Nick, Author at OPUS Music CIC

Music in Healthcare Apprentices

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We’re delighted to introduce our new Music in Healthcare Apprentices for 2015/16. This innovative programme, now in its second year, is designed to support emerging Music in Healthcare musicians in developing their own regular, professional practice.

pictured L-R: Nick Cutts, Rachel Fillhart (Apprentice), Sarah Matthews, Aisling Holmes (Apprentice), Becky Eden-Green (Apprentice), Richard Kensington, Kate Jackson (Apprentice)

Last year’s programme was extremely successful, with Apprentices collaborating to form two new Music in Healthcare organisations, Wellspring Music CIC and Pulse Arts CIC, working in Nottingham and London respectively on new programmes of practice including at Great Ormond Street Children’s Hospital. These new organisations remain connected to OPUS Music CIC through the growing Music in Healthcare Network, and through its Associate Musician Programme.

Our new Apprentices, all who previously took part in one of OPUS’ five-day Music in Healthcare Settings training programmes, have already spent a few days working alongside OPUS Musicians to begin planning their own programmes of work, and to develop repertoire and approaches to Music in Healthcare practice. Each Apprentice will work alongside mentors (OPUS Musicians) in one of our regular Children’s Hospital practices:

Becky Eden Green will be based at Leicester Children’s Hospital
Rachel Fillhart will be based at Nottingham Children’s Hospital
Aisling Holmes will be based at Derbyshire Children’s Hospital
Kate Jackson will be based at King’s Mill Hospital (Children’s wards)

We’re delighted to be able to continue our Apprenticeship programme in 2015/16, and looking forward to seeing (and hearing) new practitioners and programmes of practice emerging.

The Apprenticeship programme is made possible using public funding by Arts Council England.

Drumming in Intensive Care Units

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Five years ago, during my initial training as a musician in healthcare settings, one of the first challenges I faced was how to take my specialism of percussion into hospital settings. How could I use percussion instruments, particularly drums, in spaces that I assumed would be very quiet in a way that would enhance that environment? How could I use something as potentially noisy and intrusive as a drum in an a space populated by children suffering from a variety of illnesses or conditions which are unknown to us and doctors and nurses doing a job that required great concentration and accuracy? After having spent 10 years playing in a variety of loud percussion based bands and running drum circles and percussion workshops, I couldn’t see how a drum would do anything other than disrupt a hospital space, over excite or disturb patients and distract doctors and nurses. At that time the thought of taking a drum into a hospital ward seemed like a bad idea and if the possibility of taking one into an intensive care unit had been raised it would have seemed ludicrous.

In the last couple of months I’ve had cause to remember and reflect on my initial thoughts and reactions to drumming in hospital.

The first occasion started with walking into a children’s intensive care unit in a large hospital in the East Midlands. The unit has about 10 beds in it with only a few feet in between each bed to allow access for nurses, parents etc. The feeling on the ward is quite enclosed and cluttered due to the large amounts of medical equipment around each bed and the large numbers of staff attending the patients.

I was working with two colleagues, Sarah on fiddle and Marc on guitar. We had been requested by a parent to come and play music with her little girl who was about two years old. The little girl, who we will call Lisa, had special needs, no speech and had recently had a tracheotomy, so she couldn’t make any sounds at all with her voice.

When we arrived Lisa was sitting up in bed and her mother was at the bedside. Marc started playing a nursery rhyme and her actions and facial expression showed that she was immediately responding positively to the music. Her mother reinforced our reading of this response with positive comments and an increase in engagement with Lisa. We continued to play, with Marc leading the interactions and encouraging Lisa to shake along or engage with the animal toys around her bed. I changed from accompanying a lullaby on ukulele to playing a deep quiet and steady beat on the bodhrán on the next song. As I did so I noticed a shift in Lisa’s focus towards the drum so I asked Marc to make some space so I could get to the bed.

I knelt down at the bedside and asked Lisa’s mother if I could place the drum on the bed so she could see it and hear it more clearly. I continued to tap along on the drum as we sang, just keeping a gentle pulse and as I did so Lisa leant forward and started touching the drum skin. She was exploring how it felt, sometimes tapping it and sometimes just leaving her hands on the skin to feel the vibration as I continued to tap the drum. Sometimes I copied what she did on the drum but she seemed to be getting the most pleasure from experiencing the vibration from the skin as I hit it. She moved from having both hands on the drum, to both hands and one foot on the skin, to putting both hands, one foot and her face pressed against the drum as I continued to gently tap the pulse of the song that was being played and sung by all the musicians.

Once Lisa had become used to the sensation she decided she wanted to find out more about this object so she started to try and move it around. I responded to her attempts to move the drum, moving it for her in the direction that she was trying to get it to go. She turned the drum around and put her hands inside it. She tapped inside the drum and left her hands on the skin as I played the other side. This continued for at least 5 minutes after which time Lisa started to get tired which she showed by simply disengaging from the drum and leaning backwards onto her bed.

All the way through the interaction was accompanied by beautiful music and songs from Marc and Sarah. As Lisa was exploring the drum and interacting with me, a group of nurses and doctors had gathered to look at what was happening. From their comments and faces they all seemed to be really enjoying the opportunity to see their little patient behaving like a normal child enjoying her exploration of her environment.

The second instance of drumming in ICU was in a different large hospital in the East Midlands. This time a nurse said it would be ok if we went into a side room where a young toddler, we’ll call him Mohammed, was standing in his cot. His mum was in the room with him and the TV was on with the volume turned up. After saying hello to them both we checked with the boys mum if they would like us to play. They had already seen us playing in the main part of ICU so we felt like they would understand what we might be offering. When Mum agreed we asked if we could turn the TV off. Once we had done this we had Mohammed’s full attention.

As soon as we started playing he was jiggling around to the music and wiggling about holding onto the bars on his cot. He also had a tracheotomy and was attached to oxygen through that. I was surprised at how much energy he had and how little the tracheotomy and the oxygen tube hindered his enjoyment or compulsion to move. He was really grooving and smiling. We gave him a shaker and he quickly learnt the ‘throwing the shaker out of the cot’ game so I approached him with my drum. His response was very similar to Lisa’s. His hands were immediately on the skin and again rather than his focus being on hitting the drum himself he seemed to be enjoying feeling the vibration through the skin. Mohammed too was intent on exploring the drum, constantly turning it around and around so he could feel it inside and out. The drum must have seemed enormous to him, as he was only just taller than it’s diameter. Once he got the hang of how to get a sound from the drum he started really enjoying the loudness of the instrument and as we were in a side room I was able to allow him to really get into this, knowing that the volume outside the room wouldn’t be distressing to other patients and staff. As he started to lose interest in the interaction I refocused my playing of the drum to join back in with the tune that Sarah had been playing throughout the interaction and so we were able to leave the room in a musical way with Mohammed having played his part in some great interactive music making while learning about and experiencing a person sized drum!

In order to use a bodhrán in hospitals I’ve had to develop my technique so that I can play very quietly whilst maintaining accuracy and positivity. I’ve also had to develop and change my musicality to think about how I use the drum to accompany song. Traditionally the drum is used to add drive to tunes and to bring out the rhythm and shape of tunes. There can be a lot of ornamentation used in bodhrán playing and I often choose to strip much of this away so that I focus on the essence of the rhythm of the song or tune, focusing on groove more than the shape of a tune. I always try and keep in mind that my focus is on playing for the space and the person rather than for my own enjoyment. The drum I have has a very rich bass end and even the top end is mellow sounding. This enables me to play with a variety of dynamics without bringing in any harshness to the sound. It has been my experience that choice of instrument is very important when using percussion in hospitals. My preference is for warm sounding drums that can be played to obtain a variety of pitches. The other factor that I’ve had to consider is the weight of the drum. The bodhrán is often played sitting down, so walking around a hospital for a day carrying the drum also presented problems. I fitted a strap to my drum and this has helped a great deal.

When using the drum for interactions there are number of things to bear in mind, not least of all the potential volume of the instrument and the impact that this can have on the space around. There is a lot of satisfaction and a sense of power to be gained by a child when they hit a drum hard and get a loud sound in response. It’s a great thing to allow this but the musician also has a responsibility to their surroundings and the other people in the space. Sometimes it’s not a problem to allow a child to make a lot of noise, sometimes it’s ok once or twice but then the volume needs to be managed. Other times a loud noise is not appropriate. I dampen the drum with my hand, use explicit verbal instructions or offer beaters with softer heads in order to manage the volume of the drum. If volume is becoming an issue I also try to refocus onto rhythm, pattern or copying.

I’ve come to realise that there is no problem with bringing and playing drums into the most sensitive of environments. My skepticism at the start of my training was rooted in the way I was seeing drums, thinking about them and relating to them at the time. The power of drums to transform mood, empower people, to facilitate communication and connection and to bring joy seems consistent in all situations. This power is not constrained to the volume or complexity of what is played. It’s up to the drummer to learn and then decide how to best use the drum to the maximum benefit in any given circumstance. Working with drums in hospitals has given me a great faith in the efficacy of what I do as percussionist and inspires me to explore the huge potential of drums still further.

Richard Kensington, OPUS Musician

Reflections on Practice: Partnerships with Doctors

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We entered the ward as a group of three musicians. As soon as we entered though the doors we were noted by a doctor in the second bay down who had a group of 7 junior doctors with him.

He turned to us, introducing us to his group as a regular team that come into the Children’s wards each week, playing music for and with the children, parents and staff.

As the junior doctors were currently doing some observations on a small child at the time, we asked if it was appropriate to play some music at this time and the doctor (trainer) welcomed the opportunity to see how the junior doctors dealt with the situation and how they could use the music as an aid to their work.

We then played a gentle version of ‘Wind the bobbin up’ on Melodeon, Fiddle and Ukulele, adding vocals to act as a distraction to the small child whilst the junior doctors listened to her breathing through a stethoscope.

The child and her mum instantly recognised the song and joined in with the actions, singing along very happily. The junior doctor was instantly able to listen to the child’s breathing without any fuss from her, as she was far more interested in the music and joining in with us.

It wasn’t just the parent and child that enjoyed our music, as very quickly all junior doctors joined in the singing and actions too, much to the child’s delight.

Oli Matthews, Musician, OPUS Music CIC

Reflections on Apprenticeship: Joe Danks

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Dancing in Hospital Corridors

‘Jim knew that he wasn’t much of a singer or dancer, and to him, a public display of singing and dancing implied he thought himself and expert. The villagers just stared at Jim and said, “What do you mean you don’t sing?! You talk!” Jim told me later, “It was as odd to them as if I had told them that I couldn’t walk or dance, even though I have both my legs.” Singing and dancing were a natural activity in everybody’s lives, seamlessly integrated and involving everyone. The Sesotho verb for singing (ho bina), as in many of the world’s languages, also means to dance; there is no distinction, since it is assumed that singing involves bodily movement.’

This Is Your Brain On Music – Daniel Levitin 2006

To some people, making music is an activity reserved for the elite. This is no more apparent than in the UK’s concert halls, with their ritual flower bouquets and coughing breaks. This is the same for dance, an art form most commonly seen at the wedding disco. So where does that leave us, stone cold sober in the harshly clinical environment of a hospital corridor, bobbing up and down in time to ‘Wind The Bobbin Up’?

I love dancing. As a child my role in my parent’s band was to be the first on the dance-floor and to encourage others to join me. Im still doing that now! I’ve pogoed and shuffled and bopped and moshed and salsa danced to all kinds of music and I hope I always will. However, most of my dancing has been with others doing the same thing in a dimly lit venue. Using movement in my music in healthcare practice has been a relatively new exploration for me. Its important to recognise that the young people we’re working with are often dancing, and we should positively reinforce this engagement with our music.

I do this sometimes by mimicking the movement of a young person, and sometimes by responding to their movement with music too. An example of this happened in a corridor, with a young person en route somewhere with his mother. He boogied along to the music we were playing in the adjacent ward, and his mum stopped and the both stood and watched. I turned away from the ward and noticed them. The child started, slowly at first bobbing up and down with the music. I joined in, naturally! This lasted for a minute or so. The music came to a natural conclusion, and I started improvising gently around a G chord, just to keep the music and dancing going. The rest of the musicians started to join in, not only with the music but with the movement too. Dave then led us into ‘Round and Round the Village’, an English Childrens song, and we all marched!

I think this highlighted the point to me that we are only embarrassed about dancing because we are told to be, and often children are yet to feel that embarrassment. I am now as confident in using movement in the hospital ward as I am singing and playing, and I feel that it is becoming an integral part of my practice. Its useful for making people laugh, making people dance and keeping people engaged; definitely not something to be embarrased about! Perhaps we all need a little more ‘Ho Bina’ in our day to day lives?

Reflections on Apprenticeship: Marc Block

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James and I had been playing for a while with B (a boy of around 5 with Down’s), who had been enthusiastically playing on the xylophone. We played through a song and brought it to an end, and B carried on playing, so we picked up his tempo and played chords along to him until another piece of repertoire emerged and we played that through, B focussed intently all the while on his playing. There came a point where B very clearly stopped and gave the beaters to his mum, who remarked how impressed she was that we were able to play in such a way that made B the musician and us his accompanists, and that we played something really good that he was taking a leading part in. This felt like a ringing endorsement, that what she described is EXACTLY what we’re aiming for.

Three of us had played to a whole bay, where I had offered a teenage lad with cerebral palsy a shaker – a bit tentatively as I was not sure if he would be able to hold it and I knew his motor control would be limited. His face, however, was such a beaming welcome of the music that it felt right. He did hold the shaker and was able to move it from side to side and played exactly on the rhythm. The song ended and he handed it back. The others said their goodbyes and made to go, but I was having a strong feeling that the lad could happily play more. I decided to go with that and, rather than be led by the others, said we could do more and went back to him with the xylophone. He struggled a little with the beater (we need a thick-handled one!) but clearly enjoyed being able to make sounds as Rich played and we sang along, and his brother came along and helped him with it. Meanwhile, across the bay, Sarah had engaged a mother and child in more play with the glock. It seemed very much the right thing that I had followed my instinct there and gone back to him, and the others agreed. At this point in the apprenticeship (very few sessions left) I’m pleased to be taking a lead in this way.

Reflections on practice: The Art of Conversation

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Working as an associate musician for OPUS provides me with the great privilege of working musically within my local hospital setting. Three times a month, I visit both adult and paediatric wards at Furness General Hospital, making music for and with patients, staff and visitors.

Unlike the main OPUS music in healthcare practitioners, my work is mostly solitary, and I am aware of how this brings slight differences in our practices. I am also learning all the time, and the ‘expect nothing’ mantra is key to approaching each interaction with eyes, heart and mind open.

Music in a clinical setting has potential for impact in so many ways, from bringing a change in the atmosphere, providing comfort and distraction, reinforcing the well side of patients, through to providing some autonomy and control in a setting where so much can feel out of a patient’s hands.

Perhaps the biggest, lasting impact I notice in my own work is that of being the starter of conversations. On a bay of 6 beds, the shared experience of the musical presence frequently opens up interaction between patients on their own music experiences. The joy of music is something almost all have been affected by at some point or other in their lifetimes.

It is something we all have opinions on – ‘I don’t like this modern stuff’ ‘I like all sorts of music’ ‘You can’t beat the old classics’ ‘You can’t beat a bit of rock & roll!’

It is also something many have had lasting experiences with, whether it was watching live-aid or the proms on the telly, to seeing an act live on stage or at a wedding. Not forgetting how many of us either had the opportunity to learn an instrument as a child, or wish that we had. Perhaps family members play something now.

Conversations starting from the basis of music can lead to all sorts of further topics, from who is in your family to the places you’ve lived over the years… And even if no memory is sparked from being a part of this musical experience in the hospital, there is always the current shared music itself to discuss!

Also of note, is the way the music can spark non-medical interactions between staff and patients. Whilst of necessity tending to be briefer, these discussions take place between two human beings, at once equals and brought together by this shared experience. No longer a care-giver talking to a poorly person, the music can really have an impact, allowing both to see the other for the human being they are.

And let us not forget the family and visitors of patients, who may sit at their bedside for hours at a time. As before, sharing in the music together can spark so much to talk about, often when the day-to-day news has dried up. It can also provide a respite from having to talk at all – an opportunity to be present together without need for words – and this can be just as valuable.

I have also had the privilege to witness the presence of live music-making provide opportunities for parents of very young or very sick children to find additional ways to engage with their loved ones. Where words aren’t cutting through to a child’s understanding, the music can. As their mother, father, grandparent, aunt, uncle hold them close, or stroke their head, or hum and sing along, it can really help to convey their love, their caring, their desire to comfort.

I have found in all my work as a musician in healthcare that where the music itself ends, the interactions it sparks continue to ripple through the space remaining, often long after the musician has gone. Perhaps one of the biggest impacts of my work is when I am not present to witness it…

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Mary Dunsford is an associate musician of OPUS Music CIC, and has been working at her local hospital setting, Furness General Hospital, for the last 12 months. We are delighted that Mary has been granted a further 2 years funded residency, through the Sir John Fisher Foundation, to continue her programme of work making music on her harp for and with visitors, staff and patients at their bedsides.

Listen here for a BBC Radio Cumbria clip of Mary’s work from last year.

Reflections on practice: Responses to music in hospitals

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We get a wide range of reactions to our music-making in children’s hospitals – from the babies, children and young people themselves, and from their families and staff.

Staff greet us with delight as colleagues, often give us a ‘heads-up’ about their ward, and go about their work with the confidence that we will contribute positively to the environment and the people within it.

Patients and their families, especially those who have not previously experienced music-making in the hospital, often greet us with a look of surprise and amazement that music is ‘allowed’ in such an environment. Many instantly express delight that music can now be part of their hospital experience, some exhibit initial slight concern or embarrassment about what might be expected of them in return.

The interaction between professional musician and professional healthcare staff, both working as part of the same team, along with some gentle confidence on the part of the musician of their place and potential value in the setting usually sets everyone at ease, and allows the music to flow from everyone.

There are some patients, however, for whom there are no inhibitions, potential embarrassments or pre-conceived perceptions of what a musical offering could be. We met one such patient recently in an Accident and Emergency department. Sitting on his Mum’s knee, this young baby engaged the moment we began to play. Showing no signs of embarrassment, he looked straight into my eyes and connected instantly. He had been crying before we entered the space, but was now transfixed by the music and the human connection, and began gently wriggling and vocalising along to the music, taking time out occasionally to grin at his Mum and at us until eventually gleefully playing a shaker along with us. The sense of relief and joy between baby and his Mum was palpable.

At the same time, an older boy was sat with family in the next bed. His initial reaction, and to some extent that of his family, was one of giggling, possibly through embarrassment and the lack of ‘coolness’ of the whole situation. He and his family, however, watched intently as we played for the baby and his Mum. What I think they saw, was a musical connection made between musicians and family, one where no-one had any expectations, where everyone could be exactly who they are, and where they could all be part of a beautiful artistic exchange.

By the end, the older boy was filming us on his ‘phone, watching everything intently and joining in with songs along with his family. His family said he had been very upset before we arrived. We had, at least for a short while, given him some relief from this, and demonstrated the impact of strong connections made through honest music-making. As we left, he smiled, clapped, and thanked us for visiting. Upset was replaced by delight in the shared experience he had just been part of with his own and another family, and with the two rather ‘uncool’ but egoless musicians who had, for a short while shared some quality time through music making.

Music, especially in the hospital environment, gives everyone the chance to be themselves, to forget inhibitions and embarrassments, and to make human connections and great music which supports their own health and wellbeing.

Nick Cutts
Director, Musician & Trainer, OPUS Music CIC

Music in Healthcare Settings Conference: Derby, 16 July 2015

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Thursday 16th July 2015, 9.30am – 4.30pm Education Centre, Royal Derby Hospital, Uttoxeter New Road, Derby, UK.

We are delighted to launch the forthcoming International Music in Healthcare Conference, hosted by OPUS Music CIC in partnership with Royal Derby Hospital and Air Arts to Aid Wellbeing.

Bringing together music for health practitioners, healthcare staff, promoters, funders, researchers and other key stakeholders, this event promises to provide stimulus for discussion and debate around the ongoing development of Music in Healthcare settings across the UK and beyond.

A mix of thought-provoking presentations and discussion groups throughout the day will leave all stakeholders with new contacts and new ideas for continuing to develop their own practice.

Places are available to book for a modest charge of £10 from the Eventbrite link below (includes tea and coffee on the day).

We are also hosting a Music in Healthcare Settings ‘Music Sharing’ day on Friday 17th July 2015, to be held in Derby. Any musicians attending the conference are invited to come along from 9.30am-3.30pm (stay for as long or short a time as you like!) to make music with like-minded musicians (small charge of £2 payable on the day to cover refreshment costs).

Please email us at conference@opusmusic.org if you would like to come along to the Music Sharing day.

Reflections on Apprenticeship – Joe Danks

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My experience as a Music In Healthcare Apprentice in 2014/15 has provided me with a fantastic platform to build my own practice in the coming months and years. I strongly believe that good MiH practice comes from experience, and that this work is all about learning how to adapt to different situations.

One thing I would like to highlight is how a combination of non-verbal approach techniques and repertoire in different languages can help overcome some of the challenges posed by cultural diversity in our hospitals. Instrumental music is not bound by language constraints at all and part of good practice is using repertoire with a ride range of languages. Working as a MiH practitioner has strengthened my belief that music is hugely effective as a communication tool between people from all backgrounds and all ages. There are countless examples of this happening in the last 6 months, and it was been noticeable from when I first engaged in this work in November 2013.

One that springs to mind happened in a neo-natal intensive care unit. Myself and Oli were working as a pair in a small space with 3 newborns. These rooms can often feel very cramped and often the breathing apparatus and monitoring machines can make them feel very noisy. For this reason it is important to be aware of the sound you are making and make sure you are not just contributing to the hum of medical equipment and causing a negative effect. Whilst we were making music with ukulele and melodeon, I feel that the most effective instrument in that space was our voices. We sung, Kyla Vuotti Uutta Kuuta (a traditional karelian wedding song sung in a Finnish dialect) and Zamina Mina (a cameroonian song sung in Fang). We also sung some traditional English Lullabies like Twinkle Twinkle Little Star. This seemed to be working well and the two parents in the room were making physical contact with their children and even singing to them!

We were then greeted by a young girl around 5 or 6 who had come to visit her baby sister; she was accompanied by her mum. We continued to play as they got settled. I then went to fetch the box of instruments from outside the room, and chose the Glockenspiel to get out first. I continued to play along with Oli on Melodeon but on the Glockenspiel now. Being aware of the sensitivities of the space, I carefully chose which beater to offer to the young girl and continued to play very quietly along with the music. The young girl hesitantly began to join in and grew in confidence as the music continued. We played 5 Little Speckled frogs together, and then she took to a spark shaker as we played Galopede, an english country dance tune. We were aware all this time of the other parents in the room smiling and vicariously enjoying the music making through the young girl who was clearly having a wonderful time.

As the final tune wound to a close we were asked to stop by a member of the medical team as one of the babies in the room was about to have an X-Ray and they had to move the X-Ray machine into the room. We did so quickly and packed away our instruments. It was only then did we say thank you to the young girl for playing and realise that she spoke very little english. It struck me that we had managed to facilitate music making for a young person, relax the room and provide music for patients and parents, and perhaps most crucially of all provide a platform for parents and siblings to interact with their newest family members using almost no words.

It is important to say that this is one of the instances where music has really been useful to overcome cultural barriers, but this is not always the case. There has been times where it has not worked so well (presuming that every child knows wind the bobbin up springs to mind!). Even the trickiest interactions provide an opportunity to learn, and I am trying to soak in as much as I can from the apprenticeship programme as I begin work at Great Ormond Street Hospital, a hospital that will provide an even more diverse body of young people to make music with and learn from.

Nick

Music in Healthcare Apprentices

Drumming in Intensive Care Units

Reflections on Practice: Partnerships with Doctors

Reflections on Apprenticeship: Joe Danks

Reflections on Apprenticeship: Marc Block

Reflections on practice: The Art of Conversation

Reflections on practice: Responses to music in hospitals

Music in Healthcare Settings Conference: Derby, 16 July 2015

Reflections on Apprenticeship – Joe Danks

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