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According to the United Nations Convention on the Rights of the Child, a child has the right to be brought up in a spirit of understanding, tolerance and friendship among people (1). A child also has the right to play and the right to enjoy their own culture, language and religion (1,2). As our community becomes more diverse, it is even more important to inculcate this spirit in all children and their families.
Modern medical technology and scientific advances have improved paediatric health care; however, there is more we can do to focus on the child’s greater well-being (3). This includes taking into consideration the child’s family, values, faith and cultural background. Social determinants of health require a recognition and appreciation of social grouping, culture and diversity, as well as an understanding of the influences of the patient’s socioeconomic status (4). At The Hospital for Sick Children (Toronto, Ontario), located in a large Canadian metropolitan city, we challenge ourselves to practice in a way that is sensitive to social, emotional and cultural needs.
Peace is a common platform that can bring families closer together. We took our inspiration from a movie The Peace Tree (Figure 1). This movie focuses on peace and diversity shared through the voices of children. In the movie, students from different ethnic, religious or geographical backgrounds contribute paper symbols of peace to their class’s three-dimensional Peace Tree. The film has triggered initiatives in many communities across Ontario, including the proclamation of Peace Tree Day in Toronto. Thus far, Peace Tree Day has been celebrated mainly in school and community settings, but not within the paediatric health care system. Understanding the importance of children’s emotional, social and spiritual well-being in the context of their overall health and recovery (4), we believe this would be a very suitable endeavour for our children’s hospital.
The authors collaborated and identified the Peace Tree as an opportunity to celebrate diversity and peace within our acute care hospital setting. Research shows that looking at and discussing visual art significantly improves subjects’ social interaction, perceived life situation, happiness, peacefulness, satisfaction and calmness (5,6). Hospitalized preschool and school-age children who used expressive art materials showed improved self-concept, a sense of accomplishment and pride, and willingness to express feelings (7–10).
A large tree trunk and branches were painted. It was displayed in October 2008 on a large wall in a playroom that is easily accessible to all children admitted to the ward and their families. Children admitted to our inpatient ward were introduced to the Peace Tree and asked to contribute to it. Children made pictures, symbols and crafts. Each motif was added to the Peace Tree as if they were the fruits. The tree has been up for three months and has 12 motifs (approximately one per week). The Peace Tree will be up permanently.
This art activity was adaptable to patients’ needs and abilities, and it was inclusive of all family members. The students and other volunteers working on our unit really helped in bringing this project to life. We anticipate celebrating Peace Tree Day on June 1, 2009, here at the hospital.
The Peace Tree inspires children to take pride in their heritage and share it with others, while also discovering the vibrant cultures, traditions and festivals of every culture and faith. In doing so, they learn to develop compassion and tolerance for others who are from different cultural, ethnic and religious backgrounds, who may look, sound or seem different.
This is also especially important for our residents, as clerkship and residency program directors are starting to recognize the importance of formal teaching of cultural competence. Currently, very few reports address this aspect of patient care in the existing curriculum (11,12). Table 1 shows comments made by patients, a parent and a staff member about the Peace Tree. The comments reflect the positive effect that the tree has made in acknowledging cultures and traditions, while allowing the child freedom and choice.
The Peace Tree activity encourages young people to share their talents and creativity. It offers children some choice and control in the hospital setting, a setting where they often experience lack of autonomy. It is an experience that is similar to one they may have at school, and thus normalizes their hospital stay (13). Finally, it encourages health care professionals to value everyone who comes for care at our inpatient unit, so that patients feel cared for physically as well as emotionally, spiritually, culturally and socially.
The Peace Tree can form a bond among the patients, their families and the hospital staff. In the future, we would like to evaluate the impact of this project and hope that by celebrating cultural diversity, we can instill a spirit of acceptance as well as convey this to all families.
The Peace Tree movie was shown nationally on the Canadian Broadcasting Corporation and has been invited to more than 50 festivals, including the Tribeca Film Festival, and received 12 international awards including the Liv Ullmann Peace Prize.