A place on Earth

Pondering the power of a place, Elizabeth Wainwright believes it roots us and asks us to play our part here and beyond.

Elizabeth Wainwright

Elizabeth Wainwright is a writer, coach and walking guide. She's a former district councillor and has a background in international development.

A ploughed field of red soil is in the foreground, sloping down into a valley with a track and green fields beyond

Red Devon soil near South Hams.

Tony Atkin, CC BY-SA 2.0, via Wikimedia Commons.

“Different places on the face of the earth have different vibrations, different polarity with different stars. Call it what you like, but the spirit of place is a great reality.”

DH Lawrence

I hoped it would be a David and Goliath story – big national developers, small local community, the community wins, the developers leave town. Instead, the application for almost 300 uninspired and loveless houses passed despite concerns over affordability, wildlife enhancement, and lack of green infrastructure. As an elected District Councillor, I spoke my concerns alongside residents. Some improvements were made, but the story is now a familiar one: the planning committee recognised the concerns, but felt their hands were tied – if they refused permission, the wealthy developer would appeal, and probably win, and our District Council would have to pay costs from its ever-dwindling budget.

Developers are invested financially in a place, but not relationally or ecologically. The land becomes a blank canvas; the otters, oaks and fertile soils are an inconvenience which can be replaced with some token tree planting and bat boxes afterwards, in the name of ‘development’ (a slippery idea that is often interpreted as profit rather than value). The layers of the place – of farming and memory, of community and care and stories through seasons – are invisible to distant developers, but not to those who have eyes to see.

I have been trying to see the layers in these Devon lands where the soils are red, and where the farmers are still “buried deep in their valleys, in undateable cob-walled farms…connected by the inexplicable, Devonshire high-banked, deep-cut lanes…” as poet Ted Hughes observed. Unearthing the layers of a place can lead to topophilia – a bond we feel with its emotion, memory, geography, heritage. I’ve felt pulled instantly to places before – Scottish islands, Zambian savannahs (the pull to Zambia eventually led me to live and work there, and now I feel folded into its red soils just as I am into the red soils of Devon). But I think topophilia is different, more gradual, a slow intertwining of roots as a place becomes known to us. Whether instant pull or slow-burning topophilia, I’ve been thinking about place, and why it matters.

When the global is often more glamorous than the quiet hush of the deeply rooted local, knowledge of and respect for place feels rebellious but vital.

God’s first words to humans were to Adam and Eve in the Garden of Eden near the Tree of Life: “Where are you?” They were hiding, ashamed of their nakedness. He could not find them. Where are you? In an increasingly remote and rootless age, with access to everyone and everything 24/7 yet loneliness still on the rise, perhaps this question is one to consider anew. When borderless corporations can be more influential than governments, and when the global is often more glamorous than the quiet hush of the deeply rooted local, knowledge of and respect for place feels rebellious but vital. Kentucky farmer and author Wendell Berry knows this:

“…one cannot live in the world; that is, one cannot become, in the easy, generalizing sense with which the phrase is commonly used, a "world citizen." There can be no such thing as a "global village." No matter how much one may love the world as a whole, one can live fully in it only by living responsibly in some small part of it. Where we live and who we live there with define the terms of our relationship to the world and to humanity.”

I have long admired Berry’s writing, and his choice to care for a patch of Kentucky land. His is no bucolic rural idyll – his, for decades, has been a cry for re-rooting and for neighbourliness, because “it all turns on affection” and because that is how the world is made and remade; through imperfect places and the encounters in them. We are situated in a landscape, and it is through this particularity that we engage with creation. We exist at the scale of human relationship, in this place, amongst these people, in this time. The grass may seem greener elsewhere, but the grass here is green nonetheless – and greener still when I stare at it, and get curious about it, and get to know the many years and hands that have tended it, and take part in tending it myself.

The cornerstone of the Christian story is that Jesus came into the world as a human. And humans exist in place. In the short documentary Godspeed, Alan Torrance – a giant, kilted, red-haired Scottish man – shared that the reason he came to believe in Jesus as an adult was not because of theology or preaching, but because of the scale of the map in the back of a Bible. The map depicted the area where Jesus lived – the north edge of the sea of Galilee. It was the same scale as the place Alan lived in Scotland. He knew that relationship and community mattered (“we’re not rich folk, but to me you’re poor if you cannot offer hospitality”) – he knew that Jesus would have been found out if he were a fraud. God didn’t just come into the world; he came into a place built on relationships. It wasn’t theology that changed Alan’s mind about Jesus, it was a map of a particular place.

Nature writing… a genre that explores the natural world, often through authors’ relationship to particular places, and often touching on the numinous and unseen.

In the Bible and I think in life, God – or some sense of the divine – is often encountered not only in a particular place, but in the natural world there – a garden, a burning bush, a desert wilderness. Throughout the Bible from Genesis on, we are called in different ways to care for the natural world, to treat it as a gift, to treat it as if God might be found there. But it is often the secular world that most passionately calls us to reconnect, to care, to pay attention to the natural world. I’ve seen this in campaigns, in popular media, and in ‘nature writing’ which takes a prominent place in bookshops; it’s a genre that explores the natural world, often through authors’ relationship to particular places, and often touching on the numinous and unseen. The Bible could easily be classified as nature writing, or place writing, or poetry – writing of wonder that might re-enchant us in a tired age – but instead it is restricted to the religion or theology shelves, and its wild rooted transcendence goes unheard by people of faith and no faith.

That rooted transcendence that I see in the Bible is something I see in the places I know too. The root of the world ‘parish’ links to both ‘neighbour’ and ‘soujourner’ – ideas that speak simultaneously of being here and reaching beyond. My parish in Devon asks me to listen, to know, to be known – to be a neighbour. But it also asks me to use the nourishment of these deepening roots to reach, to not cling too tightly to ideas of ownership, to face the world and offer love. Berry says,

“I take literally the statement in the Gospel of John that God loves the world. I believe that the world was created and approved by love, that it subsists, coheres, and endures by love, and that, insofar as it is redeemable, it can be redeemed only by love. I believe that divine love, incarnate and indwelling in the world, summons the world always toward wholeness…"

I think knowing our place is important today – because it roots us, and asks us to play our part in the ongoing incarnation of love.

The wholeness and healing of the world depends on love incarnate and indwelling. Love is not a theology, or a card on Valentine’s day, or any of the other packages it gets squashed into. Love created the world, and has the power to keep doing so if we let it. Love dwells incarnate in a place, in the people and encounters in that place – it can be messy and confronting as well as life-giving and transforming. We draw from and add to its deep well, and by doing so, heal the world starting right where we are. That’s why I think knowing our place is important today – because it roots us, and asks us to play our part in the ongoing incarnation of love, and so in the ongoing becoming of the world.

My discovering the world has included travelling and working throughout it – but now the discovery comes through a small imperfect parish in a district in Devon that is shining and struggling all at once, where stories run deep. My husband and I and our soon-to-arrive baby are beginning to hear them. I feel layers of emotion, history, and memory here; I am trying to invest in its hope and reality, to be present in its here-ness and now-ness. I will always love visiting new places and feel a pull to other places. But in this place, when I look and listen and know and be known, I find love indwelling and incarnate. It’s in the hedges, the neighbours, the birds that sit and sing about things we can’t hear, the communities that come together to resist placeless loveless development. It’s in the foodbank, the fields, the relationships that can start off challenging but which soften and deepen over time and despite difference. At a time when I think God is asking us again “where are you?” how good to be able to answer, here, in this imperfect place, where love dwells.

Article

Change

26 July 2024

6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient

Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care. Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions?

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers.

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’.

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care.

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?”

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness.

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.”

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.