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Pastoral Care for Sikhs
Abstract: This research aims to examine the perceptions, experiences and expectations of the Sikh community through the views expressed by patients and the community members. It took nearly two years to collect the information to write this article.This research reveals the experiences and views of many Sikhs on pastoral care and highlights the needs and requirements of Sikhs. It also draws attention to the key themes showing evidences of synthesis between existing literature on pastoral care and the Sikh perspective.
Introduction
This research attempts to fill a gap in the pastoral care literature, providing a resource for Sikh pastoral practitioners working in hospitals and giving an insight into the complexity of the situation. This may also be helpful for Sikhs living in India to introduce this in hospital care and care in the community, home and family. The emergence of Sikhism is relatively new for the chaplaincy departments of National Health Service (NHS) hospitals, and the service has been delivered by volunteer visitors for the last decade. Most volunteers are either retired or of retiring age. English is their second language making it hard for them to access the mainstream chaplaincy literature generally written in academic language. Some young students do it to oblige the Sikh religious dictate of seva (caring for the humanity) not necessarily to own this profession due to the lack of professional opportunities.
Sikhs and Sikhism
The Sikh religion was founded by Guru Nanak (b.1469-1539) in north-west India towards the end of the 15th century. His religious philosophy and expression has been traditionally known as the gurmat (teachings of the Guru). He was succeeded by nine successor gurus. The gurus are the spiritual teachers in Sikhism. Guru Granth Sahib, (GGS), the Holy Scripture of Sikhs was written during the life times of Gurus and holds a status of living Guru. Sikhism is considered to be the fifth largest world religion and fourth in terms of its adherents in the UK (2011 Census). Sikhs prefer to use the word ‘Sikhi’ or ‘Sikh dharam’ and not Sikhism, the term used by the British during colonial times. In this study both terms are used interchangeably for convenience.
Sikhism is a monotheistic religion. It gives a message of universal love, peace and harmony. It promotes human rights such as equality, social justice, religious freedom, and religious tolerance. Its ethical principles are kirt karna (honest earning), naam japna (remembering the name of God) and wand chhakna (share with needy and less fortunate). The core values are equality, seva and regarding the world as real and meaningful. Sikhism advocates full participation in life and establishes the primacy of family life. It is against renunciation and meaningless rituals. Sikhism believes in the concept of ‘karma’ (taking responsibility for one’s own actions) and transmigration of souls. Sikh gurus put these ideas in practice to achieve their vision. It is a distinct religion, having a founder, holy scripture and place of worship with its own distinctive customs, traditions and ceremonies.
Sikhs have settled in many parts of the world leaving their homeland Punjab, often due to political, educational and economic reasons as well as their adventurous nature. Sikhs in the UK are direct migrants from India, twice migrants (migrated from India to another country and then the UK) from East Africa, Malaysia, Singapore, asylum seekers from Afghanistan and British-born Sikhs. This creates a mixture of cultures within Sikhism. The values, behaviour and attitude of UK born Sikhs have changed considerably due to indigenous influences of media, education, culture and societal expectations. There are different traditions and behaviour patterns within the Sikh community depending on their cultural origins (Bhachu 1985) and religious adherence i.e.amritdhari,keshadhari and sehajdhari (Rait 2010). There are also sects, denominations and religious groups led and influenced by saints and religious leaders.This highlights the need to be aware of individuality when considering caring needs.
Chaplaincy and pastoral care
The terms religion, spirituality, chaplaincy and pastoral care occur frequently in this study and the definitions given by NHS Education for Scotland (2009) have been used. Religion and spirituality are related but not identical concepts. Religion involves an organised belief system with agreed practices and rituals. Spirituality is a more personal endeavour to find meaning in life and a relationship with the transcendent. In this study, pastoral care is considered as a distinct and unique activity carried out in response to the needs of patients, their families and hospital staff. It is a supportive activity of caring for someone as a whole person, being mindful of their best interests and willing to promote those interests by a wide range of actions. The term pastoral, in this article, is used for convenience, and not necessarily for its links with Christianity.
There is a long history of Chaplaincy in British hospitals (Pattison 1994; Swift 2009). The Christian churches have dominated this sphere of work making it the preserve of ordained ministers or priests. Religion lost its unquestioned supremacy, due to the influence of psychology and psychotherapy, to secularization. It then moved towards integration with the suggestion that religion can play a vital role (Weatherhead 1951) and Jung’s belief in the positive evaluation of the place of religion in human life (Jung 1933). For Sikh patients, religion and culture cannot be ignored as being the main resources of pastoral care.
The NHS was founded in 1948 and healthcare chaplaincy became an inherited and accepted service in the NHS as a part of holistic care. This gave chaplaincy, including pastoral care, the opportunity to grow professionally and find its own identity. It is a structured service embedded in western values and publicly funded. In addition to Christianity, Judaism as an original partner of pastoral care, and Islam as a majority within a minority have found its way into the NHS structure and moulded chaplaincy to fulfil their specific needs. Other world religions including Sikhism, are, lately recognised and are not yet fully accommodated in hospital chaplaincy structure.
Chaplaincy Services for Sikhs
Compassionate care and concerns for those who are suffering, sick or infirm forms an intrinsic part of the Sikh traditions. Traditionally families look after their sick and vulnerable in India (Rait 2010) and some other parts of world from where Sikhs migrated to UK. They had not previously experienced the benefits of the system like NHS and seemed to be unaware of chaplaincy services. NHS provides sick and injured not only medical treatment but also holistic care. NHS hospital chaplaincy departments in the beginning used to make referrals to gurdwaras in response to the requests made by Sikh patients. A Sikh priest or a community leader, generally a male, attended to the needs of patients, mainly a supplication (Rait 2013). The transition from faith leaders to voluntary visitors came with the setting up of the UK Sikh Healthcare Chaplaincy Group in 2005 [http://www.Sikh chaplaincy.org.uk]. This group has been proactive in raising awareness, recruiting volunteers and giving them basic training.
Research findings
This research reveals the experiences and views of the informers on pastoral care and highlights the needs and requirements of Sikh patients and their families. It also draws attention to the key themes showing evidences of synthesis between existing literature on pastoral care and the Sikh perspective.
Pastoral care
Pastoral care is a foreign word for Sikhs and there is hardly any parallel term which can provide the exact expression. The term ‘seva’ (compassionate care), the nearest approximation, to chaplaincy service is better understood by the Sikhs. It is a sort of spiritual care which literally means ‘care of souls’. As quoted by one participant: “In my understanding, pastoral care covers a sort of spiritual care within the community, care within the home and family; cover care that is offered by one community member to another”. Infact, it is more than that. It supports religious and spiritual care by various activities. When it is given to the sick, vulnerable, poor and emotionally upset, it is called compassionate care (Rait 2010). Care helps recovery and well-being by comforting and giving support required by sufferers and also points to the basic human need of dependency on each other (Wright 1982). Wright’s comment on the basic human need is confirmed by McNeill (1977) in the statement that the concept of care existed before the Christian era. There is also an injunction to care in most religious traditions (Lartey 2003). The concepts of ‘seva’ and pastoral care are both rooted in Holy Scriptures. Pastoral care is rooted in the Judeo-Christian Scriptures (Old and New Testaments) and seva in GGS. The source of both is love, agape in Christianity and God’s love in Sikhism. Pastoral care is the Christian commitment to the statement ‘God is love’, implying that love is the strongest force in the world (Wright 1982, p.4). The Sikh belief that human beings are created to look after God’s creation (humans and nature) on this earth ties itself with divine love, compassion, kindness, caring and sharing. Examples of caring for the sick and vulnerable are found in the life stories of Sikh gurus. Both pastoral care and seva in NHS hospitals aim to support patients in living according to their values and beliefs by having a religious and cultural orientation.
Awareness
The research findings suggest that Sikh patients are unaware of this service and so is the Sikh community. Majority of Sikhs do not understand the term, its depth and the advantages of this service. Some say it is like the work of a Sikh priest. It is also obvious from the research that there is a genuine need for the service as traditional support mechanisms are weakening leaving many requiring help and support.Those who had the opportunity to experience the service in the hospital found it very useful and much needed.Sikhs are usually hesitant to demand any service. They do not know how to demand and raise their voice for a service tailored according to their religion and culture. A strategy is needed to improve awareness keeping in view the local traditions of the community. Initially, the emphasis should be on making the community aware, educating them about the service and how to demand and access it. It requires a united effort.
Pastoral Provision
This study explores what should be covered by pastoral provision. Carey and Davoren (2008) gave a detailed description of pastoral provision which includes a sensitive approach, physical resources, being there/presence, listening and providing reassurance. They further added under the specialist pastoral religious functions, prayers, scriptural reading and organising or assisting with rituals. Wright (1982) suggests that it is an important service which addresses or seeks to answer the deepest needs of patients; listen to them, provide end of life care and visit them on wards. The study findings suggest that there are similarities in pastoral provision such as building resources, visiting patients on wards and listening to them, organising prayers and assisting with rituals and end of life care, that seem to be shared by Carey and Sikh participants. The difference is inadequate provision for Sikhs and insensitivity for their religious and cultural needs.
Pastoral Resources
Resources are the backbone of any service and play an important role in delivering quality service. The list of resources provided by Carey and Davoren (2008) include provision of sacred texts, faith specific pamphlets, pictures and icons, books and pastoral manuals. In order to provide seva to Sikh patients there is need to collect sacred texts (gutkas), prayer books, CDs of recorded kirtan (religious music) and path recitations (recording of Scriptural texts), CD players and iPods as suggested by patients. Collecting prayer cards, greeting cards, cards for festivals and anniversaries are essential. Books and manuals are useful tools for chaplains and interested volunteers (Rait 2013). Participants suggested there should be a container or basket for keeping the articles of Sikh faith and cloth wrappers for prayer books.
Ward Visits
As a hospital chaplain, says Wright (1982), much of the time is spent on pastoral care: visiting patients on the wards; knowing their well-being; listening to their anxieties and concerns. They are asked to come to perform rituals like baptism (Speck 1988) and to give emotional support in case of death (Dyne 1981). It is for the patient to indicate whether he/she wishes to be visited (DHSS 1978). This links to consent from a patient, not only to visit them but also for repeat visits. Sikh patients are visited by volunteer visitors on the wards. The visits are fragmented due to the nature of the service. Most patients have a short stay in hospitals that deprives them of this service.
Speck (1988) suggests making a distinction between need and want. Rait (2013) agrees with Speck’s suggestion when she says that the service should be based on the audit of needs.There is a need for more work to be done for minority faith communities unaware of the availability of the service in NHS hospitals in spite of having the desperate need for it.
End of Life Care
End of life is particularly worrying and anxious time for any one. Most important is to be present with a dying patient with willingness to listen actively. Chaplains also care for emotionally upset family members. Consoling and giving them emotional support is a significant part of pastoral care as expressed by a participant “It is a kind, caring and supportive presence at critical times given with thorough understanding of our culture and religion”.Service providers should be skilled to give advice and support on religious and cultural rituals around dying and death.
Pastoral care assumes a special salience in care at the end of life. Attending to the needs of a dying patient and family is an integral part of the work of a healthcare chaplain. Religious traditions generally have clear guidelines on healthcare in general and on end of life care in particular (Sulmasy 2006). This study supports this view. Sikh religion is flexible in the ways a dead body can be disposed (GGS, Singh 2009) though have adopted cremation, a cultural dictate (Rait 2013). Bathing the dead body is important for Sikhs before cremation. This ritual requires the use of certain things that are listed by Rait (2013 pp89-90). Numerous studies have demonstrated that religious practices are correlated in complex ways with patients’ attitudes about various aspects of care at the end of life e.g. deliberate hastening of death (Suarez-Almazor et al. 2002), life prolonging (Heeren et al. 2001) and life sustaining treatment (Johnson, Elber-Avela and Tulsky 2005). Sikhism believes in natural death.
Dying patients want to know if there is any meaning in their suffering or in their dying (Buckley and Herth 2004). Dying, death and bereavement have huge implications in religious and cultural terms. For example, when a person is dying he/she may ask questions about pain and suffering, karma, what is going to happen after death, fear of death, worries about their spouse and children (Rait 2013). Regardless of religious affiliations, the need of the dying to understand that they are valued and cherished is a powerful spiritual need (Sulmasy 1997). Sikhs also believe in saying good things about a dying or dead person. Sikh families may want to know how they can comfort the dying person, for example use of holy water (Nesbitt 1997; Labun and Emblen 2007) or organising kirtan or path (recitation of gurbani) for the dying. It is normal practice that chaplains are requested to administer sacraments, pray commendations and offer spiritual care (Cobb 2005).Younger generation often find it hard to cope with death, and the deceased being unsure of what to do culturally and religiously to get ready for the last rites. The bereaved and their families need support and advice. Egan suggests that many pastoral carers possess the skills to do brief and short-term counselling with the bereaved and their families. Pastoral carers by nature of their role frequently offer more ready access to such people, especially as a first point of contact (2014, p.8). Patients of various faith traditions often have very specific religious needs, including Sikhs
Listening to Stories
Chaplain and volunteer visitor spend a great deal of time on the wards listening to patients and their families. Listening is a core skill in any form of care (Pattison 1989) and Thurneysen points to the need for pastoral care to be grounded in the ability to listen (1962, p.147). It is much more complex than the ‘just listening’ of everyday conversation, listening openly and permitting the other person to be what they are, freely, without controlling, coercing or censoring what they say (Lartey 2003, p. 90). “The essential features of active listening are: look and be interested, inquire with open questions, stay alive to the speaker, test your understanding by checking, empathize and neutralize your feelings” (Lartey 2003, p. 91).
Many pastoral writers have observed the great relevance and significance of words in pastoral care (Lartey 2003). Deeks (1987) begins with an examination of how storytelling and conversation can be of value in pastoral care. Pattison (1989) makes an analysis of ‘conversation’ as a useful way of conceptualizing and engaging in theological reflection on pastoral practice. In the story-listening role, the pastoral caregiver enables people to hear their own stories aloud, to hear it for themselves and thus possibly obtain a more objective view of who they are in their multifaceted complexity.
Stories told by Sikh patients included family disputes, marital problems, disrespectful behaviour of siblings, attitudes of daughters-in-law, financial impropriety by family/friends. Some of them take pride in telling stories of success and of unity in their families. In the light of stories told, it appears that there exists an intra-psychic conflict in some Sikh patients and chaplain needs to support them to resolve their internal conflict and enable them to find personal integrity. Making sense of stories requires cultural competency and language skills. Listening to their stories enables both speaker and listener to get in touch with what may well be the core of a person’s need (Lartey 2003).
Language is a medium of communication between care receiver and care provider. Communication in the language of the patient is important for conversing fluently and understanding their emotions, gestures and expressions (words, idioms, intonation,jokes and sarcasms). Listening to the stories of Sikh patients requires proficiency in the Panjabi language and possibly the understanding of dialects. Lartey also pointed to the need to pay attention to the form of language, including the issue of dialect, intonation, choice of expression, familiarity with particular idioms as well as meaning (2003, pp.73-74), It is essential to demonstrate a non-judgemental and unconditional attitude in listening. They should have empathy and self-awareness (Rogers 1951). He also suggested the need to critically examine one’s own practice with regards to language.
Interaction
There is a hospital protocol in NHS on conversing with patients embedded with western values putting emphasis on listening. The Sikh culture has its own unique way of communication. Sometimes cultural differences make it obligatory to differ. For example, in the Sikh culture participatory conversation, listening and responding with empathy and understanding is expected. They should bear in mind, however that listening needs to precede responding if pastoral communication is to be effective (Jacob 1985). McClure speaks of the pastoral carer not just be a listener to stories and an interpretive guide, but a participant. This will mean engaging in a wide variety of practices involving interpreting, consciousness raising, coaching and advocating (2012, p.275). Christian chaplains are unlikely to know patients personally whereas Sikh volunteers happen to know most of them. It makes hard for them to balance relationship and professionalism. Due to the close-knit nature of the Sikh community, volunteers could bring their own problems into conversation and may dig into any of their personal information. This is unethical and they can be accused of prying affecting trust building. Sikh volunteers need to be careful and use their own judgement to assess the situation. If they are not sure, a referral should be made to another colleague. Taking patient’s consent for visiting is most important and it works in their favour.
Patients would like to share their feelings and stories with someone they could trust. Trust building in the Sikh community is a skill as the word spreads quickly in a negative or positive way due to interconnectedness. Maintaining confidentiality is absolutely necessary in hospitals (Foskett and Lyall 1990). It is of utmost importance for Sikh volunteers not to cross the ethical boundaries.
Faith Advisor
Chaplains are faith advisors for the NHS, hospital staff, patients and families. Hospital staff does not want to offend faith communities by taking decisions which are contrary to their beliefs. Patients who are unsure of making decisions involving faith also consult chaplains. All rites of passage are closely bound with religion and culture e.g. pregnancy, birth and death. The participants gave examples of some questions asked around pregnancy whether IVF is ethical, issues of feeding honey to new-born babies, initiation, giving a special diet ‘panjeeri’ to the mother (Rait 2013). Such questions have religious and cultural implications. Performing Anand Karaj (Sikh marriage ceremony) in hospital is a controversial matter. The marriage ceremony is considered a sacred institution and an essential component of a couple’s social and religious life (Singh 2013). Sikhs go through a civil marriage ceremony but consider it incomplete until the marriage is solemnized under the auspices of the Sikh religious order (Singh 2013). To keep the theological essence Rait (2013) suggested a compromise by having a civil marriage and then blessing from the Sikh priest or chaplain for a dying patient who is unable to go through a Sikh religious ceremony in a gurdwara.
From time to time questions arise within the NHS which requires theological reflection and approval from diverse faith communities. Blood transfusions and transplants meet with general approval from Sikhs as ‘a good example of ‘selfless giving’ (Mandair 2010). Clearly practitioner’s guidelines which suggest that Sikhs accept abortion only for medical reasons (Hollins 2009) or which extrapolate from the gurus’ prohibition of female infanticide, fail to indicate the actual pressures on women (Nesbitt 2007). There are no religious objections to a post-mortem but Sikh’s preference is most certainly for a loved one’s body to be left intact (Hollins 2009). Some obviously have religious implications such as hand lotions containing alcohol. Others need common sense for example whether Sikh surgeons can cover their beard before doing operations. Some questions are easy to answer and others have to be adapted by balancing theological essence and practicality making it necessary to interpret Sikh texts and principles to meet the challenging pastoral needs.
Multi-disciplinary Care
Multidisciplinary care is a care which covers areas of human needs other than specific pastoral needs such as meals, personal care and hygiene and private space.
Hospital Meals
Sikh religion is a way of life, touching many areas of life, including diet. Sikhs are both vegetarian and non-vegetarian (Rait 2005). Sikh vegetarians do not eat fish and eggs though consume milk and milk products (lacto vegetarians). Most initiated Sikhs are strictly vegetarians considering it to be intrinsic to their spirituality. Milk and yoghurt are significant part of the Sikh diet (Rait 2005). They do not take cheese with animal fat. Strict vegetarians will not eat food which has come into contact with prohibited food or cooked with utensils used for cooking meat. It should not be kept or stored in close proximity with non-vegetarian meals (Greenwood 2010). Some Sikhs may not eat meat but consume eggs and fish. It is a patient’s individual preference to opt for vegetarian or non-vegetarian meals. Non-vegetarian Sikhs do not eat any meat that is ritually prepared by either sacrificing the animal to please god or by killing the animal slowly to drain out the blood (Singh 2010). The Sikh Rahit Maryada (Sikh Code of Conduct 1992) recommends jhatka, where an animal is killed instantaneously. Therefore, serving halal, or by extension Kosher, is against Sikh religious values. Sikhs wash their hands before touching food (Rait 2005).They also observe the concept of jooth, the left-over food from one’s serving, and food eaten or tasted with a used spoon from a dish becomes a jootha food (Rait 2010).
Personal Care & Hygiene
Personal care and hygiene is an important part of Sikh culture and religion (Rait 2005). Pastoral care needs to focus not just on the care of the person but also on the environment in which they live (Graham 1992). Personal care and Clean surroundings are important for praying and listening to prayers. They need to wash hands for handling Scriptural texts like a gutka (prayer book). It is important for staff to do the same and also to handle the gutka with respect. It should be wrapped in a cloth cover and kept at a clean place (Rait 2005, Hollins 2009). This requirement of washing hands is also applied before and after having meals. It is the duty of the hospital staff to clean them regularly and routinely. Advising on training caring staff on personal care is part of pastoral care with a particular attention to washing and combing hair and changing of kachha (underpants) for initiated Sikhs (Rait 2013) according to their wishes.
Private Space
It is a cultural norm in the Sikh community to visit the dying or dead relative in hospital to pay their last respect to show sympathy and support for the family. This can create a larger presence near the bed of the dying or deceased patient. There is a need for a quiet room in the same ward where family and relatives can have private space to assemble. This will also help in contributing to the normalicy on the ward avoiding any disturbance.
Interaction
There is a hospital protocol in NHS on conversing with patients embedded with western values putting emphasis on listening. The Sikh culture has its own unique way of communication. Sometimes cultural differences make it obligatory to differ for example, in the Sikh culture participatory conversation, listening and responding with empathy and understanding is expected. They should bear in mind, however that listening needs to precede responding if pastoral communication is to be effective (Jacob 1985). McClure speaks of the pastoral carer not just be a listener to stories and an interpretive guide, but a participant. This will mean engaging in a wide variety of practices involving interpreting, consciousness raising, coaching and advocating (2012, p.275). Christian chaplains are unlikely to know patients personally whereas Sikh volunteers happen to know most of them making it tough for them balancing relationship and professionalism. Due to the close-knit nature of the Sikh community, volunteers could bring their own problems into conversation and may dig into any of their personal information. This is unethical and they can be accused of prying, affecting trust building. Sikh volunteers need to be careful and use their own judgement to assess the situation. If they are not sure, a referral should be made to another colleague. Taking patient’s consent for visiting is most important and it works in their favour. Patients would like to share their feelings and stories with someone they could trust. Trust building in the Sikh community is a skill as the word spreads quickly in a negative or positive way due to interconnectedness. Maintaining confidentiality is absolutely necessary in hospitals (Foskett and Lyall 1990). It is of utmost importance for Sikh volunteers not to cross the ethical boundaries. It is also essential to use the language spoken and understood by patients and their families in making conversation to ensure the meaning is understood.
Touch is a basic human gesture and physical contact is an integral part of healthcare. Christians make use of touch in the anointing sacrament. It is a means of comfort and healing (Sayre-Adams and Wright 2001, p.3). Touch conveys reassurance, care and concern and it can be a valuable expression of a supportive or therapeutic relationship (Cobb 2005). Touch is a powerful and non-verbal signal, and one, which is often perceived as being deeply meaningful (Hayes 2000, p.469). It is conditioned by social and cultural norms. The use of touch to strangers in the Sikh culture is unacceptable. It appears that participants are willing to bend the rule of touching in favour of its therapeutic and psychological benefits. Participants also realised that female Sikh chaplain/ volunteer visitor might feel intimidated holding hands or putting their hand on stranger’s head especially of the opposite sex. In my view, to start with, it should only be done in exceptional circumstances and not as the norm or as a rule. Care providers have to make decisions with which they can live and feel comfortable. If prayer has to be performed by holding hands, the consent of the patient, and if possible the family is necessary. Touch is not value free, and it can convey powerful signals. Therefore, touch may be perceived as threatening and manipulative (Cobb 2005, p.159).
Conclusion
There is not any exact word in Panjabi for chaplaincy or for pastoral care. I propose ‘rogi da/dee ruhani sevak’ (ਰੋਗੀ ਦਾ/ਦੀ ਰੂਹਾਨੀ ਸੇਵਕ) for a chaplain and ‘mili juli ruhani rogi seva’ (ਮਿਲੀ ਜੁਲੀ ਰੂਹਾਨੀ ਰੋਗੀ ਸੇਵਾ) for pastoral care within the context of hospital. This seems to be the nearest approximation of pastoral care. If the word 'rogi’ is removed, it can be applied in the community, family and home. It is good to have any suggestions on this. Similarly, there is not any definition I know off for pastoral care. I suggest, “Pastoral care is a compassionate care and supportive activity, unique in its nature, given in times of need and crisis. It works within the confines of religion and culture which not only supports but also empowers spiritual care in hospitals. In a wider context, it covers kind, caring and supportive care in the community, care in the home and family being mindful of the needs of care receiver”. Pastoral care is a supportive activity keeping in view the needs and beliefs of care receivers.
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