I was stood by the door waiting for someone else to arrive when a refugee banged on it. I was annoyed. It wasn’t opening time yet and it’s always awkward explaining that across a language barrier. I took my time coming to the door and fiddled with the key, hoping my body language would set the tone for a short conversation.

“We’re not open yet”, I said as I cracked the door open and felt the chill of the early December cold snap.

The Iranian man looked me earnestly in the eyes, thrust a heavily laden shopping bag into my hands and said in a heavy accent:

“I’m sorry, I can’t come today”.

He flashed me a grin that showed his missing teeth, leaned over to hug me, turned his bike around and rode off up the hill.

I’d known Ebrahim (not his real name) for a few weeks – maybe a month – since another refugee had introduced me to him. I’d heard rumours of his generosity, but this was my first experience of it.

I shut the door to the church against the cold, and as I locked it my mind wandered back to an interaction with John Barclay – a professor at Durham University. I was a PhD student at the University of Nottingham at the time, and he was a world-leading theologian who had been invited to give the Firth Lectures. It was as close as you come in academia to meeting a rock star.

He came to mind as I closed the door because in those lectures, he argued that one of the key reasons the first Christian communities grew was because they practiced risky generosity.

The first followers of Jesus were likely poor enough that they relied on each other to get by: you can borrow my coat today because I’m going to need your saucepan tomorrow. That was not unusual in the ancient world and lots of communities were generous in that way.

What made Christians unique was that they were much more willing to risk including outsiders – they were willing to give to people who they didn’t know well enough to be able to rely on them giving back.

I retreated from the door wondering what had just happened and whether Ebrahim would get a decent meal today if he couldn’t come to our drop in. But mostly, I wondered why he was being so generous and I was so stingy. I mean, one of us is rich by almost any metric – and it’s not Ebrahim.

As I turned round, I saw Sami (not his real name) across the room. He’s been around longer than Ebrahim and has actually been helping us by translating sermons into Farsi for other Iranian refugees. He was already inside because he was helping us today.

They show up with gratitude, and give generously of the very little they have. They practice this risky generosity with no guarantee of return.

I know a bit of Sami’s story – how he has arrived in the UK seeking asylum because his family found out about his faith and suddenly he was no longer safe in his own home. I’ve seen the scars he got from living through that story. And yet, when Sami manages to find a way to work under the radar to supplement the pittance he’s living on and make his days more meaningful, he is as generous with what he earns as he is with his time.

There’s something striking about the risky generosity I see in Ebrahim and Sami. I can’t imagine living through what they’ve endured, but they show up with gratitude, and give generously of the very little they have. They practice this risky generosity with no guarantee of return – not least because the church is so mindful of being taken in by a sob story that we make big demands before we’ll baptise or send letters of support for anyone. It challenges me. Despite the fact that I’m the rich one, my asylum seeker friends seem closer to the attitude of the first Christians than I am.

It particularly challenges me when I then read stories about small boats, Home Secretaries and Rwanda. Because somehow people like Ebrahim and Sami seem to go missing in all the debate.

I’m not in a position to solve immigration, and I’m not for a second pretending it’s not complicated. But I thought about Ebrahim, Sami and John Barclay again when my children’s CofE primary school told me what they were teaching my boys about British values and Christian values. It’s probably no surprise that there was no mention of this kind of risky generosity that was in fact a hallmark of the first Christian communities and that I think I’ve seen in these brothers from another nation. I think that’s a shame.

There’s no doubt that the Bible talks clearly about God providing for his people –wealth is not bad, and Jesus’ call to give it all away came to one particular person rather than to every follower. But God’s own generosity runs like a thread throughout the story told in Scripture.

Maybe that’s why Paul writes that ‘God loves a cheerful giver' . The original Greek word translated ‘cheerful’ there is hilaron and we get the word ‘hilarious’ from that root. It might not be funny, but within the conversation we tend to have about wealth it is surely laughable for Ebrahim to give away a bag full of goodies when he has nothing? It’s risky, certainly: better to hold onto the money as you might need it next month if the Home Office moves you without warning again. And yet, he gives.

And because he gives, he challenges me. If John Barclay is right – and I think he is – Christians have always been the kind of people who take risks to welcome others into their community. That makes no sense if you’re trying to keep your own food and energy bills down in the face of inflation. It’s laughable, in fact. But apparently, that’s the kind of giver God likes – a hilarious one!

I think he likes that kind of giver because when he looks at them he sees the image of his own generosity. After all, according to Genesis, that’s the image humans were made to carry. Seeing Ebrahim and Sami giving reminds me that for all the complexity of the immigration debate these are human beings. Their risky generosity challenges me to live up to the actual values of the first Christian community.

Article

Care

Change

26 July 2024

6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient

Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care. Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions?

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers.

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’.

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care.

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?”

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness.

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.”

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.