Maskarinec Gregory G, Yalmadau Kelly, Maluchmai Maryann R, Tun Petra, Yinnifel Cyril, Hancock W Thane
Department of Family Medicine and Community Health, University of Hawai‘i at Manoa, John A. Burns School of Medicine; 95-390 Kuahelani Avenue, Mililani, HI 96789-1192, USA.
Hawaii Med J. 2011 Nov;70(11 Suppl 2):27-30.
Death remains one of the most important and significant activities in Yap, an event that involves the entire island. A death of a Yapese not only unites the family, it initiates a complex series of reaffirmed kinship ties, rituals and exchanges that refocus the entire community and create new social identities for the participants. How these ties, exchanges, and identities are changing due to new economic challenges and new social pressures were the focus of this preliminary study, which sought to document the resiliency or fragility of traditional structures, measured in the efforts around death and dying in Yap and to identify ways that the health care system can intervene to improve palliative care.
226 persons (49 on Wa'ab--Yap Proper--and 177 on the Outer Islands) participated in 16 focus groups, of which eight were on Wa'ab and eight on four Outer Islands: Fais, Falalop, Fetherai, and Mogmog. We additionally conducted 6 semi-structured open-ended key informant interviews, added to capture more of Yap's enormous sociocultural diversity.
The islands of Yap, particularly the Outer Islands, continue to support one of the world's best traditional palliative care involving the immediate family, more distant relatives and in many cases the entire community. However, participants showed considerable concern for ways that this system is weakening and offered numerous suggestions for improving and strengthening palliative care in Yap.
Although caution must be exercised not to undermine the existing system, six recommendations on how the health system can intervene can be identified. These involve identifying a key resource person on each island; supplying small, practical "comfort care" kits; making more pain medication available; conducting regular home visits; improving patient-physician and physician-family communication; designing a suicide intervention strategy; and documenting existing variations of how the dying are cared for on the other Outer Islands of Yap.
在雅浦岛，死亡仍然是最重要且意义重大的事件之一，这是一个涉及全岛的活动。雅浦人的死亡不仅使家人团聚，还引发了一系列复杂的亲属关系重新确认、仪式和交流活动，这些活动使整个社区重新凝聚，并为参与者创造了新的社会身份。由于新的经济挑战和社会压力，这些关系、交流和身份正在发生怎样的变化，是这项初步研究的重点。该研究旨在记录传统结构的韧性或脆弱性，衡量标准是围绕雅浦岛死亡和临终的各项努力，并确定医疗保健系统可以采取哪些干预措施来改善姑息治疗。
226人（49人来自瓦阿普岛——雅浦岛主岛——以及177人来自外岛）参与了16个焦点小组，其中8个在瓦阿普岛，8个在外岛的四个岛屿：法伊斯岛、法拉洛普岛、费瑟莱岛和莫莫格岛。我们还进行了6次半结构化开放式关键信息人访谈，以进一步捕捉雅浦岛巨大的社会文化多样性。
雅浦岛，尤其是外岛，仍然维持着世界上最好的传统姑息治疗体系之一，涉及直系亲属、远房亲戚，在许多情况下还包括整个社区。然而，参与者对该体系的弱化方式表现出相当大的担忧，并提出了许多改善和加强雅浦岛姑息治疗的建议。
尽管必须谨慎行事，以免破坏现有体系，但可以确定医疗系统可以采取的六项干预建议。这些建议包括在每个岛屿确定一名关键资源人员；提供小型实用的“舒适护理”包；提供更多止痛药物；定期进行家访；改善患者与医生以及医生与家属之间的沟通；设计自杀干预策略；记录雅浦岛其他外岛照顾临终者的现有差异。
