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《The Hospice in Houston|休斯頓的臨終關懷》
（中英文雙語版）
By Charles Wang
To Patricia Family,My Volunteer coordinator Mr.Jonathon Mook,My American patients and my bro Johnny Chen.
Internship in the US
From July to September in 2018,I joined a project named HCEE (Homestay Cultural Experience and Enrichment Program) held by Jilin Provincial Education Service Center For International Exchange.This project is an international exchange program for undergraduate international volunteers,co-hosted by Jilin Provincial Education Service Center For International Exchange and Global Cultural Adventurers.I entered the US agency after an interview and a two-way selection match,working with American colleagues and other national volunteers in a 6-week volunteer internship and practice.During this period,I lived with a US homestay family -The Patricias.They took good care of me.And I would like to express my sincere gratitude to them.My internship city is Houston, Texas.
初到美國
Hospice agency
My volunteer service location is in Encompass Hospice of Houston,a hospice agency in Houston.Hospice is a great cause that marks the great progress of human civilization.The main job of hospice is to provide care for all types of recipients who are dying in six months.Measures such as taking care of patients integrally and applying scientific psychological and clinical care to them can help patients reduce physical and mental pain.We try to make patients respected,improve their dying quality and let patients die in a peaceful,calm and comfortable environment.At the same time,the family members may not have serious regrets and shadows after the death of the patient.
工作培訓
The hospice business is rare in China,but it is very popular in the United States.There are more than 200 similar organizations for hospice in Houston.Differences in economic power and cultural attitudes have contributed to this phenomenon.The advanced concepts and working methods in the United States have broaden my horizons.
作者在單位
The history of hospice
The term」hospice」(from the same linguistic root as 「hospitality」)can be traced back to medieval times when it referred to a place of shelter and rest for weary or ill travelers on a long journey.The name was first applied to specialized care for dying patients by physician Dame Cicely Saunders,who began her work with the terminally ill in 1948 and eventually went on to create the first modern hospice-St.Christopher’s Hospice-in a residential suburb of London in the 1960s.
辦公室
Saunders introduced the idea of specialized care for the dying to the United States during a 1963 visit to Yale University.She lectured medical students,nurses,social workers,and chaplains about the concept of holistic hospice care,included photos of terminally ill cancer patients and their families,showing the dramatic differences before and after the symptom control care.This lecture was the catalyst within the medical community that resulted in the development of hospice care as we know it today.
The beginning of the modern hospice movement is credited to Dame Cicely Saunders」.Her concept of hospice was to combine the most modern medical techniques in terminal care with the spirtual commitment of the medieval religious orders that had once created hospices as way stations for people on pilgrimages.」
單位
Hospice in United States
During the late 1960s another instrumental woman who promoted specialized care for the terminally ill,Dr.Elisabeth Kübler-Ross,a psychiatrist,began to attract national attention for her views on death and dying.In her book,《Death and Dying》,she interviewed over 500 terminally ill patients and introduced the concept of five」 stages of grief」that the dying person might emotionally experience:Denial,Anger,Bargaining,Depression,Acceptance.
Kübler-Ross also encouraged the medical community to begin dialogues with patients about death and the dying process and to acknowledge the presence of the grief process within the framework of the patient care model.
與主管Jonathon Mook先生
In 1974 Connecticut Hospice opened in Branford,Connecticut,the first hospice program in the United States.Started by Florence Wald,RN and Dean of the Yale University School of Nursing,a chaplain and two pediatricians,specialized care of dying was now available.Volunteers have always been instrumental in providing care to the dying and during the next few years volunteers across the country came together and opened hospices in Miami,New York City,St.Paul,Marin County,and in many other cities.In 1975 the first national gathering of hospice workers was held in New Haven,hosted by Connecticut Hospice and attended by people representing 17 states.
辦公室工作
It became apparent to the pioneers of hospice that a national organization was needed to assist hospices during this period of growth.In 1978 the first National Hospice Organization Board of Directors was elected and an office was established in the nation’s capital.The name of the national organization has since been changed to The National Hospice and Palliative Care Organization.
單位廚房
It is important to remember that was no financial reimbursement for hospice care at this time.Volunteer nurses,doctors,social workers,chaplains and business specialists secured donations of medical equipment and supplies,medications,and money to fund their hospice organizations while donating their own time and clinical expertise.In 1979 the Health Care Financing Administration awarded 26 demonstration project grants to hospices in 16 states.They were directly reimbursed by the federal government for hospice care provided to seriously ill Medicare beneficiaries,allowing HCFA to collect data on hospice utilization,quality of care,and cost.As a result of the data gathered during the demonstration project and the hard work by NHO and other volunteers,the Hospice Medicare Benefit was enacted in August of 1982.
每日簡餐
In 2015, 1,381,182 Medicare beneficiaries were enrolled in hospice care for one day or more.A total of 4,199 hospices were paid by Medicare through the hospice benefit.
My job
Originally,I had to do some office work,but as a medical student,I would like to contact American patients.After signing a number of agreements and doing a two-week subcutaneous test named TBtest,finally,I can go to the patients' home and caring home to care for them.The first job is to go to a patient's home to help them move.They are a pair of elderly people who had both lost the ability to tidy their messy home due to illness and old age.My companions,American volunteers and I helped them clean house for 8 hours.
美國家庭
The second time was to help another pair of elderly childless people who liked sitting on the sofa all day.We went to talk with them on some basic situations in China and the United States and cared for them through psychological communication.Other job is to care for patients in the care facility of Oyster Creek,Houston.Some of them suffer from cancer,some of them lose memory,and most of them are old and frail.They do need help from institutions and volunteers.We push wheelchairs on the corridor to let them see the scenery,use balls and plastic foam sticks to help them exercise upper limbs,use words to communicate with them,and use digital chess to maintain their intelligence.In addition,we also feed,clean,learn sing a hymn to help patients who are dying or missing memory.
公司外景
From my working experience,I learned to face,be patient and love.
To face. Learn to face death.The first thing to adapt to Encompass Hospice of Houston is to learn to face death and to be scientifically aware of death.Everyone of us will die.However, can we face death in a right way?In the Chinese concept,we fear of death and think death is unlucky.Americans can face their own death because they know that death is the end of physical life.What’s more, it is the threshold to reach heaven,and patients can accept it well on hospital beds.At the same time,facing death is not only responsible for themselves,but also for their families.
美國家庭
To be patient.The hospice seems like a simple job,in fact, it needs a multidisciplinary team to complete.Doctors,nurses,social workers,volunteers and even pastors are all involved in this team.The interdisciplinary team as the specific implementers of taking care for dying patients, fully reflects their noble medical professional ethics and social service spirit.
To love.The love I have learned in this trip is love for work and patients.International volunteers and hospice are great.We provide selfless help to countless recipients,which can let the patients receive quality care at the end of their lives and relieve the medical resources of medical structures and improve hospital efficiency.Some patients have lost their memory and they always introduce themselves every few minutes;some patients are blind and they need volunteers to feed them;some patients can't control their emotions and curse somebody;some patients even have incontinence and they need special care.Patience is not enough to support hospice,and volunteers are more likely to take care of them with love.Our love for patients is unconditional,so that our hospice will be done well.
美式廚房
Mabel,Terri,Lucy,William,and all the patients I have taken care of in the United States,I wish all of you have good health.
Other itineraries in the US
In addition to going to work in the United States,I also used my spare time to thoroughly experience the customs of Houston,Texas,and traveled to Los Angeles,California,New York,New York,the top two cities in the United States.I am joking myself,thinking that I can be called a half Texas man. As an NBA fan,I also took photos in the front of the 3 NBA Arenas and wear their home stars』 uniforms.
中國城
In New York City,my brother Chen took me to experience Manhattan and gave me a lot of help.I am here to express my gratitude to him.In these three cities,NASA headquarters,NFL games,Universal Studios,shooting experience,flight experience,Hollywood,Empire State Building,Times Square,Metropolitan Museum,Wall Street,etc.left deep impression on me.But what impressed me most was Encompass Hospice of Houston still.
中國城王致和
Traditional Chinese medicine in three cities
Because my major is traditional Chinese medicine,I am willing to look for Chinese traditional medicine in various places especially in the United States.The traditional Chinese medicine clinics I saw in Houston,Los Angeles,and New York were only open in Chinatown and most patients who came to see the doctors were Chinese.Americans rarely take acupuncture and cupping.I once suspected that Americans do not preserve their health because they do not drink hot water,but the factors such as race,genetics,and environment determine that they only drink ice water.
油膩膩
Therefore,I think that TCM theory may not be applicable to the whole world,TCM has a unique geographical attribute and it is a kind of practical medicine born in China.
Medicine must be adapted to local conditions and varies from person to person.Developing TCM cannot be spread blindly.It may conform to local science and humanities and advance with the times.Only in this way, can TCM effectively serve human beings.
中國城青島啤酒
Conclusion
From the trip to the United States as a volunteer,I actually learn a lot in terms of volunteering and traveling.I did improve cross-cultural and cross-language communication skills.And my social service awareness and volunteerism were also developed.I thoroughly felt the American culture,gained the American working experience,and understood the development mode of operation and advanced management methods in the related fields in the United States.It is undeniable that the United States is still the most powerful country in the world,many of their humanities and sciences are worth to learn.I have traveled to many countries and regions:the rich and peaceful Denmark,the post-war Japan and South Korea,the post-colonial Hong Kong and the superpower US.
NASA
We may experience the world from what we hear and what we see.There are still many different humanities for us to experience.
Do you believe what you hear or what you see?Let's explore.
中文版
謹以此文，獻給Patricia一家、我的志願者主管Jonathon Mook先生、我的美國患者們和我在紐約讀書的好兄弟陳立桐。
赴美實習
在2018年7月—9月期間，我參加了由吉林省教育國際交流服務中心舉辦的HCEE項目（Homestay Cultural Experience and Enrichment Program）。這個項目是大學生國際志願者海外交流實習項目，由吉林省教育國際交流服務中心和Global Cultural Adventurers聯合主辦。我經過面試及雙向選擇匹配，進入美國機構，與美國同事及其他國家志願者並肩開展為期6周的志願實習和實踐活動。期間我全程入住美國寄宿家庭——Patricia家庭，他們很照顧我,在此我對他們表示真摯的感謝。我的實習城市在德克薩斯州休斯頓市。
阿波羅號
臨終關懷機構
我的志願服務地點叫Encompass Hospice of Houston，這是休斯頓的一個臨終關懷機構。臨終關懷是一項崇高的事業，標誌著人類社會文明的高度進步。臨終關懷的主要工作是對確診六個月內死亡的各類受助者提供照護。對患者進行整體的照護，用科學的心理關懷方法、高超精湛的臨床護理手段，可以幫助患者減輕軀體和精神上的痛苦。我們使患者得到尊重，提高他們的臨終生命質量，使患者在安寧、平靜、舒適的壞境中走向死亡，同時也能讓家屬在病人死亡後不留下嚴重的遺憾和陰影。
豐田中心
臨終關懷事業在中國並不多見，卻在美國很普及。光是休斯頓就有200多家關懷組織，我認為經濟實力和文化觀念的差異造成了這種現象。在美國學習先進的理念和工作方式增長了我的見識。
臨終關懷的歷史
「臨終關懷」這個詞可以追溯到中世紀。它指的是長途旅行中為疲憊或生病的旅客提供庇護和休息的地方。這個名字最初是由內科醫生西塞莉·桑德斯夫人應用於臨終病人的特殊護理。她於1948年開始治療臨終病人，並最終在1960年在倫敦郊區的住宅區創建了第一家現代臨終關懷院——聖克里斯多福臨終關懷院（St.Christopher's Hospice）。
NFL
桑德斯夫人在1963年訪問耶魯大學期間向美國介紹了專門為臨終的人提供護理的想法。她向醫學生、護士、社會工作者和牧師整體的講授了臨終關懷的概念，展示了晚期癌症患者及其家屬的照片。這個講座是醫學界推動臨終關懷發展的催化劑，正如我們今天所知。
現代臨終關懷運動的開始應歸功於桑德斯夫人。「她的臨終關懷概念是將臨終關懷中最現代的醫療技術與中世紀宗教秩序的精神結合起來，這些宗教秩序曾經創造了臨終關懷，將其作為人們朝聖的一步。」
墨西哥灣
美國的臨終關懷
在20世紀60年代後期，另一位為臨終病患者提供專業護理的女性，精神病學家伊莉莎白·庫伯勒羅斯博士，因其對死亡和臨終的看法而開始引起全國的關注。在她的著作《死亡與臨終》中，她採訪了500多名絕症患者，並介紹了垂死者可能在情感上經歷的五個「悲傷階段」的概念：拒絕，憤怒，討價還價，抑鬱，接受。
伊莉莎白·庫伯勒羅斯博士還鼓勵醫學界與患者進行關於死亡和死亡過程的對話，確認患者照護模式之中會有悲傷的過程存在。
環球影城
1974年美國第一個臨終關懷項目——康乃狄克州臨終關懷醫院，在康乃狄克州布蘭福德開設。由佛羅倫斯的Wald，耶魯大學護理學院院長，牧師和兩名兒科醫生開始，專門針對臨終患者。在那幾年裡，全國各地的志願者聚集在一起，在邁阿密，紐約市，聖保羅，馬林縣和許多其他城市開設了臨終關懷醫院。1975年，第一個國家收容臨終關懷站在紐哈芬舉行，由康乃狄克州臨終關懷醫院主辦，有17個州的代表參加。
顯而易見的是國家組織需要臨終關懷的先驅者在這一需求增漲的時期來支持這項事業。1978年，第一個全國臨終關懷組織董事會選舉成立，並在該國首都設立了辦事處。此後，國家級的組織名稱改為國家臨終關懷和緩和治療組織。
霍格沃茲學院
重要的是當時對於臨終關懷並沒有的經濟補償。志願者護士，醫生，社會工作者，牧師和商業專家獲得醫療設備和用品，藥物和資金的捐贈，來資助他們的臨終關懷組織，同時奉獻了他們自己的時間和臨床專業知識。1979年，醫療保健金融管理局向16個州的臨終關懷醫院提供了26個示範項目補助金。直接由聯邦政府報銷，為重病醫療保險受益人提供臨終關懷服務，允許組織收集有關臨終關懷醫療服務的數據，護理質量和成本。由於在示範項目期間收集的數據以及其他志願者的辛勤工作，臨終關懷醫療保險福利金於1982年8月頒布。
2015年，1,381,182名醫療保險受益人參加過一天或更長時間的臨終關懷護理。醫療保險福利共支付了4,199名臨終關懷醫生的工資。
夢露
我的工作
原本我們是做一些辦公室的辦公工作，作為一名醫學生更想接觸一下美國患者。在籤署諸多協議和做了為其兩周的TBtest皮下測試後，終於能到患者家裡和照護機構照護患者。第一次的照護工作是去患者家中幫助其搬家，這戶患者是一對年邁的老人，因為疾病和衰老已經沒有整理能力，家中十分雜亂。我和同伴與美國志願者同事們幫助美國患者整理了8個小時的家務。第二次是去另一個患者家中，也是一對年邁老人，他們無兒無女，整日坐在沙發上。我們去和老人們暢談，聊起中美兩國的一些基本情況，用心理溝通照護患者。剩下則是在休斯頓Oyster Creek地帶照護機構照護患者。他們有些身患癌症，有些記憶缺失，基本都是年老體弱的老人，他們確實需要機構和志願者的照護。我們在走廊裡推輪椅帶他們看風景、用球和塑料泡沫棒來幫助他們運動上肢、用言語和他們進行心理溝通、用數字棋維持他們的智力，不僅如此，我們還餵飯，打掃，學唱聖歌，給臨終或記憶缺失患者幫助。
射擊體驗
在工作經歷過程中，我學到了面對、耐心和愛。
面對。學會面對死亡。適應機構第一件事就是需要學會面對死亡，能夠科學的認知死亡。人終有一死，但是我們是否能夠面對死亡？中國人觀念中對死亡恐懼，忌諱死亡，認為這是不好的徵象。美國人能正視自己的死亡，因為他們清楚死是肉體生命的終結，是到達天堂的門檻，患者在病床上能很好的接受。同時，面對死亡不僅僅是對自己負責，也是對家人負責。
耐心。臨終關懷事業看似是簡單的照護，其實需要多學科交叉團隊一起完成。這個團隊要有醫師、護士、社會工作者、志願者等人員，甚至還有牧師。這些人組成的跨專業團隊作為照護臨終的具體實施者，充分體現了他們高尚醫護職業道德和社會服務精神。
AR15
愛。此行我學到的愛，是對工作的愛和對患者的愛。國際志願者和臨終關懷事業十分偉大，我們對無數受助者提供無私的幫助，這不僅能使患者在臨終得到優質的照護，還能緩解醫療結構的醫療資源緊張，提高醫院效率。有些患者記憶缺失，每幾分鐘會來一次自我介紹；有些患者眼盲不能視，需要志願者來餵飯；有些患者因病情控制不住情緒，激動同時還會罵人；有些患者甚至大小便失禁，需要專人照護。耐心不足以支撐一次次的照護，志願者們更多的是用愛來照護。我們對患者的愛，是無條件的，這樣我們的臨終關懷事業也會做好。
Mabel、Terri、Lucy、William以及我在美國照護過的所有患者，祝你們身體健康。
在美國的其他行程
我在美國除了上班，還利用休息時間徹底體驗了德克薩斯州休斯敦市的風土人情，還遊歷了加利福尼亞州洛杉磯市、紐約州紐約市這美國前兩大城市。我自己開玩笑，覺得我可以稱得上半個德州人。
作為NBA球迷我還在這三個城市的NBA球館面前著其當家球星球服以留念：
Houston Rockets
Los Angeles Lakers
New York Knicks
在紐約市我的好兄弟陳立桐帶我一起領略曼哈頓，給了我很大的幫助，我在這裡向他表達謝意。在這三大城市中，NASA總部、NFL比賽、環球影城、射擊體驗、飛行體驗、好萊塢、帝國大廈、時代廣場、大都會博物館、華爾街等等給我留下了深刻的印象。但是最令我印象深刻的依舊是我的實習單位——Encompass Hospice of Houston。
飛行體驗
機艙內
三個城市的中醫
因為自己的專業是中醫學，出於專業素養我願意在各地考察中醫情況，尤其是想看看美國的中醫是什麼樣子。我所見的休斯頓、洛杉磯、紐約的中醫館只是開在唐人街，來看病的患者也基本都是華人，並沒有看見美國人經常針灸和拔罐。我曾懷疑美國人不喝熱水乃是不養生的行為，但是人種、基因、環境等因素確實決定了他們只喝冰水。所以我想，中醫理論未必適用於全世界。中醫是有著獨特地域屬性，它是一種在中華大地上孕育而生的實踐醫學。醫學必然應該因地制宜，也要因人而異，發展中醫不能盲目推廣，不僅要符合當地的科學與人文，還要與時俱進，這樣醫學才能有效的服務人類。
Ins網紅打卡地Brooklyn Bridge
結語
此行來美國志願服務，更是通過志願服務和遊歷來學習。我確實提高了跨文化、跨語言的溝通和交際能力；培養了自身的服務社會意識、志願精神。我徹徹底底感受了美國文化，獲得了美國職場體驗，了解美國相關領域的發展運作模式及先進的管理方式。不可否認美國仍然是世界最強大的國家，他們的人文、科學很多都值得我們去學習。我遊歷過很多國家和地區：富饒祥和的丹麥、戰後崛起的日韓、殖民後的香港和世界第一的美國。我們對這個世界的認知不僅要耳聞，還要實踐，仍然有很多不同的人文需要我們去經歷。
NYC
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