Commentary
Volunteering: a valuable experience and a new perspective Alison Kate Lillie
© 2013 MA Healthcare Ltd
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olunteers enhance the quality and range of health care. Although dying is a universal experience, volunteering in an international context brings complex cultural and practical challenges (McGannan and Jackson, 2010). I recently spent a week with Smile International at Kujdesi Paliativ in Gjakova, Kosovo. The service opened in May 2011 with a part-time doctor and a nurse, and a year later a second nurse was appointed. Gjakova is the third largest city in Kosovo and was severely affected by civil war in 1999. Kosovo is one of the poorest countries in Europe. A third of the population live below the poverty line and 12% in extreme poverty (World Bank and Statistical Office of Kosovo, 2011). Life expectancy is low, and many elderly Kosovars live with multiple long-term conditions (Jerliu et al, 2013). This is associated with increased symptom load (Chaudhry et al, 2013), compounded by ongoing psychological and physical harm from the war (Wang et al, 2010). It was a privilege to work with the committed and caring team. As anticipated, language and culture were barriers to sharing skills (McGannan and Jackson, 2010). The aim was to observe and learn about the service to enable appropriate future educational support. The experience highlighted how service provision is affected by scarce resources and the cultural context. Intellectually I had long been aware that palliative care is offered when there is limited access to prompt and effective treatment (Sepúlveda et al, 2002). However, it was sobering to observe this in Europe. A survey of elderly Kosovars found that 42% had difficulty accessing health care, primarily because they could not afford it (Jerliu et al, 2013). The ramifications were brought home when I visited a woman with teenage children who had referred herself to the team because she could no longer afford chemotherapy. This reaffirmed my support for a health system in which treatment is provided free at the point of delivery. I have always worked in a multidisciplinary team, with access to multiple textbooks and the research literature. It was salutary to observe a small committed team striving for excellence with
International Journal of Palliative Nursing 2013, Vol 19, No 11
no peer support, no specialist textbooks in their native language, and a computer that was (temporarily) disconnected from the internet. This enhanced my appreciation of the role of nurse education in empowering high quality care. In Kosovo nurse education was traditionally given in secondary school, with students choosing a diploma programme aged around 15. Although there are ongoing developments in both graduate and continuing nurse education, an informal study found that few Kosovar nurses were aware of the possibility of further nursing education, contributing to low individual and professional self-esteem (Goepp et al, 2008). This emphasised the importance of the professional development that is provided by Smile International. The principles of palliative care appeared to be successfully integrated into the culture. Kosovo is primarily Muslim and although Smile International is run on Christian principles, help is offered to those in need regardless of ethnicity, nationality, or religion. The principles of palliative care that help patients and their families live as actively as possible until death seemed as appropriate and relevant in this context as in my own, and I would encourage other practitioners to consider volunteering overseas. I● JPN Chaudhry SI, Murphy TE, Gahbauer E, Sussman LS, Allore HG, Gill TM (2013) Restricting symptoms in the last year of life: a prospective cohort study. JAMA Intern Med 173(16): 1534–40 Goepp JG, Johnson TD, Maddow CL (2008) Challenges and promises for nurse education curriculum development in Kosovo: results of an “accidental ethnography”. Nurse Educ Today 28(4): 419–26 Jerliu N, Toçi E, Burazeri G, Ramadani N, Brand H (2013) Prevalence and socioeconomic correlates of chronic morbidity among elderly people in Kosovo: a population-based survey. BMC Geriatr 13: 22 McGannan M, Jackson A (2010) International Volunteering in Palliative Care: Tips To Get You Started. Help the Hospices, Hampshire Sepúlveda C, Marlin A, Yoshida T, Ullrich A (2002) Palliative Care: the World Health Organization’s global perspective. J Pain Symptom Manage 24(2): 91–6 Wang SJ, Pacolli S, Rushiti F, Rexhaj B, Modvig J (2010) Survivors of war in the Northern Kosovo (II): baseline clinical and functional assessment and lasting effects on the health of a vulnerable population. Confl Health 4: 16 World Bank and Statistical Office of Kosovo (2011) Consumption Poverty in the Republic of Kosovo in 2009.
Alison Kate Lillie is Lecturer in Adult Nursing, Keele University, School of Nursing and Midwifery, Clinical Education Centre, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, ST4 6QG, England Email: [email protected]
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onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 29, 2015. For personal use only. No other uses without permission. . All rights r
Volunteering: a valuable experience and a new perspective Alison Kate Lillie
© 2013 MA Healthcare Ltd
V
olunteers enhance the quality and range of health care. Although dying is a universal experience, volunteering in an international context brings complex cultural and practical challenges (McGannan and Jackson, 2010). I recently spent a week with Smile International at Kujdesi Paliativ in Gjakova, Kosovo. The service opened in May 2011 with a part-time doctor and a nurse, and a year later a second nurse was appointed. Gjakova is the third largest city in Kosovo and was severely affected by civil war in 1999. Kosovo is one of the poorest countries in Europe. A third of the population live below the poverty line and 12% in extreme poverty (World Bank and Statistical Office of Kosovo, 2011). Life expectancy is low, and many elderly Kosovars live with multiple long-term conditions (Jerliu et al, 2013). This is associated with increased symptom load (Chaudhry et al, 2013), compounded by ongoing psychological and physical harm from the war (Wang et al, 2010). It was a privilege to work with the committed and caring team. As anticipated, language and culture were barriers to sharing skills (McGannan and Jackson, 2010). The aim was to observe and learn about the service to enable appropriate future educational support. The experience highlighted how service provision is affected by scarce resources and the cultural context. Intellectually I had long been aware that palliative care is offered when there is limited access to prompt and effective treatment (Sepúlveda et al, 2002). However, it was sobering to observe this in Europe. A survey of elderly Kosovars found that 42% had difficulty accessing health care, primarily because they could not afford it (Jerliu et al, 2013). The ramifications were brought home when I visited a woman with teenage children who had referred herself to the team because she could no longer afford chemotherapy. This reaffirmed my support for a health system in which treatment is provided free at the point of delivery. I have always worked in a multidisciplinary team, with access to multiple textbooks and the research literature. It was salutary to observe a small committed team striving for excellence with
International Journal of Palliative Nursing 2013, Vol 19, No 11
no peer support, no specialist textbooks in their native language, and a computer that was (temporarily) disconnected from the internet. This enhanced my appreciation of the role of nurse education in empowering high quality care. In Kosovo nurse education was traditionally given in secondary school, with students choosing a diploma programme aged around 15. Although there are ongoing developments in both graduate and continuing nurse education, an informal study found that few Kosovar nurses were aware of the possibility of further nursing education, contributing to low individual and professional self-esteem (Goepp et al, 2008). This emphasised the importance of the professional development that is provided by Smile International. The principles of palliative care appeared to be successfully integrated into the culture. Kosovo is primarily Muslim and although Smile International is run on Christian principles, help is offered to those in need regardless of ethnicity, nationality, or religion. The principles of palliative care that help patients and their families live as actively as possible until death seemed as appropriate and relevant in this context as in my own, and I would encourage other practitioners to consider volunteering overseas. I● JPN Chaudhry SI, Murphy TE, Gahbauer E, Sussman LS, Allore HG, Gill TM (2013) Restricting symptoms in the last year of life: a prospective cohort study. JAMA Intern Med 173(16): 1534–40 Goepp JG, Johnson TD, Maddow CL (2008) Challenges and promises for nurse education curriculum development in Kosovo: results of an “accidental ethnography”. Nurse Educ Today 28(4): 419–26 Jerliu N, Toçi E, Burazeri G, Ramadani N, Brand H (2013) Prevalence and socioeconomic correlates of chronic morbidity among elderly people in Kosovo: a population-based survey. BMC Geriatr 13: 22 McGannan M, Jackson A (2010) International Volunteering in Palliative Care: Tips To Get You Started. Help the Hospices, Hampshire Sepúlveda C, Marlin A, Yoshida T, Ullrich A (2002) Palliative Care: the World Health Organization’s global perspective. J Pain Symptom Manage 24(2): 91–6 Wang SJ, Pacolli S, Rushiti F, Rexhaj B, Modvig J (2010) Survivors of war in the Northern Kosovo (II): baseline clinical and functional assessment and lasting effects on the health of a vulnerable population. Confl Health 4: 16 World Bank and Statistical Office of Kosovo (2011) Consumption Poverty in the Republic of Kosovo in 2009.
Alison Kate Lillie is Lecturer in Adult Nursing, Keele University, School of Nursing and Midwifery, Clinical Education Centre, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, ST4 6QG, England Email: [email protected]
525
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 29, 2015. For personal use only. No other uses without permission. . All rights r
