Towards cultural landscapes of care.

This paper sets out a theoretical agenda for Cultural Landscapes of Care. It highlights the importance of engaging the cultural vectors within different 'care-ful geographies', in order to highlight the role of culture as both a lens of knowing a meaningful way of life, and a critical hermeneutic. Through revisiting discussions around everyday practices of care, both in this journal and elsewhere, we outline a research agenda that re-engages culture with inquiries into the relations between place and care, including spatialities of care, ethics and justice. We call for a shift to thinking with culture and its moral dimensions in order to make sense of the tensions, ambiguities and boundaries of care marked by austerity, neoliberalism and globalisation. We therefore coin the term 'cultural landscapes of care' to advance an agenda that is contextually and culturally sensitive, and committed to understanding what good care means in diverse trans-local contexts. Gathering together the papers in this collection, we show how culture 'filters' through meaningful everyday care practices. We argue for an understanding of culture as a toolkit and a condition for ethical encounters of care. Thus, we translate situated examples of caring experiences into a global standpoint of care-ful geography.

Enabling care: Maggie's centres and the affordance of hope.

This study explores the role of architecture in the affordance of hope for people with cancer. Specifically, it revisits 'enabling places' debates to understand the influence of spatial design in the experience of cancer care. Combining interviews and focus group data from two separate studies of visitors, volunteers, and staff members of Maggie's Centres, an organisation providing cancer support in the UK and internationally, the study investigates the emotional power of their buildings. In particular, we explore how Maggie's Centre buildings provide material, social, and affective resources for their users. We argue that Maggie's Centres help its visitors to orient themselves to their changing lives and uncertain futures in thoughtful ways and, thus, their buildings offer examples of the 'taking place' of hope.

Pathways, practices and architectures: Containing antimicrobial resistance in the cystic fibrosis clinic.

Antimicrobial resistance and the adaptation of microbial life to antibiotics are recognised as a major healthcare challenge. Whereas most social science engagement with antimicrobial resistance has focussed on aspects of 'behaviour' (prescribing, antibiotic usage, patient 'compliance', etc.), this article instead explores antimicrobial resistance in the context of building design and healthcare architecture, focussing on the layout, design and ritual practices of three cystic fibrosis outpatient clinics. Cystic fibrosis is a life-threatening multi-system genetic condition, often characterised by frequent respiratory infections and antibiotic treatment. Preventing antimicrobial resistance and cross-infection in cystic fibrosis increasingly depends on the spatiotemporal isolation of both people and pathogens. Our research aims to bring to the fore the role of the built environment exploring how containment and segregation are varyingly performed in interaction with material design, focussing on three core themes. These include, first, aspects of flow, movement and the spatiotemporal choreography of cystic fibrosis care. Second, the management of waiting and the materiality of the waiting room is a recurrent concern in our fieldwork. Finally, we take up the question of air, the intangibility of airborne risks and their material mitigation in the cystic fibrosis clinic.

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.

"I'm a foreigner there": Landscape, wellbeing and the geographies of home.

The experience of migration brings particular challenges for wellbeing, especially as an individual's sense of disconnection from previous homes can persist over many years. This paper reports on how visitors to a Chinese community centre in NW England reflected upon their experiences of being uprooted from their homelands, even in cases where they had lived for more than half of their lives in the UK. Memories of their previous homelands were persistently called upon in understanding their sense of belonging and cultural identities in the present. We use their accounts in dialogue with recent theories of landscape, especially those that argue for an understanding of place as embodied, ambivalent and in a continual process of making and re-making, in order to trace memories of home in contemporary cultures of wellbeing.

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.

Materializing architecture for social care: Brick walls and compromises in design for later life.

This article reports on an ethnography of architectural projects for later life social care in the UK. Informed by recent debates in material studies and "materialities of care" we offer an analysis of a care home project that is sensitive to architectural materials that are not normally associated with care and well-being. Although the care home design project we focus on in this article was never built, we found that design discussions relating to a curved brick wall and bricks more generally were significant to its architectural "making". The curved wall and the bricks were used by the architects to encode quality and values of care into their design. This was explicit in the design narrative that was core to a successful tender submitted by a consortium comprising architects, developers, contractors, and a care provider to a local authority who commissioned the care home. However, as the project developed, initial consensus for the design features fractured. Using a materialized analysis, we document the tussles generated by the curved wall and the bricks and argue that mundane building materials can be important to, and yet marginalized within, the relations inherent to an "architectural care assemblage." During the design process we saw how decisions about materials are contentious and they act as a catalyst of negotiations that compromise "materialities of care."

Affecting care: Maggie's Centres and the orchestration of architectural atmospheres.

This article presents research on the architecture of Maggie's Centres, a series of buildings for those with cancer, their families and friends. In particular, we explore the way in which their architectural atmospheres are spoken of by architects who have designed individual Maggie's Centres, in interviews with staff members and volunteers in the buildings and in focus groups with visitors to their sites. We bring together qualitative research from two separate projects, and present findings from interviews, across the UK and internationally, with 66 visitors, 22 staff members and 7 architects of Maggie's Centres. How our research participants discussed the atmospheres of their Maggie's Centres is broken down into an analysis of, respectively, how building materials are used in these buildings; how colour and light are experienced in the buildings, and how the shape of the buildings in themselves affect the ways in which people use the spaces. These separate aspects of the buildings combine to become what can be described as the generators of architectural atmospheres. We discuss how architects, staff members, volunteers and visitors translated their intuition of intangible atmospheres into a recognition of architectural qualities, and linked these to questions of care. Maggie's Centres, we argue, are emotionally charged buildings that shape the ways in which care is staged, practiced and experienced in everyday ways, through the orchestration of architectural atmospheres. We use the example of Maggie's Centres as a comparison with how social scientists have characterised the design of mainstream hospital settings, in order to draw out the implications for questions of healing and recovery from illness, and how buildings may hold the potential to affect care.

Envisioning bodies and architectures of care: Reflections on competition designs for older people.

Architects shape future dwellings and built environments in ways that are critical for aging bodies. This article explores how assumptions about aging bodies are made manifest in architectural plans and designs. By analysing entries for an international student competition Caring for Older People (2009), we illustrate the ways in which aged bodies were conceived by future architectural professionals. Through analysing the architectural plans, we can discern the students' expectations and assumptions about aging bodies and embodiment through their use of and reference to spaces, places and things. We analyse the visual and discursive strategies by which aged bodies were represented variously as frail, dependent, healthy, technologically engaged and socially situated in domestic and community settings, and also how architects inscribed ideas about care and embodiment into their proposals. Through our analysis of these data we also attend to the non-representational ways in which design and spatiality may be crucial to the fabrication of embodied practices, atmospheres and affects. We end by reflecting on how configurations and ideologies of care can be reproduced through architectural spaces, and conclude that a dialogue between architecture and sociology has the potential to transform concepts of aging, embodiment and care.

'Essentially it's just a lot of bedrooms': architectural design, prescribed personalisation and the construction of care homes for later life.

This article draws on ethnographic data from a UK Economic and Social Research Council (ESRC) funded study called 'Buildings in the Making'. The project aims to open up the black box of architectural work to explore what happens between the commissioning of architectural projects through to the construction of buildings, and seeks to understand how ideas about care for later life are operationalised into designs. Drawing on recent scholarship on 'materialities of care' and 'practising architectures', which emphasise the salience of material objects for understanding the politics and practices of care, we focus here on 'beds'. References to 'beds' were ubiquitous throughout our data, and we analyse their varied uses and imaginaries as a 'way in' to understanding the embedded nature of architectural work. Four themes emerged: 'commissioning architectures and the commodification of beds'; 'adjusting architectures and socio-spatial inequalities of beds'; 'prescribing architectures and person-centred care beds'; and 'phenomenological architectures and inhabiting beds'. We offer the concept prescribed personalisation to capture how practising architectures come to reconcile the multiple tensions of commodification and the codification of person centred care, in ways that might mitigate phenomenological and serendipitous qualities of life and living in care settings during later life.

Conceptualising 'materialities of care': making visible mundane material culture in health and social care contexts.

'Materialities of care' is outlined as a heuristic device for making visible the mundane and often unnoticed aspects of material culture within health and social care contexts, and exploring interrelations between materials and care in practice. Three analytic strands inherent to the concept are delineated: spatialities of care, temporalities of care and practices of care. These interconnecting themes span the articles in this special issue. The articles explore material practice across a range of clinical and non-clinical spaces, including hospitals, hospices, care homes, museums, domestic spaces, and community spaces such as shops and tenement stairwells. The collection addresses fleeting moments of care, as well as choreographed routines that order bodies and materials. Throughout there is a focus on practice, and relations between materials and care as ongoing, emergent and processual. We conclude by reflecting on methodological approaches for examining 'materialities of care', and offer some thoughts as to how this analytic approach might be applied to future research within the sociology of health and illness.

Architecture and health care: a place for sociology.

Sociologists of health and illness have tended to overlook the architecture and buildings used in health care. This contrasts with medical geographers who have yielded a body of work on the significance of places and spaces in the experience of health and illness. A review of sociological studies of the role of the built environment in the performance of medical practice uncovers an important vein of work, worthy of further study. Through the historically situated example of hospital architecture, this article seeks to tease out substantive and methodological issues that can inform a distinctive sociology of healthcare architecture. Contemporary healthcare buildings manifest design models developed for hotels, shopping malls and homes. These design features are congruent with neoliberal forms of subjectivity in which patients are constituted as consumers and responsibilised citizens. We conclude that an adequate sociology of healthcare architecture necessitates an appreciation of both the construction and experience of buildings, exploring the briefs and plans of their designers, and observing their everyday uses. Combining approaches and methods from the sociology of health and illness and science and technology studies offers potential for a novel research agenda that takes healthcare buildings as its substantive focus.