New series: Posters from the 15th World Congress of the European Association for Palliative Care
Poster presentations are an essential cornerstone of every EAPC Congress – this year in Madrid more than 900 posters were on display representing the scientific rigour and commitment of people involved in palliative care from across the world. If you were not able to attend the congress in Madrid, now’s the chance to see some of the posters close up and to enter into discussion with the contributors . . .
Dr Yvonne Bray, Academic Coordinator and Lecturer, Palliative Care, Department of General Practice and Primary Health Care, Auckland, New Zealand, explains the background to her poster: ‘The experience of spiritual pain for dying migrants away from their birth countries’.
Migrants bring cultural expressions, rituals and traditions from an identity developed in their birth country to their adoptive country. When aspects of historicity and life meaning, culture and religion are not recognised and acknowledged in settling into a country, spiritual pain in end of life may result.
The stories of the migrants in this research project, as they reflect in end of life, illuminated their possession of a new hybrid identity and their inner ethnic and cultural identity, which were not always harmonious. In this article, I would like to focus on the group of migrants who experienced dissonant feelings and spiritual distress as a result of concealing their different cultural expressions brought from homeland in their everyday living. Their feelings of being different affected their sense of belonging in an adoptive country.
Hemani was of Indian ethnicity, Hindu by religion, she drew the picture of exclusion with her words “if you saw someone and said ‘Hi’ they don’t say hello back to you.” Her disappointment with this new world could be detected as her need to be included, supported and acknowledged in this new country, was rejected.
Raymond was from a Chinese ethnicity and Buddhist religion, and he expressed sadness that he was in a place, not of choice, but out of duty to offer his children the best future as a parent. Both Hemani and Raymond displayed physical and cultural expressions in appearance, speech, beliefs, values, cultural approaches to life and religious affiliation, which were different to the dominant (European) population group of western ethnicity in New Zealand. For both these migrants, their bond with country of birth was strong and represented their home community that they now wanted around them in end of life. Living with difference now became a longing for both of them to be back in their birth country.
As their life review continued with impending end of life, they reminisced like all dying people but pondered their migration decisions, loss of dreams of going home and savoured the good memories of ‘homeland’. These represented significant losses for them. Bowlby (1977) in his attachment theory described “the propensity of human beings to form affectional bonds to others” (p. 201), and to places, things and other living creatures. Unwilling separation in the attachment can lead to a perception or reality of ‘aloneness’. The intense emotions that arise as a result of disruption result in sorrow. The ‘continuing bonds’ model of grief depicts a person who is suffering a loss and holding on to what is lost with a degree of unresolved grief feelings (Silverman and Klass, 1996).
In their efforts to resolve their feelings of aloneness, grief and sadness, Hemani and Raymond turned their attention in the time left before end of life to enacting continuity with their motherland through their children. Conveying dying wishes and remembrance through acts of cultural legacy were also a part of this wish. For migrants, finding belonging is fundamental to settling in their adoptive country and achieving spiritual peace in end of life.
Bowlby J (1977). The Making and Breaking of Affectional Bonds. British Journal of Psychiatry 130: 201 – 210.
Silverman P and Klass D. Introduction: What’s the Problem? In: Continuing Bonds. New Understandings in Grief. D. Klass D, Silverman P and Nickman S (eds). Washington: Taylor and Francis, 1996.
I wish to acknowledge the support and time that Professor Rod MacLeod has afforded my research work in this topic. As palliative medicine specialist at a hospice in Auckland, his clinical perceptions brought new awareness to the discussion.
Links and further reading
- Read the abstract of ‘The experience of spiritual pain for dying migrants away from their birth countries’ (Poster no: P01 453) in the EAPC 2017 Book of Abstracts.
- Contact Dr Yvonne Bray by email.
- Read more posts from the Madrid Posters series and other posts from the 15th EAPC World Congress on the EAPC Blog.
- The EAPC Task Force for Refugees and Migrants.
- Read more posts from the Palliative care in Humanitarian Crises series.
Submit your abstracts now . . .
10th EAPC World Research Congress, Bern, Switzerland – 24 to 26 May 2018. Submit your abstract now. Closing date:
15 October 2017.