FEATURE CARE OF THE DYING fending van containing the body is out of sight. Death is still generally isolated from daily life and we appear to need this physical distancing from it. Kalighat opened in 1942 and is the first of Mother Teresa's 145 homes for the dying world wide. It offers basic care and love to the destitute and serves a popula­ tion of 12 million. Funding is by donations but fund-rais­ ing is forbidden by Mother Teresa in the belief that ‘God will provide’. This for­ mer pilgrim rest house stands next to the Kali temple which is a holy place of pilgrimage. It was built to honour the goddess Kali, wife of Shiva the god of destruction. For a rupee, offerings of rose petals in a cupped leaf could be purchased. [ Kalighat is run by Sister Luke, an ex-nurse and rather brisk nun who, under the supervision of Mother Teresa, has been the Superior for 15 years. A volun­ for patients with cancer, offering palli- teer doctor visited twice a week for two ative and respite care to the dying and hours. Trained nurse or doctor volunteers their families. Specialists, with the bene- were used as a teaching resource, giving fit of extensive training, and Western the sisters basic practical and theoretical medicine were responsible for the diag- teaching. Organisation of ward routine noses. A pain clinic was held for outpa- was similar to this country but was to tients and doubled as a teaching resource some extent dependent on the number of for learners. Medical and nursing staff volunteers available; the wards could, numbers were high and in-house training therefore, be over- or under-staffed. As at was arranged for staff. Pain control was j St Luke’s, a hierarchical system existed meticulously monitored and prescribing | between workers. Hot meals, usually was tailored to the patients' needs, with dahl and vegetables with fruit followed exhaustive attempts made to control by water or hot sweet tea, were served distressing symptoms. The individuality three times a day. of patients was promoted: patients were encouraged to maintain control of their Terminal stages of life lives within the restrictions imposed by The sisters recognised that many of the | the illness. The patient’s sense of well- sights were distressing to Westerners and being was paramount and efforts were encouraged us to talk about our feelings ' directed at promoting physical and spiri- and fears. These meetings seemed to tual comfort. restore our emotional equilibrium. On After death had occurred, the family my first day at the home for the dying, were encouraged to remain w'ith their my senses were stunned. I was not loved one until they felt ready to leave. prepared for the pitiful sights and the They were welcome to return to the stench of disintegrating bodies. Most hospice in the following weeks if they patients were in the terminal stages of life wished. A team of Macmillan nurses was and the high death rate warranted two based at the hospice and a relatives’ collections of bodies daily at 10am and evening was held once a month and 3pm. A multitude of diseases presented; bereavement counselling was available, TB, cancer, malnutrition and leprosy There was no support system for staff to were widespread, but often we had no release their feelings or distress, clue as to diagnosis. Some would have The Western attitude to death and the been preventable but we were told that a removal of the body is strikingly different factor difficult to dispel was the concept from that observed in India. In the West of Kali’s will. This is the belief held by curtains are drawn, patients and relatives the Hindu street dweller that disease is a are politely asked to move to another manifestation of Kali s will, passively room, doors are closed until the of­ accepted by the afflicted.

Dying East, dying West

The contrast between caring for dying people here and in India is enormous but, as Wendy Bainbridge discovered, each culture has its own strengths. I have always been concerned about the plight of the homeless but had no idea this interest would one day take me from a seaside town in Dorset to a city in East India. Working as volunteers on the nightly soup run with Mother Teresa’s order, the Missionaries of Charity, gave my friend and me a glimpse into the loneliness and poverty of the Western I world. After discussions with our fami[ lies, Mary and I decided to extend our ' experience and ourselves by spending our annual leave working in India. -------

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Death-Care facility

Our journey took us from Weymouth to Calcutta to work at Kalighat, Mother Teresa’s home for dying destitutes. This journey began in January 1990. In October of the same year I started the care of the dying course at St Luke’s Hospice which allowed me to reflect on the differences and similarities between Calcutta and Plymouth. St Luke’s is a spacious, purpose-built, j 20-bed unit, designed for ease of work and maximum comfort for patients. It I stands in beautiful surroundings and serves a population of 0.5 million. The hospice is dependent on donations and fund-raising to provide the £60,000-amonth running costs. The hospice has a good national and international reputation for its skilled care. Spreading the hospice philosophy was emphasised to learners so that expertise gained would be passed on at their places of work. The hospice cares almost exclusively

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22 Nursing Standard October 30/Volume 6/Number 6 1991

Both wards had about 60 patients. was washed away with a bucket of water. There was one dressing tray per ward. By All of the work at Kalighat was hard Western standards, dressings were lim­ and by noon, with the temperature ever ited and often inappropriate. Instru­ rising, we were exhausted. Blankets and ments were washed after use and left in gowns were washed by hand in vast tubs spirit. 'Disposable' needles and syringes and carried up four flights of stairs to dry were used many times, rinsed and left in in the scorching sun. The wards were spirit. The commonly used drugs were a kept very clean. We mixed ashes with limited selection of antibiotics, anal­ water drawn from the Hooghli river to gesics and vitamins. Intravenous therapy make an abrasive paste which was used to was frequently used to promote comfort clean the ward with twigs bound toge­ in the dying. The experience of pain ther into brushes. We squatted on the appeared to be interpreted differently by floor to wash aluminium plates in tubs patients and we did not witness distress using ashes and hemp. in patients as seen in this country. There were no aids to mobility and aids to Smiles and laughter physical comfort were restricted to nar­ Dialects vary greatly in India and as a row iron beds about 15 inches appart, a result many of the sisters could not blanket and a small pillow. As the beds communicate verbally with their fellow were always full, floor space was used, Indians. Although a few words became although a straw mattress and rough familiar to us, much time was spent blanket must be welcome if your usual using intuition to gain information from the patient. Often the less ill would : resting place is the pavement. One of the few comforts enjoyed by attempt to communicate on behalf of even the most desperately ill was the their sicker fellows. Patients constantly daily bath, Indian style; tipping a jug of communicated their thanks with a head water over the patient. Four patients at a tilt and the greeting 'nameste'. Smiles and laughter were a frequent time were bathed and we got almost as wet in the crush! There were a few means of communication and therapy. bedpans but toilet paper was not availa­ Much happiness was generated between ble. The toilet was an open gutter the sisters, volunteers and patients in running behind the washroom and waste grim conditions. Emotional comfort was

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The women’s ward at Kalighat offers few comforts.

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spontaneously given with hugs, touching or stroking. Massage was commonly used; it was routine to see the destitute massaging their babies with mustard seed oil. Open visiting existed but, almost without exception, the patients had no-one. Many had children, hus­ bands or wives who had died, or from whom they had become parted. Volun­ teers became their carers, friends and visitors. Communication from the world outside drifted through the shutters, however. Calling to prayer and the mu­ sical cries of blind beggars tapping their chime sticks, the vital sound of drums and cymbals crashing in nearby temples were enveloping and somehow created a sense of oneness and companionship. Hinduism is the major religion of ' India. One of the basic tenets is that people go through many reincarnations which eventually lead to salvation and freedom from the cycle of rebirth. Per­ haps this sense of spiritual direction facilitated the giving up of life for the gentle deaths we witnessed. As Western nurses we noticed how quietly and with- | out anxiety the patients died. This might have been connected with the low expectations of a long life which i seemed common in India. The actual act I of dying was quiet and without struggle or the benefit of analgesia or sedation. Patients at all stages of the dying process appeared to accept death with the bustle and business of living carrying on around them. Spirituality seemed to have an extra dimension which overcame physio­ logical deficits. Caring for dying destitutes in Calcutta J was a privilege from which I received far more than I gave. The experiences gained at the hospices have each enriched me in their own way. Both teach their own sphere of expertise, whether the delivery of medical and nursing care in the West or an enhancement of spirituality and expansion of the consciousness and the many intangible things of the East. When we said goodbye to Mother Teresa she urged us to seek out the poor, the sick, the lonely and the destitute in our own country. Despite the material and cultural differences we found, the intention of both hospices was the same to provide the maximum comfort, care and love to the dying. Wendy Bainbridge RGN. NDNCert, is a district nursing sister in Dorset.

October 30/Volume 6/Number 6 1991 Nursing Standard 23

Care of the dying: dying East, dying West.

FEATURE CARE OF THE DYING fending van containing the body is out of sight. Death is still generally isolated from daily life and we appear to need thi...
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