Euro News 2009 Edition 1

The summer edition of Nurses Christian Fellowship International EuroNews is availabe for download here.

This edition contains:
* 2010 Regional Conference News
* Report on International Student Nurses’ Spiritual Care Conference
* Report on palliative care training visit in Moldova
* Updataes from National Christian Nursing Fellowships:

o Norway

o Germany

o England & Wales

o Finland

o Scotland

o Spain

CSNM 11 Years On

CSNM Update by Tim James - Student Liaison, CNM

Perhaps you were a Christian during your nurse/midwifery training? Do you remember what it was like the first time you saw somebody die? Those thoughts, feelings and emotions that struck you?

The first death I witnessed was a child during my first year of nurse training. I remember asking myself questions like: Why did God allow that to happen? Is that child in heaven or hell? How can I nurse patients as a Christian when I have no answers and feel so useless? Well, six years on and I don’t necessarily have the answers, but through experience and a constant maturing relationship in Christ Jesus I have a peace. The questions that I asked and many similar ones are still being asked by Christian student nurses and midwives in training throughout our universities and hospitals today! In our day-to-day practice we come up against many painful situations and ethical and moral dilemmas. How as a nurse or midwife should we respond? But more importantly how about as a Christian nurse or midwife?

This is just one of the reasons why we need organisations like Christian Nurses and Midwives (CNM) and Christian Medical Fellowship (CMF). As Christians we need to support and encourage one another so that we will be spurred onwards in our relationships with Christ Jesus. Within CNM though, we come together as Christian brothers and sisters with the additional privilege of being nurses and midwives too. This was also the rationale behind setting up an organisation for nursing and midwifery students: Christian Student Nurses and Midwives (CSNM), which started eleven years ago. Liz Capper who is currently on the CNM Council was one of the key people involved in setting up of CSNM.

CSNM Aims:

1. To encourage and advise Christian student nurses and midwives in their faith and witness.
2. To help Christian student nurses and midwives think through the relevance of the
Bible to the practice ofnursing and midwifery.
3. To provide links with and support for Christian student nurses and midwives on a
local and national basis.

CSNM is part of the CU Movement – the Universities and Colleges Christian Fellowship (UCCF), which works to make disciples of Jesus Christ in the UK student world. CSNM has been overwhelmingly supported by UCCF over the past decade, which has employed several staff workers to lead the work with student nurses and midwives.

Over the years, students have benefited from CSNM through a regular termly magazine, ‘Face Value’ with articles on many subjects relevant to nursing and midwifery. The annual national conference has always been very popular and widely appreciated and found to be encouraging and fun! CSNM groups have been set up across the country by students and meet in houses or church buildings for a meal, bible study, prayer or support weekly or monthly. Student representatives of the CSNM council have been appointed from different areas across the UK to support local CSNM groups and to disseminate information. A CSNM website is managed by UCCF (www.uccf.org.uk/yourcourse/csnm), which holds a database with articles and bible studies, as well as carrying news of upcoming events.

In September 2004 Christian Medical Fellowship held its annual student leaders conference. Because of strong and closer links being formed with CMF, CSNM council members were invited to benefit from this training. CSNM gladly accepted the invitation and a few members of the council and I attended the training event. The weekend led to productive discussions and the chance to form links with student medics and the leadership of CMF. Nurses, midwives & doctors work every day as part of a multi-disciplinary team within hospitals up and down our country – this was a great way of instigating future relationships in the same context.

The Nottingham CSNM meeting is affiliated with a local student doctors’ group. They meet together weekly as a joint nurses’ and doctors’ meeting (known as Christian Medics and Nurses). Because both nurses and doctors study together in the same university buildings they saw the need for their two organisations to work together and in February they organised a mission week holding ‘grill-a –Christian’ and other gospel events in the university refectory. God really blessed that mission. The unification of these two groups has had an outstanding effect, pulling resources together and allowing gospel events to be run. PRAISE GOD!!

If you are a regular reader of CNM News you would have read the article I wrote about last year’s student nurses conference which was a great success – well worth coming to again! It was during the conference last year that I became more involved with the work of CSNM and CNM. Currently I am voluntarily coordinating the work of CSNM with support from Liz Capper and acting as Student Advisor to CNM council. I work full-time as a Staff Nurse within a busy Paediatric Intensive Care Unit. My voluntary role is not overseen by UCCF (despite some links), but I report regularly to CNM Council. Much of my working time for CSNM is put into helping to organise the national conference, whilst offering limited support and advice to students via email. Because I am not employed by UCCF this does make the ongoing student work difficult to carry out.

God has blessed CSNM since it began over a decade ago and the work of CSNM has grown, although at times it has hit rocky patches! Over the past eighteen months in particular it has hit another rough patch. Since 2003 UCCF has not been able to find a full-time CSNM staff worker, and due to developments within UCCF it has become necessary that those who are coordinating the current work of CSNM consider new options for the future.

I believe CSNM is vital to Christian nursing and midwifery students in this country. God’s desire is that we will all grow and mature in our faith in Him, but this can be particularly tricky for our students in the 21st century healthcare setting where there are considerable pressures. They do not necessarily have the experience that we have as qualified professionals and we therefore have an obligation to support them in practice and as an organisation. The question is – HOW? Over the next few months, CNM Council will be considering very carefully how the work with student nurses and midwives should continue. CNM itself needs to become more stable structurally and financially. There are close links being made with the Christian Medical Fellowship, which could be fruitful.

To move forward we need to be praying and asking God to be at the heart of our deliberations and planning. We need YOU as CNM members to pray and consider the part you play in CNM. Perhaps you could become more actively involved and offer a few hours a week to the student work or you could be co-opted onto the CNM council? Who knows! – God Does!

Once again – keep praying and please feel free to contact me if you would like to talk about anything I’ve raised.

God Bless
Tim James

You can contact Tim via the CNM email or telephone number.

CNM News Back-Issues

Issue Number 26
(Summer 2011 A.D.)

Issue Number 25
(Spring 2011 A.D.)

Issue Number 24
(Summer 2010 A.D.)

Issue Number 23
(Spring 2010 A.D.)

Issue Number 21
(Spring 2009 A.D.)

Issue Number 19
(Spring 2008 A.D.)

Issue Number 18
(Autumn 2007 A.D.)

Issue Number 17
(Spring 2007 A.D.)

Issue Number 16
(Autumn 2006 A.D.)

Issue Number 15
(Spring 2006 A.D.)

Issue Number 14
(Winter 2006 A.D.)

Issue Number 13
(Autumn 2005 A.D.)

Issue Number 12
(Summer 2005 A.D.)

Issue Number 11
(Spring 2005 A.D.)

Issue Number 10
(Autumn 2004 A.D.)

Issue Number 9
(Spring 2004 A.D.)

Issue Number 7
(Autumn 2003 A.D.)

Issue Number 6
(Spring 2003 A.D.)

Why Be Part of CNM

Steve Fouch - CNM Secretary

In his 2001 book, “Bowling Alone”, Robert Putnam argued that civil society was breaking down as we become more disconnected from our families, neighbours, communities, churches, etc. We just don’t join anything any more, but instead get caught up in the pressures of commuting miles to work, shopping in large, out of town supermarkets and living in isolated homes where we do not even know our neighbours’ names. Our main relationship with the outside world is through our TVs, radio and the Internet.

You only need to look at the regular church statistics to see how this sense of isolation and withdrawal has affected the Christian community. Pews are increasingly empty, and those that do turn up are less and less likely to give time and energy to the life of the church. It seems that as a nation we are too busy, too individualistic and too preoccupied.

We can all relate to this in some manner. I am up at 5 most mornings, I spend three hours a day commuting, eight hours at work, and by the time I have got home in the evening, eaten and spent time with my kids, all I am good for is to watch the first half hour of Newsnight before collapsing into bed! And I do not have to contend with shift work, regular weekends and Bank Holidays, night duty, split shifts etc, etc. I am sure we can all tell similar tails. Where do we fit anything else into this kind of punishing lifestyle?

But is this the way that God would have us live? Twenty First Century living in the Western world is not really in harmony with the way most people in the world live, or indeed how we lived here a couple of hundred years ago. We are meant to live in community, meant to know our neighbours, be near family and friends, to share a common life together in some manner. This is the reason that Jesus never talked of faith just in terms of a vertical, one-to-one relationship with God, but also as a horizontal relationship with our fellow believers and with the wider world. Jesus came to bring us life in all its fullness. The Church was created to allow us to share in that life together.

And we have a God who understands relationships intimately because He is three – Father, Son and Holy Spirit in an eternal, loving relationship. Individualism is, if anything a result of sin, rather than something in the original design of human nature.


Why CNM?

So, having established that we are made to live in a common life together, especially as believers in Jesus, why then does CNM matter? Surely, if we have a local church, why do we need a special fellowship of Christian nurses? Are we not adding yet another meeting and set of commitments to an already over stretched diary?

I guess from my own experience the answer is quite simple. Much as I get a lot of encouragement and support within my church, the reality is that the church is not usually geared up to supporting people in the workplace. Because, if we face the facts, our workplace is where we have most contact with people, where we put the largest part of our time and energy. It is often the only place most of us come in contact with non-Christians on a sustained and regular basis. The pressures we face as nurses and midwives are also quite different from those most of our church fellows experience – we deal with illness, disability, death and dying, birth and pregnancy – real human joy, suffering and tragedy, on a day-to-day basis, in a way that most people in our society only see sanitised on TV screens. And we do this in an environment where the Christian faith is seen as at best a harmless irrelevance, and at worst as a danger to be marginalised at all times.

We need others who understand these pressures to stand alongside us, because this is where God has called us to be – this is our ministry to God, our mission field. Church meetings and events are often useful and valuable, but to be honest, how often do we see many non-Christians at a church event? It is at work that we are the most effective witnesses to Christ, not in Church. And at work, we have no chance to hide behind events and meetings; we are often the only Christian in our workplace, and we will be watched, not just for what we say or what we do, but who we are!

Francis of Assisi once said that he preached the gospel on all occasions, using words if he really had to. I have heard it said that people often cannot hear what we say as Christians because who we are screams too loudly. In other words, how we live, our attitudes, behaviour, moods and reactions speak volumes for the God whose name we own. Let’s be honest, that is an awful pressure to bear, let alone to bear alone. Yet I know of very few churches that seek to empower us ordinary believers in the workplace to be witnesses to Jesus. So often, the message we get from church, however unintended, is that our real Christian work and witness is within the four walls of the church, not out in the home and the workplace! But surely Jesus is Lord of all our lives, even (or especially!) our careers.

A CNM group, even if it only meets infrequently, is a chance to share with others who are in the same boat as us, to learn from those who have been there longer, to encourage others who are struggling, to create a brief, regular space where God can speak into our busy work lives and professional practice. Even if there is no local, group near you, the strength of the fellowship, especially in this modern telecommunications age, is that we can share over distances by phone, email, or through regular publications.

And for student nurses and the newly qualified, coming out into the unsheltered environment of work for the fist time can be a traumatic experience (mine certainly was – I can recall vividly, spending most of my first year getting things wrong and being torn off a strip by my charge nurse – I can recall regularly thinking ‘how can I ever say that I am Christian at work again?!’).

CNM is now about to become a fellowship for graduates and students – partly because we believe that students have a lot that they can get from being with mature, Christian nurses and midwives, and partly because the energy and fresh thinking of students does a lot to invigorate and challenge us oldies! Tim James’ article gives some of the other reasons and background to this change.

But for CNM to be able to provide this space to bring God into our professional practice, we need the energy and commitments of our members. We all have something to share from our own experiences as Christian nurses and midwives that can encourage others.

If you feel able to, we would love to hear your stories and experiences, and be able to share them through CNM News. We hope to have more talking points and issues for discussion in upcoming editions of the newsletter, and we would love to hear from you what issues are coming up where you work. Questions, letters, articles and ideas – all are most welcome. We are a fellowship; all of us, not just the CNM Council, and we all have as much to give as to receive from being a part of CNM. You are the life of CNM, and we need you!

Challenged to Care

A Report on the 16th Quadrennial Congress of NCFI, July 4 – 9 2004, Seoul, South Korea

Written by Steve Fouch

Anyeong Haseyo - Greetings from Korea! This was the sixteenth gathering of the Nurses Christian Fellowship International (NCFI) since it was founded in 1957, and drew together some 379 delegates from 33 nations. The Conference aimed to explore the biblical basis of caring; to build and strengthen Christian values as a foundation for knowledge and practice in nursing; and to explore and challenge the context of Christian nursing practice in the 21st Century.

The Christian Medical Fellowship sponsored three of the CNM committee to attend the conference – Angela Thavaraj, Tim James and Steven Fouch. This was a great opportunity for CNM to re-connect with the global Christian nursing community.

The concepts of leadership, scholarship and servanthood were integrated throughout the conference program in specific seminar and academic “tracks”. The mornings consisted of a Bible exposition and a linked plenary session exploring the issues of “Care of the Caregiver”, “Globalisation, Health and Nursing”, “The Paradigm Shift in Nursing” and “Nursing and Diversity”. The afternoons were split between hour and half seminars, and twenty minute academic paper presentations on issues as diverse as “The Relationship of Suicidal Ideation, Depression and Spiritual Well Being of Korean Adolescents” to an application of the Book of Job in dealing with spiritual pain in the terminally ill, using Kubler Ross’ model of grief. There were many papers on Spiritual care, but also on as diverse a range of topics as HIV care delivery and aseptic practice by Nigerian nurses, to developing family health nursing in Uzbekistan.
Dr Kim Mo Im, past president of the International Congress of Nurses (ICN) was the keynote speaker for the opening ceremony. Other key speakers included Dr Suzie Kim (Florence Nightingale International award winner at ICN 2001), Dr Judith Allen Shelly (outgoing Editor of the Journal of Christian Nursing), Professor Barbara Parfitt (Dean of Nursing at Glasgow Caledonian University), and Kamalini Kumar of Mercy Medical Centre, Clinton Iowa.

NCFI is structured around six regions (Caribbean & North America [CANA], Latin America, Europe, Africa, Central Asia & Middle East [CAME], and Pacific & East Asia [PACEA]). The largest region (in both geographical and membership terms) is PACEA, and was also, given the location, the most represented at the Congress. However, Africa, CAME, CANA and Europe all had good sized delegations, although Latin America was only represented by one delegate, for geographical and linguistic reasons (the conference was held exclusively in English, with the only parallel translation facilities being into Korean).

Highlights
The first thing that struck me was the high level of scholarship in the Bible expositions, plenary sessions and paper presentations. However, it was also highly applied research, and when one heard the background of the people presenting the papers, one realised how much a Christ centred focus on care had shaped their entire lives, not just their professional practice.

One of the big challenges was the call for nurses in general, and Christian nurses in particular, to have a role in shaping national and global health strategies and priorities, and the need to challenge a market driven approach to healthcare provision that reduces healthcare to mere service delivery, marginalises the poor and sidelines the issues of public health. These are all areas where nurses are in a key position to challenge the current paradigm in global healthcare, but where we are mostly excluded from the process.

Almost all the national fellowships that I talked to are facing similar problems to CNM – lack of committed members, difficulty finding people to work on the committee, how to keep in touch with and encourage students, etc. Even the larger fellowships struggled with this. The issues are pretty global, not specific to UK or NHS culture!

Spiritual care was very high on the agenda – varying from US and Australian groups who have done extensive research and developed models of care that are Biblical and highly professional. It would appear that there is a lack of knowledge about spiritual care in the UK, how to practice it, or even how to assess and evaluate the care given. One encouragement was from Linda Ross, who showed that Christian nurses are addressing the issue, while secular nursing bodies are hopelessly lost in either rigid, superficial and religious definitions of spirituality, or wandering off on vague and irrelevant New Age models of spirituality.

One very striking moment was in the final plenary session on diversity. The leader of the delegation of Japanese Christian nurses, Fukushima Chieko, got up to explain her reasons for attending the conference. These were in large part to offer an apology to the Korean people, and especially to her Korean colleagues and Christian sisters and brothers for their treatment at the hands of the Japanese during the occupation of the first half of the twentieth century. The deep hurts that the Koreans have felt towards Japan are not dissimilar to those felt by Jews towards Germany, and to hear a group of five Japanese nurses standing in front of several hundred Korean nurses and apologising in Korean for the suffering caused by their fathers and grandfathers during the occupation, was something that will be hard to forget. The impact was profound on all those present. Koreans were going forward and embracing the Japanese, then the Fijian and Papua New Guineans (who also suffered badly under the Japanese) doing likewise. It was deeply moving, and there was real sense of being on Holy Ground – that God was right there in the midst of the reconciliation that was going on in the meeting.

Another great encouragement was the six Mainland Chinese nurses who were in attendance – this was the first time NCFI had had any delegates from the Chinese mainland. There were significant ethnic Chinese delegations from Hong Kong, Taiwan, Malaysia and Singapore as well. That it was at all possible to get the Mainland Chinese to the Congress was an achievement in itself, and the hope is that this will be the first spark of a Chinese NCF coming to life in the next decade.

A final personal highlight was Korean hospitality. The food was not to everyone’s taste certainly (raw fish, pickled vegetables (kimchi) and rice noodles with every meal), although I personally loved it, but the warmth of welcome was wonderful, especially the groups of student nurses who met us at the airport, guided us around and helped us throughout the conference. Angela even got to enjoy a Korean church service in one of the more “medium sized” churches in Seoul (35 – 40,000 congregation on a Sunday morning). My abiding memory of Seoul is of a huge, bustling, vibrant city that was at the same time very friendly and welcoming, and of a strong a vibrant Christian community that has helped shape modern Korea for the better.

Implications for CNM and Student Work
One thing that cropped up over and over again was how encouraged people were to see three delegates from the UK (there were seven actually, including Barbara Parfitt of NCF Scotland and Linda Ross of the University of Gwent, who were presenting papers). That there was a new England/Wales fellowship starting was a great encouragement to many that I talked to. Many of the West Africans (especially from Ghana) had been deeply hurt when the original English NCF had closed down twelve years ago. I met a group of Fijian nurses who had been specifically praying on a daily basis over the last few years for a new fellowship to get off the ground in England/Wales. It is both a privilege and a responsibility to be part of the answer to such fervent prayer!
We made contact with NCF groups in Nigeria, Fiji and the Philippines who all have members here in the UK, and we hope to build links with these Christian nurses over the coming year. With the vast influx of nurses from Africa and Asia to the UK, many of them being Christians, there is considerable scope to develop a more international Christian nursing group across the country. Many will be isolated and away from home for the first time, some will have little or no Christian fellowship and friendly face and point of contact will do a lot to help them feel at home and find their feet. Furthermore, with concerns about the global impact on the health of the poor of this migration, and its implications for world mission, this will be an initially small but significant development.

We have built stronger links with the European Region of NCFI. There is to be a European Region Conference in 2006 in Ede, the Netherlands (August 22-26) on theme of Ethics and Spirituality. This is being organised with three nominally Christian nursing schools by Dr Bart Cusveller. This will be a key event to bring CNM and CSNM (Christian Student Nurses and Midwives) members to.

As a result, we have far closer connection with NCF Scotland, NCF Europe and NCFI as a whole. We are in discussions with Harry Louden (NCFI Director) on seeing CNM become a full member of NCFI over the course of the next few years.

Conclusion
It was certainly worth the time and energy and expense of going to the conference. Without the financial support of CMF, it would not have been possible, and it was of far more value to have three delegates who could each follow different contacts and get different emphases out of the conference than to send just the one. We even managed to have an impromptu publications meeting and outline the next eighteen months worth of CNM News and commission a few articles in the space one dinner break! Watch this space for the results.

We are working closely with NCFI on membership, on promoting the 2006 European Conference (see CNM Notice Board) and we are looking forward to taking a bigger delegation (including students) to the 17th Congress in Abuja, Nigeria in 2008!

The "Joffe" Bill

Assisted Dying for the Terminally Ill

As many of you will be aware from the last edition of CNM News, we have been in the midst of putting together a submission to The Lords Select Committee scrutinising Lord Joffe’s “Patient Assisted Dying Bill” which seeks (among other things) to decriminalise physician assisted suicide and voluntary euthanasia for the terminally and chronically ill.

In addition to sending our own submission directly to the Select Committee in September, we also encouraged individual CNM members who are RCN members to send personal submissions to the Royal College as it prepared to make its own submission. In the past, the RCN position has been that assisted dying is illegal and that nurses should not participate in any such practice.

There was some concern, fostered by some pro-euthanasia reporting in sections of the nursing and national press, that the RCN was under considerable pressure from its membership to change its position and adopt a pre-euthanasia stance. However, as many of you will now know, at the end of September, the RCN stated publicly that it continued to oppose any move to legalise assisted dying. Stating that asking nurses to take part in assisted suicide and euthanasia “would undermine the nurse-patient relationship and frighten vulnerable people”, and furthermore would “normalise the concept that some lives are not worth living”, the RCN deputy president, Maura Buchanan said, “the overwhelming response [from RCN members] has been to oppose the Bill and reaffirm nursing’s core principle of valuing life and ensuring patients are well cared for.”

CNM is greatly encouraged by the RCN’s reaffirmation of it commitment to good quality palliative care and opposition to assisted dying. It is also worth noting that the British Medical Association has also not come out in favour of the Bill, although it has chosen to remain neutral. Sadly, the Royal College of Physicians and the Royal College of GPs have both dropped their opposition to the Bill, despite many doctors being strongly opposed to legalising assisted dying. Nevertheless, the BMA’s stance, like the RCN’s has been set by its membership. This sends out a strong message to the select committee that health professionals (who would be the ones to enact the legislation) do not want to see this Bill become law, whatever the current trend in wider public and media opinion is on the matter.

Thank you to all those of you who wrote to the RCN and The Select Committee on this matter – you really did make a difference. Please continue to pray for the Select Committee as it prepares to report back to Parliament in the New Year. It is still possible that the Bill may be passed, and we need to continue to pray and lobby on behalf of the vulnerable who could be adversely affected by this legislation.


For more information on the Patient Assisted Dying Bill and a Christian response, see:
http://www.cmf.org.uk/press_releases/joffebill3.htm

Crying for Comfort

CSNM Conference, Ledbury 2004

Tim James, Paediatric Staff Nurse, Paediatric Intensive Care Unit, Bristol Royal Hospital for Children

In March I attended the Christian Student Nurses and Midwives (CSNM) conference, which was held at Dyke House, Ledbury in Herefordshire. The Conference was shared between students and qualified practitioners which also included Allied Professionals from Christian Therapists Network (CTN) & Therapy Students Christian Fellowship (TSCF). The conference was in conjunction with the C.U movement named Universities, Colleges Christian Fellowship (UCCF). The theme of the weekend away was looking at ‘suffering’ and it’s application to Christians as health professionals.

The weekend consisted of lots of fun, games, worship, fellowship, seminars, talks, getting to know other health professionals and plenty of food! Our speaker for the weekend was Hugh Thomson, a surgeon and church leader of City Evangelical church in Birmingham. Hugh’s teaching came from the book of Job looking at what suffering is, how we can help those who suffer and consider where God is in suffering. The talks were enlightening, helpful and very practical.

I learnt so much from the
weekends teaching and I would
need all the room of this
magazine to share it with you!

One thing which really struck me from Hugh’s teaching was that God is always with us during the midst of suffering. The Lord God our Heavenly Father feels and shares the suffering of His children. That was a real comfort to me and also helped me gain insight into the reasons behind suffering in this world.

Some of the seminars on offer this year at conference were: Christian medical ethics, overseas mission as the healthcare professional, working in a low-morale environment, listening, and preparing for new disability regulations in the church. All the seminars were enjoyed and well attended. I went along to the Ethics seminar looking at some case studies, which had occurred recently within the UK. It was really interesting because we were looking at these case studies from the Christian healthcare perspective. It gave the ethical decisions we were discussing a different slant from the world perspective. The conference is a great event to attend if you want to pick up information about Christian Healthcare missions and work in the UK and overseas. There is also literature about healthcare issues and ethics from the Christian perspective. The conference holds a large bookstall with fantastic books including apologetics, theology, healthcare, mission, and biographies. Some of the books are also heavily discounted too! The best thing about the conference this year was that it was health professionals from a variety of fields in healthcare. We came together as part of God’s church and those present included not just nurses but Occupational Therapists, Dieticians, Physiotherapists and Speech Therapists too. As we worshipped God and had fellowship together, it was such an encouragement because we were firstly together as God’s children, secondly brothers and sisters in Christ and thirdly as health professionals who understood one another’s profession. So often I find professional issues and events of a working day difficult to share with family and friends because they don’t understand the ‘ups’ and ‘downs’ of healthcare. But here at the conference there were brothers and sisters who I could talk to not just about Jesus but also about professional issues. I made new friends who I keep in touch with and it means we are able to encourage one another in our walks with Jesus and within the workplace.

I highly recommend the conference and next year another joint conference is being planned for 4th-6th March 2005 at Quinta near Oswestry. CNM members are invited to join with the Christian Therapist's Network, Therapist Student Christian location has moved to create space for more people to attend. Please note this date and further details will be available shortly.

If you would like to hear those talks and the teaching on suffering, they can be purchased in audio-cassette format for a small fee from UCCF via http://www.uccf.org.uk/resources/index.php?resourcetype=17

Suffering

This article has been written based on my own experience, professional
practice and reflection on suffering teaching I received at the CSNM conference 2004.

Tim James, Paediatric Staff Nurse, Paediatric Intensive Care Unit,
Bristol Royal Hospital for Children


The book of Job is a fantastic example of what suffering can be like, and is relevant to the world around us today. Job was your usual kind-of-guy who suffered, but yet trusted in God and brought glory to our Father. I know from my own sufferings of past depression, I’ve often asked God the question of Why? In my work in Paediatric Intensive care I’ve been involved with children and families who have suffered and sadly sometimes died, and I’ve asked God along with my patients – “Why?”

Often as humans we want to know the reasoning behind our sufferings and we can’t understand why God has allowed it to happen to us. We begin to question God’s motives and doubt his love for us. The story of Job shows us how he went through dreadful sufferings. Satan believed that if the Lord took away all that had been given and blessed to Job, then Job would curse God and turn away from the Lord. So Job went through ill health and God allowed Satan to take away Job’s children, property and livelihood too. But Jobs response is amazing throughout the book. He gets down on his knees and worships the Lord: “The Lord gave, and the Lord has taken away; blessed be the name of the Lord.” (Job ch1 v21b).

This bible book goes on to tell us of the further sufferings of Job and how God eventually rewards him with fortunes, twice as much as he had ever had before. Personally, Job’s story reminded me of how God has strengthened my relationship with him through 3 years of ill health. I’ve been well for over a year now. Through my experiences of severe depression and desperation of life, there has been much good which has come from those awful times. My relationship with the Lord is ten times greater than it ever was before my illness. I have learnt to be reliant on God and involve him in all areas of my life. I have a better understanding of Mental Health issues and feel more equipped in supporting friends, colleagues, patients and families who are ‘low’ or depressed. It’s been a privilege to bring this skill into my professional capacity.

But there’s even more to the events of Job to encourage us. The book of Job reminds us of how God is sovereign overall and that includes suffering and the control of Satan too. We will as Christians ask the question of why we are suffering and why others suffer too. Could it be a consequence of ‘the fall’? Probably I would say! But we aren’t always capable of understanding all of Gods actions. Suffering is a mystery, which is to be accepted. There will be times of testing for Gods people: Do we love God? Or do we love our careers, car, comforts and other things of this world? What we can be sure of knowing, is that all things which have occurred, occur for God’s purpose (ch42 v2). It’s an opportunity for glory to be brought to the Lords name!!!

Within the health profession we will most definitely see our patients and their families question suffering and many will perhaps turn to God and ask ‘why?’ There maybe an opportunity here for us as Christian health professionals to tell them about God and how he sent his only son ‘Jesus’ to suffer for all mankind’s transgressions. God is somebody who knows all about suffering and most definitely suffers when his own dear children suffer.

So what does it mean for us in this life? Well, I have learnt that at times, things will be given and taken away. The question is, what will our response be to God? Will we curse the Lord and turn away or will we praise God and remain in “real faith” (commitment to God which is unconditional)?

What will you do the next time you’re suffering…?

Reflect on this song by Beth & Matt Redman…

BLESSÈD BE YOUR NAME

In the land that is plentiful,
Where Your streams of abundance flow,
Blessèd be Your name.
And blessèd be Your name
When I'm found in the desert place,
Though I walk through the wilderness,
Blessèd be Your name.

Every blessing You pour out I'll
Turn back to praise.
When the darkness closes in, Lord,
Still I will say:

Blessèd be Your name
When the sun's shining down on me,
When the world's 'all as it should be',
Blessèd be Your name.
And blessèd be Your name
On the road marked with suffering,
Though there's pain in the offering,
Blessèd be Your name.

You give and take away,
You give and take away.
My heart will choose to say:
Lord, blessèd be Your name.

Further Reading:

Message of Job - David Atkinson, 1991, Inter-Varsity Press
If I were God, I’d end all the Pain - John Dickson 2001, Matthias Media
How Long, O Lord? - Don Carson, 1990, Inter-varsity Press
What Could I say? - Peter Hicks, 2000, Inter-varsity Press
A Practical Workbook for the Depressed Christian - John Lockley 2001, Authentic Lifestyle

Assisted Dying Bill for the terminally ill

The Royal College of Nursing (RCN) has recently requested its members to put forward their views on assisted dying in preparation for their submission to the House of Lords Select Committee in July 2004 (see RCN bulletin issue 104).

The RCN currently uphold the present legal position, that assisted dying is illegal. However, the RCN desires the opportunity for debate on this issue. This is an opportunity not to be missed and CNM member are strongly encouraged to consider writing to or emailing the RCN to oppose any changes in legislation and in particular this Bill. Details of where to address your correspondence can be found at the end of this article. Lord Joffe’s Assisted Dying for the terminally Ill Bill (now reworked and renamed from the Patient Assisted Dying Bill) passed its second reading on 10th March 2004 and goes to the House of Lords Select Committee for detailed scrutiny. The revised bill seeks to legalise assisted suicide and voluntary euthanasia.

Some objections to assisted dying include:

1. Assisted suicide and voluntary euthanasia are unnecessary because alternative treatments for the symptoms prompting requests for euthanasia exist (e.g. treating depression, good palliative care)

2. As nurses we want to promote patients rights but not at the expense of our responsibilities as nurses (our duty to care) and in society to protect the weak and vulnerable.

3. The argument for showing compassion, promoting patients ‘self worth’ and respecting them as individuals is cited by those in favour. However, as individuals we are all unique (Christians believe that we are made ‘in the image of God’) and for that reason have intrinsic value. By promoting self worth we should value people and demonstrate our compassion by caring for them. This is a stronger action than simply giving up on them and promoting their death.

4. The right to die could become a duty to be killed, for those feeling that they are a burden to their families and carers.

5. This Bill may cause irreproachable damage to the clinician/nurse patient relationship, which is founded on trust. Patients would be fearful that they may be killed without consultation (especially for disability groups and those unable to communicate) Further excellent information is available at:

http://www.cmf.org.uk/index.htm?helix/spr04/editor2.htm
http://www.hospice-spc-council.org.uk/public/APM_NCHSPCS_Brief_PAD.pdf

Christian Nurses are encouraged to forward their views as a matter of urgency to the RCN encouraging them to oppose this Bill. Those who wish to contribute views and experiences should send them to Carol Bannister, PND Coordinator, Room 401, 20 Cavendish Square, London, W1G 0RN or email carol.bannister@rcn.org.uk by mid-July.

Shifting the Balance

Written by Ros Holliday

How do I fit it all in? What should my priorities be? How do I balance work, leisure, church, family? How many times do we ask these kind of questions? Many, if not all of us, struggle with this issue daily. How can I prioritise rightly in the face of so much? This was the question we posed Helen Wilcox who spoke at the 21st June day conference in London.

We were not given a simple or easy answer but were helped to think Christianly about how to stay focussed. In the Bible there are two key commissions, firstly the Creation Commission [Genesis 1 v28] and secondly the Great Commission [Matthew 28 v18-20]. There are two schools of thought regarding these, one which says that only the Great Commission of evangelism is important, and the other that states both commissions - ruling and enjoying creation and evangelism - are important. After discussion we felt that the second school of thought that embraces creation and evangelism was key, given God's present creation and his new heaven.

However this did not answer our question. How do I prioritise? How do I live now for the not yet?

Later on in the morning, we studied three characters from the Bible to see what we could learn. In Exodus 18 Moses needed some advice from Jethro as he was struggling under the weight of so much responsibility. Jethro's advice was to give others responsibility and to delegate, resulting in Moses enduring. The story of Mary and Martha is a well-known passage from the Gospels [Luke 10 v38-42]. Mary is sitting listening to Jesus whereas Martha is rushing around doing the housework. Our first priority should be listening to God as Mary does, [however doing the housework is important too!] In Paul's letters we can see his priority and worldview [Philippians 3 v12-16]. Paul has a forward view focussed on heaven and he lets heaven and God's future glory shape him.

So how does all this help us to prioritise? The key has to be, like Paul, keeping our eyes on the future glory in heaven, listening to Jesus, like Mary, delegating responsibility, like Moses; embracing both creation and evangelism in order to make decisions about our priorities in God's present creation. Sadly no simple answer, but we did come away from the day with good Biblical principles to base our decisions on.

CNM in the Media

The Issue of Overseas Nurse Recruitment

Written by Steve Fouch

In May CNM was approached by the Times to respond to an article on the increasing recruitment of nurses from developing countries by the NHS. This was in light of the recent reporting in some of the British press of the problems with health professionals who spoke poor English and other supposed problems associated with non-UK nationals working in the British health system. Some of this reporting, especially in the tabloid press was, frankly quite racist and inaccurate.
However, my concern was more on the impact this was having in the developing world.

It is becoming a matter of increasingly high profile concern missionary and overseas development circles that many developing nations are finding that their health systems, which are already under resourced and ill equipped, now so short of staff that they can barely function.
Almost 13,000 overseas nurses were registered in the UK last year. Over 40 per cent were from the Philippines (5,594), which trains extra nurses to work abroad and remit money home, and 14 per cent (1,833) from India. A further 804 came from the European Union. Over the past five years, Britain has taken 6,739 nurses from South Africa -causing Nelson Mandela to appeal to Britain in 1997 to stop poaching South African doctors and nurses. As a result, the Department of Health urged NHS trusts to cease actively recruiting in South Africa but did not formally ban the practice until 1999. That ban included the Caribbean, which had lodged similar protests.

In 2001, the Government extended the ban to all developing countries, except for the Philippines and parts of India, which had indicated that they would allow Britain to recruit. It also published a code of practice for private recruitment agencies, which aims "to promote the best possible standards and discourage any inappropriate practices which could harm other country's healthcare systems". Agencies are invited to sign the code of practice and provide two references from NHS trusts confirming that they are observing it. About 50 agencies are listed on the Department of Health's website as having signed, about half the total believed to be operating in the UK. The remainder, it would seem, do not follow these standards at all.

Figures from the NMC released in May show that 3,472 nurses from countries on this "banned" list were registered in the UK over last year - 900 fewer than the year before, but almost one third more than the 2,638 who were recruited from developing countries in 2001, when the ban came into force.

But even countries not on the “banned” list are feeling the effects of this trend. A recent BBC report on Newsnight (August 27 2003 - see http://news.bbc.co.uk/2/hi/
programes/newsnight/3184479.stm for a transcript and on-line video clip) highlighted how much nursing staff in the Philippines are, quite literally training to work overseas and never practice in their own country. As a consequence some Filipino hospitals were functioning with one trained staff nurse for fifty patients. Furthermore, doctors, dentists, and other health professionals are now re-training as nurses too in order to get work overseas that can pay ten to twenty times as much as salaries in the Philippines. A similar pattern is replicated in other developing nations. The media are waking up to this now, and approaching Christian organisations like CNM for our perspectives, and it is a chance for us to speak out on an issue that many Christian organisations have been concerned about for many years.

For instance, the impact of this vast migration of nurses on the work of Christian mission hospitals is particularly devastating. Offering lower salaries and fewer opportunities for training and career advancement than private and some government hospitals, many mission hospitals cannot recruit staff, or train nurses only to see them leave for the cities or the West within a few years. Maintaining a viable service and Christian witness becomes extremely hard as a consequence, and the communities that they serve suffer dreadfully.

As I outlined in the very brief letter I was asked to write on the matter for the Times, the reality is that this brain drain is caused by a number of complex factors. Each year, the NHS loses 9% of its entire workforce, leaving it to find around 100,000 employees annually just to stand still. Chronic recruitment and retention problems are widespread, notably in accident and emergency, intensive treatment and theatre nursing, as well as midwifery. In addition the Royal College of Nursing reckons there are 73,000 nurses aged between 50 and 55 who are expected to retire over the next five to ten years. We are not training enough nurses to keep pace with these mounting shortfalls. Furthermore those that qualify often do not stay in practice for more than a few years. Pay, working conditions and general low morale in the NHS is causing a mass exodus from the profession.

This vacuum creates a strong pull to recruit nurses from other parts of the world. Couple this with the huge wealth inequalities between the rich and poor nations, creating a huge push to nurses to come and work in the West where they can earn many times more than at home in better conditions and with more chances for further training and professional development, and you can see at once that any attempt to address this situation cannot be dealt with by isolated polices. For instance, just stopping official recruitment doesn’t plug the gap.

If people cannot work here, they’ll go to other nations with fewer scruples about where they recruit their staff from, or use British agencies that do not sign up to the DoH guidelines. Unless we can improve the working conditions and incentives for our own staff, and address the huge inequalities of wealth globally, we will see a continuing, life threatening haemorrhage of nurses and doctors from the poorest nations.

How does this affect us in practice as Christian nurses? Certainly most of us will have African, Caribbean, Filipino, and Indian colleagues, and we cannot sit in judgement on them for leaving their countries to come here to work - if we were in the same situation most of us would do the same to give our families a chance of a decent quality of life. Indeed, Asian and Caribbean nurses have been the backbone of the NHS for decades.

They may well need our support and friendship as they struggle to live and work in an alien culture. Many will be Christians, and we can help support them in finding and integrating in to a local church. But we also need to be thinking about how we can lobby our trusts to ensure that the agencies they use are following DoH guidelines on recruiting from developing countries. We can also think about linking in with groups like the World Development Movement and other organisations campaigning to see structural changes in inequalities between nations.

Jesus always stood on the side of those pushed to margins - the poor, the forgotten and the unloved. Scripture rails again and again at the rich who exploit the poor for their own profit. God cares about these injustices - that women in Malawi die on antenatal wards because of a lack of skilled midwives; that there are not enough nurses to provide adequate care to the critically ill in parts of South Africa. These are all symptoms of the same problem. However, one of the wonderful truths of the gospel is that whatever small thing we can do in response to God’s prompting, He can turn to something that will bear greater fruit than we can see.

It is encouraging that CNM is now being approached by the media to speak on these issues, and it gives us a chance to speak a Christian perspective into such situations. Please pray that such opportunities continue to present themselves and that we are empowered by the Holy Spirit to respond appropriately with a voice that echoes God’s heart.

The Place of Work at Prayer

There are lot of ways we can invite God to join us more closely at work. Many of us may mutter a prayer for help as we walk the last yards to our place of work and are pleased to discover that He is there as we give out the medication, organise the staff team or deliver a baby. We can also thank Him when we go home, even if things have not gone smoothly, that we can learn from our mistakes. If we get the chance, let us commit the day to Him. Having a quiet time before work can set us up for the day and keep anxiety away.

"If any of you lacks wisdom, let him ask of God, who gives to all liberally and without reproach, and it will be given to him. But let him ask with faith, with no doubting"
- James 1:5-6a.

He will help us to know what to do or say when faced with situations, and He will guide us day by day, or in our career. We may spend hours talking with others about these things and forget that God is waiting for us to talk to Him about them. We suffer anxiety because we have not really given Him our worries and left them in His hands, trusting Him to sort things and thanking Him that He will.

"Be anxious for nothing, but in everything by prayer and supplication, with thanksgiving, let your request be made know to God; and the peace of God, which surpasses all understanding, will guard your hearts and minds through Christ Jesus."
- Philippians 4:6-7

Faith is the antidote to worry, and if that faith is flagging, we need to do something about it. "If God seems far away, guess who's moved!" Growth in faith is our responsibility - reading the Bible, finding a church and going when you can, joining a home group, having fellowship with other Christians, reading books about it and then putting into practise what we are learning. The best thing for growing faith are the tests we go through - trusting in God when things get tough or feeling shaky and simply hanging on.

As well as praying for the strength to get through our shift, there are other opportunities for prayer at work if we look for them (and pray for them!). Offering to pray for another member of staff, there and then if there is privacy, or assuring them you will be praying for them. Sometimes there is a moment when you can pray with a patient - most of them are anxious about something. Offer to "say a little prayer with them"; most will be grateful and pleased by this act of kindness. Simply put your hand on their shoulder and ask God to bless them and help them in their need. What happens next is up to God, but you have created a doorway for God's touch on that person. Be praying for healing whether it be physical, mental or spiritual, for yourself, your colleagues and especially your patients. We know that illness is God's enemy - Jesus spent most of His time on earth healing people from illness, so by your job as a nurse you are doing something close to God's heart even if sometimes, their ultimate healing is to leave this earth.

Quiet Times
Where do you have yours?

On the loo can be a place for prayer! Shut away in the bathroom gives us the quiet we need. We may be able to go to the chapel if there is one during our break- it is a good way to switch off from work. Some people can cut themselves off whilst in a crowd travelling to work, and pray. Traffic jams are another place. Whilst walking the dog or in our beds last thing at night.

God does want us for Himself though - let's make sure it is somewhere that the focus can be on " Him and me ".

Prayer is our greatest resource, yet can be the one least used. It is hard finding the time for God. We are often tired, rushing to work or trying to relax after a shift. We know that God should come first "But seek first the kingdom of God and His righteousness, and all these things shall be added to you" - Matthew 6:33. Sometimes He can end up getting the dregs of our day, instead of the first fruits. However, He is a God not looking to condemn, but looking to love. When we can set aside a special time especially for Him, He says "Welcome back!" not "Where have you been lately?"

So, we've found the place, we've found the time, what next? Lots of us have a good plan for our quiet times, or we are able simply to worship and be inspired to pray. What we do in our quiet times may change with time, and there are lots of good Bible notes or books available to help us. But on those days when its hard to concentrate, or if you are seeking inspiration it is good to have plan B. Here is one pattern: -

Peace - be silent for a minute or so, still your soul, perhaps repeat the name of Jesus or a Bible verse quietly.

Recall -Think of all those things you can be grateful for and thank God.

Admit - Ask the Holy Spirit to convict you of any sin in your life. Say sorry to God, then ask for and accept His forgiveness, remembering that you need to have forgiven others to be forgiven yourself. Do this too if you need to.

Yield - Commit yourself to Him fully, invite Him to be in charge of your day or a particular situation that may be worrying you.

Exalt - Worship God. Reading a Psalm "with great gusto" can help. Using a CD, or concentrating on one of God's attributes.

Relate - Your needs, your family's needs, others needs to God. Pray for the things that come to mind. Using a book to note down your prayer requests can be helpful, as it will remind you to pray consistently for things, and you can also tick them off the when the prayers have been answered - very encouraging!

If you don't normally pray out loud - try it - it's helps concentration no end.

FAQs

Written by Peter Swift

Many thanks to our readers who completed the survey we conducted late last year. A number of frequently asked questions arose some of which we will attempt to address here.

CNM is frequently asked about it's charitable status. We have looked in to this but feel that the administrative costs would outweigh any possible advantage. We will however keep this under review from time to time, but until our membership base and budget grows it may not be cost effective... "catch 22"!

Many people have enquired about local groups. We presently have active groups in London, Bristol and Birmingham. While we would dearly love to help groups form elsewhere we believe the best strategy is first to put on an "away day" or half day event which may then become the means to kick start a local group. CNM has 120+ members spread across England & Wales with most of these clustered in the major conurbations. If you would like to have a CNM sponsored event in your locality then why not give us a call? [But bear in mind that it can take nine months from planning to execution!]

We would like to develop our internet services more. The idea of setting up a chat-room received universal approval but no-one said that they would/could access it! So we will put this on ice for now. But there may be scope to develop "special interest groups" which communicate by e-mail. We note that we have a number of academics on our books and wonder if it would be useful to facilitate contact between them via CNM. What do you think?

On the whole "CNM News" gets a thumbs-up from our readers. Some have suggested expanding or making it more frequent. We presently publish it three times per year. As things stand we probably do not receive enough material to enlarge the paper. We would consider making CNM News a quarterly publication if we could be confident of having sufficient articles. So please... write, write, write!

This June CNM will be holding it's second AGM and some of the existing committee will be retiring and others will take their place. Thanks to the support of it's members CNM has survived a tricky birth and now the next committee will have the responsibility of seeing that CNM moves from surviving to thriving. It will be an opportunity to review our mistakes and learn what works and what doesn't. We are keen that all our members feel involved in this process, especially if they are unable to attend the AGM. Please write or e-mail us with your views and ideas.

CNM is sometimes asked about it's relationship with other Christian healthcare organisations. CNM is affiliated to UCCF as one of it's "professional groups". Within this forum we meet annually with Christian Medical Fellowship, Christian Dental Fellowship and the Christian Therapists Network.

Although we are not formally affiliated to the Nurses Christian Fellowship International we have a cordial relationship with them. We also coordinate our activities with NCF Scotland.

Answers from Job

Written by Anna MacKenzie - Health Care Assistant & UCCF Staff Worker

We live in a world full of questions, a world that is forever asking ‘why?’ We witness tragedy each day on individual, national and international scales. And together with the whole world we cry out in anguish, wondering if we will ever see justice restored.

As people in nursing and caring professions, we are face-to-face with this anguish on a daily basis. We are at the front line of the battle, and we see pain and suffering take root in many different ways: the young family facing cancer, the elderly person left alone to die.

As Christian members of staff, we often feel we should be better equipped to deal with these situations. We assume that we must have the right answers as to why this is happening. When in dialogue with patients, relatives and colleagues - surely we have something more to say?

But the truth is we often have nothing to say. We could form glib theological answers in our minds, but how on earth could they relate to the real hurt, the real pain, the real grief?

The book of Job thrusts us into a world seemingly out of control. A world where justice doesn’t always prevail. A world full of questions. And as Job’s life becomes one full of terrible pain, grief and suffering - he is not afraid to ask questions:

Why am I still alive, when suffering? Why was I allowed to be born in the first place? Why does God hide from me, and consider me his enemy? Where is my hope?

How does the book of Job tackle these questions?

For the first 37 chapters, we see a human response. Job’s 4 friends Eliphaz, Bildad, Zophar and Elihu, each attempt to answer Job’s pleas for help. They rattle off lengthy spiels consisting of their own thoughts, observances and wisdom. They give simple, cold answers to the problems Job is facing.

Job is confronted by the accusation of Eliphaz: You are a sinner, and your arguments are blighted by sin; by the theological prowess of Bildad: God is being just with you; and by the legalism of Zophar - You’re not doing enough before God.

As Job is tormented by their trite and polished answers, the reader realises that human wisdom is not equipped to handle these earnest questions.

Job’s questions seem so familiar to us today. For those involved in any kind of nursing or care work, hurting people often shout their questions at us. How can the book of Job help us as we come face-to-face with human suffering?

The main character of the book speaks at last in chapter 38. The LORD, the God of the universe at last comes to answer Job’s questions.

But the surprise is, that God does not answer Job’s 37 chapters of questions. Instead he asks more. Where were you when I laid the earth’s foundations? Have you ever given orders to the morning or shown the dawn it’s place? Do you know the laws of the heavens? Can you set up God’s dominion over the earth?
Who is this God? Job finally sees: I know that you can do all things, that no plan of yours can be thwarted… now my eyes have seen you. Therefore I despise myself and repent in dust and ashes.

Job longs for answers. And the answer God gives is not a long philosophical explanation of the problem of evil. The answer given is God himself - the God who is sovereign over all. The God who calls people into relationship with him. The God whose wisdom far outweighs human wisdom. The God who offers a personal relationship with him as the answer to the problem of evil. The God who allows his creation to relate to him, to be real with him as Job was, and to find hope and true joy (even amid sufferings) in him.

As we live as Christians in a world where there is such a thing as innocent suffering, and where people will shout their questions at us - let us show them our God. He won’t answer their questions - he is the answer to their questions.

Do Not Give Up Meeting Together

Written by Angela Thavaraj

Reflections on the past 7 months for the Bristol based Nurses Prayer group

The writer of the letter to the Hebrews certainly knew the importance of meeting with fellow believers for encouragement and to ‘spur one another on towards love and good deeds.’ Although we might not always feel our day-to-day work fulfils this high calling of love and good deeds, meeting together regularly can be an active step towards developing our spiritual growth as Christians.

The Bristol based prayer group was set up in October 2001 with the aims of meeting for encouragement and fellowship and to enable us to grow in our knowledge and love of God. It is intended as a forum to discuss a Christian response to issues in nursing and to support and pray for each other in our work and witness as Christians. We are also committed to praying for the work of CNM nationwide and for the committee.

I moved to Bristol in August 2000 and was prayerfully considering the opportunity to start a group locally. I had been involved with the London based prayer group a few years earlier, before CNM was officially launched and had experienced the benefits of meeting together on a regular basis to support and pray for each other. I also gained much enthusiasm and inspiration from the weekend conferences away and the day conferences in London. I made contact with nurses from my own church and advertised in a few other local churches. At our first meeting there were 5 of us and we planned to meet on a monthly basis. This however proved to be too much of a commitment for most people. In the New Year, we resolved to meet every other month and include a meal at the start of each meeting. This has proved much more successful. At the last few meetings the average attendance has been 7, but I am in contact with over 20 nurses (from an initial number of 7).

After the meal we spend time reading the Bible together and have been working through the book of Philippians. Spending time in God’s word first, ensures that we are concentrating our minds on His agenda, before praying together. I have been greatly encouraged by the response from many in the group who share the view that the prayer meetings are a great source of encouragement and benefit. The group is still in its infancy but for all of us involved, it is a precious and valuable time to meet together to bring before God and each other the burdens and joys from our profession. We are trusting God for His leading and guiding in the future of this group and continue to pray that it might be used for His glory.

Globalisation, Health Nursing and The Gospel

Written by Steve Fouch

Many of you would have noticed in 2005 the emphasis on global poverty and the attempts to get major world leaders to do something about it. Live 8, Make Poverty History, dramas by Richard Curtis, songs by Sting and swearing by Bob Geldoff. Somehow or another, at least over the summer months, global poverty became big news – it even featured surprisingly high in the General Election in May!

Well, here we are in 2006, and it would be easy to ask, what has happened? The answer – well not that much actually. But also, surprisingly more than in previous years. There is no end to global poverty in sight, yet more people are being treated for AIDS, TB and malaria than ever before. Millions are still dying in famines and in childbirth, but debt relief and aid to the poorest nations is increasing as never before. Small steps, but as the Chinese saying goes, “the journey of a thousand leagues starts with a single step”.

William Wilberforce fought for over thirty years to end slavery – but in the end he succeeded and changed the world as a result. We are in the midst of an even bigger struggle to change the world, and like Wilberforce, it is faith in Jesus and a strong grasp of scripture that is motivating many to lead this fight, but we have to be in it for the long haul – it won’t change overnight.

Nevertheless, one could well ask, “What has this got to do with me?” After all, we have problems enough to deal with here in the UK, and what can we do to make life any better for people on the other side of the world when we cannot do much about those in need on our own doorsteps?

Well, consider a few facts, coolly and objectively. The average woman in sub-Saharan Africa has a one in six chance of dying in childbirth. If you are a midwife, think about how many babies you have delivered; how may are still born or die shortly afterwards? How may of their mothers die? One in every six? I doubt it if you are working in the UK. While we are at it, in East Africa, on average 40% of the women turning up at antenatal clinics are HIV+. How may do you see here in Britain?

What are your chances of making it to adulthood? In the UK, pretty good – only 6 in a thousand children do not make it to five. In developing countries, the odds shrink rapidly; in Turkey it’s 35 in 1,000; while in Liberia 235 in 1,000 won’t live beyond their fifth birthday.

Add to this AIDS, which claims over three million lives a year, mostly in Africa and Asia, where between six and nine million people with an AIDS diagnosis have no access to treatment. Similar statistic can be quoted for TB and malaria.

Need I go on? We are privileged here in the West, we all know that. We have access to healthcare free at the point of delivery, which most of the world’s poor do not have. We have more food than we need to survive, so much so that overeating is one of our biggest health problems. But this does not tell us why as nurses and midwives practicing in Britain this is an issue to concern us.

Well, here are three reasons. Firstly, we are in globalised world. The panics caused by avian influenza and SARS in recent years illustrate how a health problem in one part of the world affects every part of the world. Poverty, war, famine, and disease -the four horsemen ride far and wide and pay no respect to national boundaries, even to our own doorsteps. TB is on the rise in schools and communities across Britain, as any public health nurse will tell you. Refugees are living amongst us, with their own needs- many of us see them regularly in our work. What horrors have they have lived through? What physical and mental health needs do we have to deal with regularly as a result of disasters in far-flung nations? These are matters to concern us all.

Secondly, our actions and choices affect other nations. The issues of international trade are complex, but in short, the poor cannot sell us their goods at a reasonable price so they can make a living, while we unload heavily subsidised goods on them, driving their own business to close down because they cannot compete. What we buy and how we buy it, affects others. Our lifestyles have far reaching consequences, more than we can discuss in one article!

Finally, and most importantly, we should care because God tells us to! Scripture urges us to respond to the needs of the poor. Jesus’ much misquoted saying “the poor will you will always have with you” is actually taken from Deuteronomy 15: 11 – the second half of which says “Therefore I command you saying ‘You shall freely open your hand to your brother, to your needy and poor in your land’”. The New Testament also exhorts us to care for the needs of our brothers in poverty (e.g. 1 John 3: 16 –18, James 2: 14 – 17). It could be argued that this does not relate to those in other nations, but to our near neighbours, but again we are exhorted to care for the whole Body of Christ (1 Corinthians 12: 20-26), and it is clear that a huge proportion of those suffering in Africa in particular are Christians. Furthermore, Jesus made a strong point that our neighbour was anyone in need, of any nation, tribe, creed or tongue (Luke 10: 25 – 37).

Yet at the same time, giving money, sending Christian health professionals and other forms of aid are not enough. Such aid helps in the short-term, but in the long-term it fosters dependency and feeds corruption. The Levitical Law encouraged generosity to the poor, but the aid given was to help that person be able to make his own living again. The laws required that debts be cancelled and land restored to its original owners on regular cycles, ensuring that the means of living were not concentrated in one set of hands for too long, and that people could feed and clothe themselves rather than depend indefinitely on the goodwill of their neighbours (Leviticus 25 & Deuteronomy 15).

There is then above all a call for us to pursue justice as believers. Poverty may be always with us, and some degree of inequality is inevitable, and not necessarily unjust, but the degree of extreme poverty and inequality in health that we see today is not acceptable, especially as so many of the causes are due to injustice. That is why we are exhorted to speak up for the poor, and encourage those in power to act justly on their behalf.

As nurses and midwives, what can we do? We have skills that can be used in many places [see the elective report from Elisabeth Sayers, and the article from John & Mair Pugh in this edition of CNM News for some examples]. We can make a positive contribution to the health of the poor. We can get informed and speak out. There are many great sources of information on health and poverty issues around the world – Tear Times is one good example. The Micah Challenge campaign (see www.micahchallenge.org) is another example – it encourages Christian to get informed and speak out on issue of global poverty from a Christian perspective.

At this year’s national conference [see Notice Board for details] I will be looking at these issues, and how we can respond in a Christ like manner as health professionals. In future editions of CNM News we will attempt to look at some of these issues in more depth and have some examples of ways you can get involved.

As we start a New Year, full of resolutions and plans let us stop for a moment and consider what God might be saying to us about what we can do to affect positively the lives and well being of millions around the globe.

Assisted Dying for the Terminally Ill Bill

Update and points for Action

Lord Joffe’s new Assisted Dying for the Terminally Ill Bill had its first reading (announcement of publication but no debate) in the Lords on 9 November 2005. This is the third ‘assisted dying’ bill tabled in the Lords in as many years. If passed it will enable ‘an adult who has capacity and who is suffering unbearably as a result of a terminal illness to receive medical assistance to die at his own considered and persistent request’. Put simply it seeks to legalise physician assisted suicide (PAS), but not euthanasia, along the lines of the Oregon Death with Dignity Act.

The introduction of this new Bill follows the debate on Lord’s Joffe’s previous bill of the same name, which led to a House of Lords Select Committee. The Select Committee reported in April 2005 and their report was the subject of a nine-hour debate in the House of Lords on 10 October.

The new bill is now available on the UK Parliament website here

An alliance of professional bodies (including the Royal College of Palliative Medicine, the Christian Medical Fellowship and CNM), disabilities rights groups and faith based bodies (Christian, Jewish, Muslim and Buddhist) have come together to form a new alliance to campaign for more and better palliative care services in the UK, and to oppose any weakening of the law that would allow physician assisted suicide in the UK. Where palliative services are good, and the physical, social and spiritual needs of the dying patient are met, requests for help in committing suicide or for euthanasia are very rare. In the Netherlands (where full Euthanasia is legalised) and Oregon (where assisted suicide is legal), palliative services are minimal.

The alliance, called Care Not Killing has a website at www.hopealliance.org.uk where action points, articles, facts and figures can be found.

In the meantime, Action points

Our first priority must be to influence the Lords debate early in the New Year. It is unlikely now that those who have already made up their minds will change them. Our biggest enemy is apathy in that Lords who might potentially oppose the bill will simply not turn up for the vote. So it is important that they are urged to turn up and oppose the bill.

Specifically:

1. Write to members of the House Lords around the second reading probably in the New Year urging them to oppose the bill and vote against it. A full directory of members of the House of Lords, along with the postal address, is available on the Parliament website by clicking here The full debate on 10 October can be read in Hansard on the UK parliament website here . If peers have already spoken against the bill thank them for the stand they have taken.

2. Argue specifically against the Bill. You will find Andrew Fergusson's excellent article on Oregon’s Assisted Suicide legislation, ‘Going West’, in the Summer 2005 edition of Triple Helix on the CMF website www.cmf.org.uk. Further information and briefing papers are on the Care Not Killing website or are available on request from Tanya Yeghnazar at tanya@cmf.org.uk. Write the letter in your own words and preferably keep it to a single side of A4.

3. Check for updated information and comment on the Joffe bill here

4. Educate others in your church about the issues.

5. Pray for all those involved and pray specifically that the bill will not proceed.

Ethical Dilemmas 1

What would you do - tell or not tell?

In the first of a regular series, we look at some of the day-to-day dilemmas we face in the workplace as nurses, and ask, “What would you do in this situation?” Please write in with your responses [by email or post – see Notice Board for contact details], which we will aim to publish in the next edition, along with a new dilemma.

“A patient is admitted to your ITU ward. They require an urgent blood transfusion which you ask a doctor to prescribe. The doctor assures you that they will write the prescription when they have the time, but to go ahead and give the blood immediately. Ten minutes after commencement of giving the blood, a student nurse who is looking through the patient’s notes, discovers that the patient is of the Jehovah’s Witness faith, and so would very likely refuse a blood transfusion. You stop the blood immediately, and inform the doctors and ward manager about the incident. In a meeting over the incident, a vote is taken to keep what happened a secret from the patient and their family.

What would you do?”

Things to think about:

The patients right could have clearly been violated, but you and the department are withholding this information.

The patient recovered and was discharged.

The Jehovah’s Witness faith teaches that taking blood will incur a curse from God resulting in eternal condemnation including a cutting off of all links to the faith and family of the affected person.

Could saying something harm the patient even more than death could have?

Nursing Elective to Zambia Report

Written by Caroline Sawyer

I have now been back in the UK for nearly three months, having completed my nursing placement in St. Francis Hospital, Katete, Zambia, where I stayed for seven weeks (20th February - 10th April 2005) and it is only now that I have begun to sort out my thoughts and feeling regarding my time there, to be able to put my experiences into words.

So what was life and nursing like at St. Francis Hospital?

St. Francis hospital is located in the district of Katete in Zambia’s Eastern Province. It is about 500 km from the capital of Lusaka - This is a five or six hour journey on the “luxury” coaches. St. Francis Hospital is the largest mission hospital in Zambia, and is jointly run by the Anglican Church in Zambia, and the Catholic Diocese of Chipata (the nearest town). The hospital also receives funding from the Zambian government and various overseas organizations. The hospital contains about 360 beds and cots. However this total is never a limit to the number of in-patients in the hospital, as space on the floor can always be found and it is a common occurrence for patients to be found sleeping on the floors of the hospital wards.

During my time at St. Francis I spent some time on both the medical and surgical wards at the hospital and even went into theatre on a few occasions, and also the labour and maternity wards. On the medical wards, the main diseases I saw being treated were Tuberculosis, Malaria, Meningitis and HIV & AIDS. To be treated, patients must first purchase an OPD (out-patients department) card costing a little more than 50p. However, the treatment received by patients is largely free of charge, and because of this people travel for miles to receive medical treatment at St. Francis (some even travel from the capital city).

Before my time in Zambia, I knew that HIV & AIDS was a serious problem within African countries, however, until my arrival at St. Francis Hospital I never fully realized what this meant. In Zambia 1 in 5 adults are HIV positive and the life expectancy of a baby born in Zambia today is now thought to average as low as 33years . Having seen and experienced the affects of the HIV & AIDS viruses on people, these statistics become more than numbers on a page; they become real, and defy expression. Nursing these people was a humbling experience, and one that I will remember for the rest of my life.

The nursing care that I was involved in giving, such as dressing wounds, was very basic (a gauze swab and strapping), due to the simple supplies and equipment that the hospital had, though it did the job it needed to do. The basic supplies the hospital had rarely seemed a barrier to treating people. I remember one day while I was working on the male medical ward (St. Augustine) an elderly patient was admitted to the hospital for treatment of a painful right knee and bad back that he had been suffering from for 3 years. He was sent to the physiotherapy department and on returning he was shouting at the top of his voice (in Chewa – the local language), and waving his newly acquired walking stick in the air, in what I perceived as a threatening manner. On asking one of the patients (who spoke both Chewa and English) what his man was shouting about, he said that the man was expressing his thanks to the doctors and nursing staff for his new walking stick, which was now the right height for him, relieving him of his aching back and helping him to walk properly.

What I learnt from his encounter was that it is not always necessary to have the ‘high tech’ solutions to meet real needs. Yes, there were times when situations at the hospital were frustrating, such as running out of vital medicines which patients needed to survive, but when these moments arose I had to remind myself of what Dr Shelagh Parkinson, Executive Director of St. Francis Hospital wrote to me prior to my arrival at St. Francis Hospital, “When situations seem frustrating they should be compared with the absence of any healthcare as opposed to the system in richer countries”.

One major difference between nursing care in Zambia and the UK was that family members and not the nursing staff met the hygiene needs of the patients. Each patient had what was called ‘a bedsider’, a family member who remained with the patient throughout their stay at the hospital, attending to all their personal needs – eating, drinking, washing etc. Nursing ‘tasks’ were quite medically orientated due to the few doctors at the hospital, and so the nursing staff were involved in what we in Britain would term ‘extended’ nursing roles, such as taking bloods from patients and cannulation, which I too was taught how to do. This was all very new to me, but the Zambian nurses were very willing and helpful in teaching me how to do procedures that I would not have had the opportunity of being taught in the UK.

My time in Zambia has increased my confidence as an individual and also in my professional life, as I begin my first job as a newly qualified nurse. It has also broadened my understanding of what ‘nursing’ is, and the diseases and social problems that affect individuals in developing countries. Having been to Zambia twice before my elective, and experiencing the Zambian culture, the strong hold the memories have on my life are ones I will never forget. I would one day like to return to Zambia (together with my husband) to thank the people of this country, who have influenced our lives unknowingly, by returning to be of use to them. This placement has already enabled me, to some degree, to give back to a country, which is close to my heart, as well as enabling me to learn about nursing and healthcare within a developing country.

I would like to thank Dr. & Mr. Parkinson (Executive Director and Administrator) from St. Francis hospital for allowing me the privilege to spend time at the hospital and for making me feel at home.

For more inforation on taking elective placements overseas, contact HealthServe on 020 7928 4694
email: healthserve@cmf.org.uk web: www.healthserve.org/electives

Some like it hot... and some don’t

As we write this article the temperature is a hot 55 degrees in the sun, 40 in the shade and a cool 35 degrees in our office. It is the middle of November and, yes, you guessed it, we are not writing this anywhere in the UK! In fact, if you are one of the 'some' that like it hot, sticky and dusty, then Madagascar in November is the place for you.

We are John and Mair Pugh and we are now living in a remote town in the north of Madagascar, called Mandritsara, and working at a Christian mission hospital called Hopitaly Vaovao Mahafaly (The Good News Hospital). The hospital was opened in 1995 and has grown from a one doctor G.P.-type surgery to a 32 bedded in-patient unit, with a laboratory, x-ray dept, out patients unit (seeing up to 200 pts a day), ophthalmic dept, three operating theatres as well as an almost-built maternity department. The hospital is also the base for a community health team which takes vaccinations and health advice out to the surrounding villages, as well as having in it's team two village evangelists, and the necessary administration staff.

The hospital is based on the premise that people need spiritual health as well as physical health, and to this end the gospel is preached morning and evening on the in-patient unit, and each day for 15 minutes before the outpatients unit opens. Tracts have been written for specific health needs, i.e. new parents, following bereavement and for when someone is ill.

So, why are we here? We are both Christian nurses with many years of nursing experience between us, who feel that God has called us to work here. What do we do? For many years now, the hospital management committee (yes, they exist even in remote Madagascar!) have had the vision to train Christian nurses to work here in the hospital. John has been a nurse teacher (both as a clinical teacher and lecturer in nursing studies) for 20 yrs in the UK, also spending time in Romania and Malta, and when he heard of the need he felt the God was speaking to him. Mair took a little longer to decide that it was the right thing to do, but now we both feel that this is where God wants us to be.

We arrived in Madagascar in January 2005, and are now getting to grips with the cultural differences, the heat, the dietary changes, the language and the many other things in life that are different to our work in the UK. The plan, God willing, is to put together a nurse training programme that will conform to the International Council of Nurses definition of nursing, and comply with WHO directives on nurse training, as well as meet local needs and acceptance of the Malagasy regulations.

The road thus far has not been easy; selling up our home in the UK, leaving our families and beginning to learn French and Malagasy, and we very much need the prayers of the CNM members for our on-going work. The students we will train will all be practicing Christians, as are all the employees at the hospital, and we hope to hand the running of the School of Nursing over to a Malagasy Director when we leave in about 6 years time, or so. The first group, of about 12 students, will begin (God willing) in the October of 2006 and there is much planning to be done before then; a curriculum to be written in French and the school to equip with all the things needed for teaching.

We will be in the Uk for May and June 2006, and would be happy to meet any CNM members who are interested in knowing more about this project first hand, especially nurse lecturers and those attached to schools of nursing in the UK. We have some specific equipment needs, too, and if you are interested in helping in a practical way we would be pleased to hear from you.

We read with interest, in the autumn edition of CNM News, the elective report from Rachel Bowen, and would be pleased to hear from anyone who might like to do their elective here. If that interests you, you might like to know that the weather is either hot (May to October) or very hot (November to April).

There are no landline telephones here, no Internet, no text messages or mobile phones, and so if you want to contact us you need to do so by email (accessed by use of a satellite phone), and send your message in plain text format only please. The address is davidmann@uuplus.com and you need to put 'for the Pughs' in the subject bar. Please do not send any attachments. We very much look forward to hearing from you.

You can read more about Hopitaly Vaovao Mahafaly at www.mandritsara.org.uk
John Pugh RN. RCNT. ONC. MN. was latterly a Lecturer in Nursing Studies at the University of Nottingham, having qualified in Shrewsbury in 1978. Mair Pugh RN worked latterly as a Palliative Day Care Leader in Retford, Nottinghamshire, having also qualified in Shrewsbury in 1977.