Are we hearing the cries for help? Are we really relieving the suffering caused by our “care”? This is a question I have been asking myself for several years now, after having done an elective 400 hour intensive clinical pastoral education unit at Albany Medical Center (AMC), a 600+ bed regional acute, primary, secondary, tertiary care teaching hospital in Albany, New York. For about four years now I have been tracking the Pastoral Care department there and, over that period, have been able to make some on-site, personal observations of the “pastoral care” being provided at AMC, and must report that, at best, the overall care was very disappointing.
If AMC is representative of the state of “pastoral care” in the Northeast or in the United States as a whole, what does that say about all those words and ink spilled in the scientific, clinical, and professional journals about “relief of suffering?” Is it all pablum-puking palaver from the top of the ivory towers? Wishful thinking? Are the chaplaincy organizations and “certifying bodies” simply self-serving special interest (their own) groups providing certificates for cash, and satisfying the paper-mill appetites of both consumers and human resources dullards? We want certificates not skills or competence? It would seem so from our observation point.
As an informal survey, we looked at the AMC pastoral care staff page on the AMC web site and reviewed the credentials of the people working in pastoral care at that hospital. Here’s what we found:
The travesty and biggest joke that healthcare facilities — I mean hospitals offering primary, secondary, tertiary, and the rarer quaternary care — and skilled nursing facilities, including those offering rehabilitation, are foisting on the paying pubic is that they offer what is commonly called “pastoral care,” a term eschewed by those of us who are really professional chaplains because “pastoral” is a hugely Christian term and serves to alienate non-Christian traditions. Fancy that! Far from appreciating what a real chaplain is, most of our healthcare organizations use a discriminatory term to describe the paltry spiritual support they think they provide, but in fact are not providing.
Most facilities rely on volunteer pastoral care, that is, local “visiting clergy” who drop in and wander around cold-calling (dropping in on patients or residents) or visiting their own church members. As for those that actually have a paid— and reimbursed chaplaincy program — the composition of that staff raises concerns about competency and bias. Seriously.
One regional medical center in Albany, New York, Albany Medical Center — the institution does a great deal of public relations and advertising and is more in the real estate business than healthcare — shows a staff of 14, including chaplain interns, chaplain residents, full- and part-time/on-call “chaplains”: Pastoral Care Manager Jake Marvel (personal acquaintance), is a Reformed Church of America (RCA) clergyperson. The RCA is a minor denomination, an offshoot of the Dutch Reformed Church, and Calvinist in its doctrines, rightist liberal Christianity in its leanings; Harlan Ratmeyer (persoanl acquaintance), is director of a chaplain training program, a RCA minister, in his late 70’s and beyond retirement; biased and distracted. Staff Chaplain Yervant Kutchukian, is an Armenian Orthodox, with apparently various contemplative interests. Pastoral Care department secretary, Elizabeth Hall, is Roman Catholic, but doesn’t work as a pastoral care provider despite having several units of chaplain training — most of which was apparently acquired by sitting behind her desk. Aloysius Kabunga is a native of Uganda, Black African, with some seminary training and an eclectic educational background but no stated faith tradition (do we assume he’s some sort of Christian adherent?). Valerie Cox, female, another African American on staff, is an “ordained” Baptist minister with a degree from a “bible institute,” whatever that means. Kabanga Boswami — NO! I didn’t make that up — is yet another Black African on staff, from the Democratic Republic of Congo, has degrees in business admin, computer science and divinity. Marjorie S McCoy, female, Buddhist adherent to an American Buddhist tradition, has a B.A. in comparative religions, worked as attorney for 23 years, was a hospice volunteer for six years, and is now an intern in chaplaincy — this means she’s out there on the floors at AMC with little or no training. YA is a staff chaplain but I can’t make out his actual credentials from his blurb. Mary C. Craven, white female, has some credentials and 9 units of clinical pastoral education at AMC (she’s Roman Catholic by tradition). Two Roman Catholic priests serve as chaplains at AMC Kenneth Gregory and Robert DeLeon, enough said. A rabbi and an imam serve the Jewish and Muslim traditions at AMC but are not “staff” in that they are on-call, for their own people. At AMC, the Roman Catholic chaplains serve on an alternating day schedule; I have experienced situations at AMC when neither RC chaplain was available. Naturally, the on-call rabbi and imam restrict their care to their faith tradition. So that’s 4 chaplains out of the total of 14 that serve their specific faith groups: Roman Catholicism, Judaism, Islam. Two part-time chaplains, one cultural Pakistani male, Younas Azad (personal knowledge) and one elderly white female, M. Craven (personal knowledge). That leaves 4 “chaplain residents” who are still in training, under the supervision of HR, and four “full-time” staff. Of the four “chaplain residents” 2 are black African males, unknown traditions, and one is an African American female, Baptist tradition. The remaining chaplain-in-training is a white female, Buddhist, with a law background who served as a hospice volunteer. The remainder of the AMC pastoral care “full-time” staff includes two RCA ministers who are PC manager and director, and a secretary.
It needs to be said that the information provided above is publicly available at Meet the Staff and is not provided as a statement of competence or as an assessment of effectiveness of the individuals or of the department as a whole. I’m presenting it as an example of what a 600-bed regional acute, primary, secondary and tertiary care, trauma center, teaching hospital provides by way of spriritual care. Now, I have to ask my readers, given the composition of the PC staff — excluding the secretary, the part-timers, and the rabbi, imam and Catholic priests, who obviously see their own people, What do you think of the composition of the Albany Medical Center “pastoral care” staff? Presuming Albany Medical Center is a fair representation of the state of pastoral care in most similar institutions, What do you think of the likely cultural competency of the staff? Think of it this way, if you were an 84-year old white female, How open or vulnerable would you feel if one of the resident chaplains paid you a visit? How well served do you think the mainline traditions are served by the composition of the AMC pastoral care staff? Finally, do what I did and visit the site and ask yourself the question, “How well served are the some 600+ patients of AMC by this handful of questionably trained pastoral care providers?”
We chose Albany Medical Center because of its size, the extent of its services, its PR/advertising claims, and because we have personal knowledge about and experience with that institution. A simple online investigation of most of the other major hospitals in the Albany, New York, area, including Schenectady and Rensselaer counties, doesn’t provide much satisfaction. Most simply describe a vague “spiritual care” or “pastoral care” entity but not much more. None provide a staff page, which indicates quite clearly to us that they have none and that all of their pastoral care activity is provided by volunteer (= untrained, non-professionals), ancient RC nuns (that’s all that’s left), or “visiting clergy.” Point made. How is it that these so-called healthcare providers get away with not providing total healthcare?
Our conclusion is obvious: Our healthcare institutions — and we include here most hospitals, nursing homes, rehabilitation facilities, etc. — do not provide competent spiritual care for patients, residents and clients. These institutions donot provide “care” but provide only “procedures.” They operate almost exclusively on the biomedical model which has been around for more than 100 years unchanged, and is based on the body-mind duality espoused by Descartes, the so-called Cartesian duality, in which healthcare treats physical complaints, everything else is in the “spiritual” realm. In other words, our healthcare institutions treat the disease (the physical manifestations) not the illness, not the person. The treatment received in our healthcare institutions is procedural in nature and the very procedures done as treatment are the source of significant suffering, to which our “care” providers are either indifferent or of which they are ignorant.
Considering that the region we are considering, the Capital District in New York State, a region comprising the counties of Albany, Rensselaer, Schenectady, parts of Greene County, and other areas, we are talking about at least 28 hospitals and 56 nursing homes/rehabilitation facilities. The question we should be asking ourselves is not what kind of care is, rather what procedures are done, but how much suffering those environments and procedures are causing, and what is being done to relive the total suffering of the patients, residents, and clients?
Please leave us a comment but please be specific and focus on the questions we’ve posed above. We’ve tried to be non-judgmental in presenting the facts; all we ask is for your honest opinion about the pastoral care situation at this regional 600+ bed teaching hospital.