The Arbor: a film that brought new insights to ‘community orientation’

LEARNING HOW THE ‘OTHER HALF LIVES’

In March 2016 a group of GPs in their ST3 year watched a film called The Arbor, which triggered reflections on how the ‘other half lives’. This film tells the tragic, true story of a family on a deprived estate in Bradford, using a unique method: the voices we hear are those of the real people in the story, each commentating from their own point of view. However, what we see is actors lip-synching to the verbal accounts. This gives a deep sense of authenticity and accuracy to the story.

Andrea Dunbar (22 May 1961—20 December 1990) was a British playwright most famous for The Arbor and Rita, Sue and Bob Too, an unforgettable ‘autobiographical drama about the sexual adventures of teenage girls living in a run-down part of Bradford, West Yorkshire. Shelagh Delaney [of A Taste of Honey fame] described Dunbar as “a genius straight from the slums”.’¹

The main characters, members of Andrea Dunbar’s family, are seen in a drama that intertwines her successful plays about the realities of life on the Buttershaw estate in Bradford with the terrifying aftermath of her unexpected death, which affected her daughter Lorraine profoundly. After watching the film, participants wrote down their own observations using the format ‘I saw … I heard … I felt …’. We arranged their comments into a powerful poem creating a picture of life on the housing estate, with all its complexities and positive and negative features:

‘I saw a group of men taunting a girl.

Aggression, large families living under one roof,

I saw a horse, determination, and an unlikely artist.

I saw happiness, a glimpse of hope.

I saw empty houses, rubbish and dirt,

A community gathering, their doors were open,

Everyone knew each other.

I saw alcohol problems.

I heard swearing and racial abuse,

Shouting, arguments, angry voices, disrespect.

I heard warm thoughts about friends and family members.

Nostalgic anecdotes, dogs snuffling and a curlew singing.

I felt intrigued and confused, the story going forwards and backwards,

I felt uncomfortable, pity, sad, bad, helpless, Guilty, horrified and distressed.

I felt lucky for my safe life, I wanted to hug my family.

I felt the kids suffered, being “under the radar”.

I felt sad for their lost opportunities, Society failed those children.

Could this really be a true story?’

The Arbor directed by Clio Barnard. Released 2010, Arbor Films Ltd.

EVER-DEEPENING INEQUALITIES

Doctors have jobs, get paid, and usually live in reasonable accommodation. We may have little in common with our patients living in deprived communities. The Royal College of General Practitioners competence of community orientation² is there to direct trainees’ attention to the specific needs of their local communities. Although material wealth is increasing for those already at the top of the scale, divisions between the rich and the poor are deepening every year, and the impact of health inequalities is huge. Statistics may not provide us with a clear enough picture to engage our empathy, and home visits may allow only a partial glimpse into the culture surrounding patients. Will these important insights be lost if we give up visiting entirely?

With the current move towards integrating health and social care, this film helped us reflect on people’s day-to-day experiences and how this influences their behaviour: how they come to make choices about drugs, smoking, and alcohol that may not make sense from the outside. Although set 30 years ago, social deprivation still impacts greatly on our patients’ healthcare needs in the present. Using the film in this way brought the competence of community orientation into sharp focus.