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Death is inevitable but it does not mean we should not celebrate life: a reflection of the Before I Die wall in Bangladesh

Author: Rifat Akhter, PhD Associate Professor, Department of Sociology, University of Central Arkansas, USA; and Trustee, Aastha Hospice; and Dr Shahinur Kabir, Palliative Physician and Founding Director, Hospice Bangladesh
26 October 2017

This year’s World Hospice and Palliative Care Day theme was: ‘Universal Health Coverage and Palliative Care – Don’t leave those suffering behind’. It focused on the critical issue of access to palliative care, including pain management, as part of Universal Health Coverage worldwide.

Hospice Bangladesh along with Aastha, Telecare and Dhaka Medical College celebrated the day by introducing the global participatory public art project: ‘Before I Die’ on the Medical College campus, where people expressed their aspirations in life, something they want to fulfill before they die.  

The wall is a movement that opens the conversation about death and encourages people to start important healthcare conversations before they become urgent.

As many who wrote on the wall expressed, they want a cancer free life, a healthy life, and a disease free life before they die.

However, with the growing aging population and increase in life threatening diseases like cancer, dementia, kidney failure, cardiovascular disease and stroke, we need to talk openly about healthcare options, including palliative and hospice care.

The majority of people in Bangladesh do not know what palliative care and hospice care are. The Before I Die wall organised by Aastha and Hospice Bangladesh has created an atmosphere where discussions of hospice care and death become easier.

There are 2,000 ‘Before I Die’ walls created in 70 countries in 35 languages where people all over the world are sharing their perspective on death and life.

This year Bangladesh joined the league, providing a space for participants to express their wishes of thinking of others' well-being, coming to terms with who they are, to be confident about themselves, to love and be loved, to explore their spirituality through travelling places, helping others, taking care of their family and many more.

Participants belonged to all age groups. Even children of six to seven years old wrote on the wall. While the majority of the participants were medical students, since the installation was at Dhaka Medical College, there were people from all walks of life participating.

We were looking forward to finding out what people would express on the board, as talking about wishes before death is a taboo in Bangladesh and even those who do, most of the time they express spiritual aspects of wishes.

So we decided to do a short analysis of the writings. The following are examples of themes that emerged: establishing a palliative care unit and other medical services in the community, travelling around the world, doing good for others, love and loving, and focusing on spiritual aspects of life.

It is inspiring to see that more than fifty percent expressed their interest to see universal palliative care in hospitals, serve the patients selflessly, and serve the poor.

Some mentioned “Before I die I wish to establish Pediatric ICU in the hospital”, while others wrote “I wish to establish a home with special care for disabled people” and “I wish to do something for impoverished people”. 

These wishes reflect that many young people have an altruistic mind. French Sociologist Emile Durkheim argued that when young people describe acts of altruism it indicates they are ready to do good for the society.

From the writings it is apparent that the young medical students are ready to embrace any approach that will bring quality of life for them and others in the society.

What surprised us were the really powerful messages that people put up about how they see the world, which were touching, heartbreaking and sweet. 

Many wrote that their wishes are to travel around the world. Some wanted to see all the beautiful places of the world. Some were very specific, such as “I wish to visit Barcelona.”

Some even wanted their parents to be part of their travelling around the globe. Some girls expressed their intent to be empowered in many different ways, one wrote: “I wish to complete the medical degree and want to make my parents proud.”

Two other wishes that touched our hearts are: “Before I die I want to be a strong woman,” “Before I die I want to live my life to the fullest,” and: “Before I die I want to live again.”

There are desires, pains and hope expressed through these statements. Some highlighted their spirituality by writing: “I wish to remember God till death.” Some wanted to meet Lionel Messi and Novak Djokovic. One wrote “Before I die I want to meet my uncle (Kaka).”

The desires, wishes and dreams that came out writing on chalkboard is something very fundamental and simple, something that came straight from the heart.

To us that is hope. One aspect of human being is to be a dreamer. We think all these dreams that are shared in public take us to a point where we all realise that death is inevitable but that does not mean we should not celebrate life. 

Find out more about Hospice Bangladesh and Aastha - Community Hospice Palliative Care online. 

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