In-hospital Music Therapy in the time of Corona; the makings of a community

I have spent 11 years working as a music therapist in private mental healthcare hospitals. In all these years I have constantly had to negotiate for private space to practise from. I moved several times, each time thinking that the move would be final and permanent and allow me to settle into a prescribed location for practice. The movements happened just as quickly as the wind blew. I could not settle into any one room. For example, in January 2020 with the promise that it would be my final movement. I thought I had arrived in my own, private, permanent room. Life was good. I had finally arrived. Much care was taken to accommodate me, a reception area was converted into a storeroom for my instruments, art materials and mats. And then covid-19 hit.

In the earlier hard lockdown, about March and April, patients still came to my room from the 7 wards. Windows stayed wide open, mats were placed one meter apart and hands were sanitized before and after sessions. Drums and mats were sanitized and left outside to breathe between sessions. A private space, away from the noise of the rest of the hospital. I was feeling great, COVID-19 was not affecting Music Therapy until May when Boom!!! We were hit with strict COVID-19 protocols. Patients were no longer allowed to leave wards and doctors and psychologists could only serve patients from their assigned wards. Because I am a sole proprietor service provider I was offered to move between wards. That was the end of what seemed to have been a final settling into my private practise room. I worked from a dining area, an outside Lapa or a double bedroom. My favourite, became the doctor’s open-air parking lot, at the back of two wards.

In the parking lot, patients from two adjacent wards would exit through the fire escape. I would sit in the middle, separating patients from the two wards. Even the chairs from the respective wards could not be swapped.

My daily time slot is 4 to 5:30 pm. Winter in Gauteng is not for the faint-hearted. Cold and dry, often accompanied by an icy wind, darkness ascending around 5 pm. Patients emerged from the fire escape wrapped in duvets, beanies, scarves and masks. I could only see their eyes. It was eerie.

My first session in this open-air space, was at exactly the time as the garbage bins in the adjacent four-storey apartment block, was cleaned. Just as I got my group members into a calm, relaxed state with eyes closed, the noise started. I heard every one of the 25 bins been wheeled across the bricks and cleaned. I was horrified. How could I provide relaxation amongst this noise?! I continued with the visualisation, nevertheless. As I brought the patients back into an awakened state, I apologized profusely. They looked at me in puzzlement, “what noise, we didn’t hear anything, we went into the forest, we heard the river, we heard beautiful singing”. I realized that it was I who needed to relax.

As the weeks progressed, I noted that bins were not being cleaned at this time any longer. Instead, the groundsmen started to sweep and clean unobtrusively behind the wall. I heard soft singing as we sang “Si Ngaba Hamba yo thina”, “Siyakudumisa” or “Avulekile masang”. They had become part of the group, separated by a wall.

A heart-warming moment came in the cold of July, during my first drumming session in this space to warm the patients up. The moment the drums started, we heard clack-clack-clack. About 10 children who live in the apartment block, came running up the four flights of metal stairs to the top floor. They started clapping the rhythms with us, big smiles on their faces. As we ended our first rhythmic sequence, they cheered loudly. I was mindful that the patients may not appreciate the presence of an audience, but they all got up and bowed, showing peace signs to the children. One of the patients shared “who would have thought that we, who are so depressed, could bring such joy to the children”. Another shared: “my heart feels so good, now they can see we are not crazy”.

Psychiatrists, psychologists and their PA’s, often paused for a moment as they walked to their cars at the end of a tiring day, singing and dancing with us. I received messages such as, “That is just what I needed after an exhausting day. I could breathe again. I felt alive again”

In the wards where I had to work in the dining areas, I was greeted at the Nurses Station with “Yay, this week is our turn”. I once asked to stay in one ward for 2 weeks but was told that I had to move as the next ward was waiting eagerly for their turn. Cleaners started cleaning in the areas around the dining area during my sessions, singing and dancing while sweeping. Nursing Staff walked in the passageway dispensing medication, singing and dancing. Kitchen staff brought food trolleys in at 5 pm instead of 5:30, pausing for a moment, joining in. The private space became a communal space of inclusion and sharing in the rhythm, melody and harmony.

I had to let go of my need and concerns of a private therapeutic space. I had to let go of the idea of a closed group. I had to silence the critical voices within me that screamed ethical conflicts. I was not causing any harm to anyone, not the patients and not the staff. Instead, a community was forming around the music that was made from unlikely places by people who may have been reduced to their diagnosis. Ethics, after all, are for the protection of practitioner and service user. Ethical considerations can be tools for healthy community building and not rigid boundary markings. After all, the majority of my clients come from cultures where music and healing happen in a communal space. I had entered a communal space in the wards, it had to be inclusive. At a time where loss, disruption, disconnection, fatigue, increased anxiety and depression have affected everyone, allowing all members of the hospital community to participate felt crucial. A hospital becomes a community performing itself into wellbeing.