What do you do at St Joseph’s?
I’ve been at St Joseph’s now for four years, working as a Staff Nurse on Lourdes Ward.
What do you like about your job?
I love the East End for its diversity and because of our location we see patients from many different communities and backgrounds which makes this job challenging but also really interesting. It’s never boring and I’m lucky to have great colleagues.
What’s your proudest moment at St Joseph’s?
Bringing my mum to one of the famous jumble sales. Growing up she loved a good jumble sale but as they’ve died off over the years she hadn’t been to one for a long time. It was lovely to see her face light up when she saw all the stalls and the people, she even bought a few knick knacks.
Tell us something we don’t know about you?
I have always been interested in Tibetan Buddhism and have studied it extensively over the years. I was fortunate enough to meet the Dalai Lama personally and have heard him speak a number of times. I also support the Tibetan Community in Exile in the UK so I decided to take some time out from St Joseph’s and in September 2017 I set off from London to the remote town of Dharamsala, to work as a volunteer in a charity-run hospital for Tibetan refugees.
Dharamsala, known as ‘Little Lhasa’, is home to His Holiness the Dalai Lama and has become the sanctuary of thousands of Tibetan refugees since China invaded Tibet.
During the two months I spent in Dharamsala, I was incredibly fortunate to be welcomed by the staff at the Delek Tibetan Hospital and to undertake voluntary service as a nurse. ‘Delek’ is a Tibetan word meaning ‘health’ or ‘wellbeing’. The Delek hospital was set up under the patronage of the Dalai Lama in 1971 to serve the needs of the refugee community, as well as providing care to local poor Indians.
The hospital is perched high up in the mountains and has 45 beds, comprising of male and female wards, maternity ward, Outpatients and Casualty. There is also a separate TB ward and isolation rooms.
Working with the Tibetan doctors and nurses was a great privilege. The hospital has an extremely good reputation, and patients sometimes travel for days from remote Himalayan regions to benefit from its care. The Consultant, Dr Tsetan, in particular is very highly respected for his work and service to his community. The hospital won a World Health Organisation Prize in 2012 for its TB programme.
On my first day, I cared for an elderly Tibetan lady whose husband had brought her on a 200 mile journey to the hospital for medical care, involving 2 days and nights on buses. She was unable to walk, so family members and attending Buddhist monks had been physically lifting her on and off of the buses. There is no free public ambulance service in India and the family were too poor to pay for a private ambulance. This was the first of many very humbling experiences during my time at the hospital.
As a charity hospital, resources were limited. Tibetan nurses were vigilantly mindful of this, and nothing was ever wasted. Anything that could be recycled was sterilised and used again. For example, when fluid was drained off from patients with ascites, empty plastic water bottles were converted into containers for the fluid to drain into. When dressing a wound, nurses were particularly skilled in assessing how much gauze and bandaging to use, therefore not having to throw anything away.
I was able to care for patients with diseases and conditions rarely seen in the West, ranging from Typhoid fever to dysentery, monkey bites to Dengue fever. As the monsoon had only recently finished in mid-September, there were many cases of Dengue fever on the wards. This mosquito-borne disease is life-threatening, and there is no cure, so patients were admitted for supportive treatment in the form of IV fluids and close monitoring. Most of these patients had travelled up from Majnu Ka Tila, a Tibetan refugee colony on the outskirts of Delhi, where there had been an outbreak of Dengue fever.
There are high numbers of cases of TB in the refugee community, and many of the TB patients were Buddhist monks and nuns. Living in close proximity in monasteries and nunneries means that the illness spreads more easily. Treatments for TB were complex, depending on the particular strain of the disease, and MDR (Multi-Drug Resistant) TB caused particular difficulties. The hospital employed a Specialist TB Nurse to manage the care. As well as having to take several tablets every day, the TB patients also suffered from loneliness at being in an isolation room. In October, a research project was started to identify psychological needs of TB patients and to provide support based on Buddhist spiritual care and Traditional Tibetan Medicine.
Every day at the hospital was unique and varied. Nurses were not based on a particular ward, so on any given day they may be dealing with the sick, providing maternity care for mothers, dealing with emergencies, caring for children and babies. You could say, from the ‘cradle to the grave’.
The saddest part of the work was talking with the refugees themselves about the human rights abuses which Tibetans suffer inside Tibet. In particular were two monks I helped to look after who spoke of the great sadness of never being able to return to their homeland or see their families again. Both escaped by crossing the Himalayan mountains on foot.
As a palliative-care nurse at St Joseph’s, the greatest privilege for me was to be allowed to help to care for the terminally ill patients at the hospital. Coming from a world famous hospice in the UK, I was asked to share my knowledge with the staff when caring for their palliative care patients. However, I often thought that we could learn a lot from them. Most of these patients had a diagnosis of cancer, and had been brought to the hospital by their families. Some of these patients deteriorated and subsequently died at the hospital.
The first thing that struck me was the absence of morphine and sedative drugs. Morphine is highly restricted by Narcotics Law in India and its use is extremely rare. The bureaucratic procedure involved in obtaining morphine makes its use almost impossible. However, I never saw patients in distress. In fact, they were calm and peaceful.
Most Tibetans are practicing Buddhists, and within their religion and tradition there is a very open and practical attitude towards dying. Physical death is seen as the completion of the cycle of life, and it is extremely important for Tibetans to die in a peaceful and calm environment. Clarity and peace of mind at the moment of death is very important. Along with the medical care provided, dying patients were cared for by Buddhist monks and nuns who attended to spiritual needs and also washed and nursed patients in the absence of family. Unlike in UK, nurses in India do not provide personal care, this is seen as the duty of the family or closest friends. Since many of the monks and nuns had no family, their fellow monks would care for them.
After patients died, prayers and rituals continued for a further three days, since the Buddhist tradition believes that the ‘soul’ does not leave the body until after this time. It was an immense privilege for me to observe these ancient traditions being upheld. The composure and compassion of those Tibetans facing death will always inspire me.
I returned to my work at St Joseph’s in November, and it has taken a while to readjust to working in the UK. In India, there was very little paperwork and no computers, so almost all of the nurse’s time was spent with patients. No matter how busy the hospital was, the work just got done without stress and anxiety.
Buddhist philosophy teaches us that ‘You can’t change the world unless you first start to change yourself’ and I think that's a good way to live.