CULTURAL and religious issues surrounding end-of-life care for immigrants and Irish people are increasingly arising, according to the Irish Hospice Foundation. Paul Murray, communications officer with the body, told Metro Éireann that cultural and religious issues “are out there”, and caring institutions and professionals are generally “not as alert” to such situations as they should be.
He said such questions are being flagged through various structures, including the foundation’s Hospice Friendly Hospitals Programme, which aims to change the culture of death and dying in Ireland’s hospitals, and at its Forum on End of Life’s public meetings, workshops and written submissions.
Through its Hospice Friend-ly Hospitals Programme, the foundation has encountered instances of “non appreciation of cultural differences, and religious differences”, while at the forum, “the need for greater understanding of people’s cultural diversity” has been stressed.
Humanists, for example, requested that facilities “without iconography” for funerals be available, while funeral directors “said they were aware of how Ireland was becoming a multicultural society and [that] they had to deal with it”.
Murray said some caring institutions demonstrate “confusion” between culture and religion, particularly manifesting in the care of Irish people, with assumptions that they are Catholic.
Another issue is the availability of prayer rooms in hospitals. “Many do have them, but some don’t, they put it as the last thing on the agenda,” said Murray.
The Muslim view
According to Ali Selim of the Islamic Cultural Centre of Ireland, one of the most important procedures in caring for a Muslim who’s dying, or has died, is to “deal with the body the same as when they are alive”.
For example, Selim outlines that for a Muslim woman who’s passed on, her hijab or headscarf must be kept on (close relatives are permitted to see a Muslim woman without her hijab, in life and death).
The Islamic Cultural Centre of Ireland has collaborated with the Irish Hospice Foundation to produce an introductory information booklet on caring for a Muslim patient. It outlines best practice such as, if a Muslim patient is in coma, the face of the patient should preferably be turned to face Mecca – roughly the southeast of Ireland.
Similarly, the face of a deceased Muslim should face towards Mecca, says the booklet, and the whole body covered by a sheet. Moreover, the body must be handled as gently as possible.
“Muslims believe that the soul remains close to the body until burial. The body must be handled with utmost respect only by a person of the same sex,” it says.
The Hindu view
According to Sudhansh Verma of the Hindu Cultural Centre of Ireland, Hinduism subscribes to a cycle of life, death and reincarnation, until liberation (moksha) is achieved. Therefore, death is a hugely important life event, prompting either liberation or the continuation of life.
There are rituals in preparing for death, including reading passages from holy texts, using holy water from the source of the Ganges River in India and offering blessed food.
Hindus are encouraged to remember the deceased with happy thoughts, as the soul will receive these vibes, and if the body has to be left alone, a light or a candle should be left burning safely near their head. This is a mark of respect, and offer of comfort.
It is practice for interment to take place within 24 hours, and any need to delay this should be explained clearly to the family.
When a Hindu person dies, and family are not immediately available to conduct the customary preparation, healthcare staff should only carry out essential tasks such as closing of the eyes, removing any tubes and cleaning any excretions.
According to Sudhansh Verma of the Hindu Cultural Centre of Ireland, the Health Service Executive has its details for enquiry purposes, and any health professional requesting further assistance can contact the Hindu Cultural Centre Ireland (www.hindu.ie).
Family matters
Many immigrant communities are extremely family-orientated, an illustrative example being Africans. For some such communities, the idea of placing their loved ones in a hospice (in the event of requiring in-paitent palliative care), or a nursing home (if elderly and needing special assistance, or hospice-type care) is completely alien.
Nigerian woman Yemisi Ojo, founder of Integration of African Children in Ireland (IACI), says African families tend to “rally around” the elderly or dying person, the female relatives usually taking on nursing duties and the first-born son in charge of all decision-making.
Hearing the last words of the dying person is extremely important to family members, she adds.
In Ireland, most offspring of African parents are young children or teens, and Ojo says the level of responsibility they take on in the future, when caring for older relatives, will “depend on their upbringing”.
“My own generation is different from this generation,” acknowledges Ojo. “It is important to instil in the child what you want done towards the end of your life.
“Africans don’t like talking about dying, it is taboo, but no matter what, death will come one day. If parents don’t [talk to them], the children will be in a dilemma.”
Africans believe “in taking care of our old people” and the idea of placing parents in hospices or in nursing homes, may not sit well with tomorrow’s Irish-African adults or their parents, she says.
“Some people may wish to go home towards end of life,” she adds.
The hospice view
St Francis Hospice in Raheny is a well-known palliative care facility serving people in north Dublin. It offers an in-patient service, while its Community Palliative Care Team advises and supports families caring for a loved one in their own home.
According to Dr Regina McQuillan, palliative medicine consultant at the hospice, the rise in Ireland’s immigrant population has inevitably seen an increase in non-Irish nationals requiring support from specialist palliative care services such as St Francis Hospice.
Thus far, outlines Dr McQuillan, most immigrants accessing its services are eastern Europeans, Africans (especially Nigerians), and people from the far east, notably Filipinos. A significant number have been Catholics, she notes.
She says St Francis Hospice discusses “what is most appropriate for them in relation to their culture or their religion in the context of providing specialist palliative care for them”, and is also mindful that different customs exist among people who share a faith.
“One issue that arises is the use of translators,” adds Dr McQuillan. “Very often there may be some family members who speak the first language of the patient and good English. If possible, however, we try to use an independent translator because sometimes the issues that we need discussed with the patient are not things they would necessarily wish to share completely at that time with their family members. We therefore use professional translating services.“
For many people, recognising that death is approaching can be overwhelming, says Dr McQuillan.
“This may be a challenge for Irish people but we have noticed that it can be a greater issue for people from other countries,” she says. “For this reason, sometimes people have a reluctance to access palliative care services because of the drive to keep trying for life prolonging or curative treatment.
“We try very much to work alongside doctors and nurses who are providing life prolonging treatment and provide specialist palliative care alongside this.”
As well as building up its own expertise, St Francis Hospice has found a number of resources useful, such as the HSE Emergency Multilingual Aid, a multilingual, illustrated communication phrasebook, for use by patients and staff, as well as information produced by the Irish Hospice Foundation.
