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• W2019682461 abstract "I found here in the West people who were so submerged in the massive trance of modern culture that they appeared virtually unreachable. It became clear that certain topics of discussion, such as spirituality and rituals, were not permitted in intellectual and professional circles. I noticed some people, particularly those who were most enthralled by the game of consumerism, found mention of indigenous wisdom especially irritating and sometimes would lash out at me, just as child entranced by a Nintendo game reacts with a tantrum to any disturbance.—Malidoma Patrice Somé1Somé M.P. The healing wisdom of Africa. Finding life purpose through nature, ritual and community. Jeremy P. Tarcher/Putnam, New York1999Google Scholar(p. 14) “There are a billion reasons to believe in Africa” states the Coca Cola Company in the streets of Nairobi. This may be the way to catch up new consumers for the advertised product, but the statement also can encompass a great wisdom for a humanistic clinician. Indeed, one reason to believe in Africa is its incredible cultural heritage, which is only in part found, learned, and shared in Western science.1Somé M.P. The healing wisdom of Africa. Finding life purpose through nature, ritual and community. Jeremy P. Tarcher/Putnam, New York1999Google Scholar In this article, I ask whether it is possible for a humanistic clinician to learn to listen to a patient's stories of suffering, meaning, lived life, and relationships2Sasser C.G. Puchalski C.M. The humanistic clinician: traversing the science and art of health care.J Pain Symptom Manage. 2010; 39: 936-940Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar by listening to these very same stories told by vulnerable African communities. Furthermore, the focus of this article is on African spirituality as it is understood in the context of health sciences. The article aims to illuminate the rich understanding of spirituality, love, and forgiveness in the chosen geographical regions in Kenya. The objective is to gain this greater understanding through introducing two phases of a research and curriculum development project in Kenya. The first phase, “First Steps on the Footpath,” includes the elements of my doctoral3Karvinen I. Spiritual health: An ethnographic research about the conceptions of spiritual health held by the Kendu hospital staff members, patients and the inhabitants of the Kendu Bay village. Doctoral dissertation. Kuopio university publications D. Medical sciences 451.Google Scholar, 4Karvinen I. Towards Spiritual Health. An ethnographic research about the conceptions of spiritual health held by the Kendu hospital staff members, patients, and the inhabitants of the Kendu Bay village. Diakonia-ammattikorkeakoulun julkaisuja A Tutkimuksia 32, 2011.Google Scholar and postdoctoral5Karvinen I. Vaskilampi T. Kauhanen J. Conceptions of spiritual health according to the Nursing Students at religious African university.Diakonian tutkimus. 2012; 1: 114-129Google Scholar research in Kenya. These studies are briefly discussed to give an overview of the model of the conceptions of spiritual health held by Kendu hospital staff members, patients, and the inhabitants of the Kendu Bay village. The understanding of this study is a gateway to understanding the next steps of the project continuum. The next step is called “Leaving the Footprint” to highlight how the research done at the first step is implemented to sustain development of disaster management and preparedness in Kenya. This phase introduces the current efforts to design and build a Master's degree program infused by the essential spiritual values of love, forgiveness, and compassion. This article is partly a story of my personal journey as a scholar to try to capture a greater understanding of spirituality and health. Moreover, it also combines the knowledge from a growing body of literature on spirituality, health, love, and forgiveness with some empirical evaluation data to emphasize the meaning of love and forgiveness in humanistic health care. My interest in spiritual health started when I realized that spirituality is a much broader concept in health care than only religion.6Eskuri M, Karvinen I, Lehikoinen A. Nurses abilities to meet spiritual questions in nursing. Bachelors thesis. Kuopio: Savonia-ammattikorkeakoulu, 2004.Google Scholar, 7Puchalski C. Ferrel B. Making health care whole: Integrating spirituality into patient care. Templeton Press, West Conshohocken, PA2010Google Scholar Spiritual needs can be expressed in different ways in different cultures,8Coyl J. Spirituality and health: towards a framework for exploring the relationship between spirituality and health.J Adv Nurs. 2002; 37: 589-597Crossref PubMed Scopus (130) Google Scholar, 9Taylor E.J. Spiritual needs of patients with cancer and family caregivers.Cancer Nurs. 2003; 26: 260-266Crossref PubMed Scopus (113) Google Scholar and according to my understanding, it is important for humanistic health professionals to have both formal professional and private personal exposure to this area of care.10Karvinen I, Vaskilampi T. Perceptions of spiritual health held by the African Seventh-Day-Adventist nursing students. Baraton Interdiciplinary Research Journal 2012;2:31–39.Google Scholar I started my journey to study spiritual health in Africa as a postgraduate nursing student in Kenya. During my public health intensive course in the African villages in the Kendu Bay area, I realized that simple medical answers to the complex questions of well-being are not the best way to approach health in the African context. Stories of children touched by HIV, other communicable diseases, or loss of loved ones made me try to understand in a more humanistic way the health challenges and possibilities in Africa (Fig. 1). After realizing that research findings on spirituality and health especially in the African context are scattered in the health sciences and that it is often stated that explicit definitions are not possible, I started my journey to find out what spiritual health in Africa is. African understanding of health is broader than many expect. Health is much more than only physical, mental, or social well-being because it includes also the well-being of the environment and community. Illness can be observed from the physical signals of disease, but moreover, it is disruption of the spiritual and communal harmony. Therefore, illness or well-being cannot be separated from the universe of spirits or community.11Stinton D.B. Jesus as healer: Reflections on religion and health in East Africa today.in: Chepkwony A.K.A. Religion and health in Africa. Reflections for theology in the 21st century. Pauline Publications Africa, Nairobi2006Google Scholar My doctoral study, “Spiritual Health: An Ethnographic Research About the Conceptions of Spiritual Health Held by the Kendu Hospital Staff Members, Patients and the Inhabitants of the Kendu Bay Village,”3Karvinen I. Spiritual health: An ethnographic research about the conceptions of spiritual health held by the Kendu hospital staff members, patients and the inhabitants of the Kendu Bay village. Doctoral dissertation. Kuopio university publications D. Medical sciences 451.Google Scholar was published in 2009. Contrary to many other studies, I was not interested in finding out the meaning of spirituality AND health but the concept of spiritual health. The absence of the word AND is very essential in my study. This doctoral study describes spiritual health in an ethnophilosophical context by using focused ethnographic research methods in the Kendu Bay hospital and the village of Kendu Bay and its surroundings in Nyanza Province in western Kenya. The research methods for data collection included observing in the community; interviewing patients, caregivers, and villagers; and the use of visual anthropology, namely photography. According to the study's findings, the concept of spiritual health is composed of three types of factors that explain, support, or threaten spiritual health. These factors are shown in Table 1. In this article, I focus on the community's minimal protection against the factors that can harm it because these factors are closely interconnected to the next step of implementing the study.Table 1Conceptions of Spiritual Health According to Karvinen3Karvinen I. Spiritual health: An ethnographic research about the conceptions of spiritual health held by the Kendu hospital staff members, patients and the inhabitants of the Kendu Bay village. Doctoral dissertation. Kuopio university publications D. Medical sciences 451.Google ScholarThe Model of Conceptions of Spiritual HealthFactors That Explain Spiritual HealthFactors That Support Spiritual HealthFactors That Threaten Spiritual Health•Supernatural as an explanatory factor of spiritual health•Supernatural as an explanatory factor in becoming ill and healing•The conception of appropriate nutrition as an explanatory factor•Balance with culture as an explanatory factor•Ability for existential contemplation as an explanatory factor•Nursing that supports spirituality•Modern nursing that supports spirituality•Medicine men as supporters of traditional spirituality•Herbal healing•Faith healing•Moral and health teaching•Misdiagnosis of mental health problems•The community's minimal protection against factors that harm it Open table in a new tab The threatening factors found in this study were related to the community's social and economic factors, living conditions, and functions related to health. One estimated harming factor that can threaten spiritual health includes technological and natural catastrophes. These were stated as a major threat because the community was not able or it did not have an opportunity to prepare enough for these kinds of disasters.3Karvinen I. Spiritual health: An ethnographic research about the conceptions of spiritual health held by the Kendu hospital staff members, patients and the inhabitants of the Kendu Bay village. Doctoral dissertation. Kuopio university publications D. Medical sciences 451.Google Scholar As a researcher in Kenya, I was told of these threatening factors in a form of political violence that followed the elections in 2007 to 2008: stories of people who had witnessed or experienced homicide and arson were told to me. According to the Commission of Inquiry into Post-Election Violence, the violence was partly spontaneous, but in some regions, it was organized and planned along ethnic lines. Many people experienced the loss of their homes by fire, were sexually assaulted or maimed, or lost a loved one.12CIPEV. Report of the Commission of Inquiry into Post-Election Violence. 2008. Available from http://kenyaplanet.com/sites/default/files/reports/CIPEV+Report_0.pdf. Accessed November 15, 2012.Google Scholar One of the stories published in the book “Rebuilding Lives” is told by Beliah:It was the year 2007 when people came and entered the house. Beliah was alone with her four children. She tried to struggle with them after refusing to lie down. They took the children outside and to make her comply they took a knife, cut her hand then placed the knife on her neck. They kept her there for five hours, while she was repeatedly raped. Afterwards, they began arguing whether to kill her or not, but Beliah pleaded and promised them she would not reveal what happened. They left her, alone with a warning not to tell anyone …13Glover J.A. Rebuilding lives. Feminenza International, Nairobi2012Google Scholar As the Commission of Inquiry into Post-Election Violence states, communities can prevent and be prepared for these horrible disasters,14International Council of NursesNursing matters: Disaster response. International Council of Nurses, Geneva2009Google Scholar but only love and forgiveness can be catalysts for peace, reconciliation, and healing of the communities. The consciousness of this fact led me to the second phase of the project, that is, to design and build a Master's degree program infused by love, compassion, and forgiveness. As learned from Beliah's story, the International Council of Nurses states that life and the quality of life are threatened by disasters. Both physical and emotional needs of victims and health care workers need to be met in disaster management. People's experiences in technological disasters may include a fear of everything, survivor guilt, a sense of great loss, and a reluctance to express deep feelings.15International Council of NursesNursing matters: Terrorism and bioterrorism: Nursing preparedness. International Council of Nurses, Geneva2009Google Scholar The natural second phase, after my research findings on spiritual health, was to try to implement everything I had learned in Kenya. The project, called “Love and Forgiveness in the Global Community,” aims to develop a joint Master's degree program in Global Health Care with a focus on emergency and disaster management and preparedness. The goal is to have the curriculum and program content infused by the central values of love, forgiveness, and compassion. In this program, preparedness for both natural and technological disasters is introduced. The program is being designed in collaboration with three higher education institutions in Finland and Kenya: Diaconia University of Applied Sciences, Arcada University of Applied Sciences, and the University of Eastern Africa, Baraton. The planning phase of the project is funded in part by The Fetzer Institute. This program aims to answer the call for health professionals by the Fetzer Advisory Council of Health Professions:A health care system that provides caregivers – professional and family – and care receivers the opportunity to realize their full selves – physically, emotionally, socially, and spiritually; that emphasizes health and healing; and that honors the health of the community. We seek a system that promotes compassionate care, and promotes love and forgiveness through relationship-centered care.16Fetzer InstituteHealth professions.in: Becoming aware. Fetzer Institute, Kalamazoo, MI2012Google Scholar (p. 17) This Master's degree program in Global Health Care is loosely based on the Theory of Transcultural Nursing17Leininger M. Transcultural nursing: Concepts, theories, and practices. Wiley & Sons, New York1994Google Scholar and core values of love, forgiveness, compassion, participation, and safety. In all the study units, the framework for quality health care is considered. This includes religious and philosophical factors, cultural values, beliefs and ways of life as well as economic, political, and technological factors. The content of the program is divided into four main modules, each including two to three study units. Values of love and forgiveness are especially discussed in the study unit of global health ethics and values. Furthermore, these values are studied in different modules by examining them in different learning assignments.18Diaconia University of Applied SciencesArcada University of Applied Sciences and University of Eastern Africa Baraton. Draft of the curriculum: Master’s degree in global health care, Helsinki2012Google Scholar The program does not give ready answers for the questions of definitions of love and forgiveness although the increasing body of scientific literature of these is taken into consideration. On the contrary, students will be encouraged to find their own operational definitions for use. For example, some of the expected learning outcomes for the study module of global health ethics and values are as follows:The student•Is able to describe the ethical basis of global health;•Understands the meaning of love and compassion as an instrument for better understanding of health care; and•Is able to explain the meaning of human dignity and relationship-centered care in the context of global health.18Diaconia University of Applied SciencesArcada University of Applied Sciences and University of Eastern Africa Baraton. Draft of the curriculum: Master’s degree in global health care, Helsinki2012Google Scholar These outcomes are partly met by assignments where students are guided to familiarize themselves with audiovisual material of compassionate care and write an essay where they discuss the meaning of compassion, love, and forgiveness in the global health context and reflect on their possibilities to promote health systems securing these values. To develop this Master's degree program and to share the understanding of love and forgiveness in health care, three special workshops were planned, to be held in Kenya and Finland.19Karvinen I. Master’s degree in global health. Love and forgiveness in global community. Workshop plans. Diaconia University of Applied Sciences, Helsinki2012Google Scholar After each workshop, participants are not only asked to give feedback on the workshop but also asked to answer the following substantial questions about the values:1.What was the main thing learned from the session?2.What are the best ways to ensure that the curriculum of this global health program is infused with the core values of love, forgiveness, and compassion?3.What is your understanding of the role of love and forgiveness in health care education?4.How to ensure that this global health curriculum emphasizes the human being holistically, especially in times of conflict and crises? The first workshop was held in Kenya in October 2012,20Karvinen I, Kinnunen ER, Lejonqvist GB, Äärilä S. Travel report, University of Eastern Africa Baraton. Helsinki: Diaconia University of Applied Sciences.Google Scholar and seven workshop participants answered the previous questions. The answers were generally very short, but it was possible to glean four main points from the data. First, the participants stated that the values of love, forgiveness, and compassionate care cannot be expressed in professional life if these values are not lived in private life. One of the workshop participants stated, “Teachers, students and their clients need to apply these three values. This helps to provide better care to the community members.” Second, it seems to be evident that health care should always be based on these values and principles, as mentioned in one of the answers: “In health care services love and forgiveness are core perspectives to empower people to go on living life,” and furthermore, “Extension of love and forgiveness goes a long way in contributing to healing and fullness of life. When there is a feeling of forgiveness, there is a peace in mind.” As well, it could be understood that by careful planning and good implementation, love, forgiveness, and compassion can be expressed in a very pragmatic and simple way in the study program. This is based on the understanding that real science and real ethics are based on humanistic values of love and forgiveness: “The program should contain both caring component and scientific knowledge to strengthen the research capacity of the students.” The West is hungry for Spirit, for the contact with unseen forces that brings healing. The West's hunger for Spirit, however, comes with cultural constraints. People want to experience the spirit, the Other World, but they want to experience it on their own terms.—Malidoma Patrice Somé1Somé M.P. The healing wisdom of Africa. Finding life purpose through nature, ritual and community. Jeremy P. Tarcher/Putnam, New York1999Google Scholar(p. 24)" @default.
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