From San Francisco to Namibia – Father Rick Bauer on spirituality in palliative care

This article was originally published on the Africa edition of ehospice


“I’m a Catholic Priest. I did my seminary from 81-85. The seminary was in San Francisco. I entered it just wanting to be a country priest, and then HIV hit and it changed my life. It changed my understanding of church and what church could be. I knew nothing about palliative care and all of a sudden I was surrounded by people who were dying.”

Sitting in the warm afternoon sun, Father Rick Bauer relaxed back into his chair. It was clear that he was used to explaining how he was taken from his home in the US to travel across sub-Saharan African, driven by palliative care and a desire to limit human suffering. Very quickly it became clear that his early years as a priest in San Francisco were formative for him in developing his interest in spirituality as a part of good palliative care provision.

“So in the earliest days of the pandemic it was pastoral care, the doctors were saying there was nothing more we could do. Nurses would be leaving trays of food outside the rooms of the guys refusing to go in.”

His words were clearly carefully chosen – balanced between wanting to portray the reality of what he and others had felt at the time whilst clearly conscious of how common rhetoric around HIV and AIDS  had moved on since the 1980s.

“I mean…we were scared, I am not judging them. But it was up to us to carry these trays in, you know? Others didn’t want to be in there, but for me I saw no choice. There were guys needing help. People ask me if I was scared and I just think it was holy stupidity. I just saw a tray of food and a hungry guy. I don’t know, I guess yeah, I was scared.”

Father Bauer is now a specialist in spirituality in palliative care and is in Johannesburg, South Africa where he is taking part in a workshop on spirituality at the joint African Palliative Care Association and Hospice Palliative Care Association of South Africa 2013 Conference. Having spent much of his working life in different parts of sub-Saharan Africa, he now lives in Namibia where he continues to work with spirituality and palliative care.

“I spent 15 years managing HIV care and support organisations, first in Tanzania and now in Namibia. But now I am doing lots of things…one of which is teaching in palliative care and how to integrate spirituality into palliative care.”

Spirituality is included, alongside physical and psychological care, as an integral part of the WHO definition of palliative care. Despite this, it is often confused or misunderstood as just looking after the religious needs of a patient.

Father Bauer, however, was insistent that good spiritual care did not necessarily involve religion but rather that it depended upon each individual patient’s needs. Once again, he referenced his early experience with HIV patients in San Francisco to illustrate this point.

“When HIV first hit, the first thing to come up was good counselling practice. We are talking about active listening for example. I don’t think people have to be ordained or anything to provide spiritual care, but at times this can be useful. When someone is dying they have questions. You’re not there to answer them but to listen.”

The difference between psycho-social support that a patient needs and the spiritual support a patient needs is often blurred. Father Bauer offered a simple distinction for practitioners to consider when interacting with patients.

“The ‘Psycho-’ is about myself – for example, if I have been diagnosed with cancer what are my worries or concerns? The ‘social’ is how this then relates to my family my friends. The spiritual care is about helping to ask some of those deeper questions.”

It is common, as people approach the end of life, that they have questions and concerns about deeper, spiritual questions about what, if anything, happens after death. Father Bauer is insistent in pointing out that often patients have a deep spiritual need to also look back and reflect on their lives and what they have achieved.

“There is a growing emphasis on forgiveness. Social workers are seeing it’s important and this is such as spiritual concept. I can train someone on how to give an apology or even accept an apology – that’s a social thing. The spiritual thing is how to really forgive someone, or to forgive yourself. Again though, this is just about being there 100%, to be with a patient to listen to their concerns.”

Spiritual care, in one sense, is a simple amalgamation of soft skills such as active listening. Done well however, it also involves an in-depth knowledge of different cultural and religious factors to understand the specific need each patient.

“Not everyone will be trained in spiritual care, but everyone can listen in a way that puts the patient at ease. Just be there for them,” said Father Bauer.

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