Re: patch's gesundheit! institute
From: Quintal (xavier22_at_MONCULclub-internet.fr)
Date: 11/26/04
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Date: Fri, 26 Nov 2004 01:25:06 GMT
On Fri, 26 Nov 2004 00:09:11 GMT, Quintal
<xavier22@MONCULclub-internet.fr> wrote:
>http://www.patchadams.org
>
>
>All the healing arts are welcome
>All patients are treated as friends
>There is no charge for health services
>No third party reimbursement is accepted
>The health care experience is infused with fun
>No malpractice insurance is carried by the Institute
>The health of the staff is valued equally with the health of the
>patients
>The health of an individual is nested in the health of family,
>community, society and the natural environment
>
>
>_
>francom.esoterisme,fr.bio.medecine,sci.med
The Gesundheit! Institute
Patch Adams, M.D.
I entered medical school in 1967 to use medicine as a vehicle for
social change. I used my free time to study the history of health care
delivery around the world and to look at contemporary models with the
idea of creating a medical model that would address all the problems
of the way care is delivered. I didn't intend to create a model that
would be the answer to the problems; but to model creative problem
solving, and to spark each medical facility to design their own ideal
rather than succumb to the garbage of managed care, or a resignation
to the impossibility of humanistic care. Beginning in the climate of
the political "war on poverty," I felt confident that a free hospital
to serve the poorest state, West Virginia, would find easy funding and
that we would be built in four years. I smile writing this as we enter
our 33rd year without having broken ground on the hospital. However,
we have asked our architect to go to finished drawings so that we can
begin building as soon as we have funding in hand. None of the journey
has gone as I imagined and the vision is so much deeper, more
comprehensive and far-reaching as a consequence of such deliberate
progress.
The original vision had all the principles we have maintained all
these years. There would be no charge for the care. Barter was also
not an option. In fact, we wanted to eliminate the idea of debt in the
medical interaction as a way to begin recreating human community. We
didn't want people to think they owed something; we wanted them to
think they belonged to something. We could not conceive of a community
that did not care for its people. This also meant a refusal to accept
third party reimbursement, both to refuse payment and to sever the
stranglehold that insurance companies had on how medicine was
practiced. We would have nothing to do with malpractice insurance,
which forces fear and mistrust into every medical interaction. We
espouse the politics of vulnerability and are clearly aware that we
can only offer caring and never promise curing. In such a flagrantly
imperfect science, we need the right to make mistakes.
The loudest cry of patients was for compassion and attention, which
was a call for time. So initial interviews with patients were three to
four hours long, so that we could fall in love with each other.
Intimacy was the greatest gift we could give them, especially at a
death bed, with intractable pain or chronic, unsolved medical
problems. It was natural to insist on a house call to sweeten this
intimacy. When I made a house call, I opened every drawer and snooped
in every closet. I wanted to know the patients in all of their
complexities. An apparent secret in the practice of medicine (so
easily erased when business is the context) is how care is
bidirectional. This intimacy is as important for the care giver as it
is the patient. The bidirectionality of healing is at the core of
preventing burnout. The business of medicine has connected the word
care with the concept "burden," to describe all who need care, who are
not wealthy. But we found the unencumbered practice of medicine is an
ecstatic experience.
In spending this amount of time with patients, we found that the vast
majority of our adult population does not have a day to day vitality
for life (which we would define as good health). The idea that a
person was healthy because of normal lab values and clear x-rays had
no relationship to who the person was. Good health was much more
deeply related to close friendships, meaningful work, a lived
spirituality of any kind, an opportunity for loving service and an
engaging relationship to nature, the arts, wonder, curiosity, passion
and hope. All of these are time-consuming, impractical needs. When we
don't meet these needs, the business of high-tech medicine diagnoses
mental illness and treats with pills.
What the majority need is an engagement with life. This is why we
fully integrated medicine with performing arts, arts and crafts,
agriculture, nature, education, recreation and social service, as
essential parts of health care delivery. We knew that the best medical
thing we could do for the patients was to help them have grand
friendship skills and find meaning in their lives. This is a major
reason that the staff's home was the hospital. We insisted on
friendships with our patients (made easy by not charging, and giving
them our lives). A patient ideally would bring their whole family
while they were healthy, and stay a few days as friends, becoming
familiar with the hospital (home, sanctuary), so that just being there
was relaxing, even healing.
We wanted patients to bring all their interests and skills to
essentially become temporary staff as well as patients during their
stay. For example, if a car mechanic came as a patient, we could
notify the poor in our greater community who might need their car
fixed, and have it happen while the mechanic was getting care. The
mechanic may also give classes on basic mechanics. All these features
help build community, creating a sense of interdependence. Those
receiving care can not feel indebted because they become both the help
and the helped.
To help promote diversity and truly to be full service in our planned
facility, we insist on integrating all the healing arts. Allopathic
medicine, including surgery, ob/gyn, pediatrics, internal medicine,
family practice and psychiatry, will work hand in hand with
complementary medicine, including acupuncture, homeopathy,
naturopathy, chiropractic, ayurvedic, anthroposophic, herbal, body
work and faith healing. It will be an exciting opportunity to study
how they can all work together under close observation. The entire
environment will be an example of preventive medicine exploring how to
help a patient and their family grow healthy (or at least healthier!)
>From the beginning, social, environmental and global health were felt
to be essential as part of our medical practice. There, violence and
injustice became medical issues. Unemployment, the discrepancies
between rich and poor, poverty, pollution, corrupt governments and
economic systems all become concerns of a medical practice. There was
always an invitation and encouragement to become involved in social
change, even if the individual did not feel it affected their life. We
want to build a fine community of people whose ethic is caring for
all. Now, we have added to our vision a school to teach social change
with the whole community as its laboratory. Agriculture will not just
be about feeding people, but an exploration into sustainable
agriculture. We'll use designing the community as an experiment in
appropriate technology.
One of the most radical parts of the vision was that we wanted all of
the activity to be infused with fun. I wanted to build the first silly
hospital in history. Foolishness was embraced, often to extreme, in
even the most profound of situations. We had fun deaths and bizarre,
outlandish behaviors with the mentally ill. In our normal, serious
world with somber medical environments (even though no research
supports being serious and thousands of research papers encourage joy
and humor as healing), we saw no contradiction in feeling that a
hospital could also be an amusement park, even implying it is
important for staff and patient.
The ideal staff people we looked for were, by intention, happy, funny,
loving, cooperative and creative. I knew the key to the creation of
this beautiful model was in the people deciding and choosing to live
there; because it is people that really make a model. Ideas can only
be as real as the people living them. Politically, our most potent
wedge for change would be living happily together, in constant, joyful
service, fully expressing our creative selves at extremely low
salaries. The point was not to try to teach a staff this, but to find
people for whom this was their way of life.
In our first 12 years (1971-1983) we did all this as a pilot project.
Twenty adults and our children moved into a large, six-bedroom house
and called ourselves a hospital. We were open twenty-four hours a day,
seven days a week, for all manner of medical problems from birth to
death. Three of the adults were physicians. We saw 500-1000 people
each month, with five to fifty overnight guests a night; totaling
15,000 people over those 12 years. We were never sued. At least three
thousand of the patients had mental illness and we did not give
psychiatric medicines. We referred out what we could not handle. It
was truly ecstatic, fascinating, and stimulating. No one gave us a
donation and we were 0:1400 for foundation grants, so our staff had to
work part-time jobs to pay to practice medicine. After nine years of
nobody leaving, most staff said they felt we would never be funded,
and wanted to stop. It was the saddest moment for me, for I loved all
of them and knew that I had to persevere.
I tried to recreate the work for three more years and realized that in
order to continue, I need a facility to support this model of care.
Now the job was to raise the funds to build it. It appeared that our
ideas were too radical to get conventional funding, and so I realized
that we had to go to the people of the world to get the needed funds.
The model for that in modern society is through publicity and fame. So
I broke a basic tenet of our philosophy—no publicity—and became
public. For the last 20 years we have climbed that fame and fortune
ladder in hopes that we would attract funds to build our ideal rather
than compromise the vision. This went to monstrous extremes in 1998
when a feature film, "Patch Adams," was released with Robin Williams
playing me.
These efforts have brought us a three hundred seventeen acre farm in
Pocahontas County, West Virginia. The land has three waterfalls, with
caves behind one. We built a four acre pond, there is a mountain of
hardwood trees and twenty-eight acres of rich bottom land that has had
no chemicals on it for 22 years. We have built two beautiful buildings
in anticipation of someday building the hospital. Two years ago, with
a little sadness that the hospital was still not built, and a hunger
to begin seeing patients again, I agreed to consider reopening with a
first phase that would include an outpatient clinic and a school for
social change, with residence facilities for the staff. We have asked
our architect of 21 years to give us finished drawings for it. We owe
no money and have a good start for Phase I.
I could feel frustrated, even sad, that the hospital is still unbuilt.
However, in the long run it may prove to have been a very positive
time line. After 33 years, we have built a much larger, more diverse,
more intelligent, more globally influential model than we ever dreamed
of in those first 12 incubating years. Our global impact has affected
far more patients' lives and inspired more social change than if we
had gotten our funding early on. My failure at fund raising has forced
me and our evolutionary staff and friends to expand in every direction
and meet a quality and quantity of people that make our greater team
of friends and contacts number in the thousands in almost every area
of endeavor; especially healing, the arts, and social change.
Gesundheit! has indeed become a global mover and shaker active in
forty or more countries, expanding beautifully all the time.
When we build the model with people serving it, full and part time,
its example will be breathtaking with a process already in place to
have an important impact because a variation of that is happening
already. The patients of our first 12 years were individuals and
families looking closely at their organ systems. The patients of our
last 20 years have been communities and societies looking at their
organ systems: environmental, social, political, economic. All of
these "patients" will dance through the hospital when it is built. I
have had to earn the funds to support these last 20 years' activities,
with every month being a creative journey of survival. Since the
film's release, we're not on such a survival edge, but we have still
not raised funds for major construction. The beauty of the journey
makes patience easy, especially since every day is wildly exciting and
globally influential, regardless of the building progress. This is not
to say that the building of the hospital is any less important. On the
contrary: it is more important than ever since it has remained, these
31 years, the only model in the U.S. (and one of few in the world) to
comprehensively address health care delivery problems. Our example of
joyful persistence alone is an important, inspiring model for the
changes needed in the world.
We stopped seeing patients in 1983 to devote ourselves to fund raising
full time for the hospital, by expanding out into the world. I began
lecturing and performing on a wide variety of subjects (fifty
lectures, shows and workshops) with every imaginable kind of audience
and with as many as eleven lectures in a day. All levels of education
from elementary schools to medical schools (most of the ones in the
United States and in thirty to forty countries), churches, community
centers, conferences and corporations. For most of the time it was for
150-200 days a year and 300 days a year since the film, always all
over the world. A constant flow of publicity and my two books
translated into ten languages and the film have made our project part
of the medical dialogue all over the world when referring to humanized
health care.
During these 20 years our clown healing work has expanded all over the
world, so that clowns are now a regular part of hospitals on every
continent and this is expanding as people hear the message that it is
really about spreading joy in every public space as gestures toward
peace, justice and care. I started taking clowns to prisons, foreign
countries, even to refugee camps and war zones. For 18 years I've
taken thirty clowns from all over the world to Russia for two weeks of
clowning in hospitals, orphanages, prisons and nursing homes, as well
as airports, subways, streets and hotels. Ten years ago this led to
our getting involved in the care of orphans in Russia in work that is
now recognized all over. We have taken clowns into the war in Bosnia,
the Kosovo refugee camps in Macedonia, the Rumanian AIDS orphanages,
African refugee camps, Cuba, China, El Salvador, Korea and Haiti. As I
write this, we took twenty-two clowns from all six continents and ten
tons of aid for three and a half weeks into the war in Afghanistan.
Because this work has connected us with many aid and relief
organizations (like Airline Ambassadors), it is now easy to organize
huge quantities of people and aid quickly and effectively. These
experiences have also gotten us involved in the global conversations
on conflict resolution.
All of our gestures of love and fun have been a magnet for beautiful
people who want to devote their lives to loving service. Every year
thousands of doctors and nurses tell me they would be willing to live
and work full time 40 to 60 hour weeks in our hospital for
$3,000/year. Many more want to come part time. Students of medicine
from all over the world constantly entreat us to let them come study
what we are doing. This may be the most important reason to get the
hospital built.
Nine years ago a special group of old and new friends began to come
together in a real group commitment toward the dream; our second major
staff change. No longer did I have to carry the vision alone because
the individuals of this group—though quite diverse in thought and
personality—each felt they found a place and readiness in themselves
to want to be and work for the now-collective vision. For any project
created by one person this is a grand step so that the vision can
continue if something happens to the visionary. Another important
bonus is that each of them brings their special interests and talents
to the project to vastly broaden how the multiple tasks I used to do
now get done, and each adds their blessed creativity again enhancing
every part of the vision. What it feels like to me is that now
everything is in place to make the hospital a reality.
We plan to build a forty-bed rural community hospital. There will be
sixty beds for staff and beds for their families in a creative,
comfortable communal hospital. There will also be forty beds for
guests who would be healing arts students on electives, ophthal-mology
teams every three months, plumbers, string quartets, and anyone
wanting a service-oriented vacation. There will be 30,000 square feet
devoted to the arts in a fully arts-centered hospital. There will be a
school for social change and in-depth agricultural programs. It will
be funny looking, full of surprises and magic. We'll be exploring how
far below the national average our effective operating budget can
run—I believe we'll be shockingly inexpensive. Our ideal is that an
endowment would cover the annual costs and realize without this we'll
find creative ways to pay for its operation.
There will be a forty-acre village to house our children's school
(also for sick children and children of sick parents) and other
important community experiments, like how to integrate all ages in a
fun, healthy way. Staff persons who've served for four years and want
a little distance from the intensity of the hospital can create their
fantasy living space in our village.
I want to tell all readers that the journey has been heavenly all
along the way. Simply being in an idealist quest is its own reward.
I've never felt I've sacrificed anything or thought it was a hard
journey. Hard would have been having to work in corporate medicine and
lie to patients and myself every day. My concern for humanity's future
drives me to want to put whatever efforts I can to changing everything
that hurts people and nature. The Gesundheit! Institute is that for
me, and so many others.
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