Death in the African-American Community

Among the 105 nurses graduating with master's degrees from the Duke University School of Nursing May 12, 13 were the first to complete the school's innovative Partnerships for Training (PFT) program.

Students enrolled in PFT program pursue their educations through flexible distance-education methods, including online courses, online testing, electronic discussion forums, hands-on lab sessions and clinical rotations within their communities. The program allows nurses in medically underserved communities to become advanced practice providers while remaining in their home communities.

"When we began planning for this program, we knew we could have an impact on the problem of health care delivery in medically underserved areas," said Duke School of Nursing Dean Mary T. Champagne. "We're excited to see this program graduate its first students and we're pleased there are 24 more now working toward their master's degrees as part of the program's second class. The Duke School of Nursing is committed to finding ways to improve access to health care for all people, and the Partnerships for Training program demonstrates that a little innovation can go a long way."

PFT is funded by the Robert Wood Johnson Foundation, The Duke Endowment and the North Carolina Area Health Education Center (AHEC), and is conducted in partnership with the East Carolina University Schools of Nursing and Allied Health. The 13 new Family Nurse Practitioners (FNPs) began their course work in 1998 and 12 received Master of Science in nursing degrees, and one received a post-master's certificate.

Death and dying has been a fundamentally different experience for African Americans over the past century than for whites or members of other ethnic groups in the United States, according to Karla F.C. Holloway, dean of the humanities and social sciences at Duke University.

That experience, all too often marked by inadequate health care and violence, has in turn shaped a very different perspective about suffering, care and mourning. Holloway says understanding these differences will be essential to improving end-of-life care, both for African Americans and for all people.

Holloway, who is William R. Kenan Jr. Professor of English and African-American Literature, will be a featured speaker May 24 at "Crossing Over Jordan: African Americans and Care at the End of Life," the second annual symposium of the Duke Institute on Care at the End of Life. "Crossing Over Jordan" will examine end-of-life care in the African-American community from a variety of perspectives, including medicine, the humanities and theology.

Holloway will open the daylong conference with a cultural and historical look at bereavement, death, dying and burial in black America in the 20th century. Entitled "My Memory Stammers, but My Soul is a Witness," Holloway's presentation will draw heavily from her new book, Passed On: African-American Mourning Stories, now in press.

Other featured speakers are:

--Dr. Richard Payne, chief of the Pain and Palliative Care Service and Anne Burnett Tandy Professor of Neurology at Memorial Sloan-Kettering Cancer Center in New York, who will discuss racial and cultural differences in health outcomes and attitudes toward end-of-life care; and

--The Rev. William C. Turner Jr., associate professor of the practice of homiletics at Duke Divinity School, who will give a theological perspective on the African-American community and care at the end of life, focusing particularly on the role of the African-American church.

Established in January 2000, the Duke Institute on Care at the End of Life is an interdisciplinary program that brings together scholars from throughout Duke and partnering institutions to conduct research, educational initiatives and public outreach aimed at improving care for the suffering and dying.

"For this symposium, we wanted to bring together leading individuals from very different fields to talk about end-of-life care in the African-American community," said Dr. Keith Meador, director of the Institute.

Meador said the conference will address not only the challenges that African Americans face in improving care for the dying, but also the gifts and strengths that this particular ethnic community brings to the task of caring for one another at the end of life.

"We're going to talk not only about how race affects decisions about end-of-life care, but also about what we can all learn from the African-American community's rich heritage surrounding death and dying," he said.

In writing her new book, Holloway conducted extensive research into African-American death, burial and mourning practices, both in libraries and in the field. As part of her research, she interviewed black funeral home directors, attended their annual trade meetings, and visited the grave sites of famous African Americans, such as singer Billie Holliday, jazz legend Louis Armstrong and author Richard Wright.

Holloway readily admits that such interests, at least initially, may seem odd for an English professor. What draws her to the subject is a deep appreciation of and respect for "narrative."

"If those moments of death and dying -- both the outer contexts of care and the inner realms of

spirit -- are not narratively engaged, then we risk sculpting these ends of days to meet our own focused understandings," she said. "I want to engage and explore a fuller story about death and dying, and the context of culture is one way to that story."

Over the past century, Holloway said, the African-American narrative of death and dying has been marked more than that of other communities by violence -- whether through lynchings early in the century, police shootings, or, more recently, retaliatory killings by warring gang members. At the same time, she said, the African-American narrative of death and dying has also been a story of great communal strengths that have been embodied in extraordinary practices of shared suffering and deeply held obligations of mutual care.

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For more information about the "Crossing Over Jordan" symposium, call the Institute office at 660-3553. The symposium will be held in Griffith Film Theater in the Bryan Center. Registration is $35.

Tom Bacon, North Carolina AHEC director, said he is proud of the program. "We've been extremely pleased with the success of the PFT program because it gives nurses in underserved areas access to graduate degrees. Nurses remain in their home communities and are able to provide health care even as they complete the program. These things are very important to us."

PFT students make a commitment to continue practicing in medically underserved parts of the state.

Said graduating FNP Diann Beane of Laurinburg: "This community includes a diverse mix of people, and my advanced practice training will make a real difference in their lives."

Five N.C. hospital partners provide support to the PFT program. Sampson Regional Medical Center in Clinton, Southeastern Regional Medical Center in Lumberton, Carteret County General Hospital in Morehead City, Chowan Hospital in Edenton and Martin General Hospital in Williamston donated student scholarships, meeting room space and back-up computer equipment for students.