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Observations of a Danish Social Worker on Social Work Practice in the United States

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cancer-patient

I was working as a social worker in Denmark for some at a highly specialised university hospital until I moved to the United States, and I have been wondering about the differences and similarities in working with cancer patient in both places. With 10 years of experience working with cancer patients, their families and palliative care in Denmark, I can see how different Denmark is from the U.S. health and social system. I don’t think it will be fair or even possible to do a one to one comparison of the two countries.

In Denmark, the government plays a major role in providing citizens with fundamental social security and access to healthcare, which dates back to the 1800s. With a comprehensive social security system, most of the welfare state tasks is financed by taxes. In the United States, I have learned most of the social support is provided through non-profit organisations and healthcare is mostly secured by insurance. So with such big differences, I thought it would be interesting to see if there are any common denominators.

In my search for work in the United States a question I often get is do you have experience in working with Afro/American women? In the beginning I wondered a lot about that question, but then it made me really think about how do I define myself as a social worker. Working as a social worker here in the United States at a clinic for low income women with cancer I met many different ethnicities.

Mohammad, a 50-year old man, who was working as a bus driver when I first met him. Originally he was from Iraq, but came to Denmark as a political refugee. He was married and had four children. Mohammad’s wife didn’t speak Danish and she didn’t work. I met Muhammad because he was diagnosed with Colon Cancer and wasn’t able to work much longer.

Being diagnosed with cancer is mostly associated with uncertainty, hopelessness and anxiety of not having any control. Many cancer patients also experience stigma, shame and blame depending on the diagnose. Besides that most people are filled with fear of the disease, many also have concerns of what the diagnose means in relation to work, social life, economy and everyday life. A life threatening disease is an extreme and potentially stressful triggering life event which requires psychological coping.

The best results in our line of work I believe is created by being humble in the approach to the patient and by having a natural curiosity towards the patient’s life story. We must first and foremost see the patient as a person who comes to us for help because they are in a place in their life where they cannot stand alone, and we need most of all take a look at the patient’s individual experience of his or her situation. Whether the individual can adapt to the new life situation depends partly on their degree of resilience.

The first couple of times I met with Muhammad he didn’t say much, I would just talk with him about life in general, so he wouldn’t feel I pressured him into speaking about his situation. In my experience, working as a social worker, a patient in a situation like Muhammad’s is going through a lot of emotions. They may have the feeling of loneliness, lack of understanding from their surroundings, social isolation and financial difficulties.

Moreover they go between accepting the situation, to denial or to have some degree of acceptance. Every time I met with Muhammad I told him you can always come back. I would ask him how his treatment was going and asked about his life in general, this was to not only define him by his diagnose and the disease. Then after a couple of meetings he brought his wife and from there the contact to the family became more frequent. I was Mohammed and his family’s social worker until he died 4 years ago.

Sabrina a young mother of three, was diagnosed with melanoma cancer metastasis to the brain and because of some insurance issue, she had not gotten her treatment and scans. Sabrina’s husband was providing for the whole family and wasn’t home a lot which made Sabrina feel very alone in her situation. Also, Sabrina was going to die and she knew and recognized it.

Speaking with a patient in Sabrina’s situation you need to find out what is most important for her to talk about. Is it emotional support or is it more practical support she needs. First of all, I believe that we should all have an open heart, open mind and listen to the stories the patient has to tell, without race or color in mind.

It is important as a social worker to start a conversation with a patient and imperative to distinguish between the problem and the condition for knowing when to take have a solution-oriented approach, and when we do not need to act, but do something else for the patient. Problems such as financial aid, help to clean, help to care for the children and figuring out what the insurance and pension rules are, can be solved. Conditions are more definable as distressing life events, something the patient has to live with. A burden or a grief to be worn like that I am not able to work longer, I have to die from my children and the disease itself. These circumstances affect the patient on a more emotional and spiritual level.

However, it can be difficult to distinguish between problems and conditions as the patient will often ask questions or talk about the difficult life conditions in a way that invites to problem solving. The patient’s narrative and questions must be recognized and unfolded before we can assess whether it is something we must act on or not. It can be difficult to distinguish in practice, since a situation may contain aspects of both conditions and problems. Here, we must be careful not to solve problems before we acknowledge the losses that the patient has in their changed conditions of life.

I think it’s very important to remember to be truly present with people. We bring knowledge, skills, and compassion to listen in a unique and dedicated way. We need to bear witness to people’s physical and emotional pain without abandoning them or being judgmental in any way. Our role is to create a safe space for the patient to share their joys, regrets, fears, strengths, and sorrows.

I do believe parallels can be drawn between the experiences with patients that I’ve had in the United States and in Denmark. When everyday life is shaken by serious life-threatening disease and families are affected, concerns that arise in both countries are similar in nature regardless of social status and ethnicity.

However, it has surprised me that there is so much focus on ethnicity, especially when I see basically the same problems regardless of race and social status.

It is my experience from what I’ve seen here so far, that here it is more about what ethnicity do you have and what social class do you belong to, that determines how the approach to the patient will be.

A different culture, ethnicity or religion it self does not necessarily accompanied by challenges or the need to have a specific kind of approach.

A cancer – regardless of diagnosis – contains significant psychosocial impacts. In addition to the diagnosis of specific problems, patients often live with fear of relapse, depressed mood, attention and memory impairment, reduced work ability, problems in relationships which, individually or together, may adversely affect rehabilitation and retention of social and cultural status.

It’s essential for a good dialog and contact that we listen with an open-mind and acknowledge the problems coming up during the conversation. Also, it is equally important to see the patient as an individual and avoid judging or being distracted by the patient’s cultural or religious appearance. Otherwise there is a risk that factors such as racism and prejudice will get in the way of the patient receiving the best help.

Tine Christensen medical social worker, with wide experience working with cancer patients and a passion for how to be aware and developing the social work area. "We wont always know whose lives we touched and made better for our having cared, because actions can sometimes have unforeseen ramifications . What is important is that you do care and you do act." Charlotte Lunsford

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