by Kyoko Isa
Asahi Shimbun January 28, 2013 (evening edition)
The Great Eastern Japan Disaster of March 11, 2011 has provided the opportunity for religious groups in Japan to reconsider what roles they should carry out in society. In this way, we can see that religious professionals who are connected with medical services dealing with dying are gradually increasing in Japan. I recently visited the Nagaoka Nishi Hospital in Nagaoka City, Niigata Prefecture—which began to use Buddhism in its terminal care services 20 years ago—to look into the significance of medicine and religion cooperating together.
There is a nice view from the 5th and top floor where patients with terminal cancer spend their last days at the “Vihara” Palliative Care Unit, established in 1992 with 27 beds. There are always at least 20 patients in residence. In the middle of the ward, next to the nurse’s station, is a Buddha hall. Inside the hall, one finds a 17th century Shakyamuni Buddha statue, candles burning, and incense wafting in the air. This space is always open for people to come and go as they please.
“Vihara” is a Sanskrit term that means either a place of rest or a Buddhist temple. Masashi Tamiya, a scholar of Buddhist social welfare and presently a professor at Shukutoku University, proposed this word to indicate a place of care that has a Buddhist foundation and is not a hospice based on Christian teachings. Prof. Tamiya (who is also a Buddhist priest) established an association to advance this idea and to realize the establishment of such a facility like the Vihara Palliative Care Unit. Prof. Tamiya’s own household is a temple of the Jodo Shin Pure Land Otani denomination in Nagaoka, and the head of the Nishi Nagaoka Hospital is his younger brother. This unit is unique in central Niigata as the only such one with certification as a palliative care ward by the Ministry of Health, Labor, and Welfare.
One priest from the local area, while having other duties, offers himself as a volunteer to perform the morning and evening services at the Buddha hall as well as other seasonal Buddhist services. Patients attend these as they like freely. However, in reality, the number of people who want to receive some sort of Buddhist care is few. Rev. Takafumi Morita, who has been working at the ward as a Vihara priest for almost 6 years, explains, “At first patients would avoid me, but then after becoming acquainted, they came to invite me into their rooms. They eventually came to ask me things like what will happen after they die.”
It’s 2:00 in the afternoon. Patients are led one after another by nurses into the Buddha hall. One patient is wheeled in the hall lying down in his bed. The first dharma talk gathering of the new year is about to start. The priest’s way of speaking is sharp and witty and laughter breaks out on and off during his talk. At the end, the doctors and nurses together with the patients offer their thanks with by putting their hands together, the traditional Buddhist greeting and prayer form (gassho).
Afterwards, the patients and the priests sit together and chat over snacks. They know I am a reporter, and one female patient says to me, “I couldn’t stop weeping during the dharma talk that was just given. I have never prayed or done such things before, but now every day I put my palms together in gassho. I don’t think that people who are healthy can understand such a feeling.”
Dr. Takeshi Itano, the head doctor of the ward, acknowledges the power of the Buddha hall; for example, one patient in his final days began having hallucinations. Dr. Itano recounted, “Normally, one would quickly prescribe medication, but a nurse here suggested she take the patient to the Buddha hall and offer a prayer in gassho. When she did this, the patient suddenly calmed down. I was very surprised.”
Dr. Itano has experience working at a palliative care ward in another prefecture, where he encountered a patient who would secretly do Buddhist chanting when the nurses were not noticing. He says, “Many patients are elderly, and in their own homes, they have the daily custom of praying in gassho in front of their home Buddha altars. However, in hospitals there really is an atmosphere of not allowing such expressions like gassho. I would like to change the situation, but I am challenged, ‘Is this really a medical procedure?’. Finally, I have just been ignored.”
Nagaoka Nishi Hospital at first also kept a distance from these Vihara activities, saying, “We have no relationship with the Buddhist priests.” However, now they have begun to hear from the relatives of patients who say, “We ourselves would like to come participate.” There are also many researchers who come to visit from all over the country.
If you search for the Japanese Association of Palliative Care and Hospice, you find that as of November of 2012, there are 257 palliative care units in Japan. However, according to Prof. Tamiya, there are only two other Vihara units [The Asoka Vihara Clinic near Kyoto and the Kosei Vihara Ward in Tokyo].
translator’s note: for a historical background of the Vihara Movement and of experiences at the Nishi Nagaoka Vihara Ward, see Rev. Yozo Taniyama’s essay “The Vihara Movement: Buddhist Chaplaincy and Social Welfare” in Buddhist Care for the Dying and Bereaved (Eds. Watts & Tomatsu, Boston: Wisdom Publications, 2012)
The Establishment of a Vihara in a Public Hospital in Taiwan
and a Training Program for “Clinical Buddhists”
by Kyoko Isa
In Taiwan, since the 1990s, Buddhists began to get involved in palliative care for patients, and now this work has spread all over the country. Ven. Huimin Bhikshu is the president of the Graduate School of Dharma Drum Buddhist University where he studies “Clinical Buddhism”. In November 2012, he held two seminars in Tokyo on his work [at the Jodo Shu Research Institute and at the Rinbutsuken Institute for Engaged Buddhism].
According to Ven. Huimin, Buddhist styled palliative care began in 1995 at the leading Taiwan National University Hospital (NTUH). The palliative care unit established there was the at a public hospital in Taiwan. The vice superintendent of the hospital, Dr. Rong-chi Chen, thought that the role of Buddhists was needed and so created a ward with a Buddha hall. However, just this form had its limits, so with the cooperation of Ven. Huimin and other monks from Buddhist universities, they began to research how to tie together Buddhist and medical studies. The result was the creation of the “Clinical Buddhism” training program.
The training program is a comprehensive one for monks and nuns that covers how to read and work with patient’s medical documents to how to communicate Buddhist teachings; and finally taking responsibility for the care of a single patient. The student must first receive a high enough evaluation to then be recommended as a practicing clinician and a member of the palliative care unit’s professional team. It requires at least 5 years to gain such accreditation from this program. By 2009, 29 monks and nuns had gained such accreditation and began working at university and public hospitals in other parts of Taiwan.
Rev. Yoshiharu Tomatsu, a senior research fellow at the Jodo Shu Research Institute, has explained that it is difficult for Buddhist priests to work in public hospitals in Japan. However, Japanese priests have their own network of lay followers. Thus, “there should be the possibility of Clinical Buddhists offering home hospice care.”
translator’s note: for more details on the Clinical Buddhist training program at NTUH, see Jonathan Watts’ essay, “The Development of Indigenous Hospice Care and Clinical Buddhism” in Buddhist Care for the Dying and Bereaved (Eds. Watts & Tomatsu, Boston: Wisdom Publications, 2012)
Entire article translated with notations by Jonathan Watts