Arts in Medicine programs at the University of Florida
Last night, as we neared Gainesville, Florida, the plane hit storm & lightening and our small aircraft was buckled about in the air. Hard to any distance out of the window – lots of dark mass, lights, houses….By the time I’ve made it out of the airport, found my lost luggage and been collected and brought “home” to my hostel, it is dark and late evening. Falling rain, gently cricketing, quiet, and very humid – a soft warmth – not quite sticky, but like in you’re in a constant spray of moist warmth. I sense, more than I see, lushness and foliage – excitingly for me, I see longs wisps of greenery dangling, out of tress, off, fences, even off the electric wires. (Today I learn this is the famous Spanish moss) I’m asleep within a short time.
Today is my first day of a three day site visit itinerary. I decide not to record, or take extensive notes, and allow myself to listen fully, and absorb fully. Always a bit anxious about the capacity of my brain to digest a lot of new information, I decide nevertheless to trust.
First off I meet Tina Mullen, the director of the Arts in Medicine program. She, and everyone else I meet throughout the day, is very warmly welcoming, treating all questions with full attention and respect, and is deeply passionate and enthusiastic about the work being done here at SHANDS hospital. The South Tower building Tina takes me through feels calm, vast, soft, clear – she has had a direct role in designing the feel of this hospital building – a newish space. The design is intended to provide clear, uncluttered and directional navigation, a calm and welcoming space, and a beautiful space.
Tina tells me that the palette is drawn from the rural landscape of this northern part of Florida – parkland, swamps, trees – browns, greens, and tan colours. The art on the wall is by well respected local artists, and depicts familiar places, or inspiring places. Staff orient themselves by the works of art – just follow past the blue painting. Amazingly, there is a grand piano in the foyer space. Windows are wall to wall, ceilings are high. There is much attention placed on detail. The stairs up to the next floor are lit up – like being in a Broadway show – I know, says Tina – I always feel I should be wearing a ball gown when I come up these… At the top of the stairs is the waiting room for families who are waiting for news from operating theatres. This is the “busiest” area – as in, there are several televisions on walls. But again – space, natural light comfortable sofas, and armchairs, there is little clutter on the walls – signs are minimal, clear, and beautifully framed. This is all deliberate. This is all about creating a beautiful and calm space that serves to instantly relax and welcome patients, family, and of course staff.
I am shown the chapel which isn’t called a chapel – can’t remember its name but its contains the word spiritual. Tina says it was built with the traditional western spiritual space in mind – an alter, pews, but there is also a much used corner for the Muslim community, with the cardinal potions etched into the ceiling. It is clear, clean, and simple – with a beautiful wooden alter. Next door is the meditation room – especially designed sofas and chairs for meditation, screens that have varying lengths of visual slideshows to aid different lengths of visualisation practice.
Upstairs in the newly designed wards, the attention to detail and simplicity and clarity continues. Again – huge windows, lovely floors. Each patients room has a soft light on the outside – a wall of patient rooms. On the other side are the staff offices and functional rooms – these are kept visually simple, so that attention and navigation is kept minimal and focused on the patients side of the corridor. There are no messy posters on the walls, no unnecessary bits of information – people don’t read those, Tina says matter of factly – when people arrive in pain, they don’t need to be informed about non smoking programs or any outreach programs – it’s too much information – that can all come later. In the first instance, they need to be welcomed, reassured, and they need to reach their doctor as easily as possible. This is an enchanting mixture of pragmatism and aesthetics. I love it.
When this relatively new building was built, the stairs connecting the floors were deliberately built into an outward projecting shaft, filled with windows, thereby encouraging staff to use the stairs, look out, enjoy the light and the view – promoting healthy options by making it more attractive, more beautiful. On every floor, every corridor ends with a large window, with a view. In the foyer of the children’s ward, the floor of the lift is a radiant blue with golden rabbits and the words – hop on! In the children’s hospital entrance there is a huge interactive screen where animals are animated when pressed. We watch a small boy, his mother, and maybe three staff laugh, and enjoy playing together.
At SHANDS the power of art to stimulate, to beautify , to calm and elevate the spirit is taken very seriously Whether people engage with art passively or actively – art is a conduit to communicate to people that their whole being and health is taken seriously here, that people’s wellbeing is valued. Tina says the question at the core of their attitude is how do the arts influence the space you are in and how does that calibrate to your well-being?
It works the other way round as well – by exhibiting art work that patients produce, their stories are valued, collected, and communicated to the wider hospital community. In a main hospital entrance there is a beautiful purpose built wall of tiles – each tile made by a different patient: Tina brings the wall alive by telling me some of the stories around the tiles. It is of course totally moving to hear these stories. On the children’s ward there are tiles on the ceiling painted in all sorts of ways by different children. Surprising, and magical. Just where you would want to put them.
Not all the buildings are new of of course – the majority of the hospital buildings are classic 50’s hospital building – little windows, narrow hallways…but even here, efforts are made. The children’s wing has received a face lift of brightly coloured window covers, so from a distance, it looks a fun, less scary place to travel to. Their foyer has been widened, opened up, and, again simplified, so the first thing in sight is a welcome desk, with an extremely warm and welcoming receptionist.
Interior design for construction and renovation is a key component of the Arts in Medicine Program – maintaining a beautiful and harmonious hospital environment. The effect can’t be quantified statistically, Tina explains, but at CEO level, good design is endorsed because people can just see and appreciate that it works. Health care in the States has recently shifted to placing much more importance on patient well-being and health prevention – keeping people well, keeping them out of hospital. Having a beautiful and of course functional space to show off is precisely the message the hospital wants to be giving out. Its suits them to direct a part of the hospital budget towards the arts in this way.
Later on the afternoon I meet with Tina again, with Jill Sonke – assistant director of the program – and they tell me that it wasn’t always like this. When the program began initially they would squat whichever space or cupboard they could find on any given day – find a space and do their activities as and when they could. For 14 years they operated from a ward side office, offered by a nurse manager. They explain that it has taken a lot of time, patience and perseverance to finally be able to create aesthetic and functional hospital spaces.
I am taken to meet Andrew Hix, an Integrative Medicine Practitioner. Now things are getting more complicated. A recent hospital development has been to introduce Integrative medicine practitioners – meaning people who work holistically with the body – yoga, massage, martial arts. Different from artists and art therapists, integrative practitioners are working as medical staff, and are perceived as making medical interventions. Their work can be prescribed by doctors – as a doctor would prescribe a medication – and their work is recorded as part f the clinical notes. I’m not quite sure I have this right, but by Thursday, I should do…
In any case, I meet Andrew, another warm and friendly person, who works on the children’s ward, and adult ward. He does Qi Gung, Tai Chi, breath work, visualisation and massage- sometimes a combination, sometimes just focusing on one element – with his patients – by their bedsides. Patients here all seem to have their own rooms – I can’t qute believe this is possible – the hospital has 800 beds – are they all individual rooms? I seem to recall Tinay saying some are double rooms; I certainly do not visit any open wards. This is relevant, because doing bedside work holds so much more possibility.
We spend a truly lovely bit of time with a young man with cystic fibrosis in his room. We are gowned, and masked to the max, to protect him from infection. Even so, we all move together – Andrew having invited the young man to teach me what he knew already…which he did very beautifully and expressively, and then gently we moved on to learning another aspect of tai chi. I notice that when we first got there, the young man launched into his symptoms, recent developments – it was all about his illness. After 20 minutes of moving, he was much calmer, his body was softer, less held and hunched. He told us the stories of his tattoos – a very different atmosphere from when we went in. Apparantly Andrew has seen him 4 times.
Over all Andrew has 28 hours at the hospital. His time is his own to schedule – he needs to deliver when doctors order his intervention – but he can shape how/when he does that- (within 72 hours though). He can be flexible on length of tme spent with a patient. Sometimes he moves through the ward, attending to lonely or bored children, sometimes he drums up enthusiasm for a group martial art session…Mostly he works one on one with people in their rooms.
Andrew’s role is identified as facilitating the following: stress reduction, anxiety reduction, enhanced coping (with hospital stay), relaxation, pain management, sensory/motor stimulation, and to support patient well-being. After the session, I certainly feel like a lot of those aspects on the list have been ticked for me.
I then meet Jenny Lee – we immediately fall into a stimulating and mutually enthusiastic conversation about dance and movement – she is a trained movement therapist, and loves many of the same practitioners and movement practices that I do – we have a delicious lunch together – both the food and the conversation. Impossible to do any of these practitioners justice in these posts – so I will simply outline the highlights of spending the afternoon with Jenny. Jenny by the way is part of the team that delivers clinical practice as part of the Arts in Medicine program – she also delivers for their educational arm housed at the UF Centre for Arts in Medicine – teaching and training graduate students. She is also involved in their research and outreach programs. Amazing work. Much food for thought.
But to remain focused on that afternoon…we visit two women in the ante-partum ward – women who are experiencing complications in the last stages of their pregnancies, and who have been ordered bed rest. So they are visited by the movement therapist. I love it. Jenny cautions that she avoids using the word dance – it can make people nervous she explains, and it can mislead. Really she feels she is providing the mothers -to-be with a tool that can help them relax, reduce their stress, and she wants it to be something they can use again and again. She wants to move with people, she wants people to say ‘Yes!” to her when she invites them to experience a movement session with her. She wants to introduce to people just how restorative movement can be, no matter what your condition maybe. Jenny believes that through the movement she can respond intuitively to peoples receptivity. She gives me her favourite, and beautiful quote:
“Where there is conscious movement there can be health” She wishes she knew who said that – when she read those word she knew that this was something she could devote her life to, something she could follow forever.
Jenny had already gone in the morning to visit numerous women, and invite them to move. She explained that the ward had an artist in residence doing a project there, who had previously introduced Jenny to the patients – that had been her way in….She returned in the afternoon, with me in tow, and with a phone to play music. As we approached the floor she was thinking through appropriate music – both the ladies we would be visiting were Chinese – and Jenny wanted to find something suitable and relevant, but not stereotypical.
We entered the first room, after a gentle knock on the door –
(This is something I notice happen repeatedly throughout the day – patients have their own rooms, with their own doors – all the staff knock and wait gently, before entering)
-we go into the room and the sound of the baby’s heartbeat audibly monitored fills the room. The woman looks tired, slightly washed out. She is alone at the moment. Jenny ask how she is, asks if she’s ready to move,and after conversation begins very gently and simply to invite the woman to focus on her breathing, to allow the out breath to deepen and lengthen. She brings in various body parts – the extremities, no core body movement -finger, hands, feet – opening and closing… she invites gentle movement and keeps smiling encouragement and praise. Within 15 minutes, again, like with Andrew’s session, we’re moving in synchrony and the quality in the room shifts. We are moving together, something is being explored together, attention is on moving. This woman clearly enjoys moving her hands, and spends time just playfully flexing, opening and closing her hands, tracing small movements in the air.
The session is brief, and to the point. Jenny reiterates that circulation and relaxation are really great tools, and this can be done any time that suits, and asks if she would like Jenny to return to do some more. Yes is the answer. With a smile.
The second session with a different patient is similarly simple, focused, brief, and to the point, and again, feels successful – it was enjoyed, this second lady’s husband joined in as well – moving synchronously and expiring freely create a different state of being in the room – there is laughter, and focus shifts into something more playful, into sensing the body more cohesively. She is expecting twins, and had had a particularly pain filled day yesterday – this session a welcomed diversion and moment of relief.