By Dr Duika Burges Watson, Nature Recovery Ranger, Centre for Sustainable Healthcare and Newcastle Hospitals, and Catherine Howell, Seed Sovereignty Programme Coordinator, Gaia Foundation
This year’s World Kidney Day theme – Kidney Health for All: Caring for People, Protecting the Planet – was the basis for our activities at the Freeman Hospital renal ward.
In the staff room on World Kidney Day it was chatty, noisy, people squeezing into the space and squeezing in enough time to eat. We passed round a perfumer’s strip scented with “forest” and asked everyone to try the bunny sniff – tiny shallow sips of breath that draw aromatic compounds up towards the olfactory bulb – which requires focused attention. For a brief moment the room was silent, calm, focused – peaceful.
A forest on a perfumer’s strip
The forest scent was created for the Nature Recovery Programme by Michele Riveroll, clinical aromatherapist and perfumer. It is a secret blend – a complex accord and a unique interpretation of what a forest smells like. As Nature Recovery Ranger, I also carry some of the individual components: Siberian fir, fir absolute, bergamot. For groups of staff and at each bedside I started with the forest whole, asking people to sit with it and notice what it brought to mind, before introducing components one by one.
Bergamot on its own is a very different smell from the forest blend – but when people moved between the two, they could begin to find it in the accord, to locate that citrus note within the whole. More difficult with the firs for most people, but the principle of looking for a scent was established.
This opened up a conversation that surprises most people: the ability to identify notes within a blend is not something most people think about, and it is not something we naturally do – it is a learnable skill. Then, to show how much of what we call taste is in fact smell, I asked people to hold their noses and chew a piece of mango or a skittle, then release. The moment they let go, the flavour arrived. Most people are very surprised that they can only ‘taste’ the mango or skittle when the nose is in action.
While a teachable moment in how we experience food flavour, it is also significant in how this activity stops rumination. The complete attention required to smell carefully leaves no room for the mental loop of worry that a stressful job or illness generates. It is calming in a way that is hard to explain in advance, but obvious when you are in the room.
The scent map: a different kind of lunchtime walk
I introduced the scent map¹ – a map of the Freeman estate showing where plants with interesting scents can be found across the grounds: viburnum, rosemary, thyme, atlas cedar, lavender, barberries. Plants already there, made visible and worth noticing on a lunchtime walk.
Staff wanted to try it straight away. This is the heart of the green space and health work at Newcastle Hospitals: finding ways to create nature connection without necessitating costly landscaping – sometimes nature just needs to be noticed (though more investment in green space is also needed).
Why smell matters on a renal ward
On the day, several patients struggled to smell the perfumer strips. Research spanning twenty years has demonstrated that smell loss is more common in CKD than most people realise, affecting around 30% of patients compared with 15% of the general population,² and it often goes unnoticed.³ The impacts reach beyond appetite into nutrition, mental health and quality of life.⁴⁵ COVID brought smell loss into wider public awareness,⁴ and many now understand how significant the loss is on quality of life. The mango demonstration provides a window into the impact on food enjoyment.
For people on a renal ward, food can become a burden: more restrictions and often diminished enjoyment because smell – which drives so much of what we experience as flavour – may be reduced.⁶ Smell training has an established evidence base for recovery following viral smell loss⁷ and is beginning to be explored in CKD specifically. But the way I approached it on the ward was less clinical than that. Smell engagement as a form of nature connection – something that stops rumination, surfaces memory, opens attention to the living world – can simply be offered as something worth doing, without a clinical framing.
The forest smell initiated many interesting conversations and powerful memories. One man smelled the forest strip and said it reminded him of floor cleaner. I had a moment of ‘oh dear’. Then he smiled and said he loved the smell of floor cleaner – one of his most comforting smells, from childhood, meaning home and safety and someone taking care of things. The strip had taken him somewhere real and good. It just wasn’t a forest.
Another patient loved the forest, but even more a further curated nature scent of moss and soil. He was transported back through decades of working with scouts, particular camps, particular places. Someone who couldn’t get outside, briefly returned to something the outdoors had given him.
You bring what you think is an invitation to nature and discover it lands somewhere personal and sometimes quite unexpected. The point is what the smell unlocks – smell memories are typically particularly emotionally involving, with a bias towards positive childhood memories, as the research shows.
Seeds, stories and seventeen kinds of broad bean
Catherine Howell joined me to introduce the second of our caring for people and planet themes – a focus on legumes. She came with a large bowl of broad beans she had grown: seventeen varieties, many shapes and colours. We were particularly drawn to the deep reddish-purple variety – kidney-shaped, local, entirely growable here in the North East. Kidneys, beans, the strange question of why they are shaped that way.
She also brought the carlin pea. Small, brown, nutty, and connected to a story most people on the ward didn’t know. During the Scots’ siege of Newcastle in the early 1600s the city’s inhabitants were left starving inside the walls until a ship carrying carlin peas was wrecked on the Tyne and its cargo became the food that kept them alive. For generations, carlin Sunday was observed on the fifth Sunday of Lent across the North East. Of everyone we met that day, only one patient and one member of staff knew the story.
Food is a key route to nature connection – through the stories of place it carries, through growing and tending, through the pleasure of eating something with a history. Dietary advice around CKD has shifted: where legumes were once treated with some caution, a diverse plant-forward diet is now recommended for most patients, and Amita Godse, lead renal dietitian at Freeman, has been a key collaborator in bringing that conversation to patients through her work with Kidney Kitchen. Some patients left with beans to plant at home and recipes for carlin peas.
Bergamot offered a different kind of local food story. One of the components in Michele’s forest blend, it is also the flavour in Earl Grey tea – originally blended, according to Howick Hall Gardens, to cover the mineral character of the local Northumbrian water. One of the most globally recognised aromas was born as a solution to a very local problem.
Growing carlin peas outside the window
The next step will be practical. We have support from our infection control team and estates to grow ‘pop-up’ carlin peas, purple broad beans and the now renamed ‘Geordie bean’ (a yin yang black and white variety) in planters outside the windows of Ward 31, so that patients who cannot go outside can watch them grow, so staff can take a few minutes to water them, so all can see the pollinators arrive and – when the windows are open – perhaps catch their scent.
This is what the Green Spaces and Health programme⁸ is for: nature made accessible in whatever form reaches people where they are – a scent strip at a bedside, a seed to take home, a story about a shipwrecked pea, a plant flowering on the other side of the glass. Smell is an underused route into nature connection. That connection is possible even when you can’t get outside. And as the newly released RHS Health and Wellbeing Blueprint shows, green space and health is good clinical work, not amenity – something this day, we hope, helped to show.
This event was part of the Nature Recovery Programme and Green Spaces and Health Plan at Newcastle upon Tyne Hospitals NHS Foundation Trust, in partnership with the Centre for Sustainable Healthcare. With thanks to Michele Riveroll at Scentica Studio; Amita Godse, Clint Gunn and the Ward 31 renal nursing team; Catherine Howell; and the ENT team at Newcastle Hospitals for advice on the scent awareness postcard.
This work sits within a growing effort to make kidney care more sustainable. The Centre for Sustainable Healthcare’s sustainable kidney care programme offers a free eLearning module on sustainable kidney care, available in five languages, and is currently recruiting kidney care champions. If you work in kidney care and want to explore what your centre can do, the CSH sustainable kidney care pages are a good place to start.
References
1. Burges Watson D. (2025). Nature Recovery Scent Map: Freeman Hospital. Newcastle upon Tyne Hospitals NHS Foundation Trust / Centre for Sustainable Healthcare.
2. Chewcharat A et al. (2022). The association between olfactory and gustatory dysfunction and chronic kidney disease. BMC Nephrology, 23:36.
3. Frasnelli JA, Temmel AF, Quint C, Oberbauer R, Hummel T. (2002). Olfactory function in chronic renal failure. American Journal of Rhinology, 16(5): 275-9. PMID: 12422973.
4. Burges Watson DL, Campbell M, Hopkins C, Smith B, Kelly C and Deary V. (2021). Altered smell and taste: anosmia, parosmia and the impact of long COVID-19. PLoS ONE, 16(9): e0256998.
5. Bratman GN et al. (2024). Nature and human well-being: the olfactory pathway. Science Advances, 10: eadn3028.
6. Rawal S, Duffy VB, Berube L, et al. (2021). Self-reported olfactory dysfunction and diet quality: findings from the 2011-2014 NHANES. Nutrients, 13(12): 4561.
7. Pieniak M, Oleszkiewicz A, Avaro V, Calegari F, Hummel T. (2022). Olfactory training – thirteen years of research reviewed. Neuroscience & Biobehavioural Reviews, 141: 104853.
8. Newcastle upon Tyne Hospitals NHS Foundation Trust. Green Spaces and Health Plan 2026-2030.