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Health Care Chaplaincy in Czech Republic
Our Parliament is just about
to discuss a radical Health Care Reform. For us, it would be crucial if
new laws integrate spiritual care into health care which has not been the
case yet. This issue is especially sensitive because of our atheistic
history.
Meanwhile, we are doing our
best to get prepared. Our preferences are quality and ecumenicity of
spiritual care for all. The Ecumenical Council of Churches in Czech
Republic and the Czech Episcopal Conference of Roman Catholic Church in
Czech Republic made an Agreement on Spiritual Care in Health Service
including Standards of Qualifications and Ethics. The Evangelical
Theological Faculty of Charles University in Prague with the cooperation
of the 1st Faculty of Medicine of CU is organizing the first ecumenical
course of hospital chaplaincy for 20 participants.
Although spiritual care has
not been acknowledged and provided in general, we can see growing
individual activities scattered through the whole country. Some chaplains
are volunteering, some are employed by churches, some by hospitals, one by
the army (Military Hospital in Prague).
Pavel Pokorny
Commission for Spiritual Care in Health Service of Ecumenical Council of
Churches in CR,
hospital chaplain in University Hospital in Motol, Prague
[May 2008]
Health Care Chaplaincy in
Czech Republic
Marie Opatrna, MA, M.D., PhD.
Marketa Cermakova, MA
Marie Opatrna
I have worked as a spiritual care giver/hospital chaplain at the
Department of Oncology of the First Faculty of Medicine and General
Teaching Hospital in Prague since 1998. As a lay catholic woman I am not a
representative of Catholic Church. This report is report of a person who
is a spiritual caregiver for almost 11 years.
In January 2008 I defended my dissertation on the theme Healthcare
Chaplaincy as a Part of Total Care (Institute of Humanitarian Studies in
Medicine, Medical Ethics; First faculty of Medicine, Charles University in
Prague).
I am a member of the healthcare team at the department of oncology, but I
can provide the care at the all departments of the hospital. I also teach
Medical Ethics.
Marketa Cermakova
I have worked as a hospital chaplain at the Department of Oncology of the
First Faculty of Medicine and General Teaching Hospital in Prague since
2006.
During my first year I was trained and supervised by Dr. Opatrna and then
I became a member of health care team.
In February 2008 I was ordained as deacon of The Czechoslovak Hussite
Church.
From February 2005 I have studied PhD at the Institute of Humanitarian
Studies in Medicine of The Charles University, First faculty of Medicine.
Theme of my thesis is Quality of life and spiritual needs of hospitalised
patients in palliative care.
News and the present situation at the Department of Oncology
(Charles University in Prague, First Faculty of Medicine and General
Teaching Hospital)
As one of the few exceptional facilities in the Czech Republic that follow
the European trends, the Complex Oncology Centre (Oncology Clinic /
Onkologická klinika 1. LF UK a VFN and Institute of Oncology, Ples /
Onkologický ústav na Pleši) managed to fulfil the ESMO accreditation
programme criteria and was awarded the ESMO accreditation in 2006. It thus
became one of the European facilities performing integrated oncology and
palliative care, a part of which is also constituted by pastoral or
spiritual care. Within the framework of the Complex Oncology Centre, or
the Oncology Clinic, there has also been a special Clinical Pastoral Care
Unit operating since 2006.
The Clinical Pastoral Care Unit is also educational workplace. M. Opatrna
led one year “clinical pastoral training” of M. Cermakova (free of
charge). Since 2007 we have led together several trainings for students
from faculty of theology. The interest is increasing (now we have 3
entered students).
M. Cermakova became also a member of the health care team at the
Department of Oncology.
The Department of Oncology and The Clinical Pastoral Care Unit organised 3
Czechoslovak ecumenical meetings of pastoral workers in health care
settings. In 2007 about 35 persons participated (Vranov 2007). This year
we are planning to invite more than 60 persons (Velehrad 2008).
Present situation in hospitals and hospices in the Czech Republic
Generally priests come to the hospitals when a patient or family request
sacraments. Some major teaching hospitals have hospital chaplains. The
Central Military Hospital has one full time military chaplain. In few
hospitals there are also laywomen, permanent deacons or nuns who devote
their time mainly to Christians bringing them Eucharist.
None of them is a member of the health care team except the military
chaplain.
There are 11 hospices and many home care agencies. In hospices parish
priests come to hospice that is in their parish district. Only one hospice
in Moravia has its own catholic priest who is a member of the healthcare
team.
The central idea is that Catholic pastoral care of patients is
sacramental. So the catholic model has started to develop analogously to
catholic countries (e.g. Italy).
In 2006 Czech Bishop Conference and Ecumenical Council of Churches on the
Czech Republic described the Agreement on spiritual care at healthcare
settings. No chaplain has been sent according to this Agreement till now.
M. Opatrná would like to
thank Rev. Debbie Hodge and Rev.
Linda Phillips for her visit to London hospitals in 2007. It was a great
help and support for her work.
Marie Opatrna, MA, M.D., PhD. and Marketa Cermakova, MA
Charles University in Prague
First Faculty of Medicine and General Teaching Hospital – Department of
Oncology; and Institute of Humanitarian Studies in Medicine
[May 2008]
From my point of view the
patients who were baptized and stopped their religious practice during the
communist regime (or non baptized young people) stay without spiritual
care. They do not have the language to ask for it. If you ask patients:
“Would you like some support in your spiritual needs?” or similar
questions, the answer is no. But if you sit at the bedside and a patient
is able recognize you as a person who is there for him, with him, to help
him, that patient opens his/her heart. Any chaplain from any church would
help these patients to cope, would listen to them, pray with them, and
read from Bible and in some cases to call a catholic priest.
At the end I would like to present one case report:
“I am not a believer, because of so much violence in the world,” an old
woman told me. I do not persuade people. But in this case I remarked – you
are right concerning violence, but every human being has freedom – to do
well or bad. Look at Bin Ladin and Mother Theresa. A few days later the
woman was waiting for transport to another hospital. Saying goodbye I
leaned towards her. The cross on my coat lightened. “Oh, the cross! Lord
Jesus, have mercy on me!” she said.
1. A brief history and a few data
It is said that Czechs are the most atheistic nation in Europe, maybe in
the world; however Christian roots are very deep.
Christianity arrived in our territory (center of Europe) thanks to the
Irish-Scottish mission at the turn of the 8th and 9th century. Another
mission followed by what is now Germany. Missionaries were not too
successful – there were political reasons and also problems concerning
language. In 863 two brothers St. Constantine (Cyril) and St. Method came
from Thessalonica. They translated the Bible into Slavonian and this
language became also the language of church service (liturgy).
The troublesome integration of Christianity is again reflected in the 21st
century. In 1921, three years after the First World War and also three
years after establishing Czechoslovakia there were 91.2% Christians
(Catholics were 82% of population). Two years after the communistic putsch
in 1948 there were still 94% Christians in our country. In 1991, two years
after the velvet revolution, statistic shows that 45.5 % of population
declare themselves as members of Christian Churches, the number of
Catholics decreases to 39% of population.
The ministry of Education published in 1998 results of a research among
young people. Number of respondents: 1007, strong atheists 20%, more than
27% suppose the existence of God, 41%! of respondents recognize themselves
as atheists but simultaneously believe in existence of phenomena
unexplained by materialism. This phenomenon was described as the
“world-view schizophrenia”.
Conclusion:
1. There are deep Christians roots in the Czech Republic
2. The communistic era damaged the nation in its roots and brought
perplexity in the minds of people concerning religion and spirituality
2. Health Care Chaplaincy during the communist regime
There was no official Health Care Chaplaincy in our country during the
communist regime. Hospital chapels were closed and largely changed into
stores or depositories. Some were totally damaged.
Priests officially managed visits to give sacraments (when a patient or
family asked for them); and this activity was more or less tolerated by
the regime. Some underground activities of pastoral care in hospitals
proceeded because some doctors, priests, nuns and lay people took the
risk. Towards the end of the regime, lay people have started to bring
Eucharist to ill people, who asked for it. This service was mostly secret.
3. Situation after the
velvet revolution
Changes have come slowly in all eras of the life. Concerning health care
chaplaincy the status quo has continued.
Now let me introduce myself. I am a Catholic woman, an oncologist, and
mother of four adult children. My husband is a permanent deacon. During
the regime I worked in a hospital in a very communistic district near
Prague. I was deeply touched by the way patients were dying. Immediately
when it was possible, still in revolution effervescence, I started with
establishing the first hospice in our country. It was too early: many
obstacles, lack of understanding. Two years later I fall from exhaustion
into the first serious attack of MS. After stabilization I started to
study theology, successfully passed through and received the degree of
Magistra.
In 1997 bishop Skarvada, the vicar general of Prague Archdiocese (who
lived at the Vatican during the regime and has a lot of experience with
pastoral care in western countries) supported me in starting pastoral care
in the General Teaching Hospital, First Faculty of Medicine, Charles
University. I became a lay chaplain. I had no experiences, no training,
except my clinical practice as an oncologist and my own spiritual
development during my illness. Lourdes and Carmelite spirituality have had
a great influence on my life and have been sources of my spiritual life.
Employing me as a chaplain was a try out, both for the Church and the
hospital. I was the first one in our country in this position. I became a
member of multidisciplinary team at the Department of Oncology. The first
perception was that I would be in the hospital (mainly at the department
of oncology) for Christian patients. However at oncology I could find only
0 – 3 Christian patients a day. So at a very early stage I experienced
that being there only for the Christian patients was not an adequate
perception. I decided to dedicate my time and effort to all patients at
Oncology. My decision was soon rewarded. I listened to many life stories,
falls, inner wounds, and spiritual needs… and also conversions during my
care. I discovered that all people with life threatening diseases have
spiritual needs and most of them have also religious needs. I was really
surprised not to meet many true atheists.
I wrote some articles, gave a few lectures – papers, but only few people
understood me; most of them were Catholic doctors. It was only some time
later I inspired some people from the Catholic and Lutheran churches.
Thanks to a Lutheran bishop the first ecumenical center for pastoral care
arose in one of hospitals. In 2000 I decided together with the general
secretary of Ecumenical Council of Churches in Czech Republic to establish
ecumenical group to study and work in the area of health care chaplaincy.
We invited priests, pastors, and laity. Unfortunately the group had no
success in its effort to move the task.
While the ecumenical cooperation has been developing very nicely in the
field of Army and prison system, there have been problems between the
catholic a protestant view on pastoral care in hospitals. Churches have
not acquired common agreement.
Similarly government agents have been positively inclined to pastoral care
in the Army and prisons. Unfortunately the Ministry of Health has not been
inclined to pastoral care in hospitals.
4. Present situation
Pastoral care is closely related to palliative care (but not only to it),
because it integrates spiritual aspects of patient care. E.g. a more
recent WHO definition of palliative care says: “Palliative care is an
approach that improves the quality of life of patients and their families
facing the problems associated with life-threatening illness, through the
prevention and relief of suffering by means of early identification and
impeccable assessment and a treatment of pain and other problems,
physical, psychological and spiritual.”
The Committee of Ministers in his Recommendation Rec (2003) 24 of the
Committee of Ministers to member states on the organization of palliative
care considers “that palliative care is an integral part of the health
care system and an inalienable element of a citizen’s right to health
care, and that therefore it is a responsibility of the government to
guarantee that palliative care is available to all who need it.” The
Committee “recommends that the governments of member states adopt
policies, legislative and other measures necessary for a coherent and
comprehensive national policy framework for palliative care.”
Despite the efforts of many people the Czech Republic stays behind the
development of western countries. Palliative care is insufficient and its
development is going on very slowly. High-quality palliative care exists
but is accessible only for about 1% of dying people. (Remark: Palliative
care is not synonymous with terminal care, but encompasses it.)
There are 11 hospices and many home care agencies, but no special
palliative unit. Palliative care is provided mainly at departments of
oncology and departments of internal medicine.
Authors of the project of Conception of Palliative Care in Czech Republic
say that a “complex of legal, economic, political and cultural barriers”
inhibit development of modern palliative care in our country. Added to the
religious problems, the development of health care chaplaincy seems rather
problematic.
In 2004 the translation of Joint Commission International Accreditation
Standards for Hospitals was published. The fundamental standards
repeatedly speak about the provision of spiritual needs. It has been a
reason to “hope” for development of pastoral care in hospitals.
Positive outlook to the
future
a) The mentioned ecumenical group was transformed last year to the
Commission of Ecumenical Council of Churches in Czech republic.
b) The Czech Bishops Conference established a Catholic group last year in
order to study health care chaplaincy. The responsible priest is also
a member of the ecumenical group and a coordinator for the work of these
two groups. The Catholic group has decided to start preparing a Catholic
model of pastoral care.
c) Present situation in hospitals and hospices
Generally priests come to the hospitals when a patient or family request
sacraments. Some major teaching hospitals appointed priests who give
sacraments or celebrate holy masses (for example in Prague we have 2
hospital chaplains-priests for 5 large teaching hospitals. In few
hospitals there are also laywomen, permanent deacons or nuns who devote
their time mainly to Christians bringing them Eucharist. None of them are
a member of the health care team.
In hospices parish priests
come to hospice that is in their parish district. Only one hospice in
Moravia has its own catholic priest who is a member of the healthcare
team.
The central idea is that Catholic pastoral care of patients is
sacramental. So the catholic model has started to develop analogously to
catholic countries (e.g. Italy).
From my point of view the
patients who were baptized and stopped their religious practice during the
communist regime (or non baptized young people) stay without spiritual
care. They do not have the language to ask for it. If you ask patients:
“Would you like some support in your spiritual needs?” or similar
questions, the answer is no. But if you sit at the bedside and a patient
is able recognize you as a person who is there for him, with him, to help
him, that patient opens his/her heart. Any chaplain from any church would
help these patients to cope, would listen to them, pray with them, and
read from Bible and in some cases to call a catholic priest.
At the end I would like to
present one case report:
“I am not a believer, because of so much violence in the world,” an old
woman told me. I do not persuade people. But in this case I remarked – you
are right concerning violence, but every human being has freedom – to do
well or bad. Look at Bin Ladin and Mother Theresa. A few days later the
woman was waiting for transport to another hospital. Saying goodbye I
leaned towards her. The cross on my coat lightened. “Oh, the cross! Lord
Jesus, have mercy on me!” she said.
As a lay catholic woman I am
not a representative of Catholic Church. This my report is report of a
person who is a spiritual caregiver for almost 9 years and who is writing
her PhD on the subject of health care chaplaincy: “Pastoral Care – Part of
Complex Care”. I am a member of the healthcare team at the department of
oncology. Since last year I have two volunteers.
MUDr. Mgr. Marie Opatrna
Charles University in Prague
First Faculty of Medicine and General Teaching Hospital – Department of
Oncology; and Institute of Humanitarian Studies in Medicine
[April 2006]
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