Music for health

 

MUSIQUE ET SANTE AND RNCM

Paris, 11th-15th February 2008

BACKGROUND AND CONTEXT

This training course was set up as an ongoing collaboration between Musique et Santé, the RNCM and Arts for Health (at Miriad, MMU). The RNCM is in the process of establishing a UK programme, drawing on the expertise of Musique et Santé and this was their first collaborative training programme. Specialist trainers from both organisations led musical workshops, seminars and hospital observations for 14 trainees from the UK, France, Ireland and Finland. The trainees were all professional musicians and worked with a variety of instruments such as clarinet, Irish drum, piano accordion, French horn, cello and voice.

 

PROGRAMME

The week consisted of a stimulating and intense blend of practice and theory. We looked at hospital contexts and environments and different ways of playing music in hospitals and we worked with participants’ instruments, looking at the importance of improvisation alongside an established and varied repertoire. Musical excellence was stressed at all times. We also participated in music training workshops and examined  DVD recordings of musician/patient interactions. Later in the week we looked at Bioethics and examined ethical issues such as consent by patients to music in their personal environment and consent by medical staff to musicians in the hospital environment.

On Wednesday afternoon we were offered choices of patient groups where we were invited to observe existing Musique et Santé collaborations within specified hospitals. The patient groups were: geriatric patients with dementia, children in oncology, paediatrics and neonatology. For my first hospital observation I was with a group of musicians on a paediatric ward and we watched Director of Musique et Santé,  Philippe Bouteloup making music with children and babies using guitar, voice and a wide range of percussion instruments. After extensive debriefing we made our second hospital visit on Thursday afternoon. This time I observed Marianne Clarac singing to very premature babies in the neonatology unit and we were invited to join in. On the final day we debriefed, exchanged our experiences and reflections and evaluated our learning.

 

THE LEARNING EXPERIENCE

ETHICS

The bioethics discussion was fascinating. We learned about the 4 principles decided upon by 20 European countries in the area of bioethics which were autonomy, integrity, vulnerability and dignity.  We also discussed two opposite views: either placing art and music inside healthcare so that it becomes part of healthcare and possibly ‘enslaved’ by another  framework, or the idea that the artists are free agents who have the right to express themselves with no constraints from the organisation they are assisting. The ideal situation might be a rather ambiguous position of collaboration between the two parties –a ‘what can we do together with this common project’ situation. It was striking how many of  the ethical conflicts that we discussed regarding music in hospitals were relevant to other workplace  situations where artists are working in non artistic environments. We also had a fascinating discussion about the ethics of patient consent to music making, for example, how to ask permission of a premature baby before playing music to him/her if the parents were not there.

NAMING

The Musique et Santé trainers believe very strongly that knowing and using the patient’s name in the music making is essential to a successful and meaningful session. Marianne Clarac pointed out that if she cannot see the name of a baby on the door or on the incubator she asks the staff to exhibit it. This is a reminder that even a baby weighing only 600g is a human being with a personal identity who deserves to be addressed by name. Marianne also reiterated this by always addressing each baby by name and often improvising a song using the name. This ensures that the music at that moment in time is being directed uniquely to and for that baby. This reinforces to the child’s parents if they are present that their baby is special and communicates a feeling of trust between musician, patient and parent. The importance of names for building good  relationships in all areas was emphasized to us throughout the week’s training. As participants we were encouraged to learn each other’s names through musical games on the first day to the extent of never being able to forget the identity of anyone on the course. Not surprisingly this meant that as a group we all felt very at ease with oneanother and networking was effortless. This also reminded me of how valuable it is to give plenty of time to everyone learning names at the beginning of new modules in the university setting.

THE MUSIC BEGINS BEFORE THE MUSIC BEGINS

Another part of the learning process was the idea of making music with the simplest objects which reminded me of when I set up and taught pre school music classes some years ago. Alongside more traditional percussion instruments Philippe Bouteloup used pieces of plastic piping which when blown gently created an evocative wind-like sound that transported you away from the hospital environment. Whilst observing Philippe in the paediatric ward I noticed how he took his time getting instruments out and tuning his guitar. His actions were slow but quite deliberate and purposeful.  He not only tuned his guitar but tuned into the atmosphere and his particular client group. I saw how he may set out a couple of instruments to generate some interest among the patients and how the patients themselves may make the first musical sounds. I noticed how the musicians played and perhaps hummed in the hospital corridors before meeting specific patients. I summed up this approach as ‘The music begins before the music begins’, a phrase that Philippe Bouteloup particularly liked. I was reminded of the need for spaciousness in music making and Cage’s ideas about the music in the sounds around us. We have time. Music should not be a way of blocking out the present world but a way of transforming it. There is not a perceptible beginning and ending as in a traditional concert; here there is no great divide between pre-performance and performance itself.

THE SIMPLE VOICE

In our singing we used what I would call the ‘simple voice’. It is obvious that when you are singing to premature babies that you do not sing loudly or with vibrato. Singing to babies requires a straightforward honest way of producing sound, in the way that a mother would sing to her baby. This is not about displaying our virtuosity as musicians. However, we need to use our technical skill in being able to sing softly and in a way that encourages the mother and baby to respond. One mother felt that she could not possibly sing to her baby as she claimed to have no singing voice. Marianne Clarac encouraged her to sing a familiar song (Frère Jacques) along with us. Using the ‘simple voice’ means that the mother can join with the musicians. She hears in our sound sounds she can make herself. Gradually this particular mother developed in confidence and after we left we heard her humming to her baby. Using the simple voice is the opposite of singing difficult repertoire in a classical concert where the audience marvels at the sounds the singer makes, sounds that the audience can probably not imitate.

COLLABORATION

Philippe Bouteloup pointed out that when you start making music in hospitals you may just want to play and perform and interact with the patients.  It is only later that you realise how important collaboration and discussion with the health professionals actually is. I noted how at both hospitals we had a meeting with the staff nurse in charge of the ward before the music making and there was time afterwards to report feedback and arrange subsequent visits. In this situation the musicians become part of the team who are caring for the patient. We learned about the issues of hygiene and security which shows our respect for the medical teams. Marianne Clarac also talked about dressing colourfully (never in white) so as to distinguish our artistic work from the medical world of the hospital environment. Although the musicians should collaborate with and respect the medical carers, in Philippe Bouteloup’s words: ‘We must not become part of the institution.’

OUTCOMES

This course gave an insight into the skills and competences required of musicians in healthcare settings and the importance of working in partnership with healthcare practitioners. It has involved applying my academic resources and my previous practical voice experience to the exploration of setting up music in healthcare settings. This is a two way process of applying the benefits of knowledge gained through teaching, research and practice at the university and in my other work, and learning from the experiences of other music practitioners working already in the field of healthcare. It has been an inspiring experience to see how my knowledge can be transferred to other areas. In the meantime, as Holly Marland of the RNCM said, ‘it is exciting to be part of a quite new and pioneering initiative to humanise the hospital environment and bring about useful collaborations between musicians and medics.’

An exciting outcome is that I have been invited to Waterford, Ireland at the end of May to train some musicians in voice and voice care, and to perform and work in Waterford Hospital as part of the Waterford Healing Arts programme. I will also be able to observe the musicians working on the psychiatric wards.

 

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1 Comment Add your own

  • 1. Ruti  |  January 26, 2012 at 4:42 pm

    Hey, it was great to read this, as I am thinking of doing that course, and wanted to know more about the content. Now I feel that I maybe don’t need to do it, except for the networking and support of other musicians. Thanks.

    Reply

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