Days 10 -12 Boston

Boston, such a beautiful city! Birth place of the US, civil rights, the women's movement and Dunkin' Donuts. Jam packed with young folk (the average age is 33), making it the youngest city in all of the US. There's almost as many education intitutions as there are students to fill them and yet it's one of the most expensive US cities to live in - which isn't too good if you're a struggling student.

Here I met with Rima Rudd at the Harvard School of Public Health, who I like to refer to as the diva of health literacy in the US. She is widely respected and extremely well connected across the US and Internationally. She started one of the first health and literacy courses back in the early nineties, she was on the Institute of Medicine's expert panel that produced the seminal document A prescription to end confusion and has been one of the key players in pushing a health literacy agenda in this country. Rima's work on hospital environments is being adopted throughout the country and today she took me to the Brigham and Women's on one of her walking tours to experience the "dense literacy demands" of a hospital. The Brigham and Women's is in the heart of the Harvard medical research and hospital precinct. It's a beautful hospital, which in many ways has the feel of a massive and stately hotel rather than a hospital; even more so today with the lullaby of live harp echoing though the grand hallways. But it is precisely this, according to Rima, that creates one of the first potential barriers to access for some patients, particularly those who are already intimidated by the pomp and circumstance of the medical fraternity. Patients aready feel vulnerable and small and even more so if you throw in poverty, language, lack of education etc. Rima talks about patients feeling underdressed and out of place and that's just the beginning.

Indeed the access issues start even before you walk through the door (they start way before that but for this exercise we have at least arrived at the hospital). An issue which is not unique to this hospital - indeed I have had this experience in all of hospitals I have visited so far - is how to get in. Rima asked me to find the main entrance and immediately I am struck by signs such as Ambulatory Care and the Jo Blogs Pulminary Centre - rather than simple descriptors that most patients need. I'm also distracted by other signs such as valet services, parking, emergency care and the list goes on. Anyway, it was a learning and enriching experience to walk with Rima through a hospital and to see health literacy through her eyes. Her approaches to improve the communications nexus between hospitals and the people that use them don't necessarily involve pulling down the buildings and replacing all the signage either. Rather, there are a number of small and simple impovements that hospitals can make - and of course key to that is engagement with the community the hospital is in.

I have added Rima's website which is a veritable treasure trove of information and tools and articles.