Project: SVO Specialist Team (Psychosocial Skills in Palliative Care)
Location: Hanoi, Vietnam
Dates: October 13–17, 2008 and February 16–20, 2009
Purpose: Teaching psycho-social skills in palliative care
Beneficiaries: About 20 doctors, nurses and assistant nurses from the National Cancer Hospital in Hanoi.

When Gilbert Fan of the National Cancer Centre first went to Hanoi to share with the staff there how to deal with patients who are dying, he began by talking about cups.

Standing in front of the audience of about 20 eager and attentive doctors, nurses and nursing assistants, he told them that conducting this workshop in palliative care for them was like drinking from a cup.

But he wasn’t using his own cup to drink. He was using theirs.

Palliative care refers to the holistic care of patients with advanced progressive illness. It encompasses pain management and psychological, social and spiritual support and aims to achieve the best quality of life for patients and their families. Palliative care is usually provided by a team that includes palliative care doctors, nurses and social workers.

“And I told them what I would be doing is adding drawings onto the blank cup. They are free to tell me they don’t like them and they could erase the drawings and redraw them until they liked it.” The analogy got the thumbs up from the Vietnamese, he says, who said they were relieved to be free of pressure to accept everything he presented.

“We realised that the skills being taught must be in the context of their culture. I may come with some expert knowledge, but it’s only useful if we take into account what the Vietnamese can do in their context, so I’m always looking to them for guidance on that,” says Fan, who was volunteering overseas for the first time, after more than 10 years of volunteering locally and serving as current president of Singapore Association of Social Workers.

He went on two trips of five days each, bringing with him four volunteer trainers who are social workers experienced in working with cancer patients and had experience with death and dying.

What are some of the cultural and geographical differences you observed between Singapore and Vietnam that create challenges for your Vietnamese counterparts?
There are the practical problems we don’t face because Singapore is so small. In Vietnam, hospitals are quite packed because of the huge population [and few hospitals]—sometimes two patients must share a single bed.

In Singapore, you can go to any hospital, go home and then return for another treatment in two days.

People in Hanoi come from the outskirts, travelling for hours or the whole day. Sometimes families will bunk in with the patient instead of travelling for five hours on the road each day just to visit the patient.

You have been volunteering in Singapore for the past 10 years. What drew you to volunteering?
I believe that it’s part of being a professional in my industry. We shouldn’t be hermits but should try to network and exchange skills by participating in a learning process.

My volunteering experience in Singapore over the past 10 years includes being a member of the Advisory Council on Registration (SASW) as of Jan 2004 and the Social Work Accreditation Board as of April 2009, Chairperson of the Professional Committee, Trans Family Service Centre (Jan 2001 to June 2004) and Chairman of the Allied Health Sub-Committee, Singapore Hospice Council (Oct 2003 to Sep 2006).

What prompted you to volunteer overseas for this first time?
Sometimes volunteering isn’t just about sharing what we know but learning from a different cultural experience. I had this enriching experience in Hanoi.

How did being in a different culture affect the exchange of skills?
In Vietnamese culture, emotions are not expressed openly because it is considered embarrassing and to some people, rude.

Studies have also shown that Chinese people do not like to talk about their emotions because it shows that they are not coping. Of course in Western countries, expressing your emotions is a good thing, because you’re not bottling them up. Before we came in, patients’ emotions were seldom expressed. Even when they were it was very superficial.

We shared with the Vietnamese staff how to engage patients to share more of their emotions so that they feel better emotionally; and psychologically they feel more confident of themselves. We did ‘live’ demonstrations with some patients’ spouses. The Vietnamese doctors would talk to them and we observed through a translator. Then we would demonstrate how we would do it, and change certain aspects for improvement.  

What was one important thing you learned from your experience in Vietnam?
I find our Vietnamese counterparts very eager to learn and apply the principles.

However they are always asking what if it doesn’t work. The doctors and nurses are very concerned about how receptive patients will be towards these new ideas. For myself, I know I can win them [the Vietnamese medical staff] over about these new methods or theories but the patients are not practitioners—how do we convince these people? For me, what I’ve really learnt from this experience is about how to communicate and influence.

For example, one idea I tried to sell them is that they have to talk to the patient about their condition. In Singapore and in the Western world, we talk about the patient’s right to know whether it is good or bad news. So we try to share how doctors can introduce the subject slowly and appropriately to the patient. This will involve a change in mindset for the Vietnamese.

Did you have concerns about volunteering overseas initially?
Yes, because it’s a two-year commitment and leave from work is involved. But my employer, the National Cancer Centre, believes in the work I do.

One of my staff is also a resident trainer volunteer for this Hanoi project. We take community leave for this so we don’t have to use our annual leave.

This volunteer work is unpaid except for the small allowance provided by the SIF. I’m single so it doesn’t affect my family life.

At the end of one of the trips, my cousins came down on the last day and we went sightseeing for a few days to Halong Bay and the Sapa highlands.  

What advice do you have for those considering volunteering for the first time?
It’s very natural to be scared no matter how much of an expert you are but I always believe you should just be who you are and socialise and you’ll find that everything goes smoothly.

If we take away our anxieties and focus instead on how we communicate with each other, I think we will find common ground.