a chance for cure in our first-class healthcare system. Sadly, it was confirmed that the cancer had spread too far for curative treatment and he was transferred to our palliative care ward.
Although our patient still hoped for a miracle, he realised he did not have long to live; his greatest wish was to be reunited with his wife (aged 27) and his two children (three and six years old) before death. The family was still in Syria, waiting at the Turkish border for a chance to reach Germany. The story of the young family moved our hearts and we tried to support them. They needed a visa, but the German consulate told us this was impossible. We were told that there were other ways to say goodbye, for example with Skype, which we found unacceptable. Days of incessant communication followed, both with the German authorities in Turkey and in Germany. I even wrote to the German president, whom I had met in a panel discussion a month before, and asked him to intervene. His office refused, saying they could not get involved – but four hours later the foreign office informed us that the family would get their visas after all . . .
Even after the family had crossed the Turkish border, there was still great suspense: the patient had deteriorated and we were afraid he would die before they arrived; the police detained the family at the airport, and only after more interventions did they arrive in Germany.
Finally, the reunion in the early morning with the two children running up to their dad who had managed to get out of bed. Talk about holistic care: with his family around him he got better, and we discharged him after about two weeks. He lived with his family in a flat until he died four weeks later from his disease. His wife and children are now staying with other family members and have asked for asylum in Germany.
What we learned
We learned a lot caring for this young man and his family. We learned about public opinion and resentment. We had informed the local media when the family was reunited. However, after the first newspaper report, the university hospital administration clamped down on the story because of serious, negative feedback from readers that the hospital was bringing even more refugees to Germany – regardless of reason.
We learned about cultural and linguistic diversity. We communicated with a little English, but mostly by translating from German to Turkish (by one of our nurses), and then to Kurdish (by the patient’s mother) and back again. Sometimes we used the iPhone translation app.
Most of all, we learned that it pays to be persistent. I had thought that it would not be possible to reunite the family, but the dedication and persistence of some of our team members, especially the social worker and one of the nurses, paid off. It was good for the team to do this, and most of all it was good for the patient and his family.
I will not forget the children’s eyes as they hugged their father early in the morning on the day when they were finally reunited.
Links and further reading
- PALCHASE (Palliative Care in Humanitarian Aid Situations and Emergencies). For information please email Joan Marston.
- New PALCHASE Survey on palliative care in humanitarian contexts – interested in joining a community of practice? Read more about the survey and take part here.
- If you’ve worked in humanitarian healthcare in the last two years, please complete this survey and add your voice to a global discussion on current practices and needs related to non-curative health care in humanitarian emergencies.
- Palliative care in humanitarian crises: Always something to offer. The Lancet Online, 15 April 2017.