A new hope


Recent work done by Maggie¹s Centres in creating inspiring environments for cancer sufferers to meet, gather information and take refuge. HD Healthcare Design & Development June 2003

Over the last eight years or so a remarkable complementary cancer care programme has been steadily taking shape in Scotland. Last November brought the opening of the second in series of Maggie¹s Centres at the Western Infirmary in Glasgow and soon the next centre at Ninewells in Dundee, by the celebrated exuberant LA-based architect Frank Gehry is due for completion. These centres are plugging the gap in provision foreseen by their instigator, architect Charles Jencks: ³Cancer is on the rise, and one in three now get it, an health services will be overwhelmed. Here is a role, and an important one, for Maggie¹s Centres.² The next few years will see Maggie¹s Cancer Caring Centres appearing across the UK, designed by leading-edge architects such as Richard Rogers, Daniel Libeskind and Zaha Hadid. Despite their lack of track record in healthcare, it is envisaged that involving high flyers will support the aspirations and profile of the centre¹s programme. The organisation¹s bold stance is that progressive design is beneficial and will impact positively upon the Centre¹s users. It represents a rare opportunity to witness a fresh approach to patient orientated design which supports complementary care and encourages self-help.

The first Maggie¹s Centre was opened at the Edinburgh Western General in November 1996. It was dedicated posthumously to Charles Jencks¹ wife Maggie Keswick Jencks, who, during her life as a cancer sufferer, identified a real gap for support in the provision for patients who are diagnosed with cancer. She initiated the project with her article ³A view from the Front Line,²* an inspiring and original essay from the patients perspective. Not only did she identify a serious void in existing cancer services, but she also advocated assisting the patient to take an active role in the whole process. More and more sophisticated approaches to cancer care exposed a need for patients and their families to have a better understanding, so they can participate and get on with living with cancer and its treatment.

Until her death in July 1995 Maggie proceeded, with her oncology nurse Laura Lee, to prepare a blueprint for the bold concept of encouraging self-help for patients and their carers. Her husband (co-founder of the first Maggie¹s Centre), believes her transformation from a passive chemotherapy patient extended her life by two years. Maggie herself believed information will relieve fear, and above all that ³What matters is not to lose the joy of living in the fear of dying.² She held that involvement in one¹s own treatment is an empowering weapon, leading to prolonged life, and that there was a reasonable amount of evidence. Patients who eat healthily, keep active and take steps to deal with stress and fear, feel fewer symptoms and less pain even in the final stages of their disease. Following extensive enquiries throughout her illness, Charles Jencks now suggests scientific verification is soon on its way.

Rather than proposing a complete alternative, Maggie¹s Centres are always complementary to the NHS mainstream cancer resources. Although Maggie Centres are self sufficient and free-standing, they are easily identifiable and located, within view from major cancer care units. Fuelled by interest from professional cancer specialists, the centres are rapidly spreading, with six in Scotland and a further seven across England and Wales. According to Charles Jencks, the paternalistic institutions are no longer trusted to know best, and what he calls ³post-modern² patient and carers are have to be interactive in terms of their choice of treatment. He describes three clear defining parameters to developing cancer care: advances in medical science, complementary support, and inspirational accommodation. At the core of the surgical aftercare process is education and personal growth, the patient confronting their illness and taking responsibility for their own lives. Surgeons can only achieve so much, beyond which individuals must be prepared to win their own peace of mind. This is an optimistic task especially in the socially deprived and depressed inner-cities which neighbour the Maggie Centres. The architectural aspect is about designing appropriate spaces of superior quality to allow the support team to confidently work together towards aiding the patient and their families towards a better quality of life.

The organisational emphasis is on teamwork, headed by an enthusiastic leader, Laura Lee. Through years of experience they have developed a highly effective and accessible information and support programme and those who wish to participate, however passively, can do so with full knowledge and approval of the clinical staff. Patients and carers may drop in unannounced, sit down have a cup of tea, browse literature, doze a while or talk to somebody. The atmosphere is informal with open access and expertise is available to offer advice, guidance and psychological comfort, but not instructions. Useful information is provided on illnesses, including how ask

the right questions and identify a suitable course of treatment. Much too modest to include her own name Maggie herself intended to call the original project the Ocancer caring centre.¹ Her husband believes this description was too anonymous: ³Cancer patients must to a certain extent take control of their lives, thus using the name of a patient is non-institutional and allows other patients to identify with her.² He believes the personal touch is the trigger to promoting self-identity and engendering confidence. When cancer strikes the patients, their family and employment structures can easily crumble, and they need causes to identify with to build them up Hopefulness for the future and determination to live life can be re-invigorated.

Focussing on accommodation

From her article Maggie¹s views on hospital services and accommodation are revealing. She writes: ³Patients should never be asked to sit out in the corridor immediately after hearing a diagnosis - people need time and space for adjustment. An old fashion ladies room not a row of partition cubicles with its solid door, own hand basin and mirror will provide privacy for crying before collecting oneself to face the world again. It is not so much the waiting times but rather the circumstances in which you wait that count. Artificial lighting and no views out all contribute to extreme mental and physical enervation. Patients who arrive hopeful soon start to wilt. Illness shrinks patients¹ confidence and messages from most hospital environments will undermine them still further: "How you feel is unimportant!¹"You are not of value!¹ With very little effort and money they could be changed to "Welcome¹ and Odon¹t worry, we are here to reassure you.¹ Why shouldn¹t the patient look forward to a day at the hospital? We need to think of all aspects of hospital layouts, which reinforce institutions, corridors, signs, secrets, confusion and unpick them.²

Guidance for the design of Maggie¹s Centres aims to make spaces which make people better rather than worse. An obvious, non-intimidating entry, with welcoming sitting, information and library area from where the layout of the rest of the building should be clear, following the client¹s desire for open, readable spaces. You should be able to see the country-style kitchen with an island stove inviting enough for all patients and carers to feel welcome and help themselves to coffee. Equally you should see the sitting room and hearth with as much daylight as possible and views out to the garden, trees and birds. The comfortable chairs and sofas arranged in groupings to encourage relaxation and informal chat. It is important to look out and be able to step out of as many rooms as possible. The information area with video viewing and computer network link should be within earshot of the programme directors space. The clients seek a balance between private and social, eg the councelling space when in use must be completely private, but open when free. The ethos and scale should be domestic for first time users to be undaunted and feel part of a special family community. Buildings are required to make users feel more buoyant and optimistic, that life is more interesting after leaving than when they walked in.

Achieving quality is not exclusive to architectural celebrities and the centres employ a mix of lesser-known but emerging designers. For the first scheme Edinburgh-based Richard Murphy converted a small stone stable block into an open, spacious volume. Daylight floods into the hall through ridge roof-lights onto a flexible interior with sliding doors to the garden patio beyond. The communal therapy suite with its flamboyant wavy canopy and generously comfortable sitting room is a recent conservatory extension. The landscaping by Emma Keswick incorporates a kinetic sculpture kindly donated by the late Glaswegian master of the mobile engineer and artist George Rickey.

Meanwhile at the stone gatehouse opposite the Beatson Oncology Centre in Glasgow, the second cancer caring centre was completed last year by architect Page and Park. The Beatson diagnoses 7500 new cases of cases each year from the Strathclyde conurbation and beyond (half the population of Scotland). Popular support from the Evening Times raised £500,000 and six months after completion the Maggie¹s Glasgow has a growing presence within the city. As in Edinburgh this is a high quality conversion; it cleverly carves out the existing stone structure with apparent ease. Contained within a larger volume, the latest centre enjoys a unified footprint with a coherent attention to internal detailing. The garden features a milled aluminium DNA double helix sculpture mounted upon a spiral landscape designed by Charles Jencks. Both these centres are vibrant and comfortable extensions couched in dignified existing buildings and we wait in anticipation to see how well a brand new bespoke Maggie¹s Centre will appear.

Learning from experience
With both Edinburgh and Glasgow centres now operable there is a valuable opportunity to access the performance of the two pilot schemes. According to communication director Barbara Kidd, they continuously access space utilisation, but what lessons from a maturing learning curve can be incorporated into future developments?

More capacity
When the centre first opened it was soon realised that more space was required to organise the support group sessions and courses. With the extension in 1999 the Edinburgh centre doubled its size to 250 sq metres and this resolved the need for a large flexible group activity room. Although important to retain a domestic scale, the volume specification for future Maggie's centres has since increased. In cities like Glasgow, where the demand is greater than the optimum size, rather than extend the existing unit, a dedicated new centre would be built in a convenient location

Achieved partly by observing how people use the building and adapting it into the programme. A reciprocal process, the core support programme influences the brief for the building and the spaces influence the programme. Visiting Maggie¹s Glasgow, one sees how the rooms integrate effectively together providing a layering of access to support, allowing visitors to choose for themselves where they wish to go. According to their mood there is the chatter around the kitchen table, or for a reflective moment there is the cosy sitting room or a quiet reading corner in the library. All these spaces open onto each other so you can see what is going on elsewhere in the building and choose to participate or not. Flexibility and adapting after completion: To introduce a new consultation room following the Edinburgh extension, it was realised they had to relocate the position of the door. For direct access the entrance in the original plan opened up onto the kitchen the hub of the centre. Given the intensity and intimacy of the interviews it was then felt inappropriate to emerge into the kitchen with its communal interactions. The door was repositioned to open onto a more discreet perimeter area giving guests confidentiality and a choice to either enter the garden or another part of the centre.

Including the surrounding environment
The setting is important for the building to function and the surrounding landscape is a key element to the success of the cancer caring centre. Spaces look out on to the garden and during the summer months and fair weather it becomes an external 'room' where visitors sit, take tea, or groups meet and hold Tai Chi sessions. After the Edinburgh extension the re-development of the garden became a priority. For the planning of subsequent new centres the landscaping has become an integral part of the project from the outset. Unlike the universal functional doctrine of modern healthcare facilities, Maggie¹s Centres offer a very specific and personal architectural statement.

The blueprint gently aims to de-institutionalise offering the recipient designer considerable scope for interpretation. The conditions appear to be compatible with the ³post-modern² ethos of patient focus and choice of privacy or social interaction, with full access to infomation in a comforting atmosphere. The new centres offer an opportunity for versatile and expandable spaces, an open cluster arrangement with few closed cells, no corridors, signs or clinical undertones. Healthcare facilities need not follow the prevailing formula. Maggie¹s Centres show it is possible to demonstrate creative flair and panache both within the existing hospital framework and at the heart of the community.

Further information
³Maggie Keswick Jencks¹ book ³View from the front line² is available from Maggie's Cancer Caring Centres The Stables Western General Hospital Crewe Road South Edinburgh EH4 2XU.
Visits to the Maggie¹s Centres can be arranged by contacting Communications Director Tel 0131 537 2457 Fax 0131 537 3130
For an overview of Frank Gehry¹s Dundee scheme, completing later this year, see HD, February 2001, p25.


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