Indigenous End of Life Care – Wendy Harris RN

Combining spiritual and physical care

6 MINUTE READ
Uncredited art: http://www.dreamstime.com

The context:

I arrived in Alice Springs as a newly graduated Registered Nurse from the east coast with the aim of developing skills as a missionary nurse. 

I came with the attitude of “I will learn so much about the indigenous culture” by “being exposed to it”. In a sense, this has happened. But what I have learnt is that there is no one indigenous culture to learn and master. Instead there are multiple layers to multiple cultures to explore, ask questions about, appreciate, decipher and watch, then know that I still can’t “understand” it all. 

Another thing I have learnt is that the diversity involved in indigenous health care, cultures and spiritual care is immense and impossible to write about with anything approaching uniformity. It is diverse at a national and local level in Central Australia due to the multiple indigenous people groups with different cultural and spiritual beliefs, different Christian denominations and historical contexts.

No Christian western healthcare practitioner in Alice Springs claims to have an in-depth understanding of indigenous culture, including me. In fact, the most Christ-like ones are humbly working alongside indigenous people and their health and spiritual leaders with genuine respect and love. These are the people I have looked up to when starting my nursing career in palliative care. 

Where the rubber meets the road:

In all areas of palliative care, cultural and spiritual activity should be integral, as the aim of palliative care is to care for the whole person. In fact, to the local Arrente, Walpiri and Pitjara people, health and spiritual care are one and the same thing. 

The area of palliative care that I have found the most challenging crossover between health and spiritual care is terminal agitation (also known in literature as terminal restlessness or delirium). It is a form of delirium that can be very distressing for the person and their families – watching as the person experiences disorientation, confusion, paranoia, hallucinations.

To the local Arrente, Walpiri and Pitjara people, health and spiritual care are one and the same thing.

They can become physically and verbally aggressive as a result. This can be a sign that the person is hours or days away from dying. 

The situation:

It was as a first year nurse that I first experienced a tough situation with a terminally agitated patient. The patient in question was a Christian indigenous man who was a leader in his community and was very respectful to others in his demeanour. During the course of the shift he developed delirium and was attempting to walk but did not have the strength. He was convinced we were trying to kill him, and at one point was trying to throw medical equipment at us. It took hours to resolve, and as we were the only two staff in the building we were also concerned for his safety and ours. We both wanted to give him appropriate medications to help him be more comfortable, however he vehemently refused and would not allow us near him.

This has not been an uncommon presentation for me through the years. At times patients have been hallucinating and talking to beings in the room that I cannot see, and no normal amount of medication or other therapies have been able to stop this. 

Differentiating spiritual and medical signs and symptoms:

There is no doubt there were many medical reasons for this man developing terminal agitation and delirium. However, I have repeatedly fallen into the trap of just recognising the medical signs and symptoms the patient is displaying, and not recognising the way they can sometimes mask spiritual experiences. Symptoms of delirium in particular can be tricky to differentiate from severe spiritual interference. 

…I have repeatedly fallen into the trap of just recognising the medical signs and symptoms the patient is displaying, and not recognising the way they can sometimes mask spiritual experiences. 

My Christian background is one of scepticism and lack of acknowledgement of different spiritual forces and Satan’s use of them. This made it hard and surprising for me to be aware of the spiritual aspect involved in a patients’ care at times. However, the Bible tells us that there are many ways that Satan works, including through cultures where spiritual beliefs are integral to everyday life and culture. 

“See to it that no one takes you captive through hollow and deceptive philosophy, which depends on human tradition and the elemental spiritual forces of this world rather than on Christ.”
(Colossians 2:8)

Combining spiritual and medical care:

Palliative care is one of the few health care areas where the spiritual care of the person is actively encouraged. While this is a good thing from a Christian perspective, it does often involve only providing the form of spiritual care that the person already identifies with. In some of our local indigenous cultures, this can include ngangkaries or witch doctors whose intentions are to provide a form of spiritual care for patients using beliefs and practices that are not from God. 

How do I … provide sound Biblical spiritual care when presented with indigenous patients who are experiencing spiritual and physical distress at the end of life?

The question then is – how do I, as a Christian nurse, provide sound Biblical spiritual care when presented with indigenous patients who are experiencing spiritual and physical distress at the end of life? While I am by no means an expert or extremely experienced, God has been growing me in this area. Recognising that there is potential for there to be spiritual warfare waging over a patient who is close to dying is an essential aspect. 

“Be alert and of sober mind. Your enemy the devil prowls around like a roaring lion looking for someone to devour.”
(1 Peter 5:8)

My first step now is to pray while actively caring. Only God can defeat any other spirits present at that time. This has worked many times since the first incident when nursing interventions alone have not. God has brought a spiritual peace into patient’s rooms where there has previously only been a spiritual discord for the patient, their visitors and staff. 

It is also important to keep actively caring for the patient and providing interventions such as medications – after all, God has given us all spiritual, emotional and physical tools to care for our patients.

Calling in the hospital chaplain, relevant priest or Christian leader to pray and read Scriptures with the patient and their family is also an effective form of spiritual care. We are blessed here to have chaplains, church ministers and lay people who are willing to provide quick and brilliant spiritual support for our patients and their families. I would strongly encourage any non-medical Christians to consider and pray about how God may use them in this form of spiritual care and warfare for any of your local palliative (indigenous or non-indigenous) people too.

The wrap up:

The care of indigenous patients throughout Australia will be both similar and different depending on their culture, the culture of the people providing the care, the historical context and type of health care needed. 

My first step now is to pray while actively caring.

Providing good palliative care in Central Australia involves appreciating the pure beauty of God working through some of the Christian indigenous patients and seeing His grace and beauty from another perspective.

It has proven essential to be aware of the spiritual and physical health of the person, their cultural situation, and be ready and willing to submit to God’s strength in engaging with different spiritual forces. 

“Finally, be strong in the Lord and in his mighty power. Put on the full armor of God, so that you can take your stand against the devil’s schemes. For our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms.”
(Ephesians 6:10-12)


Wendy Harris RN
Wendy Harris RN is currently working in Palliative Care as a Registered Nurse in Alice Springs, NT after moving from Newcastle, NSW. She enjoys being creative, going for walks in the beautiful scenery, spending time with friends and sharing God’s word.


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