This article is based on the presentation made by Barbara Linkewich, of the Northwestern Ontario First Nations Palliative Care Committee. It provides information on palliative care and pain management, how they fit into Medicine Wheel teachings, and offers practical advice on how one can lovingly support the
terminally ill person when the end is near.
The word ‘palliative’ can mean a medicine that gives temporary relief from the symptoms of a disease, but does not actually cure that disease. Palliatives are often used in the treatment of diseases such as cancer and heart disease. The word ‘care’ is added to ‘palliative’ to show who is involved in the recovery of the person. Hence, palliative care is not only for the dying person, but for the family and caregivers as well.
The term ‘palliative care’ conjures up the idea of ‘compassion’ in that it strives to answer the physical, emotional, social and spiritual expectations and needs of the patient and his or her family. At the same time, it attempts to respect their personal, cultural and religious values, beliefs and customs. Palliative care may be combined with therapies aimed at reducing or curing the illness, or it may be the complete focal point of care.
Palliative care is planned and delivered through the combined efforts of an interdisciplinary team that includes the individual, the family, and the caregivers and service providers, such as health professionals. Ideally, this care should be available to the individual and his or her family at any time during the course of the illness and period of mourning immediately after the person has passed away.

Three statements that best describe ‘palliative care’ are:

1. To cure sometimes
2. To relieve often
3. To comfort always

The First Nations and Inuit communities that are located within the region of the Northwestern Ontario First Nations Palliative Care Committee are often rural and remote. Home care programs are just beginning in some communities, and in most cases, a variety of providers are available such as nurses, CHRs, and workers who work in specific settings: home care, prevention, child care, social service and family members. It is vital for persons working within palliative care settings to be sensitive to the cultural needs of the individual who needs assistance.
Respect should always be placed first, especially towards traditional and western healing practices. It is vitally important to consider that more and more, First Nations people want to return to their home communities to die.

Palliative Care within the Medicine Wheel teachings:

The Medicine Wheel describes palliative care in four cycles:

1. Choices:
-For the person
-To retain dignity and maintain control
-For emotional and spiritual support to the person and
loved ones

2. Concern:
-For the person’s pain and suffering
-For the family’s frustrations and grief
-For the caregivers

3. Comfort:
-To the chronically or terminally ill person
-To the family/friends
-To the caregivers

4. Compassion:
-Understanding and acceptance of feelings

Pain and Symptom Management:

Pain is the way the body says there is an injury or disease that has caused tissue damage. Pain is the protective warning
system that helps prevent further damage, although chronic pain does not seem to have a purpose.

When working with a person who has a chronic illness (e.g. diabetes, heart disease), assess and reassess, listen and get to know the helping tools you will need to relieve his/her suffering. For example, be aware that there are different kinds of pain:

Nocioceptive pain – describes nerve fibres, endings or pathways that are concerned with the condition of pain (noci – a prefix denoting pain or injury).

Visceral pain – is related to the organs in the body.

Neuropathic pain – a disorder of one or more of the nerves outside the brain and spinal cord, known as peripheral nerves. The most common cause of peripheral nerve damage is diabetes mellitus.

Pain Medication:

Many people have strong feelings about pain medications. Their well-intended opinions may be expressed and responded to in the followings ways:

When you hear a person say:	This is how you can respond:
“Taking pills isn’t natural.”	“Remember that for a person with a serious illness, medication may make the difference between being in pain or being able to do the things they want to do.”
“They will get addicted.”	“The medication can be reduced gradually and stopped.”
“They will get high.”	“Only if they take the medication for reasons other than pain.”
“The medication will not work later on when the pain is very bad.”	“Medication in higher doses can be increased until there is pain relief.”
“They will be sleepy.”	“This may happen at first, especially if the person hasn’t slept well. But they will adjust. If sleepiness continues, their health care provider can add other medications.”

Pain medication should be taken regularly, including during the night. The medicines may be ordered every four hours for a short acting medication or every twelve hours for a long acting medication. There is usually a “breakthrough or rescue dose” that a person can take in between if the pain is severe. If a person needs several rescue doses, it may be necessary to have the maintenance dose increased. Consult a health care provider.

Two examples of traditional soothing remedies are:
1. chamomile tea; 2. tying rabbit skins to patient’s feet and hands and rubbing the toes and fingers.

Caring for the Terminally Ill:

Be prepared for questions that a terminally ill person might ask, such as:

Big questions in life
Who is God?
What have I done?
What is the meaning of my journey?
What will I leave behind?
How can I understand the death that is coming?
Who and what are important to me?
Is there forgiveness and love?
What does it feel like to pass over to die?
Where will I go?
Will I see my family again?

When faced with these questions, speak positively and provide affirmation and reassurance. This type of healing helps the person become ready to receive love and caring, and they will give in return.

Letting Go:

Remember, each person is special. Some terminally ill people may need silence, talking, praying, or rituals. Some may need to work through saying goodbyes before the spirit can break free. Doing any of the
following special activities with the person can help:

-Look at pictures
-Talk about old times
-Ask about special skills the person has
-Read books, poetry
-Share music
-View nature
-Talk about rituals that are important (it may involve calling the appropriate person for them)
-Meditate
-Pray
-Do whatever the person wishes

When Death is Near:

Be prepared ahead of time to know who to call, what to do, and know the funeral plans the patient desires. As a final note to this presentation, it is acknowledged that the pain of losing a close family member is devastating for all.