Beata Gubacsi shares some of the highlights from the “Palliative Care, Architecture and Design Symposium” held at the University of Liverpool in November, and her trip to the “Design/Play/Disrupt” gaming exhibition at the Victoria and Albert Museum.
In November, I attended two events related to imagining a better future with the help of technology and design. Despite the differences in topic and format, there were several overlaps between the “Palliative Care, Architecture and Design Symposium”, held at the University of Liverpool, and the “Design/Play/Disrupt” gaming exhibition at the Victoria and Albert Museum (available until 24th February). These inspiring events did not only demonstrate how much we already live in the future, but also indicated the rapid and all-encompassing technological changes we will face in the near future, and how design can facilitate inclusiveness and the extension of applicability of such technologies.
The “Palliative Care, Architecture and Design Symposium” (overview), organised and run smoothly by Amara Nwosu consultant at the Royal Liverpool University Hospital and Honorary Senior Clinical Lecturer (Liverpool), brought together practitioners, architects, sociologists, historians and representatives of digital humanities and computing sciences, to discuss various aspects of palliative care form the history of healthcare architecture to the digitisation of the NHS. His engaging and incredibly informative keynote address, “Why is Futurism and Design Needed in Palliative Care?” emphasised the necessity of futurism or “strategic foresight” as an approach to healthcare, seeing connections among data and trends presented by different fields. He discussed three recent socio-economic tendencies which have been increasingly affecting palliative care in the UK, and will do even more so in the foreseeable future. First, demographics and healthcare data shows tendencies of ageing population, and increased mortality and practice of centralised care. Second, he considered economic factors such as austerity, elongated work age, nuclear families resulting in changing community infrastructures and housing – creating spaces which are not quite suitable for palliative care. Finally, he talked about technological advances serving the purposes of convenience and comfort, pointing towards a greater degree of automation and “the reduction of friction in everyday activities” and healthcare, mentioning “big data”, “the internet of things”, and robotics as examples. As Amara Nwosu “put everything together”, he concluded that future issues will result in an older, more isolated population, and it is likely that care homes will become “the most common place of death”, consequently, the future of palliative care is to improve hospices and homes with currently available technology, and design them specifically for these particular environments.
As a continuation of Amara Nwosu’s address, Mark Mills (Marie Curie Hospice Liverpool) and Simon Roughneen (Royal Liverpool University Hospital) were providing a practical example in their presentation, “Virtual Reality in Palliative Care”. They started off by defining Virtual Reality [VR] as “a computer-generated simulation of a three-dimensional image or environment that can be interacted with in a seemingly real or physical way by a person using special electronic equipment”, and followed with examples of areas in which VR technology has been in use previously, such as medical education (virtual surgery), PTSD, treatment of phobias and most recently in hospices. They moved on to introduce the experimental application of the Samsung Gear VR System (Oculus Rift) in the Marie Curie Hospice Liverpool, providing feedback on the feasibility of VR technology in hospice setting. The overwhelming majority of the participants, both patients and staff, found the experience relaxing, resulting in reduced anxiety and pain after being exposed to VR technology. Some reported difficulty in handling the heavy multi-piece equipment, emphasising the need for a better design. Mills and Roughneen finished their presentation with identifying the next steps for further research, including expanding the use of VR to other areas such as dialysis, chemotherapy, outpatients and staff.
Terry Payne’s (Liverpool) presentation, “The Opportunities of Autonomous Systems in the Home Environment”, – which reminded me of the futuristic housing of Netflix science fiction hit Black Mirror (2011 to present) – but in this case the pieces of technology were designed to restore independence and dignity and the quality of life rather than being the backdrop for a dystopian future. He introduced the term “internet of things”, explaining that our gadgets, such as thermostats and other smart home devices, can communicate with each other and us, with the help of the internet, and they can “reach out to the physical world”. He moved on to introducing us to the concept of autonomy and autonomous environment, meaning that the community of “things” can learn and adapt to the user’s behaviour, needs and preferences. Some of his examples were “Virtual Assistants” which can do internet searches, and perform tasks like turning the lights or heating on and off, highlighting the need for advances in voice recognition technology; “Personal Devices” such as the Apple Watch 4 which has a fall detection function, enabling it to call emergency services automatically; or the trainable Obi feeding robot which can be a useful device for people with mobility issues.
Speaking of robots, Ardhendu Behera (Edge Hill) in an equally fascinating presentation, was talking about “social robotics in healthcare” emphasising it can be a plausible future solution for the healthcare crisis involving increasing “care staff vacancies”, and “waiting time for residential care placements”. He gave examples for already existing human or animal like robots, accompanying children or the elderly, assisting them with fulfilling social needs (Paro Therapeutic Robot), or completing household chores (Romeo, the helpful companion robot). The vision, as he described, is to develop a “connected care ecosystem”, and extension of “telehealth/telecare” where health practitioners could remote control robots providing “better monitoring”, or “immediate action in case of medical emergencies”. He also gave an overview of Edge Hill University’s CAVE (Computer Augmented Virtual Environment) project, a system which could make it possible for homesick patients to experience their familiar home environment in their hospice. Some other uses could be identified in healthcare architecture and design to “sense” space ensuring accessibility, “pain management with specific environments” such as snowy landscape to alleviate burns, or even gaming as distraction.
In my previous post I explored recent collaborations between the game industry and mental health professionals. The second event I attended, “Design/Play/Disrupt”, gave me some other ideas for further research. The exhibition, reflecting its title, is divided into three main areas. The first, “Design” area exhibits eight games, including items from every step of the production such as plot flowcharts, development diaries, concept art and music. For instance, the first game Journey (2012, Thatgamecompany) provides insight into developing complex visual narratives with various emotive outcomes depending on the player’s interaction with the other player. The second game at the exhibition is The Last of Us (2013, Naughty Dog), which is still held as a good example for balanced storytelling, gameplay and graphics, showcases character development and design with examples of the use of motion capture and AI controlled motion. The third game is the iconic survival/psychological horror game, Bloodborne (2015, FromSoftware) turning elements of the Lovecraftian mythos into intricate level and enemy designs – for which it received a BAFTA in Game Design category. The second area could be best described by the hanging sign that immediately caught my attention, “Games are political”. While visitors explore different social issues and interact with subversive games, they can also listen to testimonies from game developers whose projects challenge gendered and racial inequalities within the gaming world. This way the spaces of exclusion could become spaces of inclusion. In the last area, visitors can try several experimental arcade games, reflecting the themes of the previous areas.
While the exhibition does not have an emphasised medical aspect, two of the eight games were standing out not only with their uniqueness but also with their approach to representing the end of life, loneliness, eating disorder and body dysmorphia. The Graveyard (2008, Tale of Tales) was an art installation as much as a playable trial at the exhibition: its visuals inspired by paintings, experimenting with the nuanced change of lights, colours and textures combined with natural sounds and music provide an immersive experience. Following a traditional, linear quest narrative, the purpose of the game was to walk the character, an elderly lady, through a graveyard, and make her sit on a bench by a chapel. If the player breaks the habit of constant control and need for movement and action, allowing the character and themselves to contemplate and enjoy the macabre beauty of the surroundings, the game starts to play a bittersweet song about the loneliness and bereavement of the character. While the song plays, the lady seems to fall asleep, and the game ends, reloading itself for the next cycle. Ironically, I was sitting on a bench taking notes for this post, I had the chance to observe the visitors’ initial confusion over the game’s pattern breaking and their surprised reaction to the ending. I was immediately reminded of the symposium, thinking about the possibility of VR funerals, or spending time with loved ones after they passed away. The other game that is worth mentioning and trying, Consume Me by designer Jenny Jiao Hsia (available for iPhone only), focuses on dieting and body image with hilariously adorable, exaggerated two-dimensional art work. Her mini games are all puzzle solving: for example, with “Food Tetris” the player has to arrange blocks of food in a way that it meets a character’s nutritional needs, or another game focuses on trying to shop an outfit for a young person in a way that the character feels comfortable and less self-conscious about supposed imperfections. With the game she wishes to raise awareness not only of the discrepancy between healthy and unhealthy relationship with one’s body but also the importance of design in doing so.
“Putting it together”, the two events show the necessity and potential for further interdisciplinary research and collaborations between medicine, healthcare architecture, technology and design, and gaming. Some of the already established areas and ideas for future research are: how to create home environments which are more suitable for palliative care and encourages a sense of community with the involvement of smart technologies and robotics, how to make VR technology more feasible and practical in hospices and hospitals, and how to make these spaces capable of hosting VR or Augmented Reality technology for various purposes, from education to stress and pain relief for staff, patients and visitors. For now and the future, it would be exciting to create ways in which game developers could also get involved in different aspects of healthcare. For instance, would it be possible to develop more widely accessible games that can be legitimately used for diagnostic, therapeutic and pastoral purposes? Would it be possible to design games which can educate, prepare and support patients and their loved ones about certain medical conditions, possible treatment, pain and pain relief, or even end-of-life and bereavement?