Live-in Conditioning Centers

Is the Sanitarium Concept Obsolete?

Herschel C. Lamp is director of Health Education and Preventive Medicine at St. Helena Hospital and Health Center in Deer Park, California.

Richard T. Walden, M.D., is medical secretary of the Wisconsin Conference

Lilya Wagner is editorial assistant of hospital relations at Florida Hospital in Orlando, Florida.

St. Helena Health Center

WHEN the St. Helena Hospital and Health Center was opened on June 7, 1878, under the name Rural Health Re treat, with a bed capacity of 13, the principle of disease prevention was already established as a part of its basic philosophy—a philosophy solidly founded on inspired counsel that was later expressed in these words:

"The distinction between prevention and cure has not been made sufficiently important. Teach the people that it is better to know how to keep well than how to cure disease. Our physicians should be wise educators, warning all against self-indulgence, showing that abstinence from the things that God has prohibited is the only way to prevent ruin of body and mind." 1

"The feeble and suffering ones must be educated . . . until they will have respect for, and live in obedience to the law that God has made to control the human organism." 2

Within the church's health institutions the sick were to be taught by instruction, demonstration, and example that a change in habits of eating, drinking, exercising, resting, and thinking are valuable health measures that are at the same time curative, restorative, and preventive.

Undergirding this therapeutic, educational activity, however, one objective was always to be kept supreme:

"Let every means be devised to bring about the saving of souls in our medical institutions. This is our work." 3 "Our sanitariums are to be established for one object the proclamation of the truth for this time." 4

Over the past century the treatment of disease has become more technical, sophisticated, and costly. This development has resulted in an emphasis on short-stay, intensive therapy in acute-care community hospitals, where the opportunity to perform an educational and spiritual ministry has been greatly reduced. Yet in this same hundred years there has been a marked increase in life style-related diseases that are amenable to preventive measures presented in a Christian context. Diseases in this category would include coronary heart dis ease, hypertension, chronic obstructive pulmonary disease, alcoholism, and other types of drug abuse, and mental illness.

Recognizing the challenge to implement the Lord's counsel on preventive care, the board of the St. Helena Sanitarium and Hospital in 1967 voted to construct a 42-bed Health Center where ambulatory patients might come for a diagnostic and educational program, designed to help them make needed life style changes that would significantly alter their health.

In April, 1969, the live-in Stop Smoking Program was inaugurated. Although it was based on principles developed in the Five-Day Plan to Stop Smoking, it has been able to offer a great deal more to the patients in five full days than could be given in only eight hours of evening instruction on an outpatient basis. In July, 1972, a seven-day Weight Management Program was begun, and in February, 1975, the Alcoholism Treatment Unit was opened.

Before the smokers and the over weight patients can be admitted to the program they are required to have a medical clearance by their referring physician, or to get one from a staff physician on the day of admission to the Health Center. A lung function test is performed on all the smokers, and an exercise electrocardiogram plus a panel of blood chemistry determinations are done on all the overweight patients early in the program. Because the alcoholic's admission is generally unscheduled and because of the high incidence of medical problems found in this group, all alcoholic patients receive a complete physical examination and a battery of diagnostic tests on entry into the treatment unit. Because the programs are all hospital-based, every patient has access to the full diagnostic and therapeutic services of the facility should they be needed.

The content of all three programs has a fundamental uniformity. There are daily lectures, demonstrations, and films directed at not only the specific problem area for which the patient seeks help but also on such general health topics as exercise, nutrition, and emotional stress. Group therapy sessions conducted by a trained leader are an important feature of every program. Individual counseling is available too for those who need it. Active outdoor exercise (walking on the nature trails, swimming, and group games such as volleyball) as well as indoor gym activities are prescribed for everyone within his physical limitations. Physical therapy is prescribed for specific musculoskeletal problems or, as it is more commonly the case, for re lief of muscular tension. All the patients, of course, are provided a wholesome, balanced vegetarian diet free of condiments and caffeine beverages.

The spiritual objectives of the program offer the staff the greatest challenge. Most of the patients are new to the Health Center and many have come from great distances for help. Even though the patients are not acutely ill and can begin the educational process from the moment of admission, five to seven days is not much time to accomplish our goals for them. Inasmuch as the average stay in the Alcoholism Treatment Unit is 23 days, there is a much greater opportunity for spiritual input there.

One of the hospital chaplains is intimately involved in each of the programs— in lecturing, leading discussion groups, or individual counseling. A brief noontime chapel program is held daily for the patients too. In the management of emotional stress—a major consideration in this program—spiritual resources are clearly presented by the staff as the principal key to success. The fact that 95 per cent of the total working force of the institution are Seventh-day Adventists greatly increases the spiritual impact on the program participants. The greatest opportunity for spiritual growth occurs in the alcoholic patient because of his prolonged stay and also because the significant life disruptions experienced by the alcoholic prepares him to accept the spiritual approach to his problems.

Since the Health Center Program concept was begun in April, 1969, there have been 2,487 patients in the Stop Smoking Program, 740 patients in the Weight Management Program, and 350 Alcoholism Treatment Unit patients, making a total of 3,577 patients in all. What our educational and spiritual impact on these people has been only eternity will tell. Quotes from a few letters, however, can tell part of the story:

"Everyone—from the pages and kitchen crew on up to the medical staff— is helpful, courteous, and pleasant. Perhaps you are too far removed from the unfortunate average world to realize how rare it is to dwell in an atmosphere where everyone smiles!"

"My wife and I are not smoking and we are still walking every morning. And we are continuing to read the Bible you gave us when we were there."

"Thanks to your team who were as concerned with the spiritual as well as the physical, my weight loss is 40 pounds, my smoking is zero, and my self-confidence and interactions with people are a big fat positive. . . . You have a community of love in the true Christian definition of the word. Thank you also for the inspirational reading in These Times."

From one who completed both the Stop Smoking and Weight Management Programs:

"I have been attending your local Seventh-day Adventist church quite regularly. . . . Tell me, why are there so many fat people in the church? They are interested in the weight control pro gram, and I am sharing my diet and other information with them."

From a repeater of the Stop Smoking Program:

"This time it is different. I have Jesus with me all the time. When the bell rings to smoke, I pray."

 

Wisconsin Conference's New Live-in Center

THE Wisconsin Conference entered a new era of ministry with the acquisition of Mid-American Health Services Corporation. On January 1,1975, the Harold and Norris Howard families, dedicated laymen, formally presented a chain of Convalescent Homes of approximately 1,000 beds to the Wisconsin Conference.

Harold Howard and former conference Trust Secretary Glenn Aufderhar, conceived a plan to use the largest and new est of these convalescent homes as a base for the formation of a center for health teaching, or what is known as a conditioning center. The Board of Directors of the corporation is committed to this goal, and full funding should be available by 1977.

This particular home is isolated in thirty-one beautiful acres of pine and birch trees on the bank of the Wisconsin River. Wild life is abundant. The entire site is immediately adjacent to a university community of 35,000. A lab-building has been remodeled into a social, dining, and teaching center.

A total of four Live-In programs as well as a number of outpatient community services have been conducted. These programs have been the standard weight reduction, coronary risk, nutrition, and stop smoking plans.

The Five-day Live-In programs have been very successful. A primary objective has been to build a relationship with each participant. These individuals come to us seeking more than relief from the effect of the tobacco habit. We attempt to keep the number of participants to about twenty, thus permitting adequate individual contact with the staff. When the members of the staff come together as a group the effect is that of letting the participants see a sermon in action rather than merely hear it. At present our staff is virtually all voluntary or contributed by the Mid-American Corporation. The Wisconsin Academy lent their physical education director; the conference made available the president of Mid-American (a minister), and the medical director. The administrators of the local convalescent homes also contributed time and effort.

The local church community became involved. An auxiliary group of wives of Mid-American employees, conference officials, secretaries, and nurses formed a group to assist in opening the remodeled addition for the Live-Ins. Funds were raised for books, plants, and dining room decorations. We believe that a knitting together of all available church resources proves again that the whole is greater than the sum of its parts.

At first we did some of the window dressing of exercise stress testing, but for several reasons we no longer follow this plan. The 1975 statistics from the American Heart Association meeting show that there are 16 to 19 per cent false negative responses (that is, people who have serious coronary heart disease as shown by angiography dye study of the coronary arteries may have normal treadmill tests). We believe this can be an unusually hazardous procedure. It lacks applicability to most of the community programs, anyway, and should be done only under the closest surveillance of competent physicians, if done at all.

An inherent weakness of many health-evangelism programs is the difficulty of follow-up. Our objective is to keep con tact with participants regarding their success in overcoming the tobacco habit, and in developing their interest in spiritual matters. This is particularly difficult inasmuch as many of our candidates come from distant States. It is our plan to submit to each district pastor the name of the individuals in his area who have:

1. Written and expressed interest in the program.

2. Participated in the Live-In and been successful.

3. Participated in the Live-In and been unsuccessful.

This past year this was done at camp meeting time. We, of course, do the usual follow-up by mail and/or telephone.

We are learning many. things: First, it takes time to build a reputation. The relationships with individuals and small groups in these programs are beginning to have impact on the community at large. Second, we must continue to involve our constitutency. We believe people commit themselves for a cause. We've experienced it. We need more dialog with the pastoral staff, which may even cross conference lines.

We envision the Conditioning Center as a teaching model for the local community and also for the conference. Our own church people need health education desperately. This institution should provide the broad base to make this possible.

 

West Virginia Resort Program

WHEN a smoker responds to our ads on the Live-In program to stop smoking, he is well aware of the harmful effects of smoking. Through efforts of the media and public-health organizations, smokers usually are armed with the facts. They are totally convinced. What they want is a way to quit.

Modeled after the original Five-Day Plan to Stop Smoking, the main thrust of the Live-In program is to enable the three- or four-pack-a-day smoker to get over the hump of the first few days, while being given continuous personal sup port, provided as pleasantly as possible.

In 1970 an enterprising resort owner offered his facilities for a Live-In pro gram. We accepted, and from 1971 to 1974 held spring and fall programs at Coolfont, a resort located in a beautiful spot near Berkeley Springs, West Virginia, offering various opportunities for recreation and exercise in a parklike setting in the mountains.

From the beginning our committee (comprised of director, physician-in-residence, program coordinator, and physical fitness director) knew that we were treading on unfamiliar ground. We tried to model our program some what after that held in St. Helena, California, but soon found our program, being held in a resort atmosphere rather than a clinic setting, demanded a completely different approach.

Our first program (advertised as a pilot program) drew seventeen smokers. The average age was 50, and there was approximately an even number of men and women. The program called for seven initial days with two follow-up periods: a weekend two weeks later, and a day six weeks later, making a total of ten days.

A plan was worked out: the physician-in-residence was to hold morning meetings, giving instruction on various health subjects such as diet, the proper use of water and exercise, and stress; the physical fitness instructor was to lead in the early morning calisthenics, encourage and organize group activities in games, and lead out in hikes during the day.

We did not try at this time to alter the diet except to restrict coffee, tea, and alcohol, and to keep the diet balanced with plenty of fruits and vegetables. All this activity was to highlight the evening program, which was the familiar Five-Day Plan class instruction, presented by Washington Adventist Hospital Chaplain A. C. Marple and J. Donald Mashburn, M.D., who com muted 200 miles each evening for this presentation.

Through the years changes in the pro gram came, either because of an obvious need or through sheer inspiration. One such inspiration was setting up personal interviews with each participant at the end of the program. This allowed us to gain valuable critical appraisals and suggestions, many of which were finally worked into the program.

Three major changes were made after the first program ended. As the smokers quit and went through the intense withdrawal symptoms, personality conflicts began to emerge. Hostilities flared; some withdrew into themselves; others experienced personality changes of a unique character. It became apparent that a spiritual counselor was needed and that an opportunity must be made to "let off steam" as a group.

The chaplain then was included in the on-campus staff, and a period was set up from five to six o'clock in the evening when everyone was encouraged to talk and express his feelings. This proved to be one of the most important additions to the day's schedule.

It soon became evident that major changes had to be made in the diet. No attempt had been made to control the intake of fluid and food except for those previously mentioned. A lot of food went across the table. Weeks later some com plaints were received about weight gain sometimes as much as forty pounds in four months.

After the first program, a strict adherence to a balanced diet with attention to low calorie foods was made. No desserts were served. Creamed foods and gravies were eliminated, and fruit juices were laced with water. Menus were meticulously planned by the dietary staff of WAH and were followed by the cooking staff of Coolfont.

We learned that to eliminate all food on the fasting day led to much gastric distress, weakness, and headache. We reasoned that because we were expecting our group to exercise actively on that day, we should break the fast at supper with creamed soups and light sandwiches, something to soothe the stomach.

By the evening of the fast day, most participants were not thinking of cigarettes as much as food. We feel that much of the success of the plan begins with the proper use of the fast day.

The third change came with a modification of the time needed for the pro gram. We shortened the stay to five days Sunday noon through Friday noon, with only one follow-up, a weekend two weeks later for additional support a total of eight days. This remains our plan.

Other additions have been made as needed to incorporate a professional attitude in the program. Most important among these have been individual inter views held with each candidate before he is finally accepted for the program and the development of a control book let to be used as a guide to the daily pro gram. Paperwork includes physicians' release forms, daily journals filled out by the participant, and follow-up forms sent periodically throughout the first year to catalog results.

We often discover, to our delight, evidences that indicate our instruction has changed the life-style in areas other than smoking. When first interviewed Gene confessed his breakfast consisted of three cups of coffee and several cigarettes. A later check indicated his appetite had improved and he was eating a very good breakfast. He admits he feels much better because of this.

We are now entering into the prepublicity phase of our ninth program. We allow three to four months to prepare for each class. Programs are held twice a year, in spring and in fall. Since the spring of 1975 the programs have been successfully held at Cacapon State Park Lodge, West Virginia.

Because the class is limited to 24 people, we have found it possible to operate efficiently with four on the main staff, with lectures provided by physicians commuting each evening from Washington Adventist Hospital. Although 20 is thought to be an ideal-sized group, we will accept up to 24 on a double-occupancy basis. We believe it necessary to establish close counseling relationships with each participant, and the results of this effort have been felt in various ways.

The friendship of many graduates has been heart-warming, both to the staff and to the other graduates. There is an intense loyalty to others within the group. We feel this group empathy accounts for much of the Live-In's success. The identification with each other, with the program, the staff, and the hospital is akin to the spirit exhibited toward one's alma mater.

I would like to think that our Live-In type of program could be duplicated all over North America. God has given us the blueprint.

It now remains for men and women with courage and vision to establish centers of rehabilitation wherever His will indicates. And as His promises are claimed, He will be responsible for its success.

 

A GROUP of enthusiastic and happy quitters held a reunion recently at Florida Hospital. All had participated in the first five-day Live-In Plan to Stop Smoking held in the South.

Extensive planning and study of the possibilities of such a program for smokers was conducted by a committee at Florida Hospital, with Dr. Raymond West, director of medical education, serving as chairman. The project was a joint effort between the hospital and the Florida Conference.

This project is only the beginning of a larger concept. The planning commit tee has given thoughtful and prayerful discussion to the developing of a permanent conditioning center and a community outreach program. Eventually, the group hopes to establish permanent facilities and conduct an on-going pro gram at a rural facility, geared specially for treatment of certain cases that would benefit from such an environment.

The five-day Live-In plan was aimed at the hard-core smoker and extended beyond the initial purpose of breaking the habit. Participants received professional counsel on diet, exercise, and general health. The smoking problem was approached from three angles: educational emphasis to intensify the smoker's decision to quit; physical activity and therapy to reduce withdrawal symptoms; and motivational guidance.

The general public heard about this innovative plan through newspaper advertising and local TV stations. Brochures were scattered throughout Orlando, and the chaplains' department contacted former Five-Day Plan members.

The twenty-five who enrolled had tried to quit before. Several, in fact, had at tended the conventional Five-Day Plan. But the group that attended the re union two weeks after the session was unanimous in declaring their intention to stick with it.

Most participants have been successful in this determination. For future Live-In programs, more individual follow-up, perhaps by using laymen from area churches, and more counsel and support to the participants are planned. Since the conclusion of the Live-In session, a number of quitters have expressed curiosity and interest about the Seventh-day Adventist Church.

Pearl Vosilla, a Pink Lady volunteer at Florida Hospital, attended the pro gram. Although somewhat acquainted with Seventh-day Adventist beliefs, she now began asking more questions. Only a week after attending the Live-In plan, Pearl was admitted to Florida Hospital and died a few days later. But several days earlier she told a friend of her interest in becoming a Seventh-day Adventist.

Perhaps the feeling of the group can best be summed up by this note to the staff from one of the participants: "It is impossible to adequately express my appreciation for what the five-day Live- In plan has meant to me. I have kicked the habit and could not have done it without your help. Your kindness, understanding, and loving support will never be forgotten. These are not easy days for me, but I am determined to stick it out. ... I hope that all our fellow ex-smokers will be able to persevere."

Notes:

1 Medical Ministry, p. 221.

2 Ibid., p. 224.

3 Ibid., p. 191.

4 Counsels on Health, p. 343.

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Herschel C. Lamp is director of Health Education and Preventive Medicine at St. Helena Hospital and Health Center in Deer Park, California.

Richard T. Walden, M.D., is medical secretary of the Wisconsin Conference

Lilya Wagner is editorial assistant of hospital relations at Florida Hospital in Orlando, Florida.

August 1976

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