In the volumes of Kharon we often undertake the honoring task to interpret results and statements of international research groups to have a view of the international literature of thanatology beyond local problems. We do so again but naturally you can also read studies about the Hungarian conditions.
First you can read the poem of Imre Payer, poet and literateur who has already won various prizes (2000: Nagy Lajos-prize, 2001: Belles-lettres Special Award, 2004: Parnassus-prize /workshop/, 2006: Aquincum Poet Contest Award) and has published 4 poem volumes so far: Létbesurranó (1991), Föl, föl, ti rabjai a földalattinak! (1998), A bábjátékos függönye meglibben (2001), Egyes szám, egyetlen személy (2003).
Led by Carlos Centeno, the European Association for Palliative Care (EAPC) Task Force on the Development of Palliative Care in Europe undertook the great task of examining the present situation of hospice and palliative care systems in 52 countries of the WHO’s European region - in the framework of an extraordinarily strong cooperation - and using the collected data to feature the development of this very important field. The task force was founded in 2003 and based its research on the data of the year 2005 which were summarized by countries in country reports. The thorough research covering every segments of palliative care allowed the performance of comparative studies considering and summarizing the differences and peculiarities in different states and publishing the results in this study. The original English version of the article is not published so far, so we owe special thanks to the authors for allowing the publication of the manuscript’s Hungarian translation, so the Hungarian readers are the first to acquaint the research results.
The study of György Gyukits et al. deals with the problem of how great difficulty is in Hungary to organize and extend the hospice care of those in need among the population segregated and living in persistent poverty. The results of interview surveys performed among mostly roma people living in larger cities and in villages reveal that both social and cultural peculiarities significantly hinder the spread of this form of care and screening of indigent patients. Fatalist approach of severe diseases (mainly cancer) indicating significant poverty-risk factor per se, and death itself reflecting helplessness and defenselessness which is also induced by poor social conditions, poverty resulting in marginalization, and deficiencies of social network contribute together to the fact that this social stratum is crowded out of the framework of hospice care.
The ethical and mental attitude toward death among the future generation of doctors is - as a result of the efforts of the recent past - is comfortably receiving more and more emphasis, thus significance of publications dealing with the death image of medical students is increasing as well. It is not accidental that the following three articles also deal with this problem. Due to the Institute of Behavioral Sciences, Semmelweis University the accredited
Thanatology, palliative care course is part of the medical faculty curriculum since 2003 which aims to prepare medical students to process the mentally straining and hardly processable facing with death in a ’healthy’ way and get acquainted with the most up-to-date efforts related to the care of dying patients. Katalin Hegedűs et al. investigate the attitude of those participating at the university courses in Budapest, the change in their approach of death, and Gyöngyi Samu, Körtvélyesiné et al. summarize the experiences of the work at the University of Szeged since 2005. At the end of the semester the students write an essay about what they learnt and answer the questions surveying their attitudes. Student of the medical faculty on Budapest, Mária Szántó wrote the essay published after the two studies which - as a lyric self confession - demonstrate through her own example how difficult is to face loss be it death or an accident affecting our entire life.
Following the change of the regime it is more and more markedly seen in Hungary as well that those unsatisfied with and not relieved by the Christian attitude of life seek the way to their spiritual peace in the philosophies of eastern cultures, and many of them study the disciplines of Tibetan Buddhism. In Buddhist regions many textual variants of the Tibetan Book of the Dead is known which sees through phases of death during the intellectual and spiritual struggle leading to reincarnation or lightening up and which already has two Hungarian translation published. With the help of Attila Kazi-Tóth our Readers can also see the road a dying person has to walk down and although these thought may seem as alien those reading carefully may discover the parallels with the world of Christian ars moriendis and with the inner fight with challenging thoughts emerging as last temptations at the end of life.
In the ’Sources’ column this time you will read fragments of the dissertation of Ladislau Vasilie Popp, a Romanian medical doctor who lived in Transylvania. The paper originally written in Latin and published in 1817 is an important source of Romanian folk funeral customs and was translated by László András Magyar on a high standard. Today it might seem strange how come this mostly ethnographic dissertation was submitted to the medical faculty of Vienna. The answer is that the issue of funerals and cemetery surveillance with its hygienic, epidemiologic and other viewpoints got gradually under the state and made an important part of public health which was then called politia medica, so such tasks were frequent among the listed theses.
In the name of the entire Editorial Board I wish a useful and pleasant time for all of our readers!
About the dead face
Facts and indicators on palliative care development in 52 countries of the who European Region. Results of an EAPC Task Forc
In the framework of a comparative study the authors introduce the development of palliative care in Europe. In 2003 a task force dealing with the developmental issues of European palliative care was established to assess and evaluate the development in the field of palliative care in the European region. A task force is supervised by EAPC (European Association for Palliative Care) in association with International Observatory of End of Life Care (IOELC), Help the Hospices Foundation and International Association for Hospice and Palliative Care (IAHPC). The study reports on the surveys done so far and the two separate international studies that were based on actual assessments: one is a qualitative the other is a quantitative analysis. The task force’s work is extended to each country of the World Health Organization’s European Region.
Different service models were developed and realized in different countries. For example, beside the United Kingdom by the day Germany, Austria, Poland and lately Italy possess well developed and extended hospice networks. Mobil teams and hospital hospice support teams are mostly denizen in France. Development of day care centers is typical mainly in the United Kingdom which includes hundreds of provisions. In the most developed countries the number of beds per 1 million inhabitants is between 45 and 75 while in other countries this number is much lower. The study includes numerical data on the physicians who practice palliative care as a full-time job. The countries where palliative care is the most developed in the given subregion: United Kingdom in Western Europe (15), Poland in Central and Eastern Europe (9) and Armenia in the Commonwealth of Independent States (8) - numbers in brackets indicate the ratio of services per 1 million inhabitants. Furthermore, the study introduces the indicators of palliative care development that are based on bibliometry (citation index of scientific journals) and on the viability of palliative movement in the given country.
The facilities to organize hospice care in the population living in persistent poverty
In the study we report on the results of a qualitative sociology survey which was aimed to promote planning of services providing hospice oriented care in the gipsy population living in persistent poverty. During the research we endeavored to question seriously and incurably ill (primarily cancer) patients and the relatives of deceased people who died of such diseases. The research was performed by an interview method: we conducted 50 structured interviews. The sites of the research were the following: 9th and 10th districts in Budapest (gipsy minority living in a block-like segregation), Szondi-settlement and Békeszálló (both of them are gipsy populations living in a block-like segregation), Taktaszada (so called gipsy settlement) and Sajószentpéter (so called gipsy settlement).
The results of the research raise the attention on the fact that extension of hospice-oriented care on marginalized roma population living under bad social circumstances is hindered mainly by social problems like the issue of medication or other, mental kinds of problems evolving as consequences of social causes such as pathological grief reactions. Difficulties evolving from cultural causes are secondary but not negligible. Furthermore these are much easier to cure if those participating in the care are empathetic an deal with the patients with appropriate thoughtfulness. In contrary, social problems are much more severe because they are off the beat of hospice care and raise the question what extra tasks should be/might be taken by the institute providing hospice-oriented care.
Medical students’ image of death and effects of courses dealing with death and dying
By exploring medical students’ fear of death and the most pivotal elements of this fear, the authors’ research aim is to open the door to the elaboration and development of education and training programs which could reduce the future doctors’ and health care professionals’ inner anxiety and could improve communication with dying patients. Their follow-up study evaluating the effect of Thanatology Course at Semmelweis University demonstrates that training related to death, dying and improvement of the care of the dying patient has an effect on medical students’ attitude toward death. Improvement is seen mainly in attitudes which can be related to the improvement of knowledge aiming quality care of the dying patients. Significant differences are seen in relation with the medical students’ age and gender in both elements of fear of death and effect of courses.
Experiences of medical students participating at thanatology courses
In Hungarian medical education students acquire only minimal knowledge in relation with death, dying an grief. At the same time during their practice as physicians care for terminal stage patients will be an organic part of their job which can be a very difficult task if the student possesses no appropriate knowledge. Severe, incurable illness is a crisis trying the whole personality. Closeness of death strengthens the spiritual need to answer the final questions of life.
In their article the authors processed the experiences of medical students who participated at thanatology courses; the results reflect how the students’ attitude toward death changed as an effect of the course. New knowledge touched the students deeply and brought them closer to accept the fact of death.
Should we do grief work? Apropos of the thanatology course...
We are loath to face death, the possibility of loosing someone, the pain of grief. But what about everyday losses when we loose ’only’ illusions, dreams? How do we cope with theese? The article was born in January 2007 at the Faculty of Medicine, Semmelweis University as an end-of-semester essay by a second grade medical student.
Dying and after-death states in the Tibetan Buddhist tradition
By introducing the Tibetan Book of the Dead, one of the main pieces of art of Tibetan culture known by more and more people the study presents what happens to human body and spirit during dying, death and in states after death. Furthermore with guiding indications and short explanations it introduces the basic ideas of the Tibetan Buddhist philosophy which suggest that it does matter how we live our lives.
On folksy funeral rituals in Romania (fragments)
PAPP, LADISLAUS BASILIUS: Dissertatio inauguralis historico-medica de funeribus plebejis Daco-Romanorum, sive hodiernorum Valachorum et quibusdam circa ea abusibus, perrpetuo respectu habito ad veterum Romanorum funera, quam... universitate Vindobonensi publicae disquisitioni submittebat Ladislaus Basilius Papp Transylvanus... Viennae, [ny.n.], 1817.