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Photo: Thomas Jefferson University Photo Services
Medical professionals develop their empathetic side at a 2017 Netter Symposium in Philadelphia.

I’m back to writing the usual posts that link to interesting articles. This one is especially appropriate, given my recent experience as a hospital visitor. The article is about techniques for “teaching” empathy to medical people, but I have to say I think every worker in that hospital was born empathetic. From the security personnel and cleaners to the brain surgeon and night nurses, it was amazing to experience how kind everyone was, and I wonder if it’s just the culture of that hospital.

Be that as it may, there are initiatives everywhere to help medical professionals develop their empathy “gene.” An article at a “platform for theatremakers” called HowlRound is about using drama for that purpose.

“As theatre folk know well, sometimes the most meaningful creations are borne out of the fruit of circumstance. To wit, the Lantern Theater Company in Center City, Philadelphia, happens to be located around the corner from the Sidney Kimmel Medical College (SKMC) of Thomas Jefferson University. In 2012, Charles McMahon, artistic director of the Lantern, and Dr. Salvatore Mangione, pulmonologist and director of physical diagnosis and history of medicine at SKMC, started discussing a way to make the most of that physical proximity — and potentially change the course of modern medicine while they were at it.

“Together, along with artistic colleagues Craig Getting and Kittson O’Neill, they developed a curriculum for what became the Empathy Project. [Mangione] and the team believed that ‘in addition to preventing burnout, and giving [students] more comfort with empathy and ambiguity, it might give them a different brain and help them become a better physician.’ …

“Part of the program focuses on playwriting. This section asks students to not only learn the technical tools of dramatic storytelling, but also to make a personal investment in the work they are creating. It helps break students out of their comfort zones by encouraging them to write about a truth that goes unsaid in their community. …

“Many of the project’s exercises have roots in Meisner work, including improv technique to facilitate open listening and taking stock of one’s ‘baseline self.’ This combination of listening and self-awareness supplies the building blocks of empathy, asking students to consider themselves and each other with perhaps more generosity and less competitiveness. …

“Plays written by students for the Empathy Project have dealt with wide-ranging topics such as immigrant experience, class issues, what it feels like to be a Muslim in America, the recent death of a parent, ethics of patient privacy, and doctors confronting cadavers. O’Neill avows she has learned more about the Muslim American experience in her class at Jefferson than she has anywhere else in her life.

“Getting believes some of the most fundamental questions playwrights ask during their writing process can easily be applied to doctors working with patients. These include: What are the given circumstances of this person? Who is supporting them or not supporting them? How do you get your audience to feel the emotions you want them to feel? How do you structure the telling of information that is at the right pace and is clear? As a result, students taking part in the Empathy Project reported seeing their patients in the hospital the way a playwright would see them.”

More here.

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Photo: Josh Reynolds for The Boston Globe
IV Safe T developers Melinda Watman (left) and Maggie McLaughlin have spent about $5,000 to make a prototype to keep IVs from slipping out of newborns.

Nurses have been a largely overlooked source of innovative ideas although they are constantly jury-rigging improvements to keep patients comfortable. Fortunately, people in the medical-device field are beginning to recognize the possibilities.

Andy Rosen writes at the Boston Globe, “Maggie McLaughlin’s path from nurse to entrepreneur started last year when an IV tube became unhooked from an infant in the neonatal intensive care unit at Tufts Medical Center, where she works, causing the child to begin bleeding unexpectedly.

“A specialist in IV procedures, McLaughlin was asked to study ways of preventing such an incident from happening again, and she learned there is no universally accepted tool to safely lock the line onto an infant’s tiny body. …

“Since then McLaughlin has been working to develop an IV connection that lies flatter on an infant’s skin and holds more securely to the needle than the alternatives on the market today. She has teamed up with a former nurse she met at a Northeastern University event to form a company called IV Safe T to make and market the device.

“McLaughlin is among a number of nurses — with the help of programs from nursing schools and their own hospitals — who are using their bedside experience to develop new products and innovations in the medical industry.

“Rebecca Love, director of the year-old Nurse Innovation and Entrepreneurship program at NU, said research has shown that nurses spend a significant portion of each shift using workarounds and making impromptu fixes to ineffective processes or equipment. …

“The NU program, which connects nurses to resources and guidance to help them carry out their ideas, said it has attracted 1,600 people to events it has held, and it has connected at least 20 nurses to business mentors. …

“These programs strive to put nurses on equal footing with other professions, including doctors. … Some who follow innovation in health care say nurses represent a relatively untapped reservoir of expertise about improving patient care. …

“McLaughlin calls her device ‘Lang lock,’ after her maiden name. The rounded device connects tubing to an IV catheter with a single twist, and it has one flat side to make the needle approach the skin at a lower angle so it sits more securely.

“She has teamed up with Melinda J. Watman, a former nurse who later got an MBA and went into business. … NU has been helping them to protect their intellectual property and study the market.”

More at the Boston Globe, here.

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Photo: Martina Bacigalupo for The New York Times
An American pediatric specialist during a radiology teaching session with pediatric residents in Kigali, Rwanda. In the past 15 years, Rwanda has worked to build a near-universal health care system.

We like to think that American medical care is top drawer, but in some developing countries, access, at least, is much better. Would you believe Rwanda, where Paul Farmer’s Partners in Health and others have offered help to local leaders?

Eduardo Porter has the story at the NY Times, “Rwanda’s economy adds up to some $700 per person, less than one-eightieth of the average economic output of an American. A little more than two decades ago it was shaken by genocidal interethnic conflict that killed hundreds of thousands. Still today, a newborn Rwandan can expect to live to 64, 15 years less than an American baby.

“But over the past 15 years or so, Rwanda has built a near-universal health care system that covers more than 90 percent of the population, financed by tax revenue, foreign aid and voluntary premiums scaled by income.

“It is not perfect. A comparative study of health reform in developing countries found that fewer than 60 percent of births there were attended by skilled health workers. Still, access to health care has improved substantially even as the financial burden it imposes on ordinary Rwandans has declined. On average, Rwandans see a doctor almost twice a year, compared with once every four years in 1999.

“Rwandan lives may be short, but they are 18 years longer than they were at the turn of the century — double the average increase of their peers in sub-Saharan Africa. …

“In some dimensions of health care, [Rwanda] gives the United States a run for its money.

“Its infant mortality rate, for one, dropped by almost three-quarters since 2000, to 31 per 1,000 births in 2015, vastly outpacing the decline in its region. In the United States, by contrast, infant mortality declined by about one-fifth over the period, to 5.6 per 1,000 births. …

“Critically, Rwanda may impress upon you an idea that has captured the imagination of policy makers in even the poorest corners of the world: Access to health care might be thought of as a human right.”

Read how poor countries, such as Ghana, Peru, Vietnam, and Thailand, are acting on that belief, here. At the rate they’re going with access, it is reasonable to suppose that more citizens will choose a medical profession and that quality improvements will follow.

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Maybe I could be a clown. One of my brothers has clowned for years, mostly at his church in Wisconsin. He really enjoys it.

This story by Elianna Bar-El story at Good magazine makes me want to know the same satisfaction medical clowns get from helping sick children. But clearly, it takes lots of training.

“On a recent visit to Wolfson Medical Center on the outskirts of Tel Aviv, Israel, Yolana Zimmerman is met with audible sighs of relief.

“ ‘Great! You’re here! We need you,’ says a nurse.

“Zimmerman is not a medical doctor. In fact, she casts quite a contrast to the typical image of a doctor with her pink leggings, cupcake apron, and eyelet bloomers — not to mention the underwear on her head and the stuffed monkey in her hands.

“Yolana ‘Yoyo’ Zimmerman is part of a team of medical clowns called Dream Doctors. The pioneering organization started in 2002 with three medical clowns at one hospital and today facilitates the work of more than 110 clowns across 28 hospitals in a country increasingly recognized as the vanguard of medical clowning. After this past April’s devastating earthquake in Nepal, for instance, the Israeli government sent an envoy from Dream Doctors to Kathmandu to work with affected children. As you might expect, the medical community is taking notice of the tiny nation’s zany medical practitioners. …

“ ‘Medical clowning has developed in Israel in a different way than anywhere else in the world,’ says Professor Ati Citron, creator and director of University of Haifa’s Medical Clowning program. ‘Medical clowns were absorbed into the medical system as part of the staff.’ …

“Walking into [a] hospital room, without missing a beat, Yoyo directs her attention to a religious man sitting beside his daughter who is sleeping in a hospital bed. He is obviously reading from the Bible. ‘Is that a good book?’ Yoyo asks. ‘I think I’ve heard something about it. … Who wrote it again?’ The father looks up at her, grinning in surprise. In the same moment Yoyo doubles over with genuine laughter, igniting a cacophony of noises from a squeezable rooster in her apron. …

“In Israel, medical clowns are involved in over 40 medical procedures, including accompanying patients to CT scans, X-rays, MRIs, chemotherapy, radiation treatment, physiotherapy, and rehabilitation. Clowns in Israel also work solo to initiate a more interactive, one-on-one relationship with patients. … Dream Doctors, which works closely with Israel’s Ministry of Health and the University of Haifa … also hosts monthly workshops for the clowns where medical staff provide them with a range of medical knowledge and training on hygiene, vaccinations, before-and-after procedures for entering a room, role-playing, case studies, and more.”

Read all the details at Good.

Photo: Ziv Sade

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Cities that want to encourage foot traffic, public transit, and getting around on bicycles are starting to remove parking spaces in favor of mini parks big enough for a couple planters and benches where passersby might read, chat, or eat a sandwich.

Eric Moskowitz writes in the Boston Globe: “The program, boston.PARKLETS, follows the lead of San Francisco, which boasts 30 parklets, and New York, which unveiled the first of what it calls ‘curbside seating platforms’ in 2010.

“They are part of the growing movement to reclaim urban space for pedestrians and bicyclists and promote public transit. Mayor Thomas M. Menino has proclaimed ‘the car is no longer king,’ citing the environmental, aesthetic, and health benefits.

“It remains to be seen how willingly Bostonians, known for fiercely coveting and protecting their parking spots, receive the parklets.

“Vineet Gupta, planning director for the Boston Transportation Department, said the city will work with merchants and neighbors to find appropriate spots, with the first parklets probably appearing next spring. They would scarcely put a dent in the city’s 8,000 metered spaces and untold thousands of unmetered and resident-permit spots, but they would enliven areas with heavy foot traffic otherwise lacking in public amenities, he said.” Read more.

If you have actually seen where this has been done, do send a photo.

These two parking spaces in Boston could become a parklet — a tiny patio with benches and planters. (Essdras M Suarez/ Globe Staff)

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Dr. Paul Farmer, the subject of a great Tracy Kidder book called Mountains Beyond Mountains, has spent many years delivering medical care — and working to alleviate poverty — in remote areas of Haiti. His nonprofit organization, Partners in Health, takes the word “partners” seriously. The teams do not tell the locals what is good for them but makes a point of learning from them and helping them get what they need.

In recent years, Farmer has been in demand in other countries, too. One focus area has been Rwanda. I liked a recent Boston Globe article on the approach to building a Partners in Health hospital there.

“The designers quickly realized that the challenge was not simply to draw up plans, as they had first thought, but rather to understand the spread of airborne disease and design a building that would combat — and in some cases sidestep — the unhealthy conditions common to so many hospitals.

“Learning from health care workers that hospital hallways were known sites of contagion, poorly ventilated, and clogged with patients and visitors, MASS Design decided that the best solution would be to get rid of the hallways. Taking advantage of Rwanda’s temperate climate, they placed the circulation outdoors, designing open verandas running the lengths of the buildings. …

“When it came to building, MASS Design looked at the Partners in Health model of involving local poor communities in health care, and realized that they could apply the same ideas to the construction process. The hospital was built entirely using local labor, providing food and health care for the workers. Unskilled workers received training that would help them get more work; and skilled laborers, notably the Rwandan masons who built the hospital’s exterior from carefully fitted together local volcanic stone, refined their craft and found themselves in demand all over the country. The construction process also beefed up local infrastructure — new roads and a hydroelectric dam — creating more jobs and literally paving the way for future projects.”

To paraphrase what Farmer often says, the biggest challenge to health is poverty. Read more.

Update on the designers from the June 19, 2012, Boston Globe.

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