Maggie's Centres offer beauty and dignity to terminally ill
Designed by famous architects and available free of charge, Maggie's Centres aim to inspire and comfort those affected by cancer, says Giovanna Dunmall
When designer Maggie Keswick Jencks found out that her cancer had spread to her bones, liver and bone marrow, she was sitting in a harshly lit room with her husband, landscape architect and writer Charles Jencks. She sat in a windowless corridor of the hospital contemplating "having two to three months to live".
This dismal episode was a catalyst for Jencks. In the short time she had left - experimental and complementary treatment would extend her life for another two years - she devised a blueprint for a progressive cancer caring centre where people felt respected, soothed and supported, and the design of the building contributed to their recovery and well-being.
The prognosis of cancer sufferers may often be bleak, she argues, but no patient should spend his or her last remaining weeks, months or years in equally bleak environments. Shouldn't the "punch in the stomach" that is a cancer diagnosis be received in a calm and beautiful setting? Also, wouldn't it be wonderful if cancer sufferers could retain their autonomy and dignity, and take control of their diagnosis, instead of just being a medical statistic?
The centre she had in mind would offer medical information, psychological support, advice on nutrition, relaxation therapies and exercise classes.
Keswick Jencks, who died in 1995, didn't live long enough to see her vision come to fruition, but if she had, she'd have liked what she saw. The first Maggie's Centre opened at Western General Hospital in Edinburgh in 1996, in a stable block converted by architect Richard Murphy. There are now 12 fully operational Maggie's Centres in Britain (funded by a mix of private and corporate donations and public fund-raising initiatives) and nine more in the pipeline.
The first Maggie's Centre abroad will open soon in Hong Kong, in the grounds of Tuen Mun Hospital. It is designed by architect Frank Gehry, a lifelong friend of the Jencks.
There is now evidence and scientific literature to support the idea that views of green spaces, and spacious sunlit rooms, have a positive impact on health. In 2011, the British Medical Association published a landmark report explicitly stating that the "architectural environment can significantly affect recovery times".
The Edinburgh centre is a welcoming place, warm and full of light. From its entrance you can see every part of the building. There is no intimidating signage outside or inside, no alienating corridors, and no receptionist or obvious person in charge when you walk in that might give you the feeling of "them and us".
An inviting, well-stocked kitchen and a large table allow visitors to make their own tea and refreshments and feel at home. Like all the other Maggie's Centres, it is free to use for anyone affected by cancer (patients, friends and family) and offers a range of classes from yoga to art therapy.
As with almost all the centres, it is located in the grounds of a large hospital that has an oncology department. The Edinburgh centre proved so popular it had to be extended in 1999. Soon, cancer sufferers and National Health Service trusts up and down Britain were asking for their own Maggie's Centre.
The roster of the centres' architects reads like a who's who of international architecture: Zaha Hadid, Rem Koolhaas and Kisho Kurokawa have all designed one, and centres by Steven Holl and Norman Foster are in the works.
Though the architects work pro-bono, the centres are often costly to build. "We want to communicate to people coming in that their life is of value, that they matter," says Maggie's Centres chief executive Laura Lee, who was Keswick Jencks' former oncology nurse. Expensive buildings made out of quality materials improve with age rather than deteriorate, she adds.
"We tell the architects how we want the spaces to make people feel," says Lee. Put simply, the buildings should be small, uplifting, welcoming and domestic in scale. They should not patronise or daunt, but rather surprise, provoke thought and inspire. They should be places where people are able to "maximise their own capacity to cope".
The Hong Kong centre has been designed as a series of connected buildings with cascading roofs inspired by Chinese pavilion houses and gardens "without being a caricature", says Gehry. It is built across a pond and surrounded by a dense landscape of mature trees, palms and bamboo.
Gehry remembers Keswick Jencks as "a bright and sunny character" with "a real creative spirit and a healthy curiosity". He designed Dundee centre back in 2003, so he is familiar with her stimulating brief.
The landscape - designed by Keswick Jencks' daughter Lily - was key to the project, says Gehry, and it was developed at the same time as the building.
"There is a real synchronicity between the two," says Lily. "Each room has a different view to the garden, or pond, or to a particular tree, or rock."
The design of the gardens is regarded as being as important as the building itself. "Looking onto a green landscape can be good for psychological well-being and a chance to connect to something bigger," says Lily. "Seeing the seasons change can take you out of yourself."
Dr Raymond Lo See-kit, chief of service at Bradbury Hospice at Sha Tin Hospital and a veteran of palliative care, agrees. "Outdoor gardens and greenery allow recreational and diversional therapy, and an opportunity for patients and families to cherish nature and augment spiritual growth and resilience." Helen Lui, manager of Maggie's Hong Kong (which has been operating out of an interim centre since 2008), says visitors to the new facility will be able to see through the windows to the ponds, and immediately feel like they have more options.
"Particularly in Hong Kong, which is very densely inhabited, people find that comforting. The space makes you feel a lot better, you feel less stressed and less pressurised," Lui says.
The design is creative and innovative, says Lui, and that's important because cancer patients can feel helpless and hopeless. "Cancer patients feel unproductive because they need to spend a lot of money on treatment, and some need to quit their jobs for a long time," she says.
"They can feel like a burden on their family and society, and may not feel like they deserve something good. When they come in here, they see that this is a very special place and I think this changes their self-image."
Asked whether famous architects are chosen to raise the charity's profile and invaluable funds, Lee says there's no doubt it helps but that it isn't really the intent: "We work with architects and designers who have the maturity and experience to handle the brief, because it's the brief that's important rather than a piece of signature architecture."
The brief is demanding, but also allows the architects a lot of conceptual freedom, resulting in some startlingly whimsical or groundbreaking designs.
A centre opening in Oxford in early 2014 designed by London-based Wilkinson Eyre architects (the designers of the IFC tower in Guangzhou) looks like a tree house set on stilts.
"The site is in a nature reserve, surrounded by protected trees, and the building rests within the beautiful natural setting without disturbing it," says project architect Sebastien Ricard. It's a technically advanced design but, importantly, it's still "rooted in human experience".
By using a different architect each time, Maggie's Centres ensure each local community gets its own special building. This allows them to feel a sense of pride. "This also helps us make sure that we raise the funds that are necessary to deliver the care that goes on inside it," says Lee.
The interiors are furnished and designed on a centre-by-centre basis by Lee and Marcia Blakenham, a long-time artist friend of Keswick Jencks and vice-chairwoman of the Maggie's Centres. No two facilities are alike. Art is used to make them feel like home and to provoke thought. The attention to detail is remarkable.
"We go about it in the way you would furnish a home," says Lee. "We buy a few things, see how it looks and then add the next few things rather than going for a hotel interior approach."
When I visited the centre in London designed by Rogers Stirk Harbour + Partners, I was struck by the warmth and character of the interiors. The floors are made of polished concrete and wood, there are generous amounts of glazing, and the courtyard gardens are filled with exotic plants.
Plush sofas and armchairs were covered in stylish, colourful blankets and cushions, the toilets were not partitioned cubicles but rather separate rooms "with a proper door in a door frame" and their "own hand basin", as directed by Keswick Jencks in the powerful essay she wrote shortly before dying, A View from the Front Line.
"What matters is not to lose the joy of living in the fear of dying," she wrote. The centres that bear her name make doing that just a little bit easier.