Indian Journal of Palliative Care
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Year : 2007  |  Volume : 13  |  Issue : 2  |  Page : 65-67

Spiritual care in a multi-religious setting revisited

Phebe Hospital and School of Nursing, Suakoko, Bong County, Liberia

Correspondence Address:
Rev. John Lunn
Phebe Hospital and School of Nursing, Post Office Box 10-1046, 1000 Monrovia 10, Suakoko, Bong County
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1075.38902

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 » Abstract 

Providing relevant spiritual support to individuals at the end-of-life often raises ethical and practical dilemmas. A little forethought and access to guidelines already in vogue can provide useful hints to many situations commonly faced in everyday practice. The author's experiences and some guidelines are discussed here.

Keywords: Anointing service, clinical chaplains, diversity, inclusively, India, Liberia, multi-religious setting, palliative care, spiritual care

How to cite this article:
Lunn R. Spiritual care in a multi-religious setting revisited. Indian J Palliat Care 2007;13:65-7

How to cite this URL:
Lunn R. Spiritual care in a multi-religious setting revisited. Indian J Palliat Care [serial online] 2007 [cited 2021 Jan 23];13:65-7. Available from:

In 2002, I wrote a journal article on spiritual care in a multi-religious setting for the Journal of Pain and Palliative Care Pharmacotherapy. Since that time, I have spent almost 4 years working in India and a little more than a year in Liberia (West Africa). I would like to revisit some of the concepts from that paper.

Let me start by stating the obvious - this is a most difficult subject as it is problematic to define "spirituality". In that article, my working definition of spirituality was "an animating or vital principle held to give life to physical organisms." [1] If I had said anything in that article that is worth repeating, it might be this: "Spiritual care, at its core, is meeting people where they are and assisting them in connecting or reconnecting to things, practices, ideas and principles that are at their core of their being - the breath of their life, making a connection between yourself and that person." [2]

Many of the people who I encountered during my time in the Palliative Care Unit at Christian Medical in Vellore, South India, and in Phebe Hospital and School of Nursing in Liberia, West Africa, had little time or desire to ponder the question of what 'animated' or 'vitalized' their lives. They were struggling with what would be considered the basic necessities on Maslow's pyramid of needs - physiological, safety/security and belongingness and love. [3] For many, the questions about food, shelter and family security were key. Nonetheless, spirituality was the foundation or base from which they addressed these physiological, safety and belongingness issues.

In India, I did not share the faith of many I encountered as they were Hindus or Muslims. In India and Liberia, I did not share the same mother tongue. For most of my time in India, I led an anointing service every Thursday afternoon. After 1½ years, chaplains from the local state joined me regularly. They spoke their mother tongue, Tamil and a neighbouring tongue, Malayalam, but struggled with Bengali and Hindi. For that service, people were invited to receive prayers with the laying on of hands and anointing with oil. Very few spoke English and very few were Christians. Some would share their request, their plea, their pain or their joy in whatever language they knew - Tamil, Hindi and often Bengali. Sometimes they said nothing and often tears spoke the intensity of pain or suffering they were experiencing. Only a small number sought out someone to translate or intentionally went to one of the other ministers who might speak their mother tongue.

People shared their requests - in words, gestures, tears or silence - and I would lay my hands on their heads, praying in English and making the sign of the cross on their forehead with oil. A Sikh man came forward at the end of one service and he knelt before me; I struggled what I should do. I knew that I should not touch his head - out of respect for his religious tradition. Yet he had been watching me lay my hands on others' heads and praying. Had he not knelt, I might have put my hands on his shoulders to pray. I was sure that he had come for this very thing, as had Muslims, Hindus and Christians who came before him. Even for many Christians, this would not be a known practice or ritual. It was, however, seen as a connection with the 'Holy'.

That Sikh man, the many Hindus, Muslims and Christians came from a tradition that does not practice the laying on of hands and anointing. They were not looking to 'convert' to something else. They were looking for something to help them connect.

Let me share an example that may help to understand this. I live in Liberia surrounded by some of the world's poorest people who live in huts and houses with roofs in various states of disrepair and damage. The rainy season is significant and goes on for many months. Thus, people patch their roofs so as to stay dry. Some might use loose pieces of zinc roofing, a piece or two of tarpaulin, maybe even some palm leaves weighed down by stones. These various things help them keep themselves, their family and their belongings dry and safe during the rains. When the crisis would pass, they may decide to build a new house or put on a new roof, but in the midst of a storm, they stay with what they know, what they have and they reach out for that bit, that patch to help them through.

These may be times that people reach out in desperation and despair. These are times that people reach out to make a connection. It is not a time to actively try to convert. In these times, people need what is known, what is familiar, what has worked. They may be very open to 'new things', but at their pace, at their request.

When I moved to India for the first time 20 years ago, I had more than my share of stomach and GI problems. I tried the things that I knew - Pepto-Bismol, antibiotics and other medications - yet these needed to be augmented with things new to me. Curd rice became my best friend! Later I added kangii. When I felt the worst, I would listen to tapes of a radio station from New York city (then my home). I would drink a Double Cola or a Thumbs Up because they reminded me of Coca Cola from home. The new came at my pace, at my request.

Liberia was a country coming out of 14 years of civil war and conflict. Hundreds of thousands of people lost their lives; the country's infrastructure was destroyed - not to mention families, relationships and communities. Daily life was a struggle with 85% unemployment, low life expectancy, high maternal/child death rate and so on. In the churches of Liberia on Sunday morning, people came alive - with music and dance. In my congregation, the liturgy was from the older Lutheran version of the early church's worship. The music (with drums and sasa - a gourd with beads) and dance were from the African heritage and tradition. I lead the liturgy, consecrated the communion elements and preached the sermon, but I could not lead the dance or singing. Yet I surely participated and enjoyed.

I will repeat the ending of my previous journal article to end this one.

The Association of Professional Chaplains, a US chaplaincy organization, puts forth the following values for clinical chaplains:

  1. The individual person possesses dignity and worth.
  2. The spiritual dimension of a person is an essential part of an individual's striving for health and meaning in life.
  3. The spiritual care of persons is a critical aspect of the total care offered in the delivery of care for public and private institutions and organizations.
  4. Inclusivity and diversity are seen as foundational values in pastoral services offered to persons, regardless of religion, race, ethnicity, sexual orientation, age, disability or gender. [4]

Embracing these traits, any clinician can engage in an exploration of spiritual resources and provide spiritual care. However, simply showing up and sitting with the person and/or their family may be the most important part of providing that care. Few people remember what you say; rather they remember that you were there and that you cared. [2]

 » References Top

1.Merriam-Webster's Collegiate Dictionary. 2001. [Last accessed on 2002 Sep 9]. Available from:  Back to cited text no. 1    
2.Lunn JS. Spiritual care in a multi-religious context: Advances in acute, chronic and end-of-life pain and symptom control. J Pain Palliat Care Pharmacother 2004;17:153-66.  Back to cited text no. 2    
3.Maslow's hierarchy of needs. [Last accessed on 2006 May 15]. Available from:  Back to cited text no. 3    
4.Association of Professional Chaplains. Values. [Last accessed on 2002 Sep 24]. Available from:  Back to cited text no. 4    


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