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Pediatricians Must Create Joie de Vivre for Children Anytime and Anywhere

Whenever we, as pediatricians, treat sick children, we are often so absorbed and engrossed in treating the disease itself that we neglect or forget the hearts and minds of children who are feeling pain and suffering from disease. When we treat sick children, it is important for us to take every opportunity to create joie de vivre for them anytime and anywhere.

I. What is Joie de Vivre?

Joie de vivre is a French word, but I first encountered it in a medical book written in English by Professor Illingworth in Scotland when I was studying in London in the early 1960's. I do not know why he used this French word, but it sounded nice to me. This French word means "joy of living" and it is a feeling that is created in children through the joy of playing and learning. It is important for us to create opportunities for hospitalized sick children to experience joie de vivre by planning daily schedules and designing methods applicable to hospital services.

II. Child Bio-emotinemics

I would like to propose the term "bio-emotinemics" (Seimei kando gaku in Japanese) which means the "science of life emotions" as a way to create joie de vivre. Child bio-emotinemics would study mechanisms of inducing positive and good emotional states such as "pleasure," "affection" or "joy" when treating children as well as developing a method to accomplish this.

III. Scientific Basis of Joie de Vivre: Theory of "Child Bio-emotinemics"

There is a known scientific basis for the effects of joie de vivre in the treatment of sick children that can be summarized as follows.
(1) Non-specific activation of the physical and mental functions of children
(2) Specific activation of the endocrine and immunologic functions of children based on neuro-psycho-endocrinology and neuro-psycho-immunology

IV. Elevating the Quality of Life of Hospitalized Sick Children through Joie de Vivre: The Practice of Child Bio-emotinemics

In order to elevate the quality of hospital life for sick children, the following facilities are usually provided, depending on their age: a hospital nursery, hospital school, and play room. Hospital nurseries or play rooms were instituted in the mid-1950's in the United States, but unfortunately, not until the 1970's in Japan. At the beginning of the 1970's, the nursing department of the National Children's Hospital started a play program at the play room offered by nurses or volunteers.

During my service as president of the National Children's Hospital, we opened a school called "Soyokaze Class (Gentle Breeze Class)." This is an official arrangement with the educational department of the Tokyo metropolitan government. However, the nursery services are still only volunteer-based and not yet officially established. In addition to school activities, the National Children's Hospital holds various events on special occasions such as Christmas, New Year, Boy's Day and the Girl's Festival, and also pleasurable visits by famous musicians and cartoon characters familiar to children. It is clear that these facilities and services can provide joie de vivre that will elevate the quality of life of hospitalized children.

V. Summer Camps for Sick Children with Chronic Intractable Diseases

Joie de vivre is very important not only for sick children, particularly those suffering from chronic intractable diseases, but also for their families, parents, and mothers, in particular. In Japan, summer camps are usually organized during the summer holidays. These camps which allow children to enjoy a stay at a cottage or simple hotel in the countryside, were begun in the late 1960's for children with diabetes, asthma, nephrosis/nephritis (including children needing dialysis), and neurological diseases such as epilepsy, autism, SSPE, and others, and also their parents and families. Summer camp activities provide opportunities for sick children to experience joie de vivre, and their families can also exchange information and share their concerns with the medical staff and others affected by the same or similar diseases.

VI. Application of Information Technology

The availability of information technology (IT) varies in each country at present, but with the rapid spread of IT, the same applications will soon become possible everywhere. The National Children's Hospital has conducted the following experimental trials.

(1) Application of Virtual Reality Technology
Virtual reality technology is particularly useful since sick children, even those who are bed-ridden, can visit the zoo, ski in snowy mountains, for go for a drive in town. In collaboration with a company involved in information technology, Dr. K. Nihei and his team produced a program on visiting a zoological garden for children admitted to the National Children's Hospital in the late-1980's. Since then, they have produced many other attractive programs. Among them, the most interesting one was a virtual exploration space flight of Venus that was created with the assistance of NASA, the Faculty of Engineering of the University of Tokyo and others.

Virtual soccer is also an exciting program for sick children, who cannot enjoy this type of sports in the field. Even if the child cannot kick the ball, it can be hit by hand, and the hit ball flies into the field where it is kicked back by a famous player.

(2) Application of Telecommunication Technology
Telecommunications technology is also marvelous since hospitalized children can communicate with people anywhere outside the hospital: family at home, sick children in other hospitals and even with their classmates and teacher at school. This technology can also be applied to treatment. We have tried on more than a few occasions to treat sick children on respirators by communicating using telephone system with a specialist at the National Children's Hospital. The specialist can communicate with the mother and even check the indicators of the respirator machine on a TV monitor.

Pediatricians have to create opportunities so sick children can experience joie de vivre anytime and anywhere, while in or out of the hospital. The purpose is not only to realize more humane medical care, but also to strengthen children's powers of self-healing as well as to enhance the quality of medical care, the effects of which have been scientifically established by neuro-psycho endocrinology, neuro-psycho immunology and other disciplines.

Furthermore, in addition to the classical and standard approaches, we can now make use of better technology, particularly information technology including telecommunications and virtual reality, in assisting sick children in hospital. Of course, there are some limitations depending on each country, but it is believed and hoped that they will be eventually overcome.

A new children's hospital called the Seiiku National Medical Center (The National Medical Center for Child Health and Development) will open in March 2002. This will be an extended type of children's hospital, equipped with facilities that are designed to assist hospitalized children in experiencing joie de vivre.

This was presented as a symposium lecture at the 23rd International Congress of Pediatrics held in Beijing in September 2001.
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