Travelling in a world of refugees

Reconciling the contrasting journeys of travellers and the migrant.

Steve Dew-Jones

Steve is news director of Article 18, a human rights organisation documenting Christian persecution in Iran.

Migrants on a freight train reach for food bags held aloft by people on the track side.

Migrants on La Bestia being passed bags of food and water.

Pequeño Mar, CC BY-SA 4.0, Wikimedia Commons.

I’ll never forget the sight, 10 years ago this month, as I hitchhiked north through Mexico, of dozens of migrants hanging off the side of a goods train as they made their own journeys towards their Promised Land.

Like me, these migrants - of whom there must have been at least 30 - were heading for the United States. Unlike me, they were doing so not for fun but for their futures.

“Come with us!” some shouted, as my wife and I lugged our backpacks towards what we hoped would be our next successful hitchhiking post, having begun our journey seven months prior at the southern tip of Argentina.

We declined the offer, but I wondered then - and still do - whether they had known we were in a different position to them, or had simply assumed us to be in the same metaphorical boat.

Around the same time, a new wave of refugees were making their way westward across Turkey and Europe, in a reversal of my first hitchhiking adventure, which took me eastward from the UK to Malaysia. And again, I found the contrast between the respective circumstances of our two journeys confronting.

There I had been, a post-university thrill-seeker, taking to the road with my best mate to open my eyes to the big wide world beyond these shores, and now six years later, these poor souls were moving in the opposite direction - again, not for fun, but through sheer desperation.

Many were fleeing ISIS, who took control of Mosul while I was hitchhiking through Brazil at the time of the 2014 Football World Cup. My chief concern during those days were the occasions hitchhiking proved less straightforward. On some days, we had to wait hours for a ride. Sometimes, night would set in as we waited, and we were forced to call it a day.

There were times, too, when we fell foul of the law, such as in the States, where a policeman told us off for hitchhiking on the freeway. But undoubtedly the most challenging moment of that trip was the time we ended up back in the same hotel we had been in two days prior, having done a 1,000km round trip only to find ourselves right back where we started.

This came about in Prince George, Canada, after we had been encouraged by a trucker on the so-called “Highway of Tears” to take a different route to our final destination: Alaska. I can still remember the feeling, as I woke up early the next morning, in the very same room of the very same hotel, of such a lot of effort wasted and a deep desire to get moving again as swiftly as possible, if only to enjoy a sense of progress.

No doubt, there have been many refugees who have experienced the same emotions - only, one imagines, with much greater intensity. Perhaps they have been deported back to where they began their journey, or simply sent back to the last country from which they arrived, in the process undoing in their minds and hearts all of the efforts that went in to getting them there.

No doubt, many of these refugees will also have fallen foul of the authorities. Some, will have been detained; others deported. Perhaps some will also have been told off for walking on a highway, or illegally crossing a border, as I myself tried to do between Bangladesh and Myanmar back in 2008 - only to be picked up by a border patrol and taken back to where I’d started again.

Yet, unlike me, I doubt many refugees were offered helping hands by strangers along their way, or at least not so frequently, and I expect many more of them experienced harsh words from passersby than the few jokey thumbs-downs or shouts of “gringos!” that I received on my own journeys.

And while I, with my Great British passport, was able finally to arrive at my goals and to feel the joy of that completion, many refugees will not have been so fortunate. And while I was able eventually to return home and continue my life - in whatever way I saw fit - for many refugees, their own journeys will still be ongoing, and there will still be a lack of clarity regarding what the future may hold.

I always used to say, standing beside the side of the road, that if only we knew how long it would be until the next ride, we needn’t worry. If someone could tell us that in four hours we’d be picked up, or that although we wouldn’t get another ride that day, that on the very next we’d be adopted by a lovely family who would end up taking us with them for 10 days (as happened in northern Argentina), then all our worries would melt away.

I felt the same way during the years in which my wife and I struggled to conceive, post-adventure. Were someone to have told us then that in a few years, we’d have three beautiful boys, we need never have suffered such heartache.

So too for refugees: if only someone was able to tell them when, where and how their journeys would end, they would be able to come to terms with what lay ahead, and to stop feeling so anxious about the many unknowns.

But of course that’s not how life works - whether you’re lucky enough to have been born with a British passport that enables you to see all the world has to offer without a second thought, or whether you’ve had the misfortune of being born in a country within which you find yourself unable to remain.

I have long wrestled with the question of whether my travels were simply a selfish waste of time. Not that they didn’t bring me great joy and truly opened my eyes to the big wide world - they most surely did - but whether I might instead have used that time in some nobler endeavour.

I find encouragement today in knowing that my love of people of different countries - and especially Iran - was birthed during those travels, and that I probably would not be doing the job I am now, had it not been for those experiences. But it doesn’t make it any easier to reconcile the contrasting journeys of travellers and refugees, which although they may share many parallels, also exhibit some stark differences.

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.