The restorative power of hospital gardens

Florence Nightingale asserted in her landmark “Notes on Nursing” that the most challenging ordeal for a feverish patient is:

“not being able to see out of window, and the knots in the wood being the only view.  I shall never forget the rapture of fever patients over a bunch of bright-coloured flowers”.

In 1859, she was emphasizing the value of plants and space in the healing of patients:

“People say the effect is only on the mind. It is no such thing. The effect is on the body too”.

Nightingale was not alone in her appraisal of gardens and green spaces as therapeutic tools which were indispensable in the recovery process. Throughout Victorian and Edwardian periods, green spaces in hospitals were championed as havens for healing.  In the succeeding decades, this notion appears to have been forgotten as priorities in hospital construction were directed elsewhere, with little attention given to green spaces, and the replacement of park areas by car park areas.

Perhaps a renaissance was provoked following a 1984 study by American psychologist Roger Ulrich, who demonstrated that patients with views of trees and animals from their wards recovered faster after gallbladder surgery, and spent less time in hospital than those who had no such views.  In the UK, we are in the midst of re-appraising the role of gardens and green spaces, not just for patients but for staff and visitors as well.  The British Medical Association stressed in 2011 that hospital design should always make allowances for the important therapeutic role of gardens.

The Ninewells Community Garden isn’t just a space for rest and relaxation, but also provides a source of community spirit amongst volunteers, be they patients, staff or visitors. Credit: Ninewells Hospital Dundee

Remembering the history of these beautiful spaces, including the unique roles of specific colours and scents in therapy, helps guide the design of future hospital green spaces. In her book “Therapeutic Landscapes”, medical historian Dr Clare Hickman summarises how importantly hospital gardens were regarded, and the plans for new well-designed green spaces in the future, for example the upcoming Horatio’s Garden at Stoke Mandeville Hospital in Aylesbury.  

Painting classes at Horatio’s Garden with artist-in-residence Miranda Creswell. Credit: Horatio’s Garden, Salisbury

Whether they deliver a natural and calming scene from a patient’s bed, an accessible treat for the senses of a waiting visitor, or some relaxation, freedom and privacy for a staff nurse away from the wards, these spaces are once again being seen as crucial for health and wellbeing.   It is no surprise that a reclaimed boiler-house roof, now showpiece garden at Great Ormond Street Hospital designed by Chris Beardshaw, won a Gold Medal at last year’s RHS Chelsea Flower Show.

Hospital gardens need not be highly conceptualized spaces occupied by incongruous abstract sculptures and with little space to walk.  They can be triumphs if they are peaceful, interesting, accessible, well-maintained and engage the senses (though not too strongly).  Here are some beautiful, functional and peaceful hospital gardens across the UK.

                      Ten Hospital Gardens around the United Kingdom

The Morgan Stanley Garden for Great Ormond Street Hospital

The Morgan Stanley Garden for Great Ormond Street Hospital. Credit: JOHN CAMPBELL

Constructed by renowned garden designer Chris Beardshaw, this woodland-themed garden was transplanted from the RHS Chelsea Flower Show (where it won a Gold medal) to a disused roof space, surrounded by tall hospital buildings that look onto it.  The garden provides a quiet and peaceful space for childern and families, with a roof designed such that summer mornings will light up the sculpture of a child which is the centrepiece of the garden.

Horatio’s Garden at Salisbury District Hospital

A path for the senses at Horatio’s Garden, Salisbury. Credit: HORATIO’S GARDEN

Horatio’s Garden is a charity which makes gardens of sanctuary in centres for spinal injury. The gardens are named after Horatio Chapple, who came up with the idea alongside his father whilst volunteering in Salisbury. Horatio was tragically killed aged only 17, but his legacy endures in these beautiful gardens which combine a sensory and aesthetic feast with events and activities. For example, painting the scenic garden with artist-in-residence Miranda Creswell at Salisbury Hospital adds the extra element of creative and expressive arts therapy for patients suffering from spinal injuries.

Ninewells Community Garden, Dundee

A community spirit in action. Credit: NINEWELLS HOSPITAL

This huge community garden is overlooked by the Ninewells Hospital, and emphasizes a spirit of volunteer gardening for patients, staff and the local community.  The garden’s vegetable and sensory gardens, orchard, wildlife habitat and play areas offer a multitude of options for people to de-stress, recuperate and exercise. 

John Radcliffe Hospital Women’s Centre Garden, Oxford

Credit: John Radcliffe Hospital Women’s Centre Garden, Oxford

This discarded area adjacent to the Women’s Centre was transformed into an open space with a compact walking area and two subtle sculptures in the centre. Instead of the previous drab view in front of the building, the colourful array of flowers and scents of thyme and lavender provide a welcome area for female patients and staff to relax during the course of the day.

Horatio’s Garden at the Scottish National Spinal Injuries Unit, Glasgow

Credit: Horatio’s Garden, Glasgow

The second Horatio’s Garden on this list was inaugurated in August 2016, with views of the stunning woodland garden (above) from the hospital wards.  The garden has six distinct spaces, all of which serve to stimulate different senses, and a greenhouse which is surrounded by areas used for horticultural therapy activities.

Chase Farm Hospital Rehabilitation Gardens, Enfield

Credit: Chase Farm Hospital

Chase Farm Hospital has just renovated two of its areas into specialist therapeutic gardens aimed for the specific needs of patients, but open to staff and visitors. One of the gardens supports dementia patients, whilst the other (above) support stroke and rehabilitation patients. Based on a Japanese design, it provides a very compact but tranquil sanctuary within the hospital.

Guy’s Hospital Courtyard Garden, London

Credit: Guy’s Hospital, London

The contemporary feel of the courtyard garden at Guy’s Hospital in London is accentuated by the number of sitting areas amidst the shrubs and hedges, with the vindicated expectation that the garden was designed that the garden would become a preferred spot for having lunch or sitting with family outside the wards.

Bournemouth Hospital Orchard Garden, Bournemouth

A desolate tarmac courtyard in the hospital has only recently been revamped into a three-segmented garden: a therapeutic courtyard garden outside the chemotherapy suite (above), a sensory garden linking the courtyard to a lakeside garden, giving patients and visitors not only options for their retreat of choice, but also a large area to walk around and exercise in.

Chapel Garden, Norfolk and Norwich University Hospital, Norwich

A bland lightwell was transformed into this chapel garden, featuring a central “wish tree” and a number of water features such as a vertical water fountain and a water rill giving the impression of water moving continually throughout the garden.  The calming flow of water and illusion of space allow for, once again, a small and previously unused area becoming a peaceful reservation amidst the hospital.

Dick Vet Hospital Gardens, University of Edinburgh

Credit: University of Edinburgh

Animals, animal-owners and animal-lovers should not be excluded from the healing power of gardens.  This luscious retreat at the University of Edinburgh’s Easter Bush Campus provides ample space and quiet, together with several benches. It is capped off by the Path of Memories, a path lined by granite stones which can be engraved with an animal’s name.

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[MUST READ] Coca-Cola’s secret influence on medical and science journalists

Please read this article from the British Medical Journal: http://www.bmj.com/content/357/bmj.j1638

 

This is a very important argument, and it is essential for healthcare professionals, journalists and politicians alike to make a concerted and aggressive effort to kick these sugar-peddling companies out of the sphere of academic influence.

The more overt “More Doctors smoke…” advertisements of yesteryear are thankfully a thing of the past, but the covert influence of sugar-saturated food companies is no less a threat to our health. Aaron and Siegel (1) report that from 2011 to 2015, the Coca-Cola Company and PepsiCo were found to sponsor 95 national health organizations, many medical and public health institutions amongst them. They also lobbied against 29 public health bills intended to reduce soda consumption or improve nutrition.

The British Nutrition Foundation, for example, lists amongst “Sustaining Members” Coca-Cola, PepsiCo, Kellogg, Nestle, Tate & Lyle and has “Corporate Members” British Sugar plc, Mars UK, KP Snacks, McDonalds, United Biscuits, Weetabix, Ocean Spray and many more. Although it is open to companies and corporations from a variety of backgrounds including healthcare and fitness, the actual members who have provided support read as a Who’s Who of Sugar Salesmen (2), making their promise of a “a focus on objective nutrition science interpretation and delivery” open to scrutiny. The American Society for Nutrition is no different, with an almost-identical list of names cropping up (3) for this group, which publishes the Journal of Nutrition.

Indeed, the editorial boards of top nutrition journals are littered by corporate affiliations with sweetie companies – The American Journal of Clinical Nutrition, for example, lists the likes of Mars, Coca-Cola, PepsiCo, Nestle, McDonald’s  and Ferrero amongst companies who have a relationship with members of their board (4). The ambassador’s reception may also be overflowing with hazelnut-and-wafer spherical treats at many other nutrition journals, who often  home of the Journal of Nutrition Education and Behavior, who have eight “corporate patron friends” and four “corporate sustaining friends.  (5)

It would be interesting to note how these journals consider submissions which report a detriment to health from these companies’ products, but when some of the largest nutrition journals display such a conflict of interest it must become clear to all that the Honey Pot relationship between “Big Food” and academia is poisonous and needs to be dealt with.

References:

(1) Sponsorship of National Health Organizations by Two Major Soda Companies. Aaron, Daniel G. et al. American Journal of Preventive Medicine , Volume 52 , Issue 1 , 20 – 30

(2) “Member Organisations – British Nutrition Foundation”. Nutrition.org.uk. N.p., 2017. Web. 10 Apr. 2017.

(3) “American Society For Nutrition – Our Sustaining Partners”. Nutrition.org. N.p., 2017. Web. 10 Apr. 2017.

(4) AJCN Editor Conflict of Interest Statement. (2017). Ajcn.nutrition.org. http://ajcn.nutrition.org/site/misc/EditorCOI.xhtml Web, 10 April. 2017.

(5) Nestle, Marion. Food Politics. 1st ed. Berkeley, Calif.: University of California Press, 2013. P112. Print.

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Dying with Indignity in Iran

Published on: https://iranwire.com/en/blogs/693/4344

In this guest blog, Dr Nima Ghadiri describes the harrowing experience of the end-of-life care his grandmother received in an Iranian hospital, and the betrayal of the principles of bioethics, which were first identified many centuries ago by Iranian polymaths, including Avicenna and Razi.

Avicenna (left) and Razi (right), Persian physicians and polymaths who helped define the principles of bioethics, used by healthcare professionals to this day

My beloved grandmother and closest friend Batool Sepassi died in an Iranian Hospital ICU (Intensive Care Unit) following a short illness.

During the course of a viral illness, she became increasingly short of breath and had to be admitted to a local private hospital. She had a chest infection and was taken to the intensive care unit accompanied by close family. At this point the family had separated to go to the payment desk, and my grandmother was taken to ICU, though no medical history was taken nor treatment started until payment was organized (the privilege of private healthcare).

There were some major flaws in treatment. Having been admitted with a chest problem, it took 30 hours for a chest consultant to see my grandmother, though not without a battle — we were told “this patient is not on my list” — and a serviceable X-ray was only taken the following day.

My family was only allowed an hour a day to visit my grandmother, which was extremely hard given that she thrived on closeness to family and friends. My close relatives stayed outside all day the ICU to be able to glance at my grandmother from a distance and hear her calling out for them. This was a traumatic experience, particularly when they heard the expressions “Saaket” or “Khafeh Sho” (“Shut up”) from my grandmother when she was undergoing procedures. My grandmother loved to communicate and form bonds with people, and appreciated having her close ones hold her hand during medical procedures. During all of her stay, her arm was outstretched to hold someone’s hand, but there was no one there and her hands were eventually fastened to the bed.

The course of the disease was unpredictable, and ultimately a poor prognosis was given, i.e. the chances of my grandmother’s survival diminished. During this period, interactions with nurses and doctors were punctuated by disregard and dismissal. For example, when one relative noticed that the nebulisers were inserted in my grandmother’s eyes rather than her nostrils (where they belong), this fact was dismissed with a “oh, her oxygen was high”. There were a few good doctors and nurses, but they were conspicuously outnumbered by the poor ones. When my cousin objected against intubation (insertion of a tube into the lungs) for the last few hours of life, instead of explaining the rationale, the doctor shouted at her “Do you want to kill your grandmother?” It took a lot of pressure to prevent the ICU team from doing a completely needless invasive procedure (kidney dialysis) with just a few hours of life remaining and kidney test results that had been unchanged for years.

Nevertheless, simple measures such as giving my grandmother something to drink were considered a luxury. When my grandmother was deteriorating, no provision was made to allow her to be close to loved ones. She and her family did not want her to be in an intensive care unit, and not only was she kept there against her will during the treatment phase, but she was kept there when she was about to die.

I asked my cousin to connect her to me by video call before her death during the one-hour visiting period. Her eyes were initially closed, but as soon as she heard my voice, they opened wide. Her mouth was entirely bandaged apart from a tube coming out of it, but I could see the outline of her lips moving briskly underneath all the bandages. She wanted to say something, and had never been stopped from talking to me before. She started vigorously shaking her tied arms in an attempt to communicate with me, but then realized her efforts were fruitless and her eyes started welling up with tears. In all my years of knowing her, I don’t remember her crying. She died just over an hour later, curtains drawn and no loved ones around her.

Nothing could have prepared me for this image, which remains traumatically imprinted in my mind. It will be a memory I will never forget. I keep wondering what she wanted to say – was she saying goodbye to me, or asking me to convey a message: to look after my mother, my brother, or help someone desperately in need? Finding the answer to this is a futile quest, but it is a rumination that will, sadly, remain.

Dying alone, with family not allowed to be with her is one thing, but my family were also denied the chance to see her after death. Only after begging were they able to get a brief glimpse of her in the corridor prior to entering the mortuary after challenging the comment, “She’s gone, why don’t you just go now”.

Passing away is an inevitable part of people’s existence, but the environment for this chapter of life is so important. As a doctor who works in the United Kingdom’s National Health Service, I have been well-versed in the importance of dignity in death. But in Iran, a country whose polymaths helped define the early principles of bioethics, it is unfathomable that core bioethical values were denied for such a sweet soul as my grandmother, and potentially for others. These principles include Non-Maleficence — not performing unnecessary procedures that serve just to prolong the patient’s life and often cause distress and pain to the patient — and Autonomy – respect for the desires and values of the patient, including how they want to be treated and how they want to die.

In my grandmother’s case this was with her family around her and without fruitless procedures. Denying someone’s spirit and character so manifestly in their final days and hours is criminal. These sentiments were shared by my family, and indeed being able to spend time with a loved one before and after their death to say goodbye should be a basic right, rather than just being able to observe this sorrowful moment from a distance. It should not be such as Sisyphean effort to spend time with a loved one and find out what happened during a hospital stay, hampered at all stages by a lack of sympathy and empathy alongside a degree of ageism against someone who is perceived as just a bed number rather than a human being.

A photo of Nima Ghadiri’s grandmother holding a pomegranate on Shab-e Yalda (An ancient Persian festival commemorating the Winter Solstice), three weeks before she died

I remain always indebted to my grandmother for looking after me as a child in the United Kingdom and being someone I could talk to and share my life with for so much of my existence. Even at her age, she had the spirit of someone many decades younger, was full of life and brought joy to so many. She shared all she had with charity and those less fortunate than herself. Strangers often commented on how sweet and bright she was and I used to talk to her about films, technology and current affairs. She remained a fountain of wisdom and I could not have dreamt of a better grandmother. Her grandchildren remain traumatized by the manner in which she has gone, and the suffering and abuse that she endured. Because she was such a positive and life-loving soul, I do not want the final page of her life to be negative. I am not sure how yet, but I know that I would be happy if the discussion arises for Iran, the country of Avicenna, Razi and numerous others, to re-discover what care, particularly at the end of life, means. Perhaps in the future, I will open a palliative care institute in her name.

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Jeremy Hunt’s Seven-Day Homeopathic NHS: Just The Tincture?

Jeremy Hunt and the government appear to be on course for the world’s first routine 7-day health service. Unfortunately, this pioneering endeavour is hindered by a marked gap in resources. Currently (as according to NHS Providers) 80% of acute hospitals in England are in financial deficit, compared to 5% three years ago. Missed waiting time targets have risen from 10% to 90% during the same period. In recent years, healthcare expenditure per capita for the United Kingdom has been stagnant in comparison with other developed countries:

 

On the path to establishing this revolutionary provision, a number of steps have been taken to ensure that the foundations are as flimsy as possible. Jeremy Hunt has pushed a junior doctor contract which undervalues them and discriminates against women. He has also removed bursaries for student nurses and allied health professionals. This has nurtured an atmosphere in which applications to work abroad have skyrocketed and the portension of mass exodus hinted at in recent years may well come to fruition. Following recent events, a significant (13.5%) reduction in medical school applications over the last twelve months is unlikely to help matters.

So the question arises, how does Mr Hunt seek to introduce this 7-day NHS with negligible funding and staffing levels? And, perhaps, the answer has been there all along…

 

Back in 2007, before landing the job of health secretary, Jeremy Hunt asked the Chief Medical Officer to review three homeopathic studies. He also signed an Early Day Motion supporting the provision of homeopathic medicines (including simple saline solutions diluted to negligible concentrations) which “welcomes the positive contribution made to the health of the nation by the NHS homeopathic hospitals”, and “calls on the government to support these valuable national assets”. In 2014, he again called for herbal remedies to be made available on the NHS.

 

When one of his constituents wrote a letter to Mr Hunt disagreeing with the evidence basis for such treatments, the Secretary of State for Health responded:

“I understand that it is your view that homeopathy is not effective, and therefore that people should not be encouraged to use it as a treatment. However, I am afraid that I have to disagree with you on this issue. I realise my answer will be a disappointing one for you”

Our Minister for Magic Health’s judgement on this matter may have been influenced by another Conservative MP, David Tredinnick. Indeed, Jeremy Hunt’s request for the homeopathic studies to be reviewed was made at the behest of Mr Tredinnick, who has previously advised parliament that blood does not clot under a full moon, advocated the use of homeopathy as a treatment for HIV, tuberculosis and malaria and asked that homeopathic borax be used to control foot-and-mouth disease.

Are Mr Hunt and Mr Tredinnick on to something? The combination of drugs for treating TB vary between £5000 and £50-70000 depending on whether the variant is “normal” or “drug-resistant”. Dilution to homeopathic doses can make these expensive drugs much less costly.

Even better, nature’s finest Witch Hazel, which has been used for TB (albeit in the 19th century), comes in at a tidy £2.99 per bottle from your local chemist and can last for months if the degree of dilution is precise. It can even be grown on hospital grounds, generating further savings.

 

The workforce could also be rationalised in a homeopathic 7-day NHS. The impact of Jeremy Hunt’s contract for junior doctors (indeed, the need for doctors in the first place) can be negated by alternative healthcare practitioners, some of whom might not even require an income. A new hospital druid role potentially offsets the vast increase in applications to Australia and New Zealand and reduction in medical school applications.

Mr Tredinnick is also a firm believer in astrology as a “useful diagnostic tool” which, alongside complementary medicine, could take “pressure off NHS doctors”. As a Capricorn, the zodiac does indeed advise that his opinion should be reliable and trustworthy for Jeremy Hunt’s Scorpio. Mr Tredinnick states “I do foresee that one day astrology will have a role to play in healthcare.” Conceivably, that day may come sooner, and we will have alternative medicine permeating into our accident and emergency departments. This delightful sketch from comedy duo Mitchell and Webb might not be too far from the truth:

When the practical and economic feasibility of a routine 7-day NHS has been roundly debunked by senior doctors, service providers and analyists, it is only natural to ask how this is going to happen. Maybe, we ought to be thinking a little more naturally ourselves, and prepare for our complementary secretary of state for health to give us a very complementary 7-day routine NHS.

This article was first posted on the Huffington Post and can be found here: http://www.huffingtonpost.co.uk/nima-ghadiri/jeremy-hunts-7day-homeopa_b_12298592.html

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