‘Enlightened’ and ‘primitive’: how can Achebe’s ‘Things Fall Apart’ inform global palliative care implementation?

Each year, nearly 60 million people need palliative care to relieve suffering associated with serious illness or trauma, yet it is rarely accessible in low-income and middle-income countries (LMICs). Thus, implementation of palliative care in LMICs is both imperative and urgent. But the assumption that palliative care as practised in Western countries is the only ‘enlightened’ way to care for the seriously ill risks bad consequences. Chinua Achebe’s novel Things Fall Apart depicts the harm that results when one culture arrogantly imposes itself on another, although with best intentions. The novel therefore can serve as a guide to culturally sensitive implementation of palliative care in non-Western cultures. While universal access to Western scientific medicine for relief of pain and other types of physical and psychological suffering is imperative, it must be recognised that scientific medicine is itself a culture and that there are fundamental differences between cultures in the meanings of health and healthcare, illness and suffering and death and afterlife. Optimum palliative care requires the recognition that people often think and suffer differently in different cultural and socioeconomic contexts. It requires the tolerance of and openness to others that is missing from the colonisers in Achebe’s novel but found in the colonised.