66th IFLA Council and General
Jerusalem, Israel, 13-18 August
Code Number: 135-143-E
Division Number: III
Professional Group: Libraries Serving Disadvantaged Persons
Joint Meeting with:
Meeting Number: 143
Simultaneous Interpretation: No
Hospital libraries and the public library system in France: how can they work together?
Hopitaux de Paris, Paris, France
For someone in hospital, "shut up" inside the four walls of a room, reading can be a marvelous escape, a way of forgetting his or her illness, anxiety and pain for a while. For a moment, a book also offers a way of entering into a special relationship with a mediator, the librarian, a friend... Reading or being read to, going to a meeting and visiting an exhibition are all things that can contribute to the patient's well-being and even recovery. The provision reading matter is now a recognized part of the quality of the hotel facilities for patients. After reviewing the state of hospital libraries in France, this paper will discuss the ways hospital libraries and other public libraries can cooperate in the light of various experiments.
1. Hospital libraries
- Historical and regulatory background
In France, reading in hospital can be traced back to 1634, when it was known as a "distraction for the patients". It was only two centuries later (1845) that concrete measures were taken to develop it and that places were provided for reading. The Assistance Publique-Hôpitaux de Paris (Paris Hospitals Authority) was the first in 1934 to appoint a professional librarian to head the Central Hospitals library. In 1938, the Hospices civils de Lyon followed suite. It was not until 1947-1948 that circulars and administrative orders from the Ministry of Public Health made it obligatory to set up a library in sanatoria and university hospitals. These texts were followed by the creation of some libraries, but they were only suggestions and of limited scope. In the 1950s, the concept of the "humanization" of hospitals led to an attempt to improve the way patients were welcomed and the living conditions of people in hospital, within which the hospital library plays an important part. Reading rooms were then developed and structured, but without any agreement or national guidelines to guide thinking on the subject.
May 1999 marked a new step, when the hospital sector was included in an agreement signed between the Ministry of Culture and Communication and the Secretariat of State for Health and Social Action, which was intended to promote the organization of cultural activities in hospitals. The first part of this text suggests setting up a twinning arrangement to encourage a cultural facility located in the vicinity of a hospital to offer some of its facilities to the hospital. The second part concerns the development of libraries, reading being the cultural activity most commonly provided in hospitals. This part includes some important guidelines with regard to premises, collections, personnel and training, the standards referred to being those recommended by the IFLA. The third part concerns the training of the cultural services managers who are intended to apply a deliberate, organized and high quality policy. It is still too early to say whether this text will have a decisive influence on improving the quality of the services currently provided which are summarized below.
- The current situation of hospital libraries in France
After some limited surveys in 1970/80, in 1992 the Ministry of National Education and of Culture (Directorate for books and reading) and the Fondation de France decided to carry out a national survey. This survey covered 1,860 public hospitals (862 replies), and is sufficiently big to estimate the provision of reading facilities and to establish an interesting overview of the situation (1).
Without attempting to give a detailed assessment of the findings, a few figures and comments should be mentioned to illustrate our purpose. Most hospitals (90%) say that they do provide "reading" activity. This finding looks rather encouraging at first glance, but in fact it covers some widely differing realities. The French scene actually includes a few libraries which are managed by professionals (Assistance Publique-Hôpitaux de Paris) or which have agreements with local public libraries (La Rochelle, Dijon...), but the majority only provide a source of reading matter most of which is supplied by donations and managed by volunteers. In 93% of cases, the running of the library is entrusted to individuals who are either untrained or who have only followed a few courses and cannot meet the requirements for providing a high quality public service. The remaining 7% are facilities run by staff, and who may not be professional librarians. We are therefore faced by a mixed situation in which professionals are rare, except in the network of 26 multimedia libraries of the Assistance Publique-Hôpitaux de Paris and the hospital libraries of a few cities (Dijon, Bordeaux, Le Havre...).
With regard to the reading matter provided, the book collections available, with a mean stock of 2,900 books per hospital, consist of 46% of purchased books, 39% of donated material and 16% on loan from the public library. This method of supply, and the absence of fixed, reliable budgets make it impossible to design a real acquisition policy, resulting in the provision of collections, which are usually old, only updated irregularly, and of uneven quality. The small percentage of documents loaned by the public library can be explained by the fact that only one third of the hospitals which responded to this survey work in partnership with their local Municipal or Departmental Lending Library. This highlights the isolation, which may or may not be deliberate, of hospital libraries and the lack of awareness of the structures of public libraries and their resources, on the part of most hospital managements.
To summarize, even though the information obtained reveals wide disparities, some constant features do emerge: variable facilities and collections, the "historic" presence of very well organized volunteers, who have the advantage of not costing anything, the virtual absence of qualifications and of partnerships with public libraries.
This national survey, which is still pertinent, has revealed the need for facilities, skills and partnerships, leading to the signature of the 1999 agreement already referred to.
2. Libraries belonging to the network of public libraries
Apart from a few individual initiatives, the public lending library system has only relatively recently begun to show an interest in outlets for reading intended for specific groups of people. Since the 1970s, efforts have focused on the building of modern libraries, the recruitment of qualified personnel and the development of innovative events. During this time, a network consisting of public institutions (schools, hospitals, prisons, barracks...) and private institutions (associations, company staff associations...) has developed, involving new readerships. The publication of the Pingaud-Barreau report in 1982 marked the beginning of a policy intended to cater for "all citizens, all backgrounds, all ages and all places". The need to go outside ones walls and work with partners in the non-public reading facilities used by hospital patients, prisoners, the handicapped has gradually been recognized. Some libraries have now developed partnership activities with "extra mural libraries (2)"; neighborhood libraries, company staff association, prison and hospital libraries ...
The question of reading in hospital now has to be viewed against the background of a twin process: the widening of traditional structures which are aware that they have a duty to provide all citizens with access to information (a hospital is one of the few places which unites a potential readership of all ages and social backgrounds); and the more recent development of awareness amongst hospitals of the value of relying on public services in developing cultural activities. If the provision of books is well-organized and of high quality, then a stay in hospital provide an opportunity for discovering the world of books. When the patient leaves hospital, this discovery may be continued by attending libraries, or cultural facilities more generally. The agreement between the Ministries of Culture and Health arose from this twin convergence of interest. The work of the Hospitals sub-section within the French Librarians Association [Association des Bibliothécaires Français (ABF)], has also helped to make the people involved in public reading aware of the importance of the challenge of reading in hospitals. In addition, there have been several regional surveys recently intended to provide an accurate map of the provision of reading facilities in hospitals. Partnerships and contacts have been developed between municipal/departmental public libraries and hospitals. Even though reading policy in French hospitals depends entirely on the attitude of hospital managers, the various aspects mentioned indicate increasing awareness of the situation by the various parties involved.
3. From service provision to partnership: a small, non-exhaustive list
Cooperation between hospitals and municipal and/or departmental public libraries, at the initiative of one or other of the partners, can take several forms, involving greater or lesser levels of investment.
- Loan of documents
Hospital managements very rarely provide their libraries with sufficient finance for acquisitions, and so loans from the municipal or departmental public library is often essential. In some cases, this involves overcoming the hesitations of some public library managers, who are worried about losing documents. Collective loans usually involve books or less often audiovisual materials. It may sometimes mainly involve specific types of material, such as large-print books, or audio books, which are in great demand amongst patients. Access to the collections of a bigger library is entirely justifiable. Today for example, there is a noticeable shift in the population of elderly people in hospital. Their requests, which are very specific and involve considerable numbers of books in some cases, will challenge any library that does not have a large, wide-ranging collection of material.
- Visits to the hospital by the library-bus
Reading matter can also be provided by regular visits to the hospital by the library-bus, as at Givors for example. Using trolleys, two municipal librarians regularly visit all the rooms and meet a wider range of people than in the municipal library. For them, this work involves enhancing awareness of reading, because many of the patients they meet do not normally use the library or library-bus. On their trolley-rounds, they often hear "I don't know how to read " or "I don't know what to read", and these comments, which are rarely heard in the municipal library, lead the librarian reconsider the choice of documents on offer.
- Home delivery
Some councils offer people who are members of their municipal library a home delivery service after they return home.
- Events at the municipal library
Joint efforts are also being developed in the context of visits to the public library. Psychiatric hospitals and child psychiatric departments are generally very keen to organize visits by small groups of adults or children who are being monitored in day hospitals or undergoing long-term hospitalization. The value of this approach is to show some of these people the resources available to the public in the vicinity and to get others out of the hospital, for books are a link with the outside world. For instance, in the Sotteville-les-Rouen area of Normandy, every month a librarian sees patients from the Rouvray hospital for a group presentation of a topic, followed by discussion and the loan of books. As well as this activity, writing workshops are set up, led by a writer and intended both for the patients and for library members. This involvement of a mixed group in a common project is very valuable, particularly if the workshops are held at different venues in the town (library, hospital...). It is a way of allowing two groups of people to discover places with which they are unfamiliar. Meeting with specific groups, which may at first quite understandably disconcert the librarian, is in fact found to be very enriching due to the intensity of the exchanges and the encounters to which it leads. It can profoundly modify the way one looks at other people and at books.
- Training of volunteers
Another aspect of the partnership consists of offering assistance in training the people who are running libraries. The Center for the coordination of hospital libraries at the Assistance Publique-Hôpitaux de Paris and the hospices civils de Lyon, for example, allow volunteers to attend training sessions, but this is not a very widespread practice.
- Three examples of partnership
Some towns, including the three examples described below, have decided to invest to a greater extent and for a longer duration in a collaborative approach.
- La Rochelle
The library of the La Rochelle hospital is an annex of the municipal library, a situation that is unique in France. This allows it to benefit from the advantages of being tied in with the public service: the list of books available is computerized and an integral part of the general catalogue which can be consulted remotely, there is a wide choice of books and subscription items, and the possibility of high quality professional exchanges.
In partnership with the University Hospital, the Carré d'Art/library has opened an annex (Serre Cavalier) in a Healthcare Center for the elderly. It caters for patients and staff, as well as the general public, and this is something entirely new in France. This library, which is linked to the public library system of the town, has a collection of 3,500 documents which are regularly replaced and book-related events are open to all: exhibitions, story-telling hours, entertainments... This locale is one of the factors that make it possible to preserve or restore the link between the elderly person and his or her social environment.
The town of Nanterre and the Raymond Poincaré (Garches) hospital (Assistance Publique-Hôpitaux de Paris) have signed a partnership agreement between their libraries. This concerns the organization of shared events: exhibitions, opportunities to meet authors and illustrators, scientists or artists... These events take place at the municipal library and at the hospital. Actors from the Théâtre National des Amandiers regularly come to the bedsides of adult and child patients to read texts. In addition, every year, as part of their support of creative material, an author-illustrator is invited to create a new book, which is then given to the children in the infant classes of the town and to children in hospital. This creative work is accompanied by workshops, entertainments and opportunities to meet the artist in both venues. These joint activities enhance the service offered to the whole population, regardless of their situation, and stimulate the activities of the professional librarians in both libraries.
Despite many examples of high quality achievements and experiments (3), much remains to be done to persuade the people running hospital libraries to open up and work with the professionals in the public library sector and also for this provision of specific reading matter to be taken into account by the public service. Some other European countries have done a lot more than France in this field, but a process seems to have been set in motion. Equal access to information for all, openness and tolerance towards other groups of people which make it necessary to take a different approach to familiarizing people with books, enhancing professionalism and improving the service provided... the benefits of partnership between the different services are making themselves felt. In recent years, the quality of life of people in hospital has become a major concern of French hospitals, and libraries can definitely make an important contribution to this development.
Claudie GUERIN, Coordinator of the multimedia libraries and documentation centers of the Assistance Publique-Hôpitaux de Paris/Délégation à la Formation, Chair of the hospital libraries sub-section of the French Librarians Association [Association des Bibliothécaires Français], Member of the IFLA Standing Committee of the Section of Libraries Serving Disadvantaged Persons.
- La Lecture à l'hôpital : Ètat des lieux de l'offre de lecture à l'hôpital. Fondation de France, Ministère de la Culture, 1993
- La Bibliothèque hors les murs / Claudie Tabet. Cercle de la librairie, 1996
- Les Publics empêchés - Bulletin d'information de l'Association des Bibliothécaires Français, 1998. n° 181