Homecoming

I ended my journey as I began it, on a red London bus. Two friends boarded and asked where I had been. Walking to my home the Secretary of the Allotments pedalled up to me and asked what I had seen. He told me the strawberries were ready on the allotments.

My garden welcomed me in abundant bloom and the allotment with abundant weeds, under which there were two kilos of strawberries and lots of slugs and snails.

The therapeutic gardens were full of roses and the hollyhocks were so tall and so English. I am off to dead head the roses…Goodbye

Thank you Scandinavians and supporters

I am very grateful to all those who hosted my visits, patiently explained what they did, fed me like a fighting cock and transported me from site to site. The welcome was warm and I hope I can reciprocate in London. The information I was given is valued. Also to the kindness of ordinary people who helped me in transit and opened their homes to me.

I applied for the Fellowship at the request of the hospital and thank my colleagues for their support, especially when I was abroad. Also two people who provided references, I hope I lived up to expectations.

The Churchill Trust provided so much more than finance, advice and encouragement as well as a wonderful opportunity.

There are domestic matters that required attention and my friends and family filled in when I was away. A large number of English speaking people who I met abroad befriended me and helped me too.

Dissemination and Implementation – What, how, where and to whom?

What do you disseminate when you have such a wealth of material? I think I need to segment what I have learned and target different groups. For my colleagues there are those who are working with Huntington’s disease and others who are working with brain injury. A third group is estates, who have a rolling improvement plan for the building and grounds and now include indoor and if possible outdoor growing areas.

At the hospital, there are lunchtime presentations most weeks that I can slot into over the next few months. Less frequently there are ‘Open lectures’ that other organisations such as local brain injury units are invited to attend. Then the patient groups: Huntington’s Disease Association and Headway for brain injuries with which I have run gardening groups locally. There is the British Society of Rehabilitation Medicine and the College of Occupational Therapists promoting therapy. The current President of the Royal College of Physicians is a strong advocate of theraputic gardening too. On the academic side, Reading and other Universities that research in this area may find information on Scandinavian research of interest and particularly the assessment methods used there.

Thrive, the British organisation for gardening for people with disabilities, kindly gave me some contacts and would like me to report back. With Thrive, other british gardening groups may be identified that could benefit from this information.

At the ‘Grass roots’, the Royal Horticultural Society provided copies of their community gardening magazine of that name and sunflower seeds to celebrate 50 Years of Britain in Bloom. They want feedback as does the Head of London in Bloom. All establishments visited were encouraged to join in this celebration by growing sunflowers and this was well received. Community gardening is supported by many of the London Boroughs and the team at Kensington and Chelsea want to know all about it and what they can learn.

Then to the deepest roots of British gardening, allotment holders and amateur gardeners. My own fellow allotmenteers are full of questions and I have had interest expressed from Scotland, well the geology is the same there and the latitude. Local churches have garden groups and a newsletter has requested information. Providing assistance to the disabled in the community, St John Ambulance have asked for a talk.

Even when travelling, people I visited said that a map of the therapeutic gardening and research will be useful for them and others in Scandinavia. I hope the report can deliver this with the blog, my first, trying to illustrate how therapeutic gardening also reflects the geography, climate and culture in which it has developed for rehabilitation programmes.

What can be implemented?

For my own practice, more fruit could be grown and more activities related to nature, I had never thought of tree bark as tactile but it is. Viewing nature is important and I have underestimated this as I am very much a doing rather than a contemplating person. The Norwegian study on the elements of a garden for care facilities I found very helpful and this could be a useful tool as I work with estates to upgrade growing areas here.

As an ‘Its Your Neighbourhood’ judge, I saw may good ideas that could be implemented in Community Gardens here, for able-bodied participants as well as disabled.

In addition to providing a map, I will contact all the people I visited and ask if an email network would be of interest to encourage the spread of innovative practise.

Finally I will encourage others in horticulture and therapy to apply for a Fellowship, it has been an amazing experience.

More conversations with Norwegians

I met a lady in the swimming pool at Roros. She had been treated there for a back injury some time ago but returned as a paying guest as the Rehabilitation Centre sells empty rooms not required for rehabilitation as accomodation. I also stayed there as a guest and it was a good experience as I could talk with patients as well as the staff. She liked Roros very much and went for walks in the forest as well as swimming. I said the centre was very good but she said it all depended on the GP you had, whether you could be referred. If people did not know about the rehabilitation centres, they did not get referred.

She taught me a lot about Norway and expressed concerns that the difference between rich and poor was increasing and the poor were being excluded from activities. She said the Green Farms initiative was interesting but controversial as some clients went from one programme to another and the programmes varied in standard. She lived near Trondheim and kindly invited me to lunch at her home. It was a lovely wooden house and I asked about fire (she explained a village had been burnt down after a storm) and she replied I will jump out of the window. I noticed Norwegians are keen to jump, to dive into the sea from high boards and the three level ski jump in Tromso looked suicidal to me but was close to the hospital. We walked in the forest and a squirrel dropped a chewed pine cone on my head, she laughed her socks off..

On the journey to Trondheim I sat next to a knitwear designer who had travelled by train because it was more environmentally friendly than flying. We discussed environmental matters and how best power could be generated with minimal impact on the environment. She had been a teacher but had given up as the norwegian curriculum was now focused on the PISA international tests and crafts got little time. I explained that crafts can be very helpful in rehabilitation. She showed me the beautiful mittens she was knitting and was interested in my Guernsey sweater.

Wherever you go in the world, you will always meet a British engineer. This one had a Norwegian mother but had read engineering at St John’s College, Cambridge. He asked me what I was doing in Oslo so I explained. He said he was very impressed with the Sunaas Hospital as a friend of his had been treated there after a traumatic injury and the psychological support he received was very good. He said Churchill College Cambridge had been built on ‘ St John’s cabbage patch.’

What have I learned in Scandinavia?

The short answer is a lot. I was kindly given ideas, shown different approaches and saw therapeutic horticulture on a broader base with more integration in the natural environment.

There were a wide range of raised beds, more robust and practical water features, very good greenhouses and more fruit being grown but less vegetables. A wide range of ornamental plants were grown and the use of botanical names was widespread. Flowers were grown to be picked and arranged. Indoor plants were more important than in England, due to the cold weather. Plant material was used in crafts. The growing methods were excellent and the vines I saw impressive.

The importance of viewing gardens and nature was really brought home to me, as I come from a production background rather than an aesthetic one. The views varied a lot and Britain has a gentler but verdant appearence, most like Denmark but more undulating. I will give this more thought and also the use of a wider range of sensory stimuli from nature was used.

Land was limited in area but well used, terraced for flatness and growing linked to farms and riding stables. Community support was evident in some projects and valuable research carried out to identify features that will enhance the therapeutic affect of gardens.

Nature and the natural world was explored more and in varied ways. Bird calls were played to identify when outside, lenses used to examine plants and tree barks used as a sensory material. Clients were encouraged to use their senses, observe and learn from nature.

More assessment was used, some scales but also timed interval observations and interviews. I was given useful jouranl material and books but the methods I had used were thought appropriate to the group with which I worked.

Craft activities linked to the garden were more extensive, cooking was a serious activity and groups could be conducted by a professional chef. Waffle making is central to therapy in Norway it seemed. The provision of high quality, nourishing food in restaurants was widespread with staff eating with clients and relatives in a restaurant rather than canteen setting.

There were more craft activities incuding woodwork and some mechanical work that may appeal more to men and were overseen by very experienced people. Jewellery, weaving, concrete items and bee hive frames were made and often sold. Running a stall or shop was part of the therapy.

In rehabilitation, there was emphasis on exercise with good gyms and swimming pools that were accessible with ramps. Outdoor exercise was encouraged wherever possible, including in wheelchairs. Sleighs, boats, tricycles and other forms of transport are encouraged. Doing exercises outside was popular, thus a good green environment was needed. Floor exercises and rest periods were conducted on sheepskins.

The most important thing was the challenge that we are all working to the same end but in different ways. The opportunity was to show what had been done in London, the trugs, ladder allotments and raised beds and these were noted as useful. More plants were grown in pots and painting done on the pots in London. The work on winter activities and gardening for Huntington’s disease and most popular how to plant a potato in a pot, with the illustrated guide. The presentation of research was copied and much interest was expressed in the computing, concerts and ceramics. There was no mosaic anywhere I went. Most hosts were pleased that I came to share, not just to take and I hope that they learned just a little in this process.

Encounters on an arctic voyage

At Trondheim, I concluded my study visits but travelled north by ship to see the fjords. The scenery is stunning but a country is not solely scenery but also the people that live there. Interacting with the local people that I encountered on the voyage gained me more insight with context and added to my understanding.

On the first evening northbound, a Norwegian lady joined my table at dinner. By an amazing co-incidence, she had worked at the rehabilitation unit in Trondheim at its previous location in Munkvoll and was travelling to a nursing re-union in Bodo. We had a great deal to discuss and I learned from her that she had really enjoyed working at Munkvoll because there was time to give to the patients but she had had to learn not to help them too much, to hold back and let them complete the task by themselves. She explained there were patients in vegetative state at the unit and I replied we had these in London too. She had also worked in elderly care and this was very busy but she had time to enjoy a joke with the patients, addressed them as ‘girls’ and liked to enjoy a joke with them. The ‘girls’ particularly enjoyed her hot chocolate topped with whipped cream but this annoyed the chef, as the cream kept on disappearing! As she left the ship she gave me a pair of socks she had knitted me on the voyage which I will treasure always.

I was particularly interested in the Lofoten Islands as despite their northerly latitude, the North Atlantic Drift warm current allows plants to thrive. At Svolvaer, there was a wonderful selection of plants for sale in the square and beautiful flowers in the gardens which I photographed. On the return journey, finding it difficult to obtain a seat in the observation cabin, a Norwegian lady said there was a seat free next to her. She worked in Svolvaer and lived nearby, I discovered after we had been in the Troll Fjord. The fjord, which is very narrow with towering mountains on either side, was very busy. Two Norwegian navy minesweepers were at anchor, a yacht was tacking out and a tripping boat had to withdraw at speed when our large ship needed to turn at the head of the fjord. I explained to the Norwegian lady what I had been studying and that I had photographed gardens in the Lofotens. She burst out laughing and asked me if I had not see the Norwegian news. Apparently, some Asian tourists had entered a Norwegian garden when a local ladies group were taking coffee and their children playing there. The Asians solemnly filmed this and the flowers before leaving. I assured her that I had only taken snaps from the outside of the gardens…The locals find the Troll fjord visits tedious as they tend to make the boat late, especially this time requiring contact with the shore to delay her lift and turn down the dinner.

In Svolvaer I went ashore on the return journey and visited the war museum. I met the man who had assembled the collection as I was a Churchill Fellow and he was delighted to meet me and to see my card. He set up the museum to show the folly of war, how it affects human behaviour and what a disaster the Second World War was, with reference to the north of Norway. He asked me particularly to see the Gestapo interrogation room, which I did briefly and it was horrible. I said that a young Norwegian had remarked on the amount Churchill drank but I had pointed out that Hitler was teetotal, did not smoke and a vegetarian. He replied, ‘Yes, he was very controlled and controlling that was the problem.’ Older Norwegians are very concerned about the activities of the far right and with good reason. He also gave me a present. On the voyage home the passengers were requested to wave to join in an open air church service commemoration of a resistance activity and I asked if my card could be given to the group with the best wishes of the Trust.

The final lady was an American and she presented me with her dog’s card, a therapy dog that worked with children but norwegian breed, like Saga I thought.

Jordhammer Vaxcraft and Grona Rehab – Back to Goteborg to fill in gaps

I am back in London and have reviewed the blog.  I feel that my post did not do justice to the first two sites visited in Goteborg so I write to give more information.

At Jordhammer Vaxcraft, Rick Mulder runs two sites. The first is a horticultural nursery with glasshouses bought from a retired grower. The mainly unemployed clients grow plug plants from seed for sale and tomatoes sold in their own shop or at market for trade price. The clients join for six months and need to progress from ten hours work per day to 20 hours in six months. Participation and choice of reporting hours is voluntary. Clients must progress and move forward to help new joiners. Many (40 per cent) have alcohol or drug problems. As the addiction may be dopamine related they are assigned hard physical tasks and the other clients help assure abstinence.  As well as propagation, crafts of carpentry, willow weaving and concrete moulding are done and sold. Bees are kept, honey sold and candles and hive frames made.

Other clients have learning disabilities, one was wheelchair-based. The project is funded from the health and unemployment budgets, after the 6 months the clients become workers at the enterprise, still subsidised by the government but costing less than full time unemployed. 40 per cent return to ‘work’ in the sheltered enterprise.  All clients and staff eat together and provision of a nourishing lunch is important in maintaining a good state of well-being, according to Rick.

Secluded site to treat clients with PTSD

I met Annika, horticulturist and Annette, social worker on the new project. It was based at a house in the country previously used by a priest. The site has established fruit trees in blossom, a green house with a peach tree, a newly tilled vegetable patch and raised beds under construction.  The two clients prefer growing flowers and learning Swedish is proving a challenge. Assistance from a computer is being considered.  The house attached to the site is being restored and the ground floor provides services and a recreation room.

Report on a visit to Green Rehab in the Goteborg Botanical garden

I was met by Eva Sabin, PhD student who has been evaluating the project, based at Alnarp. The project is led by Eva-Lena Larsson, a biologist who works at the Botanical gardens and has done research on nature and health. The project was initiated by a problem experienced by the regional government of West Gotland, with over 50,000 employees, mainly in health having high levels of sick leave, stress and moderate to severe depression. The problem was highlighted in 2004, the project funded for 3 years in 2006, is being evaluated and receives about 60 clients per year. Clients with severe depression may not have worked for between 3 months to 12 years.

The site is an old gardener’s cottage, with mature fruit trees in the front on a lawn. The rear garden is hedged for privacy, as there are allotments next door. The back garden has fruit bushes, a terrace with ornamentals, a large greenhouse for propagation and the growing of tomatoes, peppers and cucumbers. There are low raised beds, lawn and a conservatory with indoor grape vines.

The staff are a team of five: a biologist, a gardener, a psychologist, a physio and occupational therapist.

There are four groups a year, two rehabilitating long term sick and two stress management courses. All clients are anonymous, first name only and the green programme is gardening and nature. It is complemented by the white programme of body relaxation, handicrafts, art, talking therapy and exercise (on sheep skins). The wilderness is adjacent to the Botanical gardens and this is experienced in groups or alone. Monday has slow 5km walks, using a lens to focus on nature, identify bird calls, feel tree barks and this and the garden work shows nature is imperfect, this may help clients to come to term with their problems.

Seeds produce delicate young seedlings which grow on as meadow flowers are picked and taken home. Social confidence is built by holding small parties on a seasonal basis, Christmas baskets are made. In winter, crafts with wool and willow weaving are done. Art sessions are held, with each painting dated. Clients are asked to choose different colours and use symbols. The dates help trace progress.  Relaxation therapy is held with sitting, standing and prone exercises. Discussion sessions are organised so that clients support each other.

 The research has shown an initial success rate after a three month rehabilitation of 93 per cent returning to work or to study. After 18 months 86 per cent are still in work or study.  The project has been carefully evidence-based, and an established methodology has been followed. Green rehab is popular in west and south Sweden but not in the east.

Music in Norway and art in Denmark

Although I have spent much time with plants and gardens and in Oslo seen an exhibition of Edward Munch’s  nature paintings, I have managed a little culture too.

My friend took me to the Art Museum in Ribe.  An old house from a wealthy family, it has pictures of the golden age of Danish painting, sort of late Victorian.  There are family scenes , pictures of Ribe, with views now gone and work by the artists at Skagen at the northern tip of Jutland.  The light there is very clear, like St Ives in Cornwall.

In Trondheim, my hotel is close to the Cathedral, a shrine to St Olav.  Saturday marked two hundred years of independence for Norway, so there were many events.  These included a concert, of early music by a madrigal group called Motett with Palestrina and at ten at night, with light streaming through the windows an organ concert of Norwegian music, mainly Greig played on the huge organ that has nearly nine thousand pipes.  The sound was amazing, especially from low notes, the ground vibrated and the programme shook in my hands as the music reverberated around the cathedral.  You looked up at the fan vaulting, the rose window and the ceiling bosses, a sensory feast.

Liam, St Olav’s Hospital rehabilitation outdoors at Trondheim

I was welcomed by Monica and Camilla, occupational therapists at the unit.  The unit has been situated on the outskirts of Trondheim for four years.  This has the advantage of looking out over a lake, being close to the forest and the mountains, so the emphasis is on activity outdoors.

The garden is to the south of the building and above the lake.  The are two raised beds one stone, full of herbs and strawberries, the other wood, for wheelchair use with nasturtiums planted.  Below this was a shrub border being mulched with bark and fruit bushes and fruit trees which all had fruit formed on them.  The gardening group is quite large and is a mixed group of staff and clients.  Some of the planning is done by the clients and tasks allocated.  The atmosphere was very friendly and the staff say it helps build rapport with their clients for other therapies and helps with social interaction.  Even if this is stimulated by caterpillar attack on a plant.

Gardening is only one of the outdoor activities done by the clients.  Led by physio Camilla, they walk in the mountains, canoe and row on the lake, have treasure hunts, ski, have sleigh rides with both a horse and dogs, climb rocks and an eight metre climbing wall, even people with hemiplegia…

The approach is to keep outdoor interests going and stimulate them further.  It is difficult to garden at such high latitudes but they do well despite severe frost, deep snow and deer eating their hard won plants. 

It is not always what you think…

I always think the London tube must be very confusing for visitors, but this is not so I am told by Norwegians.  In Norway, much of the railway is single tract, so lines reverse direction.  This I found confusing.  Used to up and down platforms, when I found a down train on an up platform I crossed underneath the track to find the up train had gone, then recrossed to find a down train on the up platform, so I asked the guard who told me to cross to the second platform where I finally got an up train…

At breakfast in Roros, I notice a round nut or soya cutlet cake, the character-building sort of nosh, consumption of which gains rewards in the next world.  I take a small slice, it tastes like quinine.  A Norwegian tells me I should eat it on bread and butter.  I ask what it is.  Cheese mould, a very old food, for elderly people to improve their immune systems.  It is, as I understand , like the rind of a Stilton cheese but on a crispbread with some margarine, no butter available, palatable…