My colleague, child life specialist Jon Luongo, is one of the most playful professionals that I have the pleasure of knowing. He taught me all about the “tongue depressor challenge”, which is described in detail in our co-authored chapter in the Handbook of Medical Play Therapy and Child Life.  Below is a brief introduction to the activity by Jon:

I encourage the doctors to tap into their imaginative playfulness to complete what I call the ‘tongue depressor challenge.’ The task is to co-construct a teaching tool alongside a patient to explain a part of the body, a particular medical condition, or piece of medical hardware. The challenge for doctor and patient is to use at least one tongue depressor in their design; like a single LEGO brick in a set of construction toys, the tongue depressor represents a humble piece of medical paraphernalia with limitless creative building potential.

 

As with many great ideas, I borrowed Jon’s and tweaked it a bit. This past July, I brought the activity with me to the Klicek Foundation Summer Camp in Malejovice, Czech Republic. Camp directors Jiri and Marketa Královcovi graciously allowed me to lead the campers in a slight variation on Jon’s theme.

With the help of interpreters, I told the campers that I understood that many of them had been hospitalized at one time or another, some for lengthy periods of time. If they hadn’t been in hospital, they probably knew someone who had. Although hospitals are places of healing, they can also be somewhat frightening, boring, and sad. I wanted the kids to think about how they would make hospitals better, what would they change or add if they could. Their ideas could be fantastic representations of their imaginations or based in reality. Once they had discussed possible improvements, they were to use loose parts to build a representational model of their idea.

When Jon did this with child life specialists at a CLGNY regional conference several years ago, he provided small groups with a plethora of  loose parts objects to use in their creations. At Klicek, Marketa didn’t want to limit the children to what we provided them. Instead, she wished to encourage the campers to forage for whatever they might need. This indeed did expand the possibilities and scope of the project. She also had the great idea of assigning an expert to each small group, a child who had been a patient and knew firsthand what might lead to an improved hospital stay. Because I didn’t have tongue depressors available, I thought of adding a cultural component, and we asked the children to include at least one item from their natural environment in their models.

The children divided into small groups by age span, and adults joined in on the conversations. They made lists of ideas, gathered loose parts from their surroundings, created 3-D representations of their best ideas, and shared out to the whole camp. Each group had something important to add to the conversation.

The youngest group spoke to the barren cheerlessness of hospitals. They felt that doctors should dress more colorfully, and that vibrant walls and artwork would make a difference. They described a “rainbow floor” as something that would make the hospital more fun, and of course they requested a children’s corner with toys. This gives you an inkling of how drab and foreboding institutions can be in the CR. With the help of one of the adults, the children created a doll from loose parts to articulate the importance of bringing the comforts of home into the medical milieu. But their biggest focus involved a request for someone to come to the hospital with cats and dogs for children to pet. One child said that petting the animal would help them to feel less stressed. The kids gathered up one of the many camp cats and Hugo, the black lab, to demonstrate the benefits of animal presence. Best loose parts EVER!

 

 

The tweens had a lot to say about the challenge of missing normal things such as sun and fresh air during overnight stays. They built a model of a hospital building out of sticks, twigs, grass and flowers. This futuristic building should be a “special place” where medical care, kindness and nature could be merged. It would include:

• 1/3rd of the roof to be covered with grass
• a roof deck with railing to be used as a play deck
• A sand pit to play in
• Empty space – a free zone — where patients are free to do anything – like lie down and listen to birds.
• A wall of chalkboard to write and draw on
• An open air cinema for the Summer.
• A racing circuit for wheelchairs
• picnic tables in a visitors’ corner
• A sun spa with loungers, flower beds for beauty, and a mist machine.,

One boy spoke pointedly about the demeanors of medical personnel. “They are joyless. They need a play corner just for them.”  The play space would include a few tables for checkers, and some benches to rest upon. It reminded me of the nurses in the Palestinian city of Tulkarem, who while playing cats cradle with string commented that happy and playful nurses make playful and healthy children.

The teens created a list of things they find annoying in hospitals.

• A dry, sterile and lifeless atmosphere
• The smell of disinfectant
• Unfriendly staff
• White uniforms
• Doctors who are rough, rude and serious
• One bland color paint and dim rooms
• The inability to choose one’s roommate
• Doctors sharing information using big words that are hard to understand
• Soup that is too salty
• Blood pressure meters that trigger without warning
• It feels like a prison.

In order to address these annoyances, the teens suggested the following remedies:

• For children who are undergoing longterm inter-veinous treatment — the ability to push their own medications with a nurse bringing the proper dose. “I want to push my meds in slowly – the nurses do it too quickly.”
• Colorful rooms. Volunteers have painted awful, distorted murals. They need expert artists to decorate the rooms
• The ability to decorate one’s room to one’s taste.
• Good restaurants who know how to make good food being available instead of hospital food. Starbucks, good pizza, KFC …etc. The teen who suggested this printed out photos of fast food restaurants to add to the model.
• Reberbishing medical equipment so that it is not so ugly.
• The outer world coming in

Their model showed a” friendly designed” patient room with more flowers, a colored floor and bedsheets. There should be a Hawaii room like this on every floor. This room had plants and flowers, and a whirlpool, They created a tiny patient out of a pinecone and stated, “The face of Mr. Pinecone is delighted by the Hawaian room. The room exudes a free atmosphere, openness, versatility and FREEDOM!”

 

 

 

Way to go, campers! There should be a panel of experts like you involved in every hospital design and improvement committee in the world.