Arts in Medicine
So much to say about the last two days. I have met wonderful arts practitioners, wonderful leaders, and wonderful patients. Not wanting to only reach for superlatives, but it truly has felt a special experience to witness an arts program that has been working for over 20 years, and that continues to develop an authentic and honest relationship with the hospital that houses it, that maintains and develops an international, national and local network, that supports and trusts its staff, and of course that welcomes visitors like myself so warmly and openly.
By the third day I feel I could easily slip into staying on here for much longer, and take time to shadow each of the practitioners, and spend more time understanding the finer details of the complications in medicalising arts in healthcare, and liberating medical practice through the arts. Equally I feel that three days has been ample; my itinerary has been thorough, and I have a pretty good sense of the program, and now need to go away and digest and absorb. So, all in all, a good place to finish I think.
I have asked many questions, heard many stories, and am already borrowing concepts and ideas that felt good and right. My positive experience has been underpinned by the grand warmth the Gainseville residents in general – southern hospitality I keep being told, as if that explains it all, but it feels so good to experience the degree of friendliness, politeness and well-being that I see all around me. Simple example – each time I get into a hospital lift with other people, I notice they greet one another, ask how they are, check in, and of course wish them a good day, afternoon, morning…The bus ride into the hospital is like sitting in a community centre – recipe swopping, checking in on who’s having what for dinner, how are the kids…and so on and so forth. Really nice. Walking to someone’s house yesterday, I had strangers waving to me from their porches as I strode by (I was late), cyclists stopping to ask if I needed help ( I was peering about rather vacantly) and even a car stop and give me definitive directions Could be I looked a fish out of water, and they were curious – but such friendly curiosity.
All the patients I met extended that courteous curiosity as well – taking time to ask me about myself, ask how I was doing, ask about the project…wishing me a safe onwards journey and back home too.
The last two days have been an opportunity to follow the different practitioners as they do their rounds, and experience a little bit of the teaching program Jill Sonke runs, and a little bit of the outreach work.
Small bits of information to provide context:
There are both artists and arts therapists on the program. Just about all are contracted – delivering different hours – and covering their own insurance. Artists are billed as artist-in-residence. There are visual arts, music, words, movement, dance and then in a slightly different context, yoga, qi-gong, tai chi, breath work, mindfulness, and massage.
A recent development in this long standing program has been a need to clarify how artists deliver patient health outcomes – which patients they work with, how they understand their medical needs, how they make their interventions and what outcomes are desired, maybe even required. It was felt by hospital management that certification was necessary to ensure an artist be skilled and knowledgeable enough to work with patients in clinical settings where specific outcomes were desired. Because of the changing medical climate generally – with governmental initiatives’ growing emphasis on patients experiencing high level of care in hospital, care that ensures they do not suffer any setbacks during their hospital stay (falls, bed sores, infections) and care that ensures patients remain out of hospital for a significant amount of time after they leave – there has been a shift in how artists engage with patients.
A striking result of this new initiative is that dance can no longer happen in the hospital. Dance therapists can work with patients, but dancers cannot. Dance is deemed to be too risky. Rather than waste time mourning this setback, Jill Sonke and colleagues across the USA have been finding ways for dancers, and of course all artists to increase their skills and knowledge levels with courses that specifically address arts in medicine, and soon all artists will need to have received this certification before they can work in the hospital environment. I am not entirely sure if this guarantees that dancers will be able to rerun to the hospital curriculum. And I wasn’t quite sure how ready this new certification program was.
One way this initiative has been managed at Shands, has been to set up an affiliated but separate programme called Integrative Medicine. As an integrative medical practitioner, you have access (limited) to patients notes, you are required to write up notes, you are directly requested to deliver services (they call it ‘orders’ here). So, a doctor will order massage for a patient – because they are stressed, and not coping well with their hospital stay. A nurse might order a session of art therapy, or a session of Tai Chi to facilitate relaxation and breathing. (I’ still not quite clear under which umbrella the movement therapy happens – but we certainly spent time in hospital rooms, delivering movement sessions)
The idea behind ordering these activities for a patient is that they should enhance the patents hospital stay – encourage their well-being, facilitate holistic health care, and provide the patient with increased skills for making heathy choices and encouraging positive engagement in their own health care. If a patient does not respond well to the interventions of the integrative medical practitioner or art theorist, they are taken off the list. There is such demand for these interventions, and no money to employ new practitioners, that time and interventions are managed judiciously. The Integrative Medicine programme was funded by a private doner – for three years – and it is explained to me that he expects to see the money used wisely, and put to good effect. A complicated situation.
Of course, I feel its tragic to not have dancers practicing in the hospital, and I suspect maybe my feelings are shared by some, but it is explained to me that this is a necessary precaution, and an understandable one, and that ways will be found to bring dance back.
The reservations do not apply to outreach programmes, and to research programmes.