A number of hospitals throughout the world, among them the Sant Joan de Déu Hospital in Barcelona, have realised that, although life expectancy has increased and health-care conditions are improving, society is becoming increasingly dehumanised both inside and outside hospitals. The recent Conference on the Humanisation of Children’s Hospitals, held in Barcelona, focused on “all that it is possible to make the stay in a hospital, in this case of children, as pleasant and positive as possible”.

Thanks to medical and technological advances, today it is commonplace to build up experience on the diagnosis and treatment of illnesses, but it should be equally as important to pay the same attention to how the patient would like to be treated.

The patient:
This is the citizen, who for a short while patiently becomes a resident of a healthcare centre. Patiently, in the sense that he has to endure and overcome his illness, but also because he has to accept that he must halt his rhythm of life, and place himself in the hands of healthcare professionals. This role and this “time out” are not easy, either for the patient, or for the hospital. Together they must learn how to create the conditions necessary to make the stay more beneficial and bearable.

The Hospital:
The healthcare centre where, besides curing illnesses and complaints, hospitality to people must be promoted. Citizens-cum-patients will be cured more rapidly if, in addition to the required medical treatment, they are given more humane and emotionally positive treatment.

Citizen before patient:
Today’s citizen has become a sort of “socially digital being”. He is born in, grows up in, and lives in an information and consumer society, which induces him to live at breakneck speed. The individual now maintains relationships through the use of technology, which is now the principal form of leisure and communication. Innovations are used to keep abreast of things, but they are also a source of anxiety due precisely to having to keep up-to-date with this knowledge, which changes by the minute. Rapid access to information and consumer objects gives rise to reduced tolerance to dissatisfaction.
This inability to tolerate frustration is accompanied by what Manuel Castells calls the “negation of time”. The lack of familiarity with such essential aspects of life as pain, illness and even death - “because this is naturally the limit of our temporality as people” (“What sort of world do we live in”, Mayte Pascual) - means that the moment of admission to hospital is even more traumatic.

On the other hand, the patient arrives at the healthcare centre with much more information - perhaps not true or pertinent information, but information just the same - and this makes him now doubt the erstwhile authority of the physician. Thus a change in communication has been established.

Well aware of the changes and shortcomings of the healthcare system, the professionals that took part in this Conference proposed innovative formulas to encourage the humanisation of hospitals.

Curing in hospital via the senses
Patients can be treated with music therapy, as proposed by Phillippe Bouteloup, musician and director of the European project Music in the Hospital. That is, to collaborate in the treatment through emotions, to bring about a positive reaction in the feelings of babies crying inconsolably in incubators, helping to relieve the tension of a patient with the sound of a sweet voice and guitar. Working on musical group activities with adolescent patients, who can escape from the isolation of their illness inside a room to express themselves by playing instruments or singing in company. Or establishing sensorial contact with the deaf and dumb through acoustic instruments.

Dr Dominique Haumont of the Neo-natal Department of the St Pierre Hospital in Brussels, also spoke of their programme, NIDCAP (Newborn Development Care Program), in which special emphasis is placed on the importance of working with the feelings of newborn babies, care and treatment through caressing, body contact with the mother or nurse, the environmental conditions required to establish the optimal level of tranquillity or welfare.

Although they did not attend the conference, they have been working for a number of years in Art Therapy, where artists, psychologists and educationalists work on cases of autism, infantile depression, terminal illnesses, etc., making use of artistic expression and establishing a patient/care worker relationship which over time becomes ever closer and more beneficial, and which helps patients to overcome their illnesses thanks to positive emotional reactions.
 

Curing in hospital via hope
Angie Morales, director of the Pallapupas Hospital Clown Project, demonstrated in an initiative that human contact and intuition can be almost as valuable as the most advanced technology. The clown makes a decisive contribution to physicians being able to do their work, for example, in the operating theatre, by keeping children amused so that they can be anaesthetised when smiling and not crying. The clowns work in pairs in the wards or in the operating theatre. They try to play down the importance of the illness and to bring a splash of colour to the drab rooms; they explain the role of anaesthesia to the children through games, helping to relax and calm them prior to an operation, etc. Other projects in the wards, such as “Wishes” are equally attractive and effective. The aim of this foundation, which works inside hospitals, is induce to hope as an integrating life experience for children suffering from serious diseases. These children need to feel that they are capable of making a wish come true. The organisation asks children, what their greatest wish would be (e.g., “playing in the Camp Nou Stadium with Ronaldinho”, “going to the zoo and touching the animals that can be touched”, “visiting the Disney studios”). The organisation does not take it upon itself to make this dream come true; rather its task is to motivate and spur on the children to do it themselves, by promoting a spirit of overcoming. This emotional state of the reactivation and segregation of energy is fundamental in emotionally overcoming illness. By writing a letter to Ronaldinho, struggling to send him a drawing, sending him another letter, playing on their uncertainties to gradually create an atmosphere of excitement, which is always rewarded – these are phases that are established to work in parallel on the illness through the child’s feelings.
 

Curing in hospital via information
Jean Claude Demers, specialist in Child Life and founder and director of the Le P.A.S. Association (preparation, accompaniment, and discharge of the child) in the Lausanne Children’s Hospital, explained the importance of working on the healthcare worker/parents/patient communication triangle. Adapting technical information to children’s level of understanding, in order for them to accept their own illness, to know how to live with it, and even to avoid the transmission of feelings of guilt due to seeing their parents worried. He also demonstrated the importance of ludic communication between physician and child. Toys, dolls, stories, didactic material, etc, are all tools for bringing them closer together. In the same vein, he also showed how to work on the children’s admission, so that the hospital is seen as an extension of the home, and that instead of a rupture there is a transition, which at times may even be fun.

Curing in hospital via dignity
This was dealt with by Giuliana Fillipazzi, from the European Association for Children in Hospital from the Work Group dealing with the rights of hospitalised children. This was something that she herself suffered for a number of years, during the hospitalisation of her son, suffering at the same time from the inflexibility, instability, dehumanisation and even lack of respect on the part of healthcare centres. As a direct result of her experience, she resolved to fight for children’s rights in hospitals. From these articles or rights, a number of new projects and experiences are appearing all over the world, shedding light on the matter and helping to make hospitalisation more humane.

Curing in hospital via the setting
In their study, Tim Kershaw from Stefian Bradley Architects in Boston and Rosa Clotet, from Llongueras Clotet Arquitectes in Barcelona, confirmed that hospitals can and must be humanised in terms of their space, their setting. Light, views, plants, awareness of the day/night time cycle, the use of colour, smells and sounds can all play significant roles in the improvement or deterioration of a patient’s emotional state. The objective of making patients feel more at home is becoming increasingly prominent. More and more hospitals are being built with environments where children can maintain contact and make friends with other children, or areas in which families can get together in comfort, or waiting rooms where visual stimuli or interactive elements help to alleviate the boredom.
 

Curing in hospital via humanisation
At Sant Joan de Déu Hospital they maintain that “hospitality” must be professionalized by working on the human rights and values of patients. An objective that this centre is working on with optimism and energy. At least that was the impression that those of us attending their Conference got. Once again it is demonstrated that in order to face up to a change of period, such as the one we are currently going through, deep changes to structures and ideas will need to be made.
Once again, it is pleasing to come across educational, healthcare or cultural projects that are truly working. This is possible as the management of the company, hospital, museum or college transmits the energy and desire required to make these projects productive. We can verify that in order to undertake an initiative of this type, we need to ensure that all the professionals on all the different levels feel involved and motivated.