Jubilee of the World of Volunteering

On Sunday 16 May 1999, Pope St John Paul II preached at a celebration of Mass to mark the World Meeting "Reconciliation in Charity". 

 I am very pleased today to welcome you, dear brothers and sisters, who have come in such large numbers for the Day of Charity organized by the Pontifical Council “Cor Unum”. I am very happy to celebrate the Eucharist with you and for you, remembering all the “witnesses of charity” who in every part of the world dedicate themselves to eliminating the injustice and poverty which unfortunately still exist in so many obvious and hidden forms. I am thinking here of the countless faces of volunteer service, of those whose work is inspired by the Gospel: religious institutes and associations of Christian charity, organizations for human development and missionary service, groups involved in the civil sphere, and organizations for social, educational and cultural work. Your activities embrace every area of human life and your actions reach countless people in trouble. I express my esteem and gratitude to each of you....

How could we fail to emphasize [the] divine source of service to our brothers and sisters? Yes, love of neighbour conforms to Christ's mandate and example only if it is joined to the love of God. Jesus who gives his life for sinners is the living sign of God's goodness; at the same time, through their generous self-giving Christians enable the brothers and sisters they meet to experience the merciful and provident love of the heavenly Father. 

 The world of volunteering has many different expressions. There can be very informal occasions for volunteering (eg the person who looks out for the needs of their neighbour and might occasionally shop for them); there are those situations where people volunteer to support a one-off kind of event (eg the Olympic Games or a World Youth Day); there are situations where an individual regularly spends time supporting a small scale initiative (eg helping on a weekly soup run in an inner city). There are also situations where an individual regularly commits a period of time within a more organisational context (eg volunteering within a formally established charity or visiting in a hospital or prison). And, in some instances, there is a kind of "professionalised" volunteering (eg by way of a placement or paid employment with a charity or non-governmental organisation). 

Whilst some will involve themselves in these activities from the kind of Christian inspiration described by Pope St John Paul II, many will do so without any specifically religious intention, and this is a feature to be borne in mind when we reflect on the world of volunteering. The United Nations, for example, marks an International Day of Charity on 5th September each year, the date chosen because it is the anniversary of the death of Mother Theresa.

The invitation to the Jubilee of the World of Volunteering, to be marked 8th-9th March 2025, reflects this variety:

Volunteers from all associations, members of non-profit organizations, NGO workers and social workers are especially invited to this jubilee event.

A Vatican News report ahead of the event can be read here: 25 000 pilgrims to gather in Rome for Jubilee of Volunteers.

There is an interesting dimension to some of these volunteering opportunities. In volunteering in a hospital, for example, or in port chaplaincy and ship visiting, the volunteer brings their religious inspiration (or at least a level of commitment to human dignity) into encounter with a professional context. In their activity, the volunteer needs to achieve a competence in the practices of the relevant professional context alongside their goodwill as a volunteer. 

A hospital volunteer needs to respect the processes of a hospital ward or department (infection prevention and control, for example), develop the skills to meet with patients experiencing different medical conditions and understand how their role exists in relation to the roles of clinical staff. A ship visitor needs to respect the security and safety requirements specific to docks and ships, and to have an understanding of the circumstances of seafarers who may spend many months of the year away from home but only a few hours in each port before sailing again. Prison visiting or industrial chaplaincy equally need a volunteer to engage with a specific professional competence.

One paragraph of the Jubilee Prayer can speak particularly to the World of Volunteering:

May your grace transform us into tireless cultivators of the seeds of the Gospel. May those seeds transform from within both humanity and the whole cosmos in the sure expectation of a new heaven and a new earth, when, with the power of Evil vanquished, your glory will shine eternally.

The hospital as a place of evangelisation

“Hospital as a place of evangelization, a human and spiritual mission”: will be the theme of the 27th InternationalConference organized by the Pontifical Council for Health Care Workers that will be held in the Vatican this year from 15 to17 November.

See here for the Vatican Information Service report.

It will be interesting to see how the conference addresses the situation of hospitals in countries like the United Kingdom, where state run hospitals are the norm. It is possible to see an evangelising role for Catholics engaged with such hospitals, be it as staff or patients, but it is a role undertaken in a rather different way (presence in charity) than might be the case in a Catholic hospital.

The NHS: fragmented care

The broadcast media yesterday were full of coverage of a report about the quality of care given to elderly people in the National Health Service.

The NHS is failing to treat elderly patients in England with care, dignity and respect, an official report says.

The Health Service Ombudsman came to the conclusion after carrying out an in-depth review of 10 cases.

The BBC News website report can be found here. The news release from the Health Service Ombudsman is here; the full text of the report is here.

It was interesting to listen to much of the coverage, and to read a blog post (and its comments) such as this one by Fr Ray. Much was said about nursing staff, their training and their need to be more caring. But two things struck me.

The first is perhaps the less significant one in terms of the daily practice on hospital wards or in GP's surgeries. And that is that a culture in which euthanasia, and/or the idea that living at the end of your life when you are ill is something that is unwelcome and to be avoided, are entertained as a legitimate options of thought and practice - such a culture has a deep rooted ambivalence about the care given to elderly patients. It will not be that there is a definite attitude of "we should not care" about the elderly, more that, at the level of culture, there will be a hesitation about it. How far this affects health care practitioners in their day-to-day work is difficult to assess but it does have a presence in the culture.

The second is much more significant in terms of daily practice on hospital wards. This is the phenomenon that I have come to think of as "fragmented care". On a typical NHS ward, qualified nurses (and perhaps student nurses on placement) are responsible for providing clinical aspects of care to patients - dispensing drugs, inserting IV lines, changing dressings etc. Health care assistants are responsible for things like washing patients, making them comfortable, changing beds and the like. They now take and record patient observations (temperature, blood pressure, blood oxygenation), though they do not make clinical decisions based on those observations. Patient meals can be the responsibility of the staff of a third party provider in addition to this. Whilst specialist aspects of patient care - physiotherapy, occupational therapy - have often been provided by people with those specialist skills, I think there is now more than in the past the provision of different components of patient care on a ward by different people. "Fragmented care".

At one level, this is purely a question of organising how the work is carried out, and, provided that the work is well organised and carried out conscientiously, it is not to the disadvantage of the patient. But I think it does also have an implicit ethical component. Clinical care is separated from personal care, the technical/skilled care from the care of the person - the realm of the nurse from that of the health care assistant. In some of the experiences related in the Ombudsman's report and in the media coverage this has been expressed as "That's not my job". The care due to the person of the patient, though, is a single phenomenon of care - so that the care that a nurse gives when setting up an IV drip or an oxygen mask is at one with that given by the health care assistant who washes the patient in the morning. If the care is truly to be the care for a person, rather than just the care for a body, then this unity of the phenomenon of care needs to be recognised and practised.

Clearly, it will never be possible for all the care provided to a patient in hospital to be given by one person, and that is not something that would be sensible to ask for. But the structural separation of "clinical care" from "personal care" is perhaps something that should be reversed or overcome. It would appear from the Ombudsman's report that elderly patients would be particular beneficiaries of such a change.

Acts of Mercy

The National Gallery are currently displaying four paintings by Cayley Robinson, with this overall title. The pictures will be on display there until 17th October 2010, after which I assume they will return to their usual home at the Wellcome Foundation. The paintings used to be displayed in the entrance to the Middlesex Hospital, though they are now owned by the Wellcome Foundation. This press release from 2009 includes some information about the purchase of the paintings by the Wellcome Foundation, and, at the bottom, allows you to view each of the four paintings.

The National Gallery's page for the exhibition is here. The BBC link from that page takes you to an informative slideshow about the paintings, giving some idea of the place of the paintings in their original context at the Middlesex Hospital, and an idea of their usual home at the Wellcome Foundation.

Faith in Health Conference 2010: Archbishop Nichols' lecture

The first plenary lecture at the 2010 Faith in Health conference was given by Archbishop Nichols. The title of his lecture was The Spiritual Care Needs of Older People. Some details of the Faith in Health conference can be found at the website of the Archdiocese of Liverpool.

If you haven't followed the link to read Archbishop Nichols text, this comment is not going to make much sense. I think there is a very interesting parallel between Archbishop Nichols idea of an intergenerational exchange in the context of health care and something that Pope Benedict XVI was going to say had he been allowed to speak at La Sapienza university in January 2008. Pope Benedict is, in passing, commenting on how he as the Pope might be able to justify speaking at a university where some would say that, speaking from the perspective of faith, he cannot therefore also be speaking from the perspective of reason.

At this moment I would like to only briefly note that John Rawls, although denying to comprehensive religious doctrines the character of "public" reason, nevertheless sees at least in their "nonpublic" reason a reason that cannot, in the name of a secularly hardened rationality, simply be disregarded by those who support it.

He sees a criterion for this reasonableness in, among other things, the fact that similar doctrines derive from a responsible and validly grounded tradition in which, over a long period of time, sufficiently good argumentation has developed to support the respective doctrine. What seems important to me in this affirmation is the recognition that experience and demonstration over the course of generations, the historical background of human wisdom, are also a sign of its reasonableness and its enduring significance. In the face of an a-historical reason that tries to construct itself through a-historical rationality, the wisdom of humanity as such -- the wisdom of the great religious traditions -- is to be valued as a reality that cannot be with impunity thrown into the dustbin of the history of ideas.

What I found most interesting about Archbishop Nichols lecture was something that was not in his text, but which he said during the discussion/questions at the end of his lecture. In the field of education, it is a common place of Catholic teaching that the prime responsibility for the education of children rests with parents, and that others who contribute to the education of children (ie teachers and schools) do so as collaborators with the parents enabling them to fulfil their responsibility at the level at which an expertise is required that they as individual parents do not have. Archbishop Nichols suggested that the provision of health and social care should be seen in the same sort of way. It is not the hospital, National Health Service (NHS) or social services that have the prime responsibility for delivering health and social care to individuals or to society as a whole. The first responsibility rests with families (towards their family members who are sick or elderly) and with neighbours (towards those nearby who are sick or elderly). The hospital, the NHS and social services are then to be seen as collaborating with members of society in the care for the sick and elderly, enabling society to fulfil its responsibility when that requires an expertise and a level of resources that would otherwise not be possible.
 
Not only does this have implications for the relationship between national government and the health and social care system (the latter or not instruments of the policy of the former), but it also has implications for how employees in health and social care services view their role. Rather than being at the service of the government or employer, their employment mechanism, be it public or private sector, is instead at the service of civil society, at the service of what the Catholic Church would call the "common good". It also has a profound implication for the relationship of communities to their local health and social care institutions. Communities should not let these institutions take over their responsibility - they still have a duty to care for their weaker members through acts of charity and service.
 
[The agenda of "patient choice" in the NHS might appear to be supportive of this perspective. However, such "patient choice" is confined by national policy, so I suspect that its support of this perspective is more apparent than real.]

A portion of Isaiah

I had reason yesterday to visit some patients in the hospital near where I live (actually, I can see the hospital from my back windows). This is the passage of Scripture that I shared with a couple of the Christian patients I met. It is Isaiah 58:8-9a, and I chose it becaue of its appropriateness to the Advent/Christmas season.

Then shall your light break forth like the dawn, and your healing shall spring up speedily; your righteousness shall go before you, the glory of the LORD shall be your protection.  Then you shall call, and the LORD will answer; you shall cry, and he will say, Here I am.

Another passage that I sometimes use is the following, from Revelation 22:1-2, a passage to be found almost at the very end of the New Testament:

Then he showed me the river of the water of life, bright as crystal, flowing from the throne of God and of the Lamb through the middle of the street of the city; also, on either side of the river, the tree of life with its twelve kinds of fruit, yielding its fruit each month; and the leaves of the tree were for the healing of the nations.

There is a stained glass window in the hospital chapel which shows the leaves of the tree of life, which is why I use this passage.