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Asian Palliative Care

June 18, 2009

Language is inherently fluid, never static.  Am constantly reminded of changes to our language whenever I read Netspeak.  The shortening of words to communicate rapidly.  It is not the english language of my childhood or my teaching years.  Adjusting to change is part of survival at all levels.  We need to adapt in order to continue.  History has shown us this.  First we had the Industrial Revolution of the 1850’s and now we have been thrust into the Technical Revolution whether we like it or not.  We have to adapt and adjust.  So much of communication is now electronic, but often I long for the days of pencils and paper.  The wonderment of a new exercise book, covered in brown paper with one Name and Subject neatly written on the fron cover.  Nostagia, probably.

Science continues to develop and evolve.  In the medical world I first came across the phrase, Palliative Care, when my mother was dying.  It was the late 1980’s and a phenomenon unkown to me.  I soon learnt its meaning and its impact on the life of my family.  Basically it is care of the dying, nothing unusual about that in any culture.  It was team based and inclusive of the family.  Books have been written and medical faculties have established Chairs in Palliative Care.  Care givers, another linguistic innovation, come into the home and assist in making the last months of life of the family member comfortable.  It is a western concept.  It may exist in some South East Asian countried or even in the sub-continent, but imagine it only available to the wealthy.  Asia does not have a social welfare system, there are elements of it in some countries, but here, in Asia, the family provides that role.  The extended family fulfills the role of any palliative care notions we as Westerners may have.

My first experience of it came to me by way of my partner.  He had, like many children in his rural village, a close tie with his maternal grandmother, known in this culture, as ‘Yai’.  I had never met her and had never visited his rural village in the North East of Thailand known as Isaan.  It is commonly referred to as the rice bowl of Thailand.  Farming communities.  Subsistence farming.  There is little or no income from the growing of rice, it is planted, harvested and kept in a rice barn to feed the community till the next harvest.

My partner, another linguistic innovation not used in my childhood, had spoken of the westerner with whom he was now sharing his life.  Yai had become ill.  He wanted me to visit the village and see her before she died.  I did not know what to expect in such a community having spent my life as an ex-pat in urban communities.  Of course I would visit this woman who had cared for him from infancy through to his teen years.  The bond was strong and now he was my part of my family.

We all knew that Yai would soon pass away, but that legacy of love for her grandson and extended family would never be absent from out lives.

How did I come to be in the midst of this Isaan village, among an extended family I had never met.  How often such strange occurences bring people together, not that death could hardly be termed strange.  In Thai culture it is a natural part of the wheel of Life.  In the West we understand the notion of birth, ageing, sickness but the final stage, death, does not always sit well with us.  We seem to have an uncomfortableness with it.  So often people are kept alive on machines.  I find it a selfish act.  There will be no life support system for me.

I talked with Sam about the trip to the village.  The distance, the cost, the unkown, my litany of responses not to make the journey.  I relented.

I had been present at death many times before, both young and old, but always in my own Western culture.  I had witnessed the uneasiness, the taboos, the denials, the western ways of dealing with death and dying.

I walked the wooden staircase, common to houses of the poor in Isaan, to emerge in a room crowded with family and friends of Yai.

There was no weeping or wailing.  People were talking among themselves.  Some about the weather, others about this and that.

People took turns to fan the sick, yet in many ways, peaceful face of Yai.  There were no tears, not yet.  Even the children continued their lives, between scrambling up the stairs to see the old lady, prostrate on a simple piece of bamboo matting, and playing childhood games on the dry dasty earth below the room of ‘death’.

I talked with several of Yai’s daughters.  ‘There is no need for hospitalisation”, I gently murmed in my basic thai.  “She is here at home, in the bosom of her family.  It is with you that she would wish to pass away, not on some impersonal hospital trolley or bed”  They nodded in agreement.  This was Palliative care at its best.

I watched my partner, Sam, lovingly moistening his grandmothers dry lips with a cotton bud that had been immersed in water.  She had been his primary carer since his birth, which as I have said, is not at all unusual in Asian culture.  I sat back from him as he raised his voice in conversation with the semi conscious, 72 year old woman, his grandmother.

People came and left.  Old women chewing beetle nut, young children returning from a day at school.  But their focus was on the eventual passing of beloved Yai.

There was a serenity, a calm in the village.  It had happened for generations.  The wheel of life was continuing its full circle.

Had I not made the journey to that small Isaan village, had I not sat with the dying Yai, I would feel my life to have been a lot less richer.

In learning to die then we can learn to live.  What a beautiful gift that my partner had given me, allowing me to be part of  the Palliative Care in the Asian way.

And Yai, now in heaven, or wherever it is that the spirit goes after death, looks down with a glint in her eye, probably thinking, well at least I touched the heart of one Westerner.  And you know, that she indeed did!

And there was not one, white, starched, uniform to be seen, not an IV drip, no beeping machines, only the gentle care of a loving extended family.  A wonderful lesson for me in all possible ways.

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2 Comments leave one →
  1. Mitchell permalink
    June 19, 2009 2:14 pm

    Ajarn,
    You speak of the Thai village mentality: Thank you for reminding me of my three trips to my friend’s Akah tribe village in the far northwest of Thailand (near the Myanmar/Burma border) a 1 hr bumpy dirt road drive away from Mae Salong Nok. MAP: http://maps.google.com/maps?f=s&utm_campaign=en&utm_source=en-ha-na-us-sk-gm&utm_medium=ha&utm_term=map
    I only wish I had made note of all I saw and experienced there as you did as I was privy to: 1) Akah Wedding Ceremony and Feast, 2) Voting for Tribal Village Chief, and 3) my 2003 re-payment of 20K THB (thai bhat = 550usd) loaned from ‘Toxin’ Shinawatra’s deep pockets to my friend’s poor mother who continues to live on a one room dirt floor (raised bamboo intertwined slat bed) , no electricity (now 5 years later she has electricity), using oil wick lamps at night, open fire cooking, and woven bamboo slat shack walls and she was expected to repay after 2 years THE ‘gift’ AND if not repaid… then it became a loan at exorbitant rates. At the time I thought, this is how my family lived when we went went camping via car “to rough it”, YET this is how my Thai Friend’s People lived in their village everyday. I was lucky to be there in warm weather and not when snow fell, nor when it was cold and the wind blew.
    Lloyd, thanks for jogging my memory and giving me a place to write about pieces of it, albeit in your comment section.
    M.

  2. dyoll09 permalink*
    June 19, 2009 3:52 pm

    You and others Mitch, always welcome to receive some two way interaction….

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