Chronicle Of A Thai Hospice

[camerata]

This is actually a 100-page online book about a French doctor's experiences for several years (on tourist visas!) as an unpaid volunteer at the hospice of Wat Prabat Nampu in Lopburi. There are plenty of grotesque and moving stories, some philosophical rumination as he tries to deal with his own feelings, and a critique of the hospice. All in all it makes fascination reading.

There's also a more recent and fairly slick Youtube clip of a Catholic priest who volunteers at the hospice.

[garro]

Camerata, I have read this in the past and agree it is an interesting read. I have some experience of working in hospices and death is often not nice. Even in the most advanced hospices there will be those who just don't want to die. It can be disturbing to witness when this happens.

I don't mean this as a criticism but the amount of contact the physician had with the patients is unusual, and he may not have been prepared for this type of contact. Many people burnout after a few years. I would say that many of the shocking things which the good doctor mentions happen around the world.

It should also be remembered that equally stinging criticisms have been made against the hospice care of Mother Theresa.

Edited July 6, 2008 by garro

[GuestHouse]

This rings very true.

Camerata, I have read this in the past and agree it is an interesting read. I have some experience of working in hospices and death is often not nice. Even in the most advanced hospices there will be those who just don't want to die. It can be disturbing to witness when this happens.

My sister is an Oncologist and works in a center that provides Palliative Care, she has often commented on this point of people not wanting to die – her observation being that people who have prepared themselves spiritually in their earlier lifetime are far better prepared to face the end of life when it comes.

Spirituality does not of course have to be ‘mainstream religion’ but to a large extent is, which raises a point - It is often commented that ‘religion is a tool of control’ this is perhaps no where better refuted than in the part all the mainstream religions play in helping people come to terms with the end of their life.

I think those two observations are a salutary warning to those who see their older years as time to make a desperate grab at youth's distractions.

Edited July 6, 2008 by GuestHouse

[meom]

I think those two observations are a salutary warning to those who see their older years as time to make a desperate grab at youth's distractions.

Do you mean to say that some old pensioner chasing bg's down soi cowboy should better stay home contemplating upcoming death?

[garro]

This rings very true.

Camerata, I have read this in the past and agree it is an interesting read. I have some experience of working in hospices and death is often not nice. Even in the most advanced hospices there will be those who just don't want to die. It can be disturbing to witness when this happens.

My sister is an Oncologist and works in a center that provides Palliative Care, she has often commented on this point of people not wanting to die – her observation being that people who have prepared themselves spiritually in their earlier lifetime are far better prepared to face the end of life when it comes.

Spirituality does not of course have to be ‘mainstream religion’ but to a large extent is, which raises a point - It is often commented that ‘religion is a tool of control’ this is perhaps no where better refuted than in the part all the mainstream religions play in helping people come to terms with the end of their life.

I think those two observations are a salutary warning to those who see their older years as time to make a desperate grab at youth's distractions.

You are right here GH. I have seen people of different religions, and those of no real religion, meet their death with an amazing amount of calm. They were at peace with the world is how I would describe their spirituality.

[girlx]

very interesting read. especially the part about the lack of compassion in thailand- something i have often thought about. interesting that their culture has such a different (or even lack of) moral code than westerners do, yet thais as a whole seem happier.

[katana]

Looks interesting. Thanks for the link.

[sylviex]

Thanks, camerata. It was well worth reading.

A visit to the hospice website is also very worthwhile : stylite.net/index-aids-hospice.htm and stylite.net/wpbnp/0-wpbnp-media-set.htm for other media items on the hospice.

[girlx]

wow, such horrific pics and videos on those links sylvie- i don't think i would have the strength to last there long as a volunteer. very sad.

[garro]

very interesting read. especially the part about the lack of compassion in thailand- something i have often thought about. interesting that their culture has such a different (or even lack of) moral code than westerners do, yet thais as a whole seem happier.

I would strongly disagree with you on this. I have seen and benefited from great compassion from the Thai people. I also see great compassion everyday in my work. While the Thai compassion may not always be as 'in your face' as what is familiar in the west, it is most certainly there.

Edited July 7, 2008 by garro

[girlx]

maybe, but i haven't seen much of it. anyway if you read the doc you will see what i am referring to- he speaks about the sentimentality of western countries as being frivolous and counter productive in comparison to Thais, who don't seem to bother with it.

[garro]

maybe, but i haven't seen much of it. anyway if you read the doc you will see what i am referring to- he speaks about the sentimentality of western countries as being frivolous and counter productive in comparison to Thais, who don't seem to bother with it.

I have read the document, and I have also worked as a nurse in palliative care (care of the dying).

But yes, I believe that compassion without the theatricals is more beneficial.

Edited July 7, 2008 by garro

[girlx]

did you disagree with the writer's assessment too then? (he put it better than i am doing)

oh- you edited at the same time i posted

Edited July 7, 2008 by girlx

[garro]

I believe that while on the surface Thai and western compassion may look different they come from the same set of emotions. I believe that the Thai sense of compassion is tempered with realism and the acceptance that all is changing, uncertain, and ultimately all going to end in tears.

The is much debate in the west as to the role of medicine in dying. After all dying is a natural thing. Doctors often see death as the enemy and will go to extreme measures to prevent it or at least prolong it. We can keep people alive longer but does that mean that we should? Are we being compassionate or just trying to prove that we have some control over death?

Some of the attitudes of that doctor seemed out of place to me in a palliative care setting - (perhaps I am been very unfair or have misunderstood). Wanting to prolong life using anti-biotics in people actively dying being one example. If the truth be known, there is very little need of medicine in those actively dying- it is the time for preparing yourself to detach from the world and those who we leave behind.

Edited July 7, 2008 by garro

[Bluelotus]

Garro , I'm impressed with your insight . I too have been involved in hospice and as a crime scene technician, death has never bothered me only the callousness of the living. Hospice is very much an orchestrated death in the US , ever notice how many pass away just after the family leaves for the night and the last son to arrive gets a chance to say good bye.

It is a wonderfully humane exit mechanism. I hope in the end I'm lucky enough to be in the care of someone like you Garro .

Long live Jack Kevorkian ! ( typical humor of those associated with death a lot )

I always was so impressed and humbled by a certain Hospice staff member who would hold imminent infants all night to their last breath. Such strength eclipses all the bravado in every bar in the world. Not all Monks wear robes.

[Johpa]

Garro , I'm impressed with your insight . I too have been involved in hospice and as a crime scene technician, death has never bothered me only the callousness of the living. Hospice is very much an orchestrated death in the US , ever notice how many pass away just after the family leaves for the night and the last son to arrive gets a chance to say good bye. ...

Orchestrated by whom? I have seen this particular scenario, indeed have been the "last son", in my case the last grandson, to arrive. But I have seen the same scenario happen in village Thailand where hospice involves lying down on a hard mattress on the floor wasting away in a small village hut.

[Bluelotus]

Garro , I'm impressed with your insight . I too have been involved in hospice and as a crime scene technician, death has never bothered me only the callousness of the living. Hospice is very much an orchestrated death in the US , ever notice how many pass away just after the family leaves for the night and the last son to arrive gets a chance to say good bye. ...

Orchestrated by whom? I have seen this particular scenario, indeed have been the "last son", in my case the last grandson, to arrive. But I have seen the same scenario happen in village Thailand where hospice involves lying down on a hard mattress on the floor wasting away in a small village hut.

Orchestrated by the hospice workers usually an extra dose of morphine. In Thailand the use reduced calories to hasten demise

[camerata]

For those who didn't read it, here's one of the rather harsh statements made by the author. This one about the Thai manager of the hospice:

I should also have accepted that in spite of fulfilling his

responsibilities, he has a trait which he shares with nearly all

his countrymen: he has no compassion. Absolutely no

compassion.

[Ulysses G.]

During the Vietnam War, it was a widely held belief that Thais made the best button men because they had “no conscience”.

[girlx]

well i am sure there must be some out there with compassion, especially for family members, but in my experience i would agree with the doc that there is little compassion in thailand that isn't motivated by money or "making merit". thais don't seem to grow up with a moral code drilled into them though, like we do in the west- our movies for instance always seem to have a moral lesson in them.

[camerata]

thais don't seem to grow up with a moral code drilled into them though, like we do in the west- our movies for instance always seem to have a moral lesson in them.

I think the problem is that Thais grow up with the wrong ideas socialized into them - that everything that happens is a result of past karma and your destiny can't be changed, so why bother helping others when they are just "working out their own karma." But this is popular Buddhism rather than the actual teachings of the Buddha.

However, I've seen plenty of compassion from Thais over the years.

[girlx]

I think the problem is that Thais grow up with the wrong ideas socialized into them - that everything that happens is a result of past karma and your destiny can't be changed, so why bother helping others when they are just "working out their own karma." But this is popular Buddhism rather than the actual teachings of the Buddha.

hit the nail on the head for me. and really, those aren't actual teachings of Buddhism (also the principle of detachment)? why are those ideas popular? i do think Thais definitely are a product of their education and in this society things are so blatantly corrupt... i would like to hope it is slowly getting better though. then again, this might just be another cultural difference, and as the author of the hospice paper said, our western sentimentalism is no more compassionate than the Thais' detachment at times.

Edited July 8, 2008 by girlx

[GuestHouse]

I've written in the past of my personal experience of being critically ill in a Thai hospital and of how the 'medical care' was first rate but the 'patient care' was abysmal and too how when medivact back to a Hospital in Edinburgh I found the return to 'whole patient care' to be perhaps the most significant factor in my recovery.

I have no doubt that culture and the part religion has played in culture are part of the reasons for the difference. I wholey agree with the premis that Buddhism, as it is practiced in Thailand, is at the heart of the lack of compassion in Thai medical care while on the other hand the long historical links between the Christian Church and caring for the ill plays a part in western thinking with respect to illness and compassion in illness.

Girlx is right about the moral message surrounds us in western popular culture, it is a long tradition and may be found not just in movies of today, but going back into the stories and litterature of classical times. But it is also there is Thailand and by has been - However the message is differnt. Where all that happens to us in this life is a product of past lives then there is inevitably a moral judgement in addition to the belief that each individual must 'work what his karma brings him'.

[sylviex]

You might witness similar attitudes amongst Chinese (also Buddhist-influenced, of course)..

Asian societies are family-centric to a degree we find hard to comprehend. Anyone who is not part of the family belongs to the out-group and will remain there. (Hence frustration some feel here in trying to make friends who nearly always seem to remain just acquaintances).

Some of the hospice stories showed rejection of ill family members, though. Partly due to poverty, partly to ignorance about HIV/AIDS. Such abandonment affected those patients very deeply.

It is a very interesting question. Is "compassion" instinctive or largely a result of conditioning ?

Edited July 8, 2008 by sylviex

[twschw]

camerata, do you think that this quote is the message of the book? If not why did you select it? There are tales of compassion in the book but you choose this one quote...why?

"I should also have accepted that in spite of fulfilling his

responsibilities, he has a trait which he shares with nearly all

his countrymen: he has no compassion. Absolutely no

compassion. "

[girlx]

i think he was trying to clarify my post on the subject:

very interesting read. especially the part about the lack of compassion in thailand- something i have often thought about. interesting that their culture has such a different (or even lack of) moral code than westerners do, yet thais as a whole seem happier.

For those who didn't read it, here's one of the rather harsh statements made by the author. This one about the Thai manager of the hospice:

I should also have accepted that in spite of fulfilling his

responsibilities, he has a trait which he shares with nearly all

his countrymen: he has no compassion. Absolutely no

compassion.

Edited July 8, 2008 by girlx

[camerata]

camerata, do you think that this quote is the message of the book? If not why did you select it? There are tales of compassion in the book but you choose this one quote...why?

Because girlx mentioned the "lack of compassion" comments without elaborating and some of the posters probably haven't read the book. The author seems to criticize just about everyone in the book, including himself. Some of the comments are spot on, but others show a lack of understanding of Thai culture.

I'd be interested to know whether Thailand had any hospices before the AIDS epidemic. It seems to me that dying people are usually taken care of by their relatives. This would account for the situation where we now have a temple serving as a hospice in a rather ad hoc way, rather than it being, say, part of a state hospital. That it depends on donations and volunteers accounts for many of the problems described in the book.

[Ulysses G.]

However, I've seen plenty of compassion from Thais over the years.

Me too!

[camerata]

It is a very interesting question. Is "compassion" instinctive or largely a result of conditioning ?

Richard Dawkins has an interesting take on this. There are evolutionary advantages for humans to become genetically programmed to be kind and compassionate to our own group. He thinks compassion is just a kind of "misfiring" of this instinct to be considerate to group - instead of targeting our group, we target strangers. I'm sure conditioning plays a part, but Dawkins is making the point that compassion is possible without religion.

Perhaps this mis-targeting is less likely to happen in a groupist society like we have in Thailand.

[sylviex]

Perhaps the "instinct" is conditioned "out", to a degree, in communities where there's not much to spare or group values dictate it.

It can certainly be argued that there are culturally different expressions of different instincts and emotions.

The writer's point was partly that western-style sentiment served no purpose in the hospice.

I found his writing very honest. It seemed to have been written as a journal and might work a little better with a final or preliminary chapter written from a later point in time, allowing him to draw out more clearly some of the conclusions & lessons of his experience.