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Healthcare Reimagined

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Indoor and outdoor spaces promote wellbeing at Memorial Sloan Kettering Monmouth Outpatient Center, also designed by Guenther. - PHOTO: HALKIN MASON PHOTOGRAPHY
  • Photo: Halkin Mason Photography
  • Indoor and outdoor spaces promote wellbeing at Memorial Sloan Kettering Monmouth Outpatient Center, also designed by Guenther.

Many of us ache to go back to the Before Time, the halcyon days prior to the corona-pocalypse, when we could share food, show our faces in public, and give each other bear hugs. Yet if you look beneath the surface, not everything was peachy.

Our expensive and inequitable healthcare system left a lot to be desired, and still does. When the pandemic exploded in the US, it hit people of color the hardest, shining a light on deep tears in our social fabric of wellness. African-Americans make up 13 percent of the US population, yet they carry the burden of 24 percent of COVID-19 mortalities. The racial justice protests this spring—responding to the tragic deaths of George Floyd, Breonna Taylor, and Ahmaud Arbery—ignited conversations about equality, progress, and much-needed change. Rather than go back in time, we have no choice but to ride the momentum of the current uncomfortable moment to arrive at a new and hopefully better place. For clues on how to get there, I spoke to three local changemakers who shared their visions for reimagined healthcare in a post-COVID world. Their ideas and inquiries—building local and resilient wellness, rethinking hospital design, and creating virtual sanctuaries for self-care—are down-to-earth yet buoyantly forward-thinking. Maybe the After Time won't be so bad, after all.

Building a Community That Cares for Itself

The Future of Care group in Kingston is an informal think tank of sorts, an eclectic, self-selected mix of about 15 providers and local people engaged in an exploration into what healthcare for tomorrow could look like in the community. Facilitated by the Visionary Organizing Lab and supported by the NoVo Foundation—a philanthropic social-change organization run by Peter and Jennifer Buffett, son and daughter-in-law of billionaire investor Warren Buffett—the group has engaged in a series of discussions over the past several months. They don't shy away from asking earth-shaking questions. "It started as a conversation with organizers and providers from the O+ festival," says NoVo consultant Martin Kirk, referring to the city's autumn event showcasing street art, live music, and a pop-up clinic where artists and musicians receive care from doctors and healers in a unique barter system. "We asked them, 'Do you think it's possible to reconceive how we provide care in this community from the ground up in a very different way?' And there was a general sense of, 'Yes, we do believe that's possible. We have a sense of what's standing in our way. And we want to explore this question.'"

It's too early in the process for the Future of Care group to know what these conversations will yield. But they agree on where they're going. "It's a vision of a more equitable society where everyone is treated as a full, holistic human being, and all the existing biases in the system are removed," explains Kirk. "Other countries manage better in this area. They don't have the financialized healthcare system that we have, where the incentives actually encourage people to be sick, not well. The system makes more money when people are sick. It's a system of illness, not wellness." COVID-19 struck the nation just as the Future of Care group began its inquiries, followed by the racial justice protests that laid bare the hard truths of systemic racism. "The more we become aware of these things, the more likely it is we can reconceive of approaches that don't make the terrible mistake of having racism built in," says Kirk. "The in-it-togetherness of COVID awakens people to the idea that we are all interconnected." In this spirit, a subsection of the group called Kingston Resilience came together to help create a food distribution network and the Coping During COVID Helpline, where mental health support is available 24/7 via call or text at (844) 437-6856. And Kingston Mutual Aid formed, engaging citizens to create neighborhood pods—groups of 5 to 30 households dedicated to helping one another and reimagining safety without the police.

Ditching the flawed healthcare system we have is fiendishly difficult because we're all bound up in it. Change can happen through small projects of disruption, yet it also requires a big-picture view. "A lot of it has to do with the social determinants of health," explains Kirk. "What sort of food do we eat? How safe do we feel in our neighborhood? What's in the air we breathe?" A Harvard study published in May linked dirty air to worse coronavirus outcomes, and marginalized communities have more exposure to polluted air. Locally, there are steps we can take to address determinants like these. "You can deal with a lot of the reasons why people end up with doctors and in hospitals in the first place if you have an ethic where we just assume that this is what we do—we are a community that cares for each other," adds Kirk, who stresses that NoVo's role is simply to support the Future of Care group and let the community lead. "We're trying to go as deep and as full-system as possible. If it gets reduced to just providing three more doctors for the town, then we've missed our target. We're trying to do something on a whole-system level."

Future-Forward Hospitals for Pandemic Times

Bulldozing our current healthcare structure may not be a viable option, but we can create a different future within that structure through every decision we make. That's the mindset that guides Robin Guenther, principal architect at Perkins & Will, who has designed some of the greenest hospitals in the country, including Lucile Packard Children's Hospital Stanford and Memorial Sloan Kettering Monmouth. She's witnessed—and helped to propel—a transformation in hospitals from wasteful behemoths to leaner, more sustainable machines. In the last few years, shifts have included recycling both anesthetic gas, which has about 200 times the carbon footprint of CO2, and "sterile blue wrap" plastic from operating rooms. Now, with the arrival of a pandemic, even more dramatic change is in the works. "Society was caught flat-footed by COVID-19," says Guenther, "but we can't be caught like this again. And there will be an again. We can't just say this is a once-in-a-century thing."

In some ways, healthcare saw it coming. There's an ideology that breaks down modern medicine into different eras of disease. First came the infectious disease era of the 1800s, when legions died of tuberculosis and cholera, prior to the life-changing advent of antibiotics and vaccines. Then, after World War II, the era of chronic disease and lifestyle illnesses like obesity and cancer arrived. "Medical sociologists and historians have long projected that the third era would be resistant infectious disease," says Guenther. "That means it will be resistant to the antibiotics we've developed, requiring new solutions. And it will be global in scale." COVID-19 eerily seems to check all those boxes, and many experts wonder if this is the beginning of the third era. "The biggest takeaway we should have," adds Guenther, "is that healthcare is gearing up for this to happen again."

PHOTO: EMILY HAGOPIAN
  • Photo: Emily Hagopian

Yet medicine made some bad decisions from the get-go with COVID-19. The choice to shut down care that wasn't either COVID-related or an emergency has been economically devasting to hospitals and physician practices. Providers are also bracing for a wave of health impacts due to delays in patients receiving clinical care that was put on hold during shelter-in-place. "This is no way to promote population health," warns Guenther. Smarter hospital and clinic design must follow, and megashifts are taking place in the build world. First, we'll see changes to the way we arrive at and enter hospitals, which will allow for immediate screening and entirely separate pathways for infectious people. More intake may be done through smartphones, before we step into a hospital. Universal rooms, capable of either ICU or acute care as needed, will let hospitals more nimbly accommodate the critically ill. We'll also see greater investment in hands-free technologies—touchless entry, touchless faucets, touchless everything—so we can worry less about infected surfaces.

If healthcare made a few good moves during COVID's peak, one was the shift toward telemedicine. Former skeptics have become believers, and no one wants to put that genie back into the bottle. "Telemedicine is beneficial for healthcare staff, it's beneficial for patients not to have to travel to get routine stuff taken care of," says Guenther. COVID has also given us a wakeup call about the advantages of having a local supply chain, whether it's personal protective equipment, medicines, or food sourcing. And we're having a lightbulb moment about the importance of healthcare providers' mental health. Features to support staff holistically might include better access to outdoor space, better food, and partnerships with hotels for providers who need to isolate from their families. "It's a good time for hospitals to see their roles as economic anchors in their communities," says Guenther, "investing in local- and minority-owned businesses, and really raising all the boats."

Virtual Sanctuary and Care for the Caregivers

From overwhelmed healthcare workers to grieving families and isolated elders, almost no one is untouched by the pandemic's emotional impacts. Yet during the weeks of lockdown, something beautiful happened as mental health resources and angst-easing spiritual tools popped up all over cyberspace, creating a new kind of virtual refuge. "A profound sense of loneliness at the height of our social isolation was clearly evident in terms of the response that we had to our virtual offerings," says Jonathan Wiesner, CEO of the Garrison Institute, a retreat center on the banks of the Hudson River in Garrison with a focus on contemplative practices to catalyze personal and social transformation. "When we first launched what we call our virtual sanctuary program, which we started within days of closing our doors, we asked the teachers in our local community if they would mind teaching daily meditations." They agreed, and Wiesner expected 100 people to sign up—yet 1,000 people registered for the free programming. So, they kept going, adding a range of online offerings from webinars to virtual retreats. "It was a total transformation for us," says Wiesner, who had just come on as CEO in late January. "It's been an interesting and certainly unexpected challenge for us to take a place-based organization and convert it into the virtual realm."

One new cyber-hub is the Garrison Institute's forum conversations, which are free webinars led by experts in fields that are particularly resonant right now, including planetary health and social justice. Then there is the Contemplative Based Resilience (CBR) program—an entire curriculum of meditation, movement exercises, and other tools to help people build resilience in the face of challenge. Originally designed for humanitarian workers, the CBR training is now adapted for frontline healthcare workers, whether they're hospital staff, nurses, or first responders. In June, the Garrison Institute's website rolled out a video series featuring meditations with Sharon Salzberg and movement with Gayla Styles that can be watched in one 45-minute sitting or broken up into bite-sized five-minute segments. "We think it's an extraordinary tool for people working on COVID's front lines, and we're offering it for free," says Wiesner. "You read the stories about 13-hour shifts, six days a week, the stress they operate under, and the vicarious trauma they're associated with, and we hope this is going to be a benefit to them."

Also brand-new are virtual retreats, offered as half-day, full-day, and day-and-a-half options. "These are more difficult to navigate, but they come out of all the reasons why one attends a retreat in the first place—the need to regenerate, to take time to be with yourself and learn meditation techniques from a teacher." A lot gets lost in translation (say, lovely meals and a sense of place) when you convert an in-person retreat to a virtual one, but Wiesner is finding that people would rather retreat virtually than not retreat at all.

Virtual retreats will likely stay on the program until at least 2021, and the institute's other virtual offerings will remain indefinitely. "We've received hundreds of testimonials thanking us for our programming," says Wiesner. "Now that we've entered this realm, it's with us forever."

Wendy Kagan is the health and wellness editor of Chronogram.

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