Assembling atmospheres, encountering care: risk, affect, and safety in the cystic fibrosis clinic

This paper explores the design of hospital environments, in order to investigate how issues of infection control, spatial layout, and embodied practices intersect in the accomplishment of ‘care-ful’ geographies. Specifically, we trace how the material environments of three UK cystic fibrosis (CF) clinics are assembled in order to orchestrate routines that minimise the risk of cross-infection between patients and safeguard their wellbeing. Our analysis of these clinics, derived from interviews with staff and patients and ethnographic observation, reveals the importance of environmental factors in brokering affective atmospheres that can alleviate patients’ anxieties. Theoretically, we draw on Ben Anderson's understanding of how affect works as, simultaneously, an object-target, bodily capacity, and collective condition, in order to draw out the architectural atmospherics of the CF clinic. That is, we first report how clinic staff anticipate cross-infection risks and configure the physical environment in order to minimise these risks. We then describe the embodied practices of patients as they move through hospital spaces in ways that protect themselves, and others, from cross-infection. Finally, we analyse how this choreography of material environments by staff and the movement of patients’ bodies combine to evoke a shared understanding of the clinic as a safe space, in contrast to perceptions of the hospital as a threatening environment. Our focus on the affective atmospheres of the CF clinic allows us to develop an in-depth analysis of the role of materialities, mobilities, and design in the social construction of risk, especially in a post-COVID pandemic age.

The coughing body: etiquettes, techniques, sonographies and spaces.

With newfound relevance in the context of Covid-19, we focus on the coughing body, building on an in-depth qualitative study of three UK lung infection clinics treating people with cystic fibrosis. Conceptually we take our cue from Norbert Elias and the way something as physiologically fundamental as coughing becomes the focus of etiquette and technique, touching also on themes central to Mary Douglas' anthropology of pollution. This is explored through four themes. First, we show how coughing becomes a matter of biopolitical citizenship expressed through etiquettes that also displace pollution anxieties to surroundings. Second, coughing is a question of being assisted to cough through the mediation of professional skills, interventions and devices. Third, coughing is seen to be central to the sonographic soundscape of the healthcare environment whereby people learn to recognise (and sometimes misrecognise) each other through the 'sound' of the cough. Finally, coughing properly can be seen to have both a 'time and a place' including the retreat of the cough from public space into risky confined spaces. Our conclusion speculates on the way these insights shed light on aspects of life that, until the Covid-19 pandemic, lay largely hidden.

Caring through distancing: Spatial boundaries and proximities in the cystic fibrosis clinic.

This paper re-examines relations between proximity, distance and care, focusing on practices of 'distancing' in the cystic fibrosis (CF) clinic. While care is often thought of in terms of proximity, literature on 'landscapes of care' highlights the potential for 'care at a distance'. We extend this literature to examine practices of social distancing, specifically the act of maintaining a 'space between' bodies in communal areas - a practice currently brought to the fore by the COVID-19 pandemic. Using the CF clinic as a case study, we examine how distancing can be understood as an emplaced practice of care, shaped by - and shaping - architectures and materialities in particular contexts. We explore these issues drawing on data from Pathways, practices and architectures: containing antimicrobial resistance in the cystic fibrosis clinic, a UK AHRC funded study (AH/R002037/1) examining practices in three cystic fibrosis clinics using visual and ethnographic methods. Clinical staff practices of maintaining distancing were often regarded by patients as 'care-ful', part of personalised 'care in place', embroiling a wider care assemblage including ancillary staff, materialities and architectures. Patients also actively participate in distancing as an 'ethic of care', using strategies of 'holding back' and 'looking out' in confined spaces. Yet our findings also highlight tensions between care, proximity and distance in circulation spaces and communal areas, including transient spaces where the assemblage of care breaks down. The article concludes by considering wider implications for healthcare design and for the COVID-19 pandemic.

Air care: an 'aerography' of breath, buildings and bugs in the cystic fibrosis clinic.

With significant relevance to the Covid-19 pandemic, this paper contributes to emerging 'aerographic' research on the socio-materialities of air and breath, based on an in-depth empirical study of three hospital-based lung infection clinics treating people with cystic fibrosis. We begin by outlining the changing place of atmosphere in hospital design from the pre-antibiotic period and into the present. We then turn to the first of three aerographic themes where air becomes a matter of grasping and visualising otherwise invisible airborne infections. This includes imagining patients located within bodily spheres or 'cloud bodies', conceptually anchored in Irigaray's thoughts on the 'forgetting of the air' and Sloterdijk's immunitary 'spherology' of the body. Our second theme explores the material politics of air, air conditioning, window design and the way competing 'air regimes' come into conflict with each other at the interface of buildings, bodies and the biotic. Our final theme attends to the 'cost of air', the aero-economic problem of atmospheric scarcity within modern high-rise, deep-density healthcare architectures.