[Research 3 Yeovil District Hospital]

I’ve now had a few more visits to Yeovil Hospital and these have helped me to formulate my ideas around the finished installation work and the type of vocal content I would like to populate it with.

Yeovil and Dorchester Hospitals are very different beast architecturally and it is clear there are more challenges around siting a sound installation in Yeovil Hospital than in Dorchester Hospital due to the design and layout of the building. I like a challenge so am undaunted about this and will explore the possibilities in the coming weeks with staff at Yeovil. In fact, one member of staff in particular who has been a joy to work with; Janine Valentine, Nurse Consultant for Older People.

Janine has shown me around a whole range of wards and departments in the hospital that come into contact with elderly patients and therefore a proportion of those who are confused or suffering from dementia. Without fail, the atmosphere and mood of the staff on the wards I have visited has been fantastic – happy and joyous, I’d say, and this wasn’t just because I was visiting; it was clear the care, attention, camaraderie and morale was extremely high. This made the wards feel friendly, homely and much less intimidating than these busy environments would suggest, especially to the elderly, frail and confused. There is a family feeling on the wards and it was this that leapt out at me as my first impression.

IMG_8467 Janine Valentine: Nurse Consultant for Older People


As well as showing me around and meeting other staff, Janine and I had the opportunity to discuss the project. I enjoyed this bit especially, not least because Janine’s initial impressions around the outcomes of the finished piece – what it would sound like, what it would do and whom it was for where different from mine. Janine knew that my music wasn’t playful or melodic and had a tendency to be wild and dissonant.

Janine drew an interesting comparison between the intention of the music activities that occur on the wards – to soothe, entertain, provoke good memories, to stimulate participation and singing along – generally creating a good time for all, were markedly different from the outcomes of my music which could be complex, confrontational, overwhelming, not a sing-along and possibly disturbing for some.

Of course the difference in outcomes of these two activities lies with the intention of the artist [in my case] or musician in the case of on-ward activities and the audiences the outcomes are aimed at. The ward-based activities could be loosely described as therapeutic entertainment and are firmly geared towards patients. My work is neither a therapeutic activity, nor an entertainment and is aimed at a wider public including health and arts professionals with an aim of offering different perspectives around dementia when presented to audiences as an installation; a piece of art. My work is not designed for people with dementia and although being installed into public areas of each hospital for a time, the work will most likely spend most of its ‘life’ away from hospitals at arts and health conferences and arts festivals – again, reaching out to those wider audiences.

Once we had established the differences between my activity and the hospital-based therapeutic music activities I could see Janine was becoming very excited about the hospital being involved in something quite different to what had gone before and was quickly becoming as excited as me about the prospect of this new, possibly quite challenging work having a life and [hopefully] positive influence away from the hospital. I think Janine’s relationship to the idea of ‘dissonance’ in music may be on the move, too!

One outstanding area of research I needed to complete was to talk to someone about their personal experience caring for a loved one who developed dementia and what that meant to them from the very human side of living with and caring for someone who’s health consistently deteriorates until they pass away.

Janine introduced me to the amazing Sue Finer, an inspirational woman who has been on this journey with her late husband and is now sharing her thoughts about Alzheimer’s, a form of dementia, in a book she is writing. Sue is a volunteer at the hospital and has become a major advocate for the hospital’s work with dementia – in fact, the word volunteer is a little misleading as in many ways, her work with dementia has become an essential aspect of the hospital’s work advocating and supporting dementia care and activities within wider communities.

Sue very kindly spoke to me candidly about her husband’s disease, how it progressed, and how this impacted on their lives. These stories were very personal but also hugely universal to so many living with the effects and affects of dementia. It was the very personal nature of this conversation, the small details, insights and observations that really helped me to fill in the gaps in my knowledge and understanding. This information was also transformed [or at least will be] into content – vocal content, words and utterances for the installation.



Like Janine, Sue wasn’t quite sure exactly what my role as Composer-in-Residence to Yeovil District and Dorchester County Hospitals was and what sort of work was being proposed. We discussed this for some time. I talked Sue through my ideas, drew a few diagrams to illustrate how the installation would work and what sort of content would be in it – how I’d work with the choir to produce the music etc., and how I’d been conducting my research so far and where that had led me. Again, like Janine, Sue had spent some time online researching my work and listening to recordings of pieces and couldn’t make the leap between what she had heard from my asynchronous, noisy, complex music to an installation about dementia. A totally understandable position!

Sue had also read my REFOUND SOUND blogs but still was unclear where I was heading with everything, which is no surprise as there is a large aspect of the blog that is very much ‘thinking out loud’, and working through challenges and questions in an open manner. I call this ‘open research and practice development.’ It can be confusing for those looking in.

I could see the moment when Sue totally ‘got’ what I was telling her and she could imagine the finished installation and its sound-world and vocal content. It’s a wonderful moment when another person really resonates with what I’m proposing and moves from a position of uncertainty to becoming a firm ally and advocate for the work.

So now, throughout the month of April it is time to gather all this material together and produce the words and music ready for the recording session with the choir which is now confirmed for the 30th April.

It’s becoming more real!

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ReFound Sound 2

[research 2]

This second blog is mainly dedicated to an article Dr Alex Murdin, Arts and Health coordinator at Dorchester Hospital has written about ReFound Sound and my role as composer-in-residence.

But before that, a little about my last visit to Dorchester Hospital.



After attending a cookery class on Barnes Ward [they were making rock cakes] and talking to a number of patients there [and after eating the cakes] Alex and I went on a tour of the hospital to look at potential sites for the installation piece I will be creating. I will need to do the same at Yeovil District Hospital in the coming weeks, too.

I am coming to the end of my research period and am now hunting for some specific feedback around how careers outside of the health profession manage the challenges of dementia, especially when the care being provided is for someone in the family such as a partner and this care is offered at home. More about this after my visit to Yeovil next week when I shall be meeting individuals who have direct experience of caring for loved ones with dementia.

The final compositional shape for the installation is gradually ‘solidifying’ in my mind’s eye and mind’s ear – it’s important for me to see and hear the ‘conceptual’ installation at this stage so I understand how to shape the content of the installation to fulfil the goals I have developed for the piece through this research period. Visiting the locations where the installation could be sited [such as the chapel in the previous blog] helps me to think of the piece in spatial terms and how the musical content can best be delivered in this context.

We had a look at a number of locations around the hospital.




These all have potential, and there is scope for the installation to move around to different parts of the hospital, too.

My favorites are these two more complex intersecting stairways that sit on different levels. As well as acting as a thoroughfare and crossroads for a number of wards, these areas are rich because of the potential they offer for spatial location of the installation vertically on the different floor levels and also horizontally along the corridors.



Permission must to be sought for the installation to be placed in any of these locations as there are a number of people who’s working or visitor / patient requirements for the space must be considered.

A sound installation can be less than enthusiastically received if it dominates a space or drives those who work in or near it to distraction. We need sympathetic hosts who are comfortable with the installation being present whilst being mindful of how the volume of the installation might effect those working in those installed areas.

How quiet can the installation be for it to work and be effective? In my view, an installation that whispers and quietly sings its content can be very effective and affecting. As Alex and I discussed this it became clear that the installation as envisaged would be completely flexible and installed as a whispering, ghostly shimera of sound, or, in another context, such as installed at a conference or arts event, much louder, creating a completely different experience for the audience. I like the idea of the work being adaptable as it increases the scope and possibilities for its continued and varied installation across widely differing locations and hosting needs.

I’d now like to introduce Dr Alex Murdin and the article he’s written about ReFound Sound and my role as composer-in-residence.

imageThe tie between music and memory is one that we are born with and die with. Neurologically, in very simple terms, processing music involves the functioning of at least two different brain networks, as well as invoking those associated with language (songs with lyrics), movement (moving to the rhythm) and its interweaving with other long term memories (the soundtrack of our lives, our celebrations and significant moments). So when some parts of the brain deteriorate as part of conditions like dementia, where the hippocampus responsible for short term memory is effected, music is often preserved as part of other brain function and is able to bring back important memories. So called “implicit musical memory”, which is the subconscious absorption of musical melodies, may be spared until very late stages of the disease (“Why musical memory can be preserved in advanced Alzheimer’s disease” (2015), Jacobsen et al. [Online:]). Professor Paul Robertson, a concert violinist and academic who has made a study of music in dementia care, puts it another way: “We tend to remain contactable as musical beings on some level right up to the very end of life, we know that the auditory system of the brain is the first to fully function at 16 weeks, which means that you are musically receptive long before anything else. So it’s a case of first in, last out when it comes to a dementia-type breakdown of memory.”

It seemed very interesting to us (the Arts in Hospital producers at Dorchester and Yeovil Hospitals) to explore what musicians can do to help us to help those with dementia at our hospitals and in the wider community, as an ageing population means that there will be more and more with forms of cognitive impairment. Both hospitals had already worked together on music programmes before, bringing in live music to the wards with great effect, improving eating, sleep and levels of activity in patients, not to mention the sheer joy it brings – as one nurse said: “I’ve seen patients come alive in front of my eyes”. We therefore wanted to carry on with this work and also to spread the message to health professionals, care workers and carers that music is a powerful medicine. Hence the Arts Council, DCH Hospital Charity and Yeovil Council funded “Refound Sound”, a project which has commissioned more live music in wards and more unusually a composer in residence to write a new piece of music related to memory, music and place.

With the composer in residence we wanted to approach the idea as a research project. Not though in the way typical to the field of arts and health. For the most part those involved in arts and health have focussed on the scientific validation of art as having therapeutic value with direct causal outcomes, better sleep, less painkillers needed, quicker return home etc. (all of which are currently being proven in different fields of scientific research like the examples above). This is part of a burgeoning body of evidence designed to convince health commissioners to spend resources from mainstream health care budgets. With the commission for the composer in residence though we wanted to re-emphasise the innovative potential of the arts as an aesthetic practice, i.e. sensory, piece of research into a situation, context or environment through art in action. Perhaps the greatest thinker on health and society this century, Michel Foucault, describes the idea of forms of practice as research: “Practice is a set of relays from one theoretical point to another, and theory is a relay from one practice to another. No theory can develop without eventually encountering a wall, and practice is necessary for piercing this wall.”

To this end the composer, Marc Yeats, was appointed as he has experimented with the limits of the affective potential of music on a wide spectrum in order to reconfigure simplistic binaries of beautiful/ugly, harmonious/discordant, wellbeing/illness etc. In this sense his musical practice is already a prefigurement of the condition of dementia which is a breakdown of brain functions which are applied to regulating normal social relations, judgements about environment, personal activities and day to day life. Our hope is therefore that the resulting work by Marc reaffirms an aesthetic approach to health and wellbeing as a valid research tool, with affective outcomes that nevertheless effectively move people in real ways to reconsider personal and professional approaches to treating and caring for those with dementia.

Dr Alex Murdin

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refound sound 1


composer-in-residence to Yeovil District and Dorchester County Hospitals

Context and brief:
Re-found Sound is a new live music collaboration between Yeovil District Hospital Charity (YDHC) and Arts in Hospital at Dorset County Hospital (AiH), supported by Bournemouth Symphony Orchestra & the Wigmore Hall. The project runs from January 2016 to September 2016 and will:

• Commission an innovative musician in residence to work across the hospitals, researching and exploring the relationship of memory to place, resulting in a new piece of contemporary music for broadcast and performance.

The project is funded by Arts Council England, Dorset County Hospital Charity, Yeovil District Hospital NHS Foundation Trust and South Somerset District Council.

Residency and commission
YDH and AiH would therefore like to commission an innovative musician to research the relationship between music, memory and place and compose a response. We envisage a piece of music based on connections between:
• the environment, landscape and history connecting South Somerset and West Dorset
• hospitals as places in their own right, their architecture,surroundings and the communities that use the hospitals – patients, staff and visitors
• memories of place, memory-loss and the condition of dementia

Practically speaking we would like the commissioned musician to spend time at both hospitals, meeting staff involved in dementia work, patients themselves and people from other organisations who are familiar with Dorset and Somerset history and music as appropriate. There is the potential to provide space for activities to engage staff, patients or visitors at the hospitals (or facilitate engagement through other media e.g. hospital radio, newsletters etc.), but there is no studio space or music equipment available at this time.

We expect that there will be at least one opportunity for all musicians working through the other strands of Re-found Sound to meet together to share learning and experiences as part of the process. We wish to learn from the project process and to share this with others so there is also an expectation that the commissioned musician will keep a record of the project’s development, for example a diary, and participate in evaluation.

So, that was the brief. Now, onto . . . .

The challenge!

Writing a piece of music about Dementia – now, that really is a challenge. Where to start with such a huge topic? And, for a composer like me who believes that music doesn’t necessarily ‘say’ anything in a way that transmits and communicates clearly and consistently from one person to another, the opportunity to write a piece that is about, inspired by, informed by Dementia is perhaps the biggest compositional challenge I have ever faced, not least because it is such an important and emotive subject, a topic that will touch all our lives in one way or another at some time. This is BIG!

I have just completed my first few research sessions at Dorchester County Hospital and have come away a little clearer about what I can do creatively and what I can’t, certainly around methodology to gather content. As ever, I trust that the process of research and just thinking [informally, in the background] will make things clearer for me as I go along.

There’s art in the hospital in the most unexpected of places!



But first to recap:
When I applied for this post I constructed a model around what I ‘might’ make and how I ‘might’ go about making it. This model was purely a structure to hook ideas onto so I had something to work with. The model was disposable, adaptable; my experiences in the past had taught me that predetermined plans always changed in these circumstances, sometimes radically. I could feel some aspects of my model quickly slipping away.

My starting point was this very model:
I have a great interest in composition commissions that draw upon researching unusual starting points and content that effect decisions influencing the compositional process and finished piece of music. Music is not an exact science and notions of quality and meaning remain fully subjective.

Composers are often asked about the meaning of their work and most resort to a description of process of making to answer the question. This is never a true reflection of what any piece of music means or its value to, or impact on any one person. Music that is based on research of the type proposed here has a number of pointers that can inform composer and audience of the reasons why choices around process and outcome were made and how these choices related to the subject being researched. Even with a strongly demonstrable research background, the composer’s and listener’s perceptions will involve levels of subjectivity and intuition around the best ways to communicate meaning, be that in a narrative or non-narrative context. This is the joy and mystery of music – we really have no idea what it is!

In the context of ‘refound sound’ where issues around the impact of Dementia and Alzheimer’s Disease on peoples lives is being researched, issues of memory, perception, relationships, loss and connectivity are paramount. These are also issues that concern a composer within the composition of a piece of music as well as the formation of assumptions around how an audience will respond to it. These correlations can be the subject of compositional research that has the potential to greatly effect the decisions a composer makes around the content for a piece of work and its presentation to audiences.

In short, the challenge and excitement of this brief is in discovering exactly what impact the residency and research will have upon my practice as a composer and how this will influence the outcome of that experience – the composition itself.

What am I proposing?

As I have not yet undertaken the research I cannot predict the ultimate shape of the finished work and even less so, the content that will populate it. At this stage I am building a concept around assumptions. This concept can be moderated, broken and replaced completely and I present it here as a model of thinking to approach this application and the residency. I do find an initial model useful as a way to think how the work could be presented and disseminated [practical considerations] and therefore provide an initial structure to work backwards from, helping focus methods for content creation based around the residency and research.

This newly commissioned work could be a sound installation with the potential to be located in any room or building within or outside a hospital setting. The research and residency period could see me interviewing people affected by and working with Dementia through sensitive, gentle and informal conversation. These conversations may be recorded or I may take written notes whilst conversing. Confidentiality will be respected at all times and any permissions necessary will be sort. These conversations will be participant led [they will disclose what they feel comfortable with – I will not pry with questions] and I will explain clearly and carefully what I am doing and why I am doing it. All content would remain anonymous.

Purbeck Ward - model of care!

Purbeck Ward – model of care!

This research would result in a series of interviews containing verbal or written information. I would sort through the material and select words or phrases that have [to me] a particular potency or resonance in relation to the the project brief [environment, spaces, memory, loss, history etc.]. It is these words and phrases that could become the vocal [or possibly verbal] content for the new piece. I may use professional singers, a choir or perhaps voice artists to deliver this material through music I would have composed with the content being sung, spoken or intoned]

Studio or live recordings of the singers or choir could be recorded as they perform fragments of my composition. I would then assemble these fragments into larger musical strands or tracks. Each track may be 15-20 minutes long and each a slightly different length. I would envisage 4-8 tracks. These tracks will then be ready to load onto mini mp3 players with their connected speakers. Each mp3 player and speaker can then be installed, secretively into any space, large or small to create the installation. The performance will involve playing all the tracks simultaneously [on continuous loop] resulting in unforeseen and serendipitous relationships between all the tracks. The resultant composition could be spatially exciting, beguiling, beautiful, reflective, surprising and engaging. These hidden voices will become part of the fabric of any space it is installed in.

Chapel and Dorchester County - possible installation site

Chapel and Dorchester County – possible installation site

view from the Chapel

view from the Chapel

Music would be through-composed in its individual vocal tracks but asynchronous in its delivery leading to a richly varied and constantly renewing musical experience. A performance could last a few minutes to a few days and each installation and experience will be a unique iteration of the composition. The audience can drop in, stay, contemplate, pass through. There will be no obligation to sit through a traditional performance – people can wander through it and come and go as they please.

As the material is digitally formatted it becomes an easy step to create fixed iterations of the installation by mixing a version within mixing software [which I have] leading to the preparation of tracks for radio broadcast and easy sharing on social media platforms to help engage the widest possible audiences in the output of the project. Again, tracks can be formatted to any length.

Additional relevance:
Asynchronous delivery of the composition as described above has an additional resonance in connection with the project brief around memory, loss, changing perspectives and contexts, landscapes [musical], experience and understanding as the constantly iterative nature of the delivery of the composition means it can never be known, there will be reoccurring familiar and recognisable aspects but the piece is always in flux as it permutates its content in ever changing contexts reflecting, perhaps, the changing nature of memory and perception associated with Dementia.

Back to the first research sessions at the hospital:

So, that was the model – a concept for a piece and a bunch of techniques around how to achieve it. Luckily, enough of the model survived after my first visit to Dorchester County Hospitla for me not to feel totally crestfallen. Yes, it was going to be a work using the human voice, a choral piece. Yes, it was going to be an installation piece; dissemination and performance aspects were as yet unchanged. However, what had radically altered were the methods I was going to use to generate the content for this piece – that route was now closed to me.

Challenges around confidentiality and consent:
I had hoped to be able to record conversations with patients, families, careers, medical staff etc., on my iPhone, not to use as recordings within the piece but to listen to, post interviews, so I could copy down the occasional snippet, phrase or remark that I thought had mileage within the piece – sort of poetic fragments that I happened upon. I thought too that I may be able to take some photographs of hands to capture something of various peoples characters anonymously.

Both photographs of hands and recording conversations with various parties proved to be impossible because of safeguarding regulations, permissions and consents. As you can imagine, gaining informed consent from people who are confused is impossible and a legal minefield.

Purbeck Ward

Purbeck Ward

So that was that. My idea of getting verbal content straight from the horse’s mouth was no longer tenable. I should have known really; the regulations around permissions of this sort are complex and rightly so when peoples’ identities, families and friends can all be implicated in unforeseen ways. Best to avoid the need for consent entirely.

The complications around consent became very clear to me after my morning conversation with Alex Murdin, Arts in Hospital coordinator at Dorchester. I had to think on my feet as my research sessions were about to start. I needed to know how I was going to collect information so I could capture anything valuable I found for the piece without contravening permissions and confidentialities. It was whilst we were talking around this challenge that I had a light bulb moment based on a seedling idea I had a few days ago whilst brain-idling.

Possible solutions?
It occurred to me that like a storyteller, I would listen and perhaps write down the odd comment; or not, and absorb what was being said; the intent, emotional weight and content, as someone who was telling another person a story of what they had seen or experienced. Rather than collecting material ‘in the first person’, I would come away from my research sessions and regurgitate what had stuck in my mind, the impressions and phrases as best I could remember. If I embroidered or exaggerated or invented a little, it didn’t matter. This wasn’t a news real or a work of science; I wasn’t trying to reconstruct a work of fact; how could I? – this is music; it can only mean what the audience bring to it no matter what I put into it. However, the words and phrases could carry a great deal of weight if sufficiently resonant. It’s ‘golden nuggets’ such as these I’ll be on the lookout for.

One of the nursing staff told me of a short phrase that was uttered to her over and over again by a patient. The phrase stayed with her. It stayed with me too!

“I was locked in a cupboard.”

A little phrase with a huge, complex resonance. This will become one of my ‘golden nuggets’.

After speaking to the staff at Dorchester County Hospital on a range of wards and also seeing activities designed to help engage people with Dementia with their own memories, lives and surroundings it is apparent just how much dedication, humanity, compassion and professionalism is offered to patients by the teams who look after their wellbeing. All members of staff are undergoing constant training and support to understand how best to care for people who are confused or suffering from Dementia. Exact diagnosis and aetiology isn’t always clear to establish but the sensitivity with which any person entering the hospital is met, especially those who are frail and confused, is excellent and well thought through.

On certain wards the decor has been changed to make the hospital a less daunting environment, wards and bed-bays have been colour coded with specially commissioned artwork to break up the uniformity of the ward layout with more personalised and attractive spaces. On wards specialising in the care of the elderly the nursing stations have been redesigned and sometimes moved to create more open, social and comfortable spaces for patients and relatives to meet.

reception area Barnes Ward

reception area Barnes Ward

reception area Barnes Ward

reception area Barnes Ward

All in all a lot of thought has gone into the hospital environment to make it as friendly and unintimidating to confused patients as possible.

Colour-coded Purbeck Ward

Colour-coded Purbeck Ward

I was particularly taken by the Day Room on Barnes ward where older objects, clocks, fireplaces and radios had been brought into create more familiar and age appropriate spaces for elderly people who are more comfortable in surroundings that reflect or connect with their lives and experiences. The Day Room is also an area that is used for various activities such as music making, listening, conversation and crafts.

Day Room Barnes Ward

Day Room Barnes Ward

Day Room Barnes Ward

Day Room Barnes Ward

Day Room Barnes Ward

Day Room Barnes Ward

Day Room Barnes Ward

Day Room Barnes Ward

Patients who are confused or have Dementia generally enter the hospital via Accident and Emergency departments because of trauma [broken bones after falls, for example] or medical reasons such as infections and illness. Their confusion is a secondary consideration that brings with it further challenges for the medical staff caring for them over and above the primary condition. Patients coming into hospitals may experience many degrees of confusion and it is true to say that entering the hustle and bustle of a busy hospital environment away from personal routines and familiar surroundings can exacerbate any sense of confusion someone may already have. People with Dementia on trauma and medial wards are frequently with other patients of all age with similar primary conditions [trauma or medical]. Here, the nursing staff skilfully provide a full, personally tailored and considered care plan for everyone on their wards. Being able to manage such varied and challenging needs with such good spirit is a true testament to the calibre of people working on the wards. One thing was clear from the outset; these wards are happy places where staff are well motivated and engaged at the highest level with their work and the wellbeing of others.

Andy Miller [Service Manager for Elderly Care] and Kelly Spaven [Matron for Medicine]

Andy Miller [Service Manager for Elderly Care] and Kelly Spaven [Matron for Medicine]

Sister Debbie Baxter

Sister Debbie Baxter

Sister Susan Montgomery and Deputy Sister Karen Baylis [Purbeck Ward]

Sister Susan Montgomery and Deputy Sister Karen Baylis [Purbeck Ward]

Ideas of structure and anonymising information:
I have already mentioned using myself as a collector of anecdotes and pieces of information that I hear and writing these down ‘after the fact’ as third party observations to use as content for vocalisations in my piece.

Additionally I have had the idea of collecting first names and surnames [and mixing these up] or even made up, to create lists of imaginary people, to do the same with occupations and ages, places where people live, a few medical terms, a range of anecdotes and phrases and so on to create this sort of ‘hive mind’ of people and experiences.

I can see [hear] these as being different trains of though all brought together at the same time and interacting with each other to create an ever varied world or people and experiences all related to Dementia.

Why am I thinking like this?

Because I realise that Dementia is something that touches and will touch all of us, that it is no respecter of class, religion, faith, occupation, lifestyle, experience or race. That is can effect young people as well as older people, that it is, in fact, everyone’s condition – it is human-wide. To reflect that I want to create a piece that includes all voices, all names, all occupations and so on, to make it feel universal and relevant to everyone.

Additionally, and going back to my original thoughts, I would like the way these various strands of musical activity interact asynchronously with each other to in some way affect those who experience the installation – to make them feel a little bewildered, out of context, surrounded by an environment where nothing remains the same and perceptions are challenged and where the content is poignant and resonant causing reflection and awareness around the human condition that exists within and around Dementia.

mindmap - soundmap

mindmap – soundmap

That’s a pretty ambitious goal to have!

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