In 2012, Galway University Hospitals Arts Trust was awarded an Arts Council Arts Participation Project Award to work with visual artist Marielle MacLeman on a yearlong arts project in the haemodialysis unit at Merlin Park University Hospital, Galway. The project culminated in the publication, The Magician and the Swallow’s Tale, launched with an accompanying exhibition at Galway Arts Centre.
In redressing the lack of sustained arts provision for dialysis patients in the West of Ireland, the project sought to enhance the patient experience in two key ways: through art workshops, which aimed to provide positive, productive experiences during dialysis treatment, and through patient-led improvements to the waiting area, which intended to create a more pleasant environment and imbue a sense of ownership.
The celebration of ephemeral aspects of care that humanize the clinical setting was another key objective. In doing so, the project aimed to foster communication and shared understandings between arts and health professionals.
Person-centred individual art workshops took place during dialysis and included painting, textiles, sculpture, digital design and handmade book projects. Lunchtime staff workshops were also available, tailored to the individual, with the cake-decorating skills of one staff member resulting in temporary sculptural installations made of icing sugar and piping bags.
The project used digital equipment and online resources to offer inspiration in a sterile setting; to facilitate creative approaches where movement was limited by fistulas, line flows and bed angles; to enable completion where fatigue and sleep patterns restricted time; and to aid family collaboration.
Imaging technology allowed one participant, resigned to the fact that he would never go fly fishing again, to focus on the aspects of his favourite sport that were not prohibited by ill health. Using a camera and a laptop, the artist was able to show him his boat, which he had not visited for a year, and the minute detailing of his fly-tying aptitude, which he could appreciate at a new scale on the laptop.
Online resources and imagery on the project laptop were often used as a stimulus or focal point for conversation; for example, some participants took virtual walks to specific locations via Google Earth. Indeed, dialogue was the dominant creative approach for some participants. Reflecting this, the project publication adopted the style of a storybook, with interlinking narratives allowing all patients to contribute to the making of the book, regardless of their level of engagement in the art workshops. Patients and staff curated its layout and content through ongoing dialogue.
The landscaped gardens and wooded surroundings of Merlin Park inspired paintings and provided a creative resource for the artist, whose photographs were used by some patients to create digital repeat patterns. This unique setting as well as pastimes particular to the West of Ireland influenced the content of many conversations and artworks, and so the book was formatted to track their seasonal shifts.
Improvements to the waiting area were guided by three rounds of inclusive patient consultation. This included a patient’s design being presented as a choice of colourways before being used in soft furnishings. Avoiding the pressures of open competition that can negate benefits to wellbeing, the work of a patient already creating repeat patterns was selected for a blind and wallpaper. When the physical limitations of dialysis prevented this patient from painting, she would digitally manipulate artwork made in previous workshops.
The project culminated in the publication The Magician and the Swallow’s Tale, launched with an accompanying exhibition at Galway Arts Centre. Paintings, photographs and installations were specially created for the exhibition in order to bring the narratives of the book to life. For example, the story of a woman who posted paintings of Ireland to her family worldwide was recreated as a professionally printed collection of postcards. Similarly, a gallery was transformed into a patient’s design for a dialysis bed area, complete with digitally printed bed linen. In addition, waterslide decals were used to recreate a collection of crockery and napkins, designed on the project laptop by a patient who looked forward to tea time in Unit 7.
The waiting room and corridor of Unit 7 were used for a rolling exhibition programme of work from the workshops. The patient-led improvements to these areas included the repainting of all walls, woodwork and furniture; the re-upholstery of seating; new flooring; and the introduction of wallpaper and window blinds designed by a patient.
The project was monitored through reporting systems between the artist and Galway University Hospitals Arts Trust (GUHAT), a multidisciplinary Working Group and GUH Arts Committee. An internal evaluation was conducted by GUHAT with data measured against values underpinning good practice, as defined by the Arts Council and the Health Information and Quality Authority. The evaluation process examined qualitative data drawn from project documentation and stakeholder consultation including artist’s notes, comments cards, workshop dialogue, meetings, press interviews and questionnaires. An additional survey was conducted by the medical team using standardised Kidney Disease Quality of Life (KDQOL-SFTM) questionnaires.
The art project enhanced the dialysis experience and was considered to have ‘transformed the lives of so many patients and staff’ (Assistant Director of Nursing). Those specifically engaged in participative workshops had productive experiences that redressed the tedium of dialysis and fostered confidence and self-esteem. Patients, staff and families expressed feelings of ‘joy‘, ‘hope‘ and ‘pride‘ resulting from the project.
The development of new or existing skills and knowledge stimulated dialogue and activity in and beyond Unit 7, which had a wider impact on families. This became particularly evident in the case of bereavement. One family member reflected, ‘The art project is like a ripple effect. Not only has my dad benefited from the project our whole family has … His garden has never looked as good, it has flourished. The best it has been in years; partly due to the good weather but mainly because of Dad working with (the project) … He is chuffed as are we that he is now a published author.‘
The project enhanced the social dynamic of the unit, replacing ill health as the shared experience, which a staff member reflected was ‘so important for mental and emotional wellbeing.’ Another explained that the project, ‘gives staff another level on which they can interact with patients and make the whole unit more human.’ Patient-led improvements to the unit created a more welcoming physical environment for all, and were themselves described as ‘more conducive to pleasantries.’
Reflecting this sense of camaraderie, the publication allowed its protagonists to be seen as something other than the givers or receivers of care. One staff member reflected that the book ‘shows everyone that, although our patients are sick, they have a lot to provide with experience and knowledge.‘ In acknowledging the unique contribution of staff, it also enhanced the supportive dynamic that had gradually developed through ongoing dialogue, reporting systems, and staff workshops. This guided the project through a protracted period of integration, hindered by operational change and the institutional hurdles presented by a long-term care setting with no prior experience of participative arts. The participation of those who were inquisitive yet waiting for others to do so first, was further stalled by the inherent challenges of dialysis. When the first completed artworks were exhibited in the waiting room, the hesitant found the confidence to engage and an overwhelming demand confirmed the project’s second phase, which started in January 2014.
Documentation and Dissemination
The artist documented artwork throughout the project period and artistic outcomes were communicated to all GUH Renal staff via quarterly newsletters and an information leaflet produced for a GUH study day on World Kidney Day.
Thereafter, project information was disseminated through national public and healthcare platforms. This included a poster presentation of baseline data by the Renal Team at a Nephrology conference, and features in Health Matters, the IKA magazine, and the Health Supplement of The Irish Times. Additional coverage of the publication launch included FYI radio, TG4 and local press.
The book was distributed to all national renal units as well as leading national and international Arts and Health organisations. The Magician and the Swallow’s Tale is available to buy from GUH shops, Charlie Byrne’s Bookshop, Galway, and from GUHAT at firstname.lastname@example.org.
The Arts Council, Galway University Hospitals Arts Trust (GUHAT), Galway University Hospitals (GUH), Irish Kidney Association (IKA), Galway Arts Centre
August 2012 – September 2013
Galway University Hospitals Arts Trust
The Arts Council, Galway University Hospitals Arts Trust (GUHAT), Galway University Hospitals (GUH), Irish Kidney Association (IKA), Galway Arts Centre.
With additional sponsorship for the publication and promotion from Hewlett Packard and Gaillimh le Gaeilge.
Nature of project
Collaborative/ participatory, Exhibition