Epworth Villa’s Quality Life Hospice Ukraine Mission Trip

Quality Life Hospice Ukraine Mission Trip

Epworth VillasQuality Life Hospice Ukraine Mission TripMay 7th 21st, 2011 Our Team

Shannon:Left to right: A. Vail Stephens, MD, Hospice Medical Director; Dennis Pendleton, Chaplain; Shannon McClure, RN, CHPN, Executive Director; Inga Chystiakova, Interpreter; Walter Thoni, Hospice Volunteer; Kristen McCarty, Hospice Clinical Director; Rev. Patrick Whaley, United Methodist Missionary.2To educate, encourage and empower the medical community of Lugansk, Ukraine to establish a home-based Hospice Ministry.Our MissionShannon: Our mission was to educate, encourage and empower the medical community of Lugansk, Ukraine to establish a home-based Hospice Ministry.As a team we feel like we accomplished even more than we ever hoped or anticipated and as you hear from all of the team members I think you will feel the same way.3In the Ukraine, Hospice Care as we know it, does not exist.The vast majority of Ukrainians die in their home with limited or no support from the government ran health care system. The Quality Life Team spent two weeks interacting with and training the Ukrainian medical professionals and community leaders regarding the tools and framework for implementing home-based hospice care.

Hospice Care in the UkraineShannon: There is virtually no hospice care in the Ukraine. The vast majority of people die in their homes without any help or support. The focus of our team was training, encouraging and equipping the Ukrainian medical professionals with the tools to implement home-based hospice care. 4The team left from Will Rogers World Airport and flew from Oklahoma City to Minneapolis then on to Amsterdam.After a two hour lay over in Amsterdam the team flew to Kiev, Ukraine.The team arrived in Kiev the evening of the 8th.The entire trip took almost seventeen hours. There is an eight hour time difference between the time zones.May 7th & 8th - Travel DaysWalt5Victory Day or May 9th marks the signing of the treaty between Nazi Germany and the Soviet Union in WWII.During the Soviet Union's existence, it was celebrated throughout the USSR and in the countries of the Eastern Bloc.The ritual of the celebration gradually obtained a distinctive character with a number of similar elements to the 4th of July in the United States: ceremonial meetings, speeches, parades, and fireworks.After communisms fall, the former USSR retained the celebration, though it was not formally celebrated by some. Ukraine has officially recognized 9 May since 1946.

May 9th Victory Day CelebrationWalt6

Victory Day Celebration Walt7

Victory Day CelebrationWalt: Lennons Statue8

Victory Day CelebrationWalt9

Victory Day CelebrationWalt10May 9th & 10th Train Trip from Kiev to Lugansk The team boarded a train the evening of the 9th for a 15 hour train ride from Kiev to Lugansk (located in the far Eastern Region of the Ukraine, very close to Russia).The average Ukrainian does not own a vehicle and must rely on the public transportation system for travel train, bus, and/or metro. The team traveled by sleeping car with four bunks in each compartment.Most Ukrainians travel economy class and sleep in an open non-air conditioned car with 40-50 other passengers.

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Train Trip from Kiev to LuganskWalt12

Train Trip from Kiev to LuganskWalt13Our first day in Lugansk was spent preparing for the two day conference.After checking into our hotel rooms we had lunch with the conference organizers and interpreters discussed the presentations and their expectations.We toured the conference facility (public library) and made the final adjustments and preparations.Tensions were high, as everyone involved had been preparing for this event for almost nine months.May 10th Arrival in LuganskShannon14The 2 day conference was highly anticipated by the Eastern Ukrainian Medical Community and throughout the entire country.Participants traveled from across the nation from as far as Lviv (a major city in far Western Region of Ukraine).The local media was represented throughout the conference and remained with the team during our visits to the local medical facilities. Speakers were brought in from the local government and medical community each day to speak on the status of end-of-life care in the region.May 11th & 12th The Hospice ConferenceShannon15The American Philosophy of Hospice Care: The Home-Based Hospice ModelTake Care of You First: Avoiding BurnoutSigns and Symptoms of Approaching Death: Recognizing and Responding to the Needs of the Dying and Their FamiliesEffective Pain and Symptom ManagementOn Death, Dying and GriefChildren, Death, Dying and GriefAlternative Therapeutic Modalities: Combining Aromatherapy, Therapeutic Touch and Music Therapy

The Hospice Conference ContentShannon:This is a list of the presentations presented by the team during the 2 day conference. The topics were chosen based on the learning needs identified through skype and teleconferencing with the local organizers and medical professionals and were designed to give an overview of home-based hospice care. In preparing the content, we really struggled with what to include - any one of these topics could have filled a 2 day workshop in and of itself. Because of the language barrier and the need to use interpreters, we prepared the power point slides with all the information that we wanted the participants to know and then the presenter elaborated on each point during the actual presentation. This format allowed us to cover more material in a shorter timeframe than would have otherwise been possible. We combined the formal presentations with some group activities and hands on practice sessions. 16

The Hospice ConferenceShannon17



The Hospice ConferenceShannon20The Hospice Conference

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The Hospice Conference

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The Hospice ConferenceThe Hospice Conference


The Hospice Conference

Shannon26The Hospice Conference

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The Hospice ConferenceShannon: Throughout the conference the team learned of the potential barriers to the Ukrainian Hospice Movement, including lack of funding and government support; no formal education in hospice and palliative care and limited access to medications necessary for effective pain and symptom control. After all the presentations were completed we broke the participants up into small discussions groups. Each group was assigned a team member and one of the major potential barriers identified and asked to brainstorm possible solutions. Then each small group presented their ideas. One thing that the team emphasized to the participants was that the American Hospice Movement faced the same barriers only 40 years ago, so change is possible if they are willing to do the hard work to make it happen.28


Shannon30


Shannon: Certificates were awarded to participants at the end of the conference. They were very proud to receive their certificates and especially proud to have them printed in English!32The team was invited to speak to students at the medical school in Lugansk.The medical school prepares both doctors and nurses.Medical and nursing education in Ukraine consists of vocational and technical training and requires no undergraduate or general studies program.Therefore, doctors and nurses enter the medical field at a very young age.Doctors and nurses are among the lowest paying professions and the burn-out rate is extremely high.

May 13th - Medical SchoolVail: The healthcare system is funded by the government, so there are very little financial resources available. The average doctor makes the equivalent of $200 per month and the average nurse makes the equivalent of $80 per month. Many become disillusioned from the lack of adequate pay and limited patient care resources and leave the medical profession quickly. We saw very young to older physicians, but very few in middle age most likely due to this issue.33Medical School

Vail34Medical School





Vail39Pediatric mortality is disproportionately high in the Ukraine due to lack of technology to enable early diagnosis and limited access to aggressive treatment.Mothers stay in the hospital with their child 24/7.Patients are sent home when the prognosis is determined to be terminal, but without the benefit of home-based hospice care. The team distributed toys to each child, lead therapeutic play activities, spent time with supporting and encouraging the staff, patients and their mothers and planted flowers along the entrance.May 13th Pediatric Hematology Oncology HospitalKristen40Pediatric Hematology Oncology Hospital

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Pediatric Hematology Oncology HospitalKristen42Pediatric Hematology Oncology Hospital

Kristen43Pediatric Hematology Oncology Hospital







Kristen50Living Faith United Methodist Church in Lugansk played an integral role in facilitating our mission.Representatives from five different denominations gathered at Living Faith on May 15th as Chaplain Pendleton lead a discussion regarding hospice care and grief support, tools were provided to assist leaders in facilitating grief support groups.The team participated in the Sunday worship and Chaplain Pendleton delivered the sermons.Living Faith has adopted a group of African medical students with which the team interacted and answered questions about hospice care.May 14th & 15th Faith United Methodist ChurchDennis:We learned that grief is not discussed or addressed in the Ukraine. They had no concept of what bereavement care or grief support looked like. It is our hope that they will take the tools shared with them to develop support groups within the community.51Living Faith UMC

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Living Faith UMCDennis53Living Faith UMC

Dennis:Homeless ministry started by two members of Faith UMC.54Living Faith UMC

Dennis:Vail with the African Medical Students who are studying in Lugansk and are active members of Faith UMC.55Living Faith UMC

Dennis:Young member of Faith UMC who served as videographer for the Hospice Conference proudly wearing his hospice T-shirt.56Living Faith UMC

Dennis57Living Faith UMC

Dennis58The team was invited to visit the honorary museum created in honor of a prominent oncologist who died of cancer.Through his own dying process he realized the need for better end-of-life care in the Ukraine.Part of his legacy was passing on the task of bringing hospice care to the Ukraine to his daughter.His daughter, Helena is very motivated to implement a home-based hospice care program in the Lugansk Region and has created an non-profit organization toward that end.May 16th Honorary Museum Tour

Honorary Museum TourDennis60Honorary Museum Tour

Dennis61Honorary Museum Tour

Dennis62Honorary Museum Tour

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Honorary Museum TourDennis64The team visited Lugansk Hospitals Palliative Care Unit.The units total capacity is 25 beds.The total population of the Lugansk Region is close to 3 million.The patients treated by the unit have little or no family support available.The remainder of the terminally ill residents of the region will die at home without the benefit of home-based hospice care. May 16th Palliative Care UnitShannon65

Palliative Care UnitShannon66Palliative Care Unit

Shannon67Palliative Care Unit

Shannon68Palliative Care Unit

Shannon69Due to federal and global grants the AIDS/HIV Center was the most modern and technologically advanced of all the health care facilities visited.AIDS/HIV treatment in the Ukraine is very similar to other parts of the world.The staff at the center also enjoyed higher pay scales and better working conditions.The team toured the center, met with the patients and staff, and helped plant flowers around the grounds.May 16th AIDS/HIV CenterVail:I couldnt help but think that if end-of-life care could garner the same level of awareness and support that all people would benefit since 100% of us are going to die at some point in our lives.70

HIV/AIDS CenterVail71HIV/AIDS Center

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HIV/AIDS CenterVail73HIV/AIDS Center

Vail74HIV/AIDS Center

Vail75The participants and conference organizers planned a day trip to demonstrate their appreciation for the team.The team toured three small villages within the Lugansk Region very near the Russian border.Following the excursion the team met with the local conference organizers and discussed possible They plan to implement measures to start developing the framework for a Home-Based Hospice Ministry.May 17th - ExcursionWalt76

ExcursionWalt77Excursion

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ExcursionWalt79Excursion

Walt80Excursion

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Excursion

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ExcursionWalt84The team headed back to Kiev by train on the evening of the 17th arriving the morning of the 18th.May 17th & 18th Train Trip Back to KievWalt85Responsible for the treatment of all solid tumor childhood cancers throughout the entire country of Ukraine.The capacity of the hospital is 40 beds.The waiting list is long, so many receive care too late or not at all.Their parents take on the heartbreaking task of caring for their children at home without the benefit of home-based hospice care.May 19th Kiev Pediatric Oncology Hospital Kristen86

Kiev Pediatric Oncology HospitalKristen87Kiev Pediatric Oncology Hospital

Kristen88Kiev Pediatric Oncology Hospital

Kristen89The team left from Kiev the afternoon of the 20th and flew to Amsterdam.After a twenty hour layover in Amsterdam the team flew back home to Oklahoma City on the 21st.The team arrived home the evening of the 21st very jet-lagged, but forever changed by the experience.

May 20th & 21st Return Trip Shannon:Ukrainians are very reserved and there is a very real sense of hopelessness and resignation that you can actually sense among the people. I specifically remember the stark contrast and the feeling of coming back to life I felt when we arrived in back home. This experience has really taught me to appreciate the gift of being an American as well as the responsibility that we have to help those less fortunate.90This mission trip was made possible through your support! Thank You!Shannon:In closing we want to say THANK YOU! As a mission team, we went as representatives of the entire wonderful organization and this trip was only possible because of you and your support!91

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Epworth Villa’s Quality Life Hospice Ukraine Mission Trip