CARIBBEAN CULTURE ATTITUDE TOWARDS HOSPICE

1. CARIBBEAN CULTURE ATTITUDE TOWARDS HOSPICE ELAINE GODDARD, RN

2. INTRODUCTION • The purpose of this discussion is to look at the culture and traditions of the Caribbean people as a whole. • Cultural attitude towards Hospice. • The status of Hospice in the Caribbean. • Identify means to raise awareness and educate.

3. TOPICS of DISCUSSION • Profile of the Caribbean • Tradition, Culture and Subculture • (WHO) Definition • Common Misconceptions/Barriers • Lifestyle Today • Caribbean Health & Medical System • Status of Hospice in the Caribbean • Organizations/Educational Opportunities • How can you help?

4. picture Incredible diverse history Natural Resources Blended cultures and Colonial beginnings No two islands have the same tale THE CARIBBEAN

5. North: Bahamas Bermuda & Biminis South: Dominica,St. Vincent, Trinidad & Tobago, Grenada, Aruba East: Haiti, San Juan, Antigua, Barbados & Nevis West: Cuba, Jamaica & Cayman Islands CARIBBEAN GEOGRAPHY

6. TRADITION • Traditionally, the Caribbean people are health conscious. They believe more in alternative treatments as opposed to modern day drug therapies. • This comes from the approach used in older days where the practice was “toxic cleansing” or “washout” of impurities from the system. • Cod liver oil, castor oil, coconut oils, chocolate, and Epsom salt were used for natural cleansing.

7. CULTURE • Citizens of each island view their island as a real country with real politics, music, literature and history. • FOODS: Each island has its staple food or national dish. • HERBALS: Derived from plants for treatment and healing.

8. CULTURE continued • LANGUAGE: Jamaica is the largest English speaking island in the Caribbean. They are noted for their dialect called patois (broken English/slang. • Similarly, other islands have their dialect or patois, e.g. Trinidad has a sing-song dialect while Barbados has a special accent called (Bajan) • The dialect helps to identify the island resident.

9. SUB-CULTURE • Segments of the population in the Caribbean have their own beliefs and approach to medical treatments and healing. • Rastafarians: vegetarians, herbs and natural lifestyle. • Jehovah Witness, Muslims, Hindu, Adventist and others also practice a more alternative approach to treatment and healing.

10. SUB-CULTURE continued • Voodoo: Practice witchcraft, cast spells on people, deals with the devil and evil spirits. • Santoria: Some people in Latin and Spanish cultures practice rituals using blood from animals and candles to ward off evil spirits which cause sickness. • In these sub-culture, they would be resistant to hospice. They see death and dying as tied into the spirits.

11. RELIGION and PRACTICES • In the Caribbean, the predominant religion is Roman Catholic followed by English Catholic or Anglican. • We also have Presbyterian, Baptist, Moravian, Seventh Day Adventist, Jehovah Witness, Hindu and Muslim.

12. WORLD HEALTH ORGANIZATIONDefine Hospice/Palliative Care • As an approach that improves the quality of life for patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering. • Done through identification, careful assessment and treatment of pain and other problems-physical, psychosocial, and spiritual. • Dying is regarded as a normal process, and death is neither hastened or postponed [2]. • Philosophy of hospice and palliative care acknowledges death, dying and bereavement as a reality of life.

13. COMMON Misconceptions/Barriers • You are giving up on life. • Hospice means imminent death. • Patient will get no treatment. • Perceive hospice as one way to the end of life. • Financial: Who will pay? Cannot afford it. • Pride: Take pride in their way of life being independent and taking care of their own until death.

14. LIFESTYLE TODAY • Because of the proximity to the US, many people in the Caribbean now aspire to a lifestyle more representative of a wealthy industrialized nation. • These people are more susceptible to diseases such as cancer, CAD, and diabetes. The burden of HIV/AIDS and other conditions.

15. THE CARIBBEAN HEALTH and MEDICAL SYSTEM • Public and Private hospitals, clinics, medical treatment facilities and private doctor’s offices are available throughout the Caribbean. • Most if not all of these centers charge a fee, and they require payment at the time of service. • Health insurance available to civil service employees, banks and larger companies.

16. THE CARIBBEAN HEALTH and MEDICAL SYSTEM continued • Most of the population in all of the Caribbean islands have no medical/health insurance. • They rely on free clinics, public hospitals, and traveling medical missions for their health care.

17. STATUS OF HOSPICE CARE IN THE CARIBBEAN • Some form of hospice care is available in almost all the Caribbean islands. • Groups and Organizations such as PLOS Medicine, IAHPC ,FOGS, CAMEO and many medical missions are working to increase the availability and access to quality healthcare, hospice and palliative care to people in the Caribbean and other places.

18. ORGANIZATIONS • IAHPC: International Association for Hospice and Palliative care. • PLOS Medicine: Palliative Care in Africa and the Caribbean. • FOGS: Friends of Good Shepherd. • CAMEO: Caribbean American Medical Educational Organization. • All are not for profit, and are funded through donations from sponsors and charitable individuals, and companies in the US and other countries.

19. EDUCATIONAL OPPORTUNITIES and RAISING AWARENESS • In the Caribbean, people’s needs at the end of life are similar to those of people in many other countries. • To help thousands of terminally ill patients to be relieved of their pain and suffering, we need to reach out and to educate. • Hospice is a great area and a new market to target in the Caribbean as we are moving into a global economy and the need for service grows.

20. EDUCATIONAL OPPORTUNITIES and RAISING AWARENESS • Identify the Caribbean population here, educate them, have them utilize the service and it’s benefits first hand. • Encourage them to teach their families and loved ones about hospice. • Community Liaison to work through church groups, social clubs, clinics, hospitals, Dr’s offices, care homes, schools colleges and Universities.

21. EDUCATIONAL OPPORTUNITIES and RAISING AWARENESS • Create educational packets for distribution. • Work with Organizations and the Public Health System. • Health promotion (regular check ups). • Prevention (diet, weight control). • Education and screening (incl. HIV/AIDS) i.e. sex education, drug use and lifestyle. • Treatments (availability of low cost medications).

22. HOW CAN YOU HELP? • Traveling Fellowship Programs are supported by IAHPC. • Medical missions organized by Dr’s, nurses, and other individuals from the US and other countries, make mission trips to these islands to set up clinics. • They bring supplies in. • Work for 1 to 2 weeks at a time. • Health, dental, vision screening and treatments.

23. HOW CAN YOU HELP? (cont’d). • Join hands with FOGS (Hope Hospice) • Run by charity. Vitas has partnered with this hospice to provide quality hospice care in western Jamaica. • Families bring patients in to inpatient care. If they improve, they can go home, and if they deteriorate, they die there with comfort and dignity.

24. HANDOUTS • Handout from IAHPC depicts a fictional case scenario to give an impression of the sorts of problems that patients face at the Hope Institute, Kingston- Jamaica’s first public hospice. • To date we know of at least 3 hospices operating in Jamaica. • The handout lists other islands in the Caribbean and Latin America that have hospices.

25. THANK YOU! • Today, the need to care and help couldn’t be greater. • A dream which could become reality for hospice workers and the Caribbean people at large, would be to see hospice service accessible, and have everyone utilize it. • GOOD LUCK TO EVERYONE!!!!!!!

26. REFERENCES • IAHPC (International Association for Hospice and Palliative Care) http//:www.hospicecare.com/Organisation/Org.htm • PLOS Medicine (www.plosmedicine.org • http:/www.hurricanecove.com/

27. ANTIGUA’S YEPTON BEACH!!!