Fearing every bite: how to simulate difficulty swallowing

Is it possible to make a healthy person feel what a patient living with eosinophilic esophagitis (EoE) feels? To simulate the condition’s most common symptom – difficulty in swallowing – a variety of potential solutions were developed. But after testing choker necklaces, corrugated pipes and a facsimile food bolus, which turned out to be the best?

With EoE being defined as a chronic condition as relatively recently as 1993, there is low awareness of it amongst medical practitioners worldwide. Therefore, the creative team developing a new immersive experience exploring the lives of patients with EoE, considered it essential to demonstrate how the disease impacts them every single day.

During your experience, you will wake up, go to work, socialize with friends, spend time with your family and go to bed as normal – but for the duration, you will experience living with EoE whilst doing those things.

Were there any challenges in simulating the swallowing experience?

“Bringing to life the anxiety that patients face every time they eat a meal or have a snack, was a real challenge”, said Paul.

As the primary symptom, it had to be simulated in a way that made this everyday impact of the condition understandable for participants, but the key question was how A Life in a Day team create a meaningful representation of an oesophageal blockage without posing any danger to our participants.

“How could we possibly make them feel what a patient feels without causing them to have a blockage themselves?” he added.

Difficulty swallowing is the primary symptom of EoE

Inflammation of the oesophagus makes it hard for food to pass down to the stomach, causing patients to repeatedly experience difficulty in swallowing. Many describe the unpredictability of when this difficulty might result in a serious – and potentially life-threatening – blockage as, “the fear of every bite”.

EoE quote.

Simulating difficulty in swallowing was going to be tough. How do you get someone to experience the feeling of having a blockage in their oesophagus without putting them at risk? 

The creative director of A Life in a Day, Paul Gascoigne, shared details about creating experiences and simulating swallowing difficulties. 

There were many interesting ideas like:

  • wearing a choker necklace to simulate a discomfort when swallowing a food bolus.
  • attaching things like marbles to the chest to represent a food blockage in the lower oesophagus.
  • removing a pliable simulated food mass from a length of transparent piping.

However, all these ideas were rejected because they did not come close enough to making participants engage with the biological or psychological processes of swallowing, were considered unsafe, or felt like medical training tools.

And although some options did help participants understand the physical consequences of a blockage, they failed to help them feel any of the emotional impact the team was trying to bring to life.

After a lot of brainstorming and testing, the perfect solution for simulating difficulty in swallowing turned out to be a small, soft red ball.

“Rather than try to replicate an actual food obstruction in a participant’s oesophagus, the idea was to make them connect with the action of swallowing so they could then start to feel the fear of a blockage as they took each and every bite”, explained Paul.

Instructed to physically hold the ball – which is the same size as a typical swallowed food bolus – gently against the throat whilst they ate their breakfast, lunch dinner and snacks, enabled participants to engage with both the biological process and the psychological burden of fearing every bite.

“A small, simple, no risk, solution that made a huge impact in helping non-patients understand what it is like to live with EoE”, said A Life in a Day creative director.

Simulating difficulty swallowing with A Life in a Day
Position of a small soft ball / Difficulty swallowing simulation / Photo by A Life in a Day

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