Our hands are being obsessively washed (for at least twenty seconds) and sanitised. They are squeezed into nitrile gloves, they are banned from touching most surfaces and especially our faces, lest they carry germs directly to our eyes, mouth and nose. Touching another person is now an oddity.
Yet, touch is fundamental to our wellbeing and helps us feel connected to others. Nurses in ICU wards are speaking of the importance of holding their patients’ hands. It may be through layers of PPE, but that simple human touch is still there.
Iain Stewart’s series Tender was made in 1999 as a commission for the Scottish National Portrait Gallery’s exhibition Health of the Nation and resulted in a set of twelve large prints. Stewart shadowed GPs Dr Ninian Hewitt and Dr Susan Moir over a period of six months during practice consultations and home visits.
Since then, Stewart has continued to document different aspects of healthcare for the NHS. Dr Hewitt helped establish the Lothian Pulmonary Rehabilitation service before he retired a few years ago, and he remains involved in respiratory education for health professionals.
In April 2020, Iain Stewart and Dr Ninian Hewitt agreed to re-visit the series, which focuses on the significance of touch in the healing process. The following are outtakes from conversations with them.
Much of Stewart’s photographic work is very different from Tender: his landscape views are almost abstract and devoid of human presence. Yet, he keeps returning to healthcare as a subject. Being the son of two GPs, it was the theme of his first series Picture of Health (1988) when, encouraged by his tutor at Edinburgh College of Art, he shadowed his parents at work. His earliest lessons in photography were about how to disappear into the background and let scenes play out without intruding, allowing doctors and patients to forget he was there.
For Stewart, having permission to document the delicate relationship between doctor and patient is a privilege. It includes him in the bond of trust that exists between doctor and patient. His images show just how extraordinary that relationship is: ‘In another situation, you never see people let down their guard and let themselves be touched.’
In the encounter between patient and doctor, ‘a dial is turned’, as Dr Hewitt describes it, and things that would be unthinkable in any other context become completely acceptable: taking your clothes off for someone you may only see once a year, and letting yourself be touched by that person. Laying your vulnerabilities bare and being met with understanding, not repulsion or judgement. Dr Hewitt is a good-humoured, chatty man, sensitive in the way that perhaps only medical professionals are: unfazed by the realities of the human body, but profoundly attuned to the needs of others.
‘If as a doctor you shove a drug into somebody, you find that the drug is doing a huge amount, but the person in the meantime has an anxiety, and the only way to get rid of anxiety is not lots of words, but giving somebody a hug, touch, something very very simple and basic.’
‘I had concerns that I wouldn’t find the NHS in the same place as when I’d photographed my parents. The government had introduced GP fundholding where GPs were given control over budgets for their patients’ hospital treatments. There had been a lot of political tampering and there was an expectation to run practices as businesses, where patients became clients. Meeting Ninian and seeing what a kind, gentle doctor he was, reassured me that I could still make images, and that what had attracted me to making this type of work was still there. […] The core of the NHS never changes. It’s about an individual helping another individual.’
Stewart’s concern about the state in which he would find the NHS in 1999, a decade after his first project, is also the reason for the double-edged title. One meaning of the word ‘tender’ calls out a business-like approach to the healthcare system through its implications of bidding wars. But at the same time, ‘It’s a simple word that captured what isn’t on the CV – the gentleness and tenderness that I saw, that was part of their day-to-day job.’
‘A large amount of general practice is relatively mechanical, and especially because it’s a very short, brief interlude in time. But even in your official ten-minute interview, there’s always people coming in, every single day, every single consulting, where it’s not mechanical, who need to tell you something, or you the doctor have to coax out of them, something that really is very personal, very intimate.’
At the start of the project, Stewart would position himself in a corner of the room, as far away as possible from the doctor and patient.
But as he observed Dr Hewitt and Dr Moir at work, the project evolved. He began to move in closer: 'Initially, each image was supposed to tell a story, showing every bit of the doctor's office. But trying to have a story stopped it from being more universal. I had to eliminate the details to arrive at something much simpler.'
Instead of showing him with a stethoscope in a white lab coat, Stewart’s images often reduce the doctor to a pair of hands, or a compassionate listener.
When the patients involved saw the final set of photographs, Dr Hewitt recalls that it was not the kind of imagery they had expected to see: ‘They were slightly perplexed because they came with the baggage of medicine, and not with the knowledge of care. […] But when you get perplexed there’s an awful lot people then have to think about.’
‘The photographs were a very seminal event for me. […] Because of what Iain did. Because he converted what I knew but wouldn’t have probably verbalised very well at that point into an image that made me go, “Oh! It is. He’s right, it’s touch.”’
Stewart’s images invite the viewer to reconsider how they see the NHS, how they think about medical care. His lens magnifies and cherishes the small details one may not notice in situations which are, nonetheless, familiar to us all.
To our NHS and to all frontline workers: thank you for keeping us safe.