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The need for a universal language during the COVID-19 pandemic: Lessons learned from the Middle East Cancer Consortium (MECC)

Published online by Cambridge University Press:  20 November 2020

Michael Silbermann
Affiliation:
Middle East Cancer Consortium, Haifa, Israel
Ann Berger*
Affiliation:
National Institutes of Health Clinical Center, 10 Center Drive, Building 10, Room 21733, Bethesda, MD20892
*
Author for correspondence: Ann Berger, National Institutes of Health Clinical Center, 10 Center Drive, Building 10, Room 21733, Bethesda, MD 20892, USA, E-mail: aberger@cc.nih.gov
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Abstract

Type
Essay/Personal Reflection
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

We are facing a global health crisis unlike any other in the past century. During the ongoing pandemic, humanity's suffering has increased enormously. The pandemic is clearly more than a medical crisis: it is a human, economic, and social crisis, attacking societies at their core. It has awakened our consciousness of global interdependence, as the pandemic knows no geographic, cultural, or religious boundaries. Unexpectedly, this pandemic has inadvertently given us an opportunity to overcome our modern culture of individualistic isolation and to begin learning how to help ourselves by helping others; more specifically, by opening ourselves to a shared language of suffering and of hope.

Health care professionals are well positioned to promote understanding, mutual respect, and perhaps eventually peace. As the world grapples with this emerging pandemic, we offer a living model for promoting communication in times and places of strife: the Middle East Cancer Consortium (MECC).

The MECC was established in 1996 as a regional initiative for cancer research and treatment. Its initial members included the United States, Cyprus, Egypt, Israel, Jordan, the Palestinian Authority, and Turkey. Our hope was that, through this collaboration, there would be a decrease in incidence and impact of cancer throughout the Middle East. MECC's motto is “Respect all people, collaborate in fighting human suffering and help build a bridge for understanding among all” (Silbermann et al., Reference Silbermann, Khleif and Balducci2010, Reference Silbermann, Daher and Fahmi-Abdalla2015; Knaul et al., Reference Knaul, Farmer and Krakauer2018).

MECC focused on the Middle East, arguably the most restless part of the world, ravaged by incessant turmoil and conflict since the beginning of recorded history. The Middle East comprises a hodgepodge of beliefs, prejudices, and cultural trends; it seemed hopeless to unravel the knot of tribal disputes that underly the perennial Middle East wars (Silbermann et al., Reference Silbermann, Khleif and Tuncer2011). Our approach was to identify a common, concrete area for action suitable to health professionals. We chose to focus on the palliative care of cancer, as human suffering knows no religious, ideological, or ethnic bounds.

Our approach was to bring together health care providers from diverse religious and ethnic communities in the Middle East, with a common goal to implement, expand, and improve palliative care programs throughout the region. We understood that hostile communities undergo the same suffering and need mutual support to overcome the suffering associated with illnesses. Even more importantly, suffering may become a shared language, as very few people would refuse to alleviate the suffering of a dying enemy.

The primary focus of MECC has been to relieve the suffering caused by cancer, with the understanding that the physical disease is only one component of cancer. To grapple with the emotional and spiritual elements of suffering requires the ability to convey compassion and empathy. Our sessions, therefore, fostered a common language that expanded beyond the common medical vernacular. Central to the MECC gatherings are sessions where health professionals learn from each other about how to communicate clearly with patients and their families and how to convey empathy with each other. After a long day of didactics comprised of health care professionals from many countries, we would all eat together and then sing and dance. Through this, we learned the language of trust and love for each other. We learned that while we may have differences, we share far more in common.

Health professionals accustomed to expensive technological approaches to managing suffering have been surprised to learn how effective human contact and even prayer can be in countries poor in resources, where even opioids may not even be available for those facing cancer and end of life. We learned that when it comes to suffering, no one is a neutral bystander. Each of us has the ability to reduce or aggravate another's suffering.

To embrace MECC's mission of easing the suffering caused by cancer, one must recognize that suffering is a universal problem and that alleviating pain defines our humanity. We discovered that the power of science and medicine goes hand-in-hand with the power of compassion, expressed by words, touch, attitude, and through the eyes. MECC created a language of trust and knowledge among different people, cultures, and faiths. In addition, MECC ventured fearlessly into the hostile territories of prejudice, politics, and ideology, while developing a collective language of respect, dignity, and free dialogue amongst people and cultures. It has enabled clinicians to approach a worldwide crisis with a common language for overcoming political and cultural enmities.

Over time, those of us who participate in MECC have developed an even deeper language for communication among ourselves and with our patients. It is well-known that language constitutes much more than just the spoken word; facial expressions and body language often express a message contradictory to the one emerging from one's mouth. Thus, engaging in a common language also means partaking in the other's emotions. Cultivating compassion is an important coping mechanism used to deal with one's own misfortunes, as well as an opportunity to build allegiances based on mutual suffering. Thus, MECC promotes the ideal that any moment of suffering belongs to the whole of humanity, and as we allay other's suffering, we rescue ourselves in turn (Abu-Odah et al., Reference Abu-Odah, Molassiotis and Liu2020; Radbruch et al., Reference Radbruch, Knaul and de Lima2020).

MECC has thereby broken the iron walls of preconceived biases and intolerance and, in turn, created a landmark tapestry of cultural comprehension, acceptance, and mutuality of human care. MECC has taught the importance of compassion, empathy, and love for one another — all of these so important during a devastating world wide pandemic. During the pandemic, we have seen the conflict between our ideals of collective responsibility and a Western ethos of individual achievements and individual rights, an ethos that disregards societal and environmental considerations as inconsequential noise or collateral damage. Our experience with MECC has taught us that a first step to reconciling such irreconcilable value systems is the development of a common language through which we may communicate.

Conflict of interest

The authors state no conflicts of interest.

References

REFERENCES

Abu-Odah, H, Molassiotis, A and Liu, J (2020) Challenges on the provision of palliative care for patients with cancer in low- and middle-income countries: A systematic review of reviews. BMC Palliative Care. https://doi:10.1186/s12904-020-00558-5CrossRefGoogle ScholarPubMed
Knaul, FM, Farmer, PE, Krakauer, EL, et al. (2018) Alleviating the access abyss in palliative care and pain relief — An imperative of universal health coverage: The Lancet Commission report. Lancet 391, 13911454. Available at: http://www.thelancet.com/commissions/palliative-careCrossRefGoogle ScholarPubMed
Radbruch, L, Knaul, F, de Lima, L, et al. (2020) The key role of palliative care in response to the COVID-19 tsunami of suffering. Lancet. https://doi:10.1016/S0140-6736(20)30964-8.CrossRefGoogle ScholarPubMed
Silbermann, M, Khleif, AD and Balducci, L (2010) Healing by cancer. Journal of Clinical Oncology 28, 14361437.CrossRefGoogle ScholarPubMed
Silbermann, M, Khleif, A, Tuncer, M, et al. (2011) Can we overcome the effect of conflicts in rendering palliative care? Current Topics in Oncology 13, 302307.Google ScholarPubMed
Silbermann, M, Daher, M, Fahmi-Abdalla, R, et al. (2015) The Middle East Cancer Consortium promotes palliative care. Lancet 385, 16201621.CrossRefGoogle ScholarPubMed
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