The transplant unit at St James's Hospital has brought the outside world into the wards with film, music and sound. Anne Dempsey reports
Inside the Transplant Unit at St James's Hospital, Dublin, are state- of-the-art medical facilities, 21 air- conditioned en-suite rooms, and a strict clinical protocol to protect vulnerable leukaemia patients from infection after transplantation.
Outside the view is not so healthy.
"Unfortunately, we are on the ground floor, so patients look out on pipes, waste ground and in some cases a brick wall," says consultant haematologist Prof Shaun McCann, who is head of the unit.
Now a new project - Open Windows - aims to offer patients a new interactive view of the world through film, sound and music which, it is hoped, will confer therapeutic benefits during their hospital stay and beyond.
Believed to be the first initiative of its type in the world, McCann (with Open Windows director/curator Denis Roche and physicist/artist Fran Hegarty) will make a presentation at an international Arts & Health conference in Dublin Castle on June 24th, 25th and 26th.
Sitting in his office, McCann begins by explaining why his patients in particular can do with a creative lift.
"The transplant unit was founded in 1980. Before that, no adult in Ireland with leukaemia lived. Today three out of four patients need a transplant, we do 100 bone marrow transplants a year, and have an 80 per cent survival rate," he says.
The first step is to treat the patient with chemotherapy to reduce the disease, then a transplant donor is looked for, usually a family member.
To prepare for transplant, the patient receives industrial doses of chemotherapy to kill the leukaemia cells.
"The downside is that healthy cells including normal bone marrow are destroyed as well. Then the bone marrow is removed from the healthy sibling and transplanted into the patient," McCann says. "But it's like planting your tulip bulbs in a window box, you don't know for two to three weeks if they will grow.
"For this period, the patient is in total isolation, all the air they breathe is filtered, they receive blood transfusions every day, they can't eat or drink normally, they are fed intravenously at night, they receive antibiotics and anti fungal drugs," he says.
"Everything is monitored and they are marooned on a life island. We see every patient every day. In two to three weeks, the bone marrow starts to grow, and the blood count [red, white blood cells and blood platelets\] start to rise. Things are beginning to look good.
"But even then they are not out of the woods. The new marrow may settle down in its new environment, but it may not.
"Transplant marrow rejection occurs when the immune cells recognise subtle differences in the host and begins to attack the body. Internationally, we are beginning to understand more of the reasons for such outcomes, but at the moment one in five transplantees die. The leukaemia is cured but still they die.
"So here are our patients. They have lost their hair, they are completely isolated, very sick, they may be afraid they won't get better. There is a large loss of control and they realise how dependent on staff they are. In this situation, people can become depressed, frightened, aggressive, which in turn can be very stressful for staff.
"I began to think what I could do to make the environment a bit more pleasant. I wanted something spiritual, in its broadest sense, to help to calm people down.
"We have a hospital art committee, but we can't put pictures on the walls in their rooms, because they would bring in dust. Patients have their own music and they can read, but usually they don't have the concentration," McCann explains.
One day in 2001 while attending an art exhibition at the Irish Museum of Modern Art, McCann met an artist he had transplanted 10 years ago, and began discussing his wish to offer something uplifting to his patients.
Soon after, composer and sound artist Denis Roche came on board. He knew about the work of Media Lab and came up with the idea of using art and technology to create a digital window for the St James's patients to maintain their sense of connectedness with the world going on outside.
Over the next three years, Open Windows was developed with the help of Stefan Agamanolis and Cian Cullinan of Media Lab's Human Connectedness Group, with funding from the Bone Marrow for Leukaemia Group and a number of private companies, and support from the hospital's art committee.
"The aim is to give people a window on the outside world, particularly to get over the sense of isolation, which might help to make them less anxious, less aggressive and not have such a bad time. "We are not saying it will make them better," says McCann.
"I suppose, given that Irish people are not hugely exposed to images of high artistic quality, we wondered would it plant a seed which might show itself in some way down the road."
The project currently offers a choice of nature films with music made by Roche and Hegarty respectively. Open Windows gave a mobile phone camera to Sligo-based artists Barry Cooke, Pam Barry and Nick Miller to beam back images in real time.
"Now you could be lying in bed in Dublin and watch the sun rise over Ben Bulben," says McCann.
"We think it is a marvellous idea, and galleries I have spoken to all over the world find it amazing," says Cooke.
"I choose things I find beautiful. I have photographed whitethorn in blossom at the moment, and taken interior studio shots. One regret is not being able to show the person behind the picture. I think people who are cut off need images of people as well as of nature, and this project has great scope for that," Cooke adds.
Project director Denis Roche receives the images on his mobile phone, edits them and sends them through to the hospital server.
"The core aim is to break down the sense of isolation so that some of the problems associated with it may not arise.
"The artist with the phone camera aims to provide information to the patient lying in bed of what's going on in the world outside which, hopefully, fosters that continuing sense of being part of the community," Roche says.
"In the next stage of the project, we plan to commission works for more artists, musicians, poets.
"When we asked the patients what they would like, many said they would like pictures of their own home and their own area and that is something currently under review. There is no limit, really, to what we could do."
Two of the 21 patient rooms have been fitted out and equipped for Open Windows. In one room I met a patient lying in bed looking at a tranquil lake scene framed by reeds. The pictures change frequently, and he can change channels via the mouse by his side.
"It's relaxing if you're feeling uptight, particularly with the music in the background. You get sick looking at the television. I'm from Waterford, and I would also like to see pictures of home where we have some lovely beauty spots," he adds wishfully.
Open Windows has approached the Irish Cancer Society for funding for research. It plans to measure patient response by conducting qualitative interviews with patients pre and post project, and compare these with two control patients with a roughly similar personal and clinical profile, but who do not have access to the project.
"They might hate what they see, though first impressions are broadly positive," says McCann. "It looks like as if it is going to be successful. We are not saying that if you look at nice things, you are going to get better quicker, all I am trying to do in this horrible period of time is to see what we can do to make life easier for them.
"We see every patient every year after discharge also, so it will be a simple matter to evaluate what effect, if any, the project has had long term," McCann explains.
The Arts & Health conference, organised by the Arts Council, is part of an initiative to encourage a policy-based approach to arts and health.
Delegates from the worlds of medicine, science, arts and philosophy will explore the contribution made to health and illness by the visual arts, music, dance and literature - from a medical, biological, experiential and reflective perspective.
For more information, contact the Arts Council, telephone 01-6180246, e-mail sheila.gorman@artscouncil.ie/zoe.crawford@artscouncil.ie