Reflections from Pearl Harbour


Today I stand on Battle Ship Misouri in Pearl Harbour on the very spot where the surrender of Japan to Allied Forces took place on 2nd September 1945 which marked the end of World War II. This symbolic spot provides a powerful final reflection point in my Winston Churchill fellowship travels.

  


  
During my travels I have seen constant reminders of the links between UK, Japan and USA. I see plaques and memorials, museums and memorabilia reminding me of the devastation of World War II – and in particular of Pearl Harbour and Hiroshima. Visiting these 2 sites months apart bring it home to me of the loss and devastation of innocent lives. 

I see evidence of the building of relationships between these countries, like the plaque in Monterey celebrating the 20 year anniversary of the twinning of townships between Monterey and Nanao. I see people of all nationalities visiting museums and World War II sites to pay their respects, like the Midway USS naval museum in San Diego.

2015 is a symbolic year – the 50th anniversary of the death of Winston Churchill and 70 years since the end of World War II. As I stand at Pearl Harbour I consider how these countries are now fighting on a united front – the battle this time is not over territory and power but one of the most feared and devastating diseases of our time – dementia. 

Through the G7 collaboration Japan, USA and UK are working together with other countries across the world to find innovative solutions to improving the quality of care for people with dementia, to invest in research and ultimately to find a cure. 

However, we know that many people with dementia can live well and given the right support and care, can remain resilient and stay connected to their communities. It is this aspect of care quality which has been the focus of my Winston Churchill fellowship and has taken me to Japan and USA to compare practice with the UK in order to share insights. 

During this time I have heard about the national plans and strategies for dementia and have seen how these plans are being implemented in practice. I have met key organisations and individuals at the cutting edge of improving dementia care and have been privileged to meet people living with dementia and their families and heard first hand what keeps them resilient and positive. I have been amazed by innovative examples of practice and of the vision of leaders at all levels with a passion for improving the experience and care for people with dementia and their family carers.

I have heard about the challenges of complex systems and healthcare insurance, of different cultures and how diversity is being valued and supported. I have heard about social movements how the voices of people with dementia and carers are being heard and valued. I have seen personalised planning and person centred care in practice and most of all I have witnessed compassion, dignity and respect – for me the heart of improving dementia care and support.

During my travels I have kept a blog to capture my experience in the moment and help share my reflections, as well as help with reminders when writing my final report. You can view these via: https://dementiakeepingconnected.wordpress.com

Reflection Points during my Winston Churchill travels have included:

Japan: May 2015

Hiroshima peace memorial park and museum
Kinkakuji, the beautiful Golden Pavillion in Kyoto
Miyajima Island with the beautiful temple ‘floating’ in the water
Cycling along the river banks and and narrow streets of Kyoto
Cycling around the lush green countryside of Kyoto and taking in the nature and beauty of Japan, discovering ancient temples nestled in the trees and hills
Sitting on the Bullet train from Tokyo to Kyoto and admiring Mount Fuji
Sendai – the site of the tsunami and earthquake of 2011
    


USA: October – November 2015  


Standing at the spot where Marin Luther King gave ‘I have a dream’ speech in 1963 which would change the American history for ever, and looking out to the reflection pool at the Lincoln memorial reflecting on Lincoln’s aspirations of equality.

Sitting at Conorado Beach, San Diego watching the crashing waves and pure white sandy deserted beach and crashing waves. 

Cycling across the iconic Golden Gate Bridge and along beach fronts in Monterey, Santa Barbara and Santa Monica, taking in the drama of the rugged Californian coastline, white sandy beaches, wildlife and surf.

World War II memorials and reflecting on the history and loss of innocent lives.

Pearl Harbour, Hawaii 

  

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Capturing California

I’m sitting by Conorado Beach, one of San Diego’s beautiful island areas. As I look out to the crashing waves and the pure white deserted sandy beach I consider the points in my Californian journey which have provided me with the best reflection time. Cycling across the iconic Golden Gate Bridge and along beach fronts in Monterey, Santa Barbara and Santa Monica, taking in the drama of the rugged Californian coastline, white sandy beaches, wildlife and surf have all inspired me to reflect most on this experience of a lifetime.


   

   
I am very grateful to Kaiser Permanente (KP) for hosting me during my visit to California and thank them and the Alzheimer Association Northern California for their kindness and generosity in sharing their experiences of supporting people with dementia and their families, and the improvement and leadership infrastructure which is supporting these efforts.

National Alzheimer Plan in Practice
During my visit I have had the privilege of seeing how the National Alzheimer Plan (which I heard about in Washington) is being applied in practice. I have met colleagues leading the dementia improvement programme at KP and shadowed the dementia team at Walnut Creek Medical Center, including attending a memory class for people worried about memory problems and witnessed multidisciplinary practice through individualised consultations at the memory clinic between physician, nurse, pharmacist and social worker. Dr Klingman’s vision for improving dementia care is inspiring and I have heard about how his team’s exciting work is transforming outcomes for people living with dementia and their family carers. 

Personalised Planning 
I’m excited to hear how KP are collaborating with Gunderson healthcare system to learn from their Respecting Choices Programme work and develop a new Life Care Planning Programme to support personalised planning, particularly for people with chronic conditions and people with advanced illness (including people with dementia). KP are also collaborating with the Dutch health system to support people with a diagnosis of Parkinson’s disease and considering how the learning from this work can be tailored for people with dementia. I hear about the value placed by KP on patient experience and I am interested to hear about the new Care Experience Standards ‘Care About Me’ which are being developed to support high quality person centred care.

Supporting Diversity
Supporting diverse needs is a key theme during my visit and it’s great to hear from the Alzheimer’s Association about their innovative programmes and initiatives.  I hear how the Association is raising awareness of dementia amongst diverse groups and about the ‘Open House’ programme to support the LGBT community. It is a busy day at the Alzheimer’s Association as they prepare for the forthcoming memory walks and it’s great to meet the staff and hear more about their work, campaigns and exciting new developments including an expert group to improve transitions between acute care and community. I am keen to keep in touch with developments.

I have the opportunity to visit the Diablo Center – an Adult Day Healthcare Centre where people with mid to late stage dementia are being supported to live well. This centre prides itself in personalised care planning and individualised multidisciplinary support. Whilst activities are delivered in a group setting, much careful planning is undertaken prior to and during the session to ensure appropriateness of activities and tailoring to individual needs and preferences. This includes the social worker visiting the person’s home to understand their requirements, and a tailored plan developed by the nurse, occupational therapist, physiotherapist and social worker, with input from a physician and speech and language therapist where required.  Whilst at the centre I observe the compassion shown by staff, the tailored communication styles and the calm and happy environment created. I watch the smiles on the people’s faces as they take part in activities with the co-ordinator.


   

 
Responding to diverse needs are further emphasised as I pass through 2 other areas of the centre. These areas are not specifically for people with dementia.  In one area is a support group for women who have immigrated from Afghanistan.  Many of the women have post traumatic stress and I see the private prayer area created for them, the beautiful hand crafts they have made to send back to Afghanistan and then I meet the ladies in person. They are sitting in the shade of the Californian sun and are chatting and laughing together in their native language. They say hello and they smile when I tell them I have come from Scotland and how much I prefer the Californian weather to our rainy climate. As I further pass through the day centre I meet a group of people from Russia who are taking an exercise class and in the next room a group of elderly people who are also enjoying exercise to music with the physiotherapist.

Improvement Focus
During my time at KP I have had the privilege of meeting improvement colleagues. I feel right at home as many have undertaken the same Improvement Advisor course I have with the Institute for Healthcare Improvement (IHI) and using the same methodologies, approaches and measures. I hear about the exciting improvement initiatives and their advanced data systems. Similar topic areas are the focus of improvement efforts: flow, dementia, delirium, sepsis, healthcare acquired infection but to name a few. I hear about the links between inspection and improvement and I share our work in Scotland and offer to make connections. It is heartening that we share similar challenges around spread, scale and sustainability, demonstrating impact, initiative overload and data burden.  I have the opportunity to spend time on the Professional Improvement Leaders course. This is an exciting course led by KP to build leadership capability and capacity amongst its quality improvement leaders and they are an inspiring group. I have the opportunity to share the work of Focus on Dementia, my experience of visiting dementia services in Japan and learn from their insights and experience. 



  

I have had an inspiring time in California and so much to share in a single blog which only captures a fraction of my experience and learning. I hope this gives a flavour of the innovation at KP and Alzheimer’s Association and of the exciting developments taking place within such a diverse context. 

Thank you to all at KP and Alzheimer’s Association for taking time to meet with me during my visit and share expertise and insights. In particular thank you to Barbara Crawford from KP and Ruth Gay from Alzheimer’s Association – two extraordinary leaders who have made my visit possible and inspiring.
    


Cure or Care?

I am sitting on the plane from Washington DC to San Francisco and I wonder how I can possibly capture this amazing week into a short blog and give it the justice it deserves. The National Alzheimer’s Disease Plan (USA’s equivalent of our dementia strategy in Scotland) is a good starting point. 

The Plan was signed off by President Obama in 2012 and is annually updated. At first glance it seems to focus on finding ways to prevent and effectively treat Alzheimer’s by 2015 as the main priority and so I’m heartened when I read on and have discussions with key individuals and organisations this week that there is much more to the Plan. Enhancing care for Alzheimer’s patients; expanding support for people with dementia and their families; improving public awareness; and carefully tracking data to support these efforts are also part of the plan and it is these areas which  grab my attention during my visit.

Through my discussions with Government officials, lead organisations and individuals at the cutting edge of dementia practice in the USA, I get a sense of the scale of the challenge but also about the efforts to continue to drive care quality for people with dementia and their family carers. Unlike the UK there is no national health system and so I learn about the complexities of health insurance in the USA and how Medicare and Medicaid are supporting  the health needs of people with dementia.

This week has been invaluable in providing me with the strategic context for dementia across the USA. I have been inspired to hear about the work of the Administration for Ageing, National Alliance for Caregiving, Patient Centred Outcome Research Institute, LEAD Coalition, Cognitive Solutions, Alzheimer Association and the work of US Against Alzheimer’s. These organisations and initiatives are all contributing to a social and political movement to improve the experience for people living with dementia and I am inspired to find out more.

During the past week I have heard about exciting initiatives including: Dementia Friendly America, public health campaigns such as ‘Know the Ten Signs’ and ‘Healthier Habits for a Healthier You’. I have learned about annual advocacy events where 1,000 people with an interest in dementia (many with lived experience) come together with Congress to share experiences and keep the spotlight on dementia at the most strategic level. I have heard that Alzheimer’s Association have 600,000 advocates for dementia. I have learned about the Centre for Medicare and Medicaid Innovation Fund and how these projects are informing practice. I have learned about patient powered research networks and how they are supporting and valuing the experience of people living with dementia as part of the research agenda. I have heard how 77 organisations are collaborating on dementia through LEAD Coallition to share practice, ideas and work together as a force for change.

Like other countries around the globe, USA a is not without its challenges. According to the Alzheimer’s Association, 5.3 million Americans have Alzheimer’s disease. Of the 5.3 million Americans with Alzheimer’s, an estimated 5.1 million people are age 65 and older, and approximately 200,000 individuals are under age 65 (younger-onset Alzheimer’s).  Diagnosis rates, transitions between care settings, the size and diversity of the country all add to the complexities. However there is no doubt that dementia has never before been receiving such attention and there are real opportunities to capitalise on the momentum being galvanised and to continue to learn from innovative examples and initiatives. 

Thank you to colleagues in Washington DC . It has been a remarkable week in an amazing city and I now look forward to seeing dementia care quality in practice as I continue my journey to Northern California where I will spend the next week with Kaiser Permanante and spend time with Alzheimer’s Association.

And she’s off….

And relax….,,just had time to catch my breath after a morning of last minute packing and moments of panic ‘have I got everything!’  

I’m now sitting at Glasgow Airport people watching and feeling so very privileged to have this opportunity of travelling to USA to continue my Winston Churchill Fellowship.

On this symbolic year of the 50th anniversary of the death of Winston Churchill and the 70th anniversary of Horishima, I’m excited to have the opportunity to compare dementia practice between Japan and USA and understand more about the history and cultures which underpin these inspiring countries.

Thank you to my family, friends, colleagues and to the Winston Churchill Memorial Trust for this amazing opportunity. 

  

From East to West


As I reach for the anti-ageing night cream, a smile comes to my face as I reflect on my earlier conversation. Tonight, just over 3 months since I travelled to Japan, I am reunited with 2 dear friends who have arrived in Scotland from Tokyo for a holiday. We are in ‘The Bothy’ a traditional Scottish restaurant in Glasgow’s West End and we’re talking about my time in Japan. 

I reflect on the amazing sites I visited including the beautiful Kinkakuji (Golden Pavillion) in Kyoto. I hear how this temple is quite unique. Many temples in Japan which were once golden or brightly decorated are now old and brown in colour. Unlike other countries in Asia, like China and Thailand, Japan does not restore temples back to their former glory but instead the age and different stages of the temple are respected. Could this valuing of age be a clue to how communities in Japan respect their older people? Surely valuing every stage of life is something we should all strive towards?


Now back home as I glance down at my bedside table and see the range of cosmetics all designed to minimise ageing, I consider how our western society has a negative outlook on growing older and if only we could celebrate the successes of ageing and the richness of our experiences.

It is now just over 2 weeks until I embark on the next part of my Winston Churchill fellowship to USA and I look forward to comparing east with west in supporting our older people and people with dementia. 

Thank you to Ken and Niomi, my inspiration for writing this blog. 

  

Gallery

Let’s Talk About Dementia in Japan

Reflections from my experience in Japan 2015 .

Let's Talk about Dementia

Keeping Connected

In May 2015 I had the absolute privilege to travel to Japan for one half of my 2015 Winston Churchill Fellowship. During my three week visit I stayed connected with family, friends and colleagues by posting seven blogs on my travel blog site www.dementiakeepingconnected.wordpress.com. I am delighted to share with you in this week’s blog my final blog post from Japan that I posted on the 30th May, reflecting on my visit.

Time for Reflection

I am sitting by the river in Kyoto. It’s my last day before travelling to Narita for the flight home. As I sit in the shade of 34 degree heat and watch the ducks splashing around, I am grateful for this time out to reflect on my time in Japan. I didn’t realise it was possible to feel so exhausted and inspired at the same time!

During my 3 weeks here…

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Time for Reflection 

I am sitting by the river in Kyoto. It’s my last day before travelling to Narita for the flight home. As I sit in the shade of 34 degree heat and watch the ducks splashing around, I am grateful for this time out to reflect on my time in Japan. I didn’t realise it was possible to feel so exhausted and inspired at the same time!

During my 3 weeks here I have visited 9 day centres and group homes and met over 100 people with dementia, their family carers, health and social care staff, policy makers, researchers and businesses. I have had meetings with professors at the cutting edge of dementia care, met with organisations including Alzheimer Association Japan, Ministry of Health for Japan and three local health ministry departments in Uji, Sendai and Setagaya, Dementia Care and Research Centre, Dementia Friendly Community Network Japan, Tokyo Metropolitan Institute of Medical Science,  Shinko-Fukushima-Kai Social Welfare Corporation and NHK (Japan’s equivalent of the BBC). 

I have been in two earthquakes, one typhoon and was unable to visit Hakone due to volcano eruption warnings. I have been welcomed by the Mayor of Uji City, been supported by the British Embassy and many translators and met amazing colleagues, now dear friends, who have helped me with my itinerary, travel arrangements and local traditions (and after 3 weeks I have finally mastered how to use chop sticks!).

I have learned about the new Orange Plan (Japan’s dementia strategy) and how this is being developed together with people with dementia and carers. I have heard about its focus on supporting people with dementia to stay connected to their communities, ambitions which also shared by Scotland’s dementia strategy. I have been able to hear and share opportunities and challenges in timely diagnosis, post diagnostic support, care co-ordination and end of life care. I have heard about dementia supporters in Japan (a programme which inspired our dementia friends in the UK). I have had the privilege of attending the ‘Ofuku meeting’ where leaders in dementia came together from across Japan for an evening discussion on dementia priorities.

  

I have met such welcoming and respectful people who have shown compassion and a determination for improving the experience of people with dementia and their carers. They come from all different backgrounds with a shared vision for change and, despite their great work, they remain so humble.

In a culture of compliance with rules, I have seen great examples of flexibility and responsiveness, with a real focus on supporting what matters to the person rather than fitting with the system or service available. I have witnessed how people are valued and supported to continue to do meaningful activities and of the benefits of maintaining self esteem and remaining connected to their community.  The BLG day centre (featured in my ‘Men at Work’ blog) is a great example where staff have fostered win-win relationships with businesses to enable people with dementia to continue to be supported to work and contribute to their local community.  Meeting the Dementia Friendly Communities Japan Network was another great opportunity to hear how businesses are working together to design and test solutions for people with dementia, enabling them to remain connected to their communities.

   

  

I have visited a day centre in a traditional family home where people with dementia and young children all attend together. I have watched the faces of people from all generations light up as they sit in each other’s company.  I have seen people in day centres supported to do the things they want to do without fear, like baking pancakes on a hot griddle, preparing vegetables for the potato salad and cutting open packets with scissors (featured in my ‘No Ordinary House blog’). I have seen staff and people with dementia sitting around the same table enjoying the same food and chatting about every day things, just like a dinner with friends or family (see more in my ‘Ladies who Lunch’ blog). I have seen great examples of how health and social care are working together to ensure responsive and safe care. For example within Shinko-Fukushima-Kai Social Welfare Corporation staff from many sectors are all working together as one team to meet the needs of people in day care, short term respite and long term care. I have visited Uji City – a city with an amazing vision and staff, people with dementia, carers and communities working together to make this vision a reality.

  

   

 

I have experienced group homes in action, for me an excellent option for people no longer able to stay in their own homes (read more in my ‘After the Tsunami’ and ‘Making Me Feel at Home’ blogs). I have witnessed how people are supported to live their lives in a way which enables them to continue to do what matters to them and importantly to remain connected to their communities, like going to the local shops, gardening, visiting the park for a picnic and out for tea. I have met people with such resilience who have experienced the devastation of the 2011 earthquake and tsunami and yet display such positivity. People in their 90s and 100s who are so fresh faced and with wonderful smiles who have welcomed me with open arms, held my hand and made my heart melt. I have been welcomed by Robert Burns’ songs sung in Japanese and hand painted Scottish flags. 

   

 

I have been introduced to the ‘orange’ and ‘lemon’ cafes, providing opportunities for the community to come together to provide peer support, to seek advice and to build friendships. I experienced  people with dementia bonded by friendship not by a diagnosis and people living well with dementia. I have heard how people with dementia are raising their voices to be heard through conferences, strategy meetings and through the support of  Alzheimer Association Japan and the media. I had an inspiring meeting with Alzheimer Association Japan and a fascinating day at NHK hearing more about this journey.

  

Despite my busy schedule I have had the opportunity to experience some of the delights of Japan – world heritage sites, the most amazing temples, castles and shrines. I have seen weddings in the park with beautiful brides in traditional kimonos, watched a carnival where people of all ages danced together through the streets of Tokyo. I visited Hiroshima – a moving day taking in the atomic bomb site of August 1945, peace park and museum and I have cycled around beautiful Kyoto – the best way to find the hidden treasures of ancient Japan, nestled at the edge of the countryside and bamboo forests. I have visited the food markets and sampled local delicacies including sweet fish, eel, jelly fish, green tea ice cream and of course sake!  I have seen pandas and have managed to be chased by four monkeys in the monkey sanctuary, who wouldn’t let a group of us leave the park, and the next day chased by two deer who were attracted to my ice cream and map.

   

     

All of these experiences, some of which I have captured through my previous blogs, have left me feeling so inspired and as I leave the cool shade of the river bank and make my way through the winding streets of Kyoto, I feel truly privileged to have had this amazing opportunity. I have learned so much and I look forward to meeting with colleagues to share more on my return home.

Thank you to the Winston Churchill Memorial Trust for this amazing opportunity. I have such treasured memories and so much more to reflect on as I make my way home.