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Interview

Healing with plants and flowers

Pieter van den Berg, Tergooi Hospital

Healing with plants and flowers

According to Pieter van den Berg, an oncologist at Tergooi Hospital in Hilversum, there’s a lot we still need to do in the area of patient care and guidance. Taking the idea that even a subtle change of scenery could provide much needed comfort and ease, he decided to take his patients outside, closer to the edge of the forest surrounding the hospital. Here, they can sit back on comfortable chairs in a garden surrounded by seasonal plants and flowers, and enjoy the occasional passing bird or butterfly. Nominated for the Hedy d’Ancona prize for healthcare architecture, Tergooi’s Chemo Garden could be the first in a long line of hospital innovations, where the benefits and healing powers of plants and flowers can be thoroughly researched.

Siddhartha Mukherjee

The Emperor of All Maladies: A Biography of Cancer won the 2011 Pulitzer Prize in general nonfiction. As Rhodes scholar, assistant professor of medicine at Columbia University a cancer physician and researcher, Mukherjee also contributes to The New England Journal of Medicine and The New York Times.

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How did you end up working in oncology?

My career just evolved into oncology quite naturally. As a student, my first job was at the IKNL, the Comprehensive Cancer Research Centre in Amsterdam. I was responsible for registering information and data found in scientific oncological research. Collecting this kind of data is crucial to learning about and developing different kinds of cancer research. There was and is a lot of innovation in cancer research, it’s always on the move. That’s what has always interested me. With oncology, you treat people who have a tangible disease. It’s a broad subject that influences everyone’s daily life, because these days who we all know someone who has or had cancer. And if when that person dies, we are all moved because it’s a sickness we all fear. I was reading a book by Siddhartha Mukherjee, an Indian physician and scientist, the title of which sums it up perfectly: The Emperor of All Maladies. That’s what cancer is.

 

Where did the concept for a Chemo Garden come from?

There’s a lot we still need to work on in terms of patient care and guidance.You’re constantly working on being there for people, figuring out how you can help them through the day. Changing the environment you’re in sounds like a small change, but it has a huge impact on how you feel. We started with the idea to improve the chemotherapy rooms, like painting the walls a pleasant colour. But I thought, why change a room when you can go outside, to a much better environment, breathe some fresh air and be surrounded by plants and flowers? There’s plenty of research that shows the positive effects of nature on a person’s well-being. It calms you down and provides cleaner air. If a cancer patient can get away from the stifling environment of a hospital for a little while – I only saw the good in that. My fellow doctors and the nursing staff laughed at the idea. Moving chemotherapy outside, no one does that! I did some research to see if something like this had been done before, and they were right, I couldn’t find anything. In this day and age, where it seems everything has already been invented, you’d almost think there would have to be a good reason for why this hadn’t been done yet. But we went ahead and did it anyway.

What was the idea behind the design of the garden?

We asked architect Bart van der Salm to draw up some blueprints. Before he showed them to me, he said he had taken the shape of a beach chair as inspiration. When you’re at the beach, you’re in a public space where everyone is facing in the same direction, which creates a sense of privacy. So the garden became a half-circle of chairs built into a wall of plants. Plants and flowers have also been planted around the half-circle, and butterfly cabinets and bird houses have been built into the beams of the structure. The gardener chose plants and flowers according to the seasons, so that there would always be something blooming. It’s covered by glass plates but all the sides are open. And it can be taken apart easily and set up somewhere else, which was a must since the hospital is being rebuilt soon. There’s space to roll out entire hospital beds as well. Before, when bedridden patients wanted to go outside, we’d have to park them by the entrance, just sitting there as people walked by. There’s more privacy for them in the garden, which is a much more pleasant experience.

Just being outside will positively affect a patient’s well-being at any time, for any patient.

What have been patients’ reactions to the garden so far?

It’s new so people are still a bit hesitant to use it. But those who do are very positive. They like being outside, away from the typical hospital smells. There’s more privacy, fresh air, and pleasant lighting. There’s more to see, like the occasional bird or butterfly. And the staff enjoy working outside as well.

What could the benefits be of receiving chemotherapy surrounded by plants and flowers?

We’re in the middle of researching the benefits, together with the University of Groningen and VU University in Amsterdam. The idea is that people often feel more at ease and healthy when they’re outside, more capable. One way of decreasing the nasty side effects of chemotherapy is to lower the dose patients receive. If a patient is feeling better from being outside while receiving therapy, we might not have to lower the dose and the treatments could work more effectively. Additionally, just being outside will positively affect a patient’s well-being at any time, for any patient,

Sometimes you need to rethink the rules and just use common sense.

In what other ways did the garden have an impact on the hospital?

Pretty much everyone at the hospital got involved. Everyone wanted to help and make a difference. My office hours got out of control, so many patients came in and contributed to the garden with seeds or plants or bird houses. It was an incredible feeling of community to see everyone so involved and excited about the project. One of my patients, Huib Kloosterhuis, even helped organise a bike ride with which we raised almost 40,000 Euros for the project. Huib unfortunately passed away this year. The path leading from the chemotherapy rooms to the garden is named after him. So the idea for the garden was mine, but its creation was a real group effort.

What would you say to a doctor who wants to take on something similar, and use plants and flowers to create a better healing environment in hospitals?

You can add more plants to hospital rooms; even an image of a plant has been shown to make patients feel more at ease. Many hospitals aren’t build for indoor gardens, there’s no room for it as you have to transport beds through hallways quickly and without barriers. There’s rules to how much space is available in a hospital. Taking it outside is a much better solution. And of course there will be objections. There are questions about hygiene, bird poop on the chairs and such. But these patients sit outside in their own gardens too, and I’d daresay the garden is far cleaner than the public transport they take to get to the hospital. For some of the treatments it might be too cold or too warm, you can’t be in direct sunlight for a few of them. But the key is to not think in obstacles. A hospital in a city might not have room for a forest garden like this, but they do have empty rooftops they can use. Sometimes you need to rethink the rules and just use common sense. Could being out in nature help cancer patients? Yes, so we need to rethink things to make it happen. And when you do something no one expects could be done, you inspire others to push their boundaries. Cancer makes people compromise enough as it is. It would be fantastic if people could discover they can still do much more than they thought.

Let it Grow