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Sounds of Well-being

Project brings music to hospitals and skilled nursing facilities to bring comfort to patients

Antonio Donilha Neto, a resident at the Aldeia Emaús nursing facility, interacts with musicians Deisi Baptistella and Diego Angelini one late afternoon in Sorocaba

EDUARDO CESARAntonio Donilha Neto, a resident at the Aldeia Emaús nursing facility, interacts with musicians Deisi Baptistella and Diego Angelini one late afternoon in SorocabaEDUARDO CESAR

Once a week in Sorocaba, in the interior of São Paulo State, the silence and serenity of the Aldeia de Emaús nursing facility gives way to music. Almost one year ago, members of the Músicos do Elo project, launched 15 years ago in France by Brazilian conductor and composer Victor Flusser to humanize the hospital environment, visited 38 senior residents. This initiative, intended to improve the quality of life for hospital patients, has been implemented in Italy, Portugal and Germany. A little over a year ago, it arrived in Brazil.

Flusser believes that the Músicos do Elo project is unique and original in its aim to humanize hospital environments and welcome older adults by involving everyone who participates in the process (patients, family members and professionals). In addition to singing and performing a varied repertoire, the musicians impact the ambient sound quality by suggesting ways to decrease noises that bother everyone.

Dr. Fernando Antonio de Almeida, a professor at the School of Medical and Health Sciences at the Pontifical Catholic University of São Paulo (PUC-SP), Sorocaba campus, is leading this initiative. He manages the project whose objective is to offer the medical school and hospital services a humanizing model of care, in addition to establishing standards to train the musicians who are the agents of change in the model. “Our intention is to create a humanizing model of care by bringing in culture. Medical training is focused on disease, not the sick person,” says Almeida, who was introduced to the model while on a trip to France.

One of the early results of this initiative was the publication in June 2013 of the book Músicos do Elo – Músicos atuantes humanizando hospitais [Dynamic Musicians Humanizing Hospitals], in which Flusser explains how the project was conceived and implemented in Europe. The book includes a documentary on DVD produced by Luiz Fernando Santoro, a professor at the School of Communications and Arts at the University of São Paulo (ECA-USP). “Humanizing the hospital environment in Brazil is achieved, to a great extent, through play, storytelling and clown visits. Music, theater and dance end up not really being accessed,” says Flusser, who has lived in France for 30 years.

The idea for the project surfaced when Flusser was overseeing a course at the University of Strasbourg to train musicians to work in elementary schools. One of his students pointed out that hospitals also house children as patients and suggested that the project be extended to pediatric wings. “The purpose of therapy is to restore patients to as healthy a state as possible,” says Flusser.

The project at the Sorocaba nursing facility is bearing fruit first in the area of memory. The most uninhibited seniors raise their voices, handle sound-producing objects and even hazard a few dance steps when they hear a song from their past. “I could tap dance, but I am afraid of falling,” jokes retiree Wilma Oliveira Camargo, 72. Thanks to the performers’ weekly evening concert, residents recall snippets of music, and along come recollections and emotions that help the seniors detach from their illnesses and negative sensations. “Even after the musicians leave, I continue to remember old songs,” she says.

Dr. Paola Canineu, a geriatrician and Aldeia Emaús’ director, says that ever since her senior patients became involved with Músicos do Elo, the mood at the nursing facility has brightened considerably. “Ongoing contact with music can help us in some cases reduce the dosage of certain medications, like neuroleptics and anti-depressants,” according to Dr. Canineu. One of the project’s participants, USP student Diego Angelini, emphasizes that the project’s goals go beyond the therapeutic impact. “Our objective is to awaken the human being in our patients, who are often treated only as bodies that need healing,” she says.

Exhausting treatment
The first encounter occurred in the hemodialysis department at the University Hospital Santa Lucinda de Sorocaba, where the musicians work with patients who suffer from chronic kidney disease. In addition to their physical symptoms, patients are often impacted emotionally by the exhausting and painful treatment regimen. “Being in touch with music makes this process less challenging,” says Fernando Almeida.

Although everyone has warmly welcomed the work of Músicos do Elo, Almeida believes it is important to develop criteria for assessing the results. One of his master’s degree students, psychologist Thiago Reis Hoffmann, analyzed two groups of patients at the hemodialysis center: one group was visited by the musicians and the other was not. “We found evidence that the group receiving the intervention had lower levels of depression in an eight-month time period,” says Hoffman. The study was conducted between 2012 and 2013 at the Kidney Dialysis and Transplant Center of Sorocaba. Twenty-four patients on dialysis for more than six months were evaluated.

Two assessment tools were used to conduct the quantitative analysis: the Kidney Disease and Quality of Life – Short Form, which measures the quality of life of patients with chronic kidney disease; and the Hamilton Depression Rating Scale, a tool to assess depression. The former is a questionnaire that takes into account variables like the patient’s mental health status, companionability, and limitations due to physical problems. The latter assesses the impact of depression, analyzing factors like mood, anxiety and irritability. In the group visited by the musicians, indicators of depression were fewer. Initially, there were ten individuals with signs of moderate or serious depression, and two with no indicators of depression. After the intervention, six patients were identified with moderate depression – the others had no signs of the illness. In the control group, which had no contact with the musicians, 11 of 12 patients continued to report moderate depression.

Hoffmann explains that the Músicos do Elo project should be seen as one more humanizing tool to be added to the toolkit. He cites the Planetree model as another example, which has been adopted by some hospitals like Albert Einstein in São Paulo. Meditation rooms, acupuncture sessions and an architectural project that will include more open spaces and a lot of green areas are examples of this kind of approach.

Músicos do Elo in hemodialysis: Launching pad for training musicians and enhancing interdisciplinary practices aimed at humanizing hospital environments (No. 2012/20784-3); Grant mechanism Regular Line of Research Project Award; Principal Investigator Fernando Antonio de Almeida (PUC-SP); Investment R$158,286.72 (FAPESP).