Using Literature and Photography to Teach

Social Justice and Encourage Activism for

Public HealthMartin Donohoe

Portland, OregonMount Hood

Multnomah Falls, Oregon

Am I Stoned?A 1999 Utah anti-drug pamphlet warns:“Danger signs that your child may be smoking marijuana include excessive preoccupation with social causes, race relations, and environmental issues”

Public Health• Schism between medical schools and

schools of public health

– Limited public health in medical school curricula

• Institute of Medicine: ¼ to ½ of medical students should earn the equivalent of a masters in public health

– Very few do

Medical Ethics Today• Overemphasizes individual conflicts

and fascinating dilemmas involving expensive technologies (e.g., gene therapy, cloning, face transplants)

• Underemphasizes the psychological, cultural, socioeconomic, occupational, and environmental contributors to health

Major Public Health Issues

• 52 million uninsured in US• Tobacco and obesity epidemics• Massive worldwide poverty and hunger• Increasing maldistribution of wealth• Overpopulation• Environmental degradation

– Deforestation, global warming, unsustainable agricultural and fishing practices, pollution, water scarcity, mass extinction

• Wars

Headline from The Onion

Uninsured Man Hopes His Symptoms Diagnosed This

Week On House

The Decline of Medicine?• Enthusiasm, empathy, and

professionalism can decline through the clinical years of medical school and residency

• Patient and physician dissatisfaction with current fragmented health care system is growing

Charity Care and Volunteerism• Cynicism and burnout common

• Interest in primary care low/inadequate

• The proportion of physicians providing charity care has declined over the last decade

Harvey Cushing

“A physician is obligated to consider more than a diseased organ, more even than the whole man. He must view the man in his world.”

Martin Luther King

“Injustice anywhere is a threat to justice everywhere”

Important Historical Figures in Medicine/Public Health and Social Justice

• Florence Nightingale

• Clara Barton

• Margaret Sanger

• Thomas Hodgkin

• Albert Schweitzer

Important Historical Figures in Medicine/Public Health and Social Justice

• Charles Dickens

• Anton Chekhov

• Upton Sinclair

• George Orwell

• William Carlos Williams

Rudolph Virchow

• Father of Social Medicine (and founder of modern pathology)

• Argued that many diseases result from “the unequal distribution of civilization’s advantages”

Rudolph Virchow

“Doctors are natural attorneys for the poor … If medicine is to really accomplish its great task, it must intervene in political and social life…”

The Role of Literature

• Vicarious experience

• Explore diverse philosophies

• Promotes empathy, critical thinking, flexibility, non-dogmatism, self-knowledge

• Encourages creative thinking

• Allows for group discussion/debate

Why Use Literature

• Encourage appreciation of non-medical literature

• Develop reading, analytical, speaking and writing skills

• Promote ethical thinking (narrative ethics)

• Identification with doctor authors (e.g., Keats, Chekhov, Maugham, Williams)

Literature and Social Justice

• Teaching method: Literary selections paired with articles from the medical, nursing, public health, and ethics literature

• When: Dedicated courses, ward rounds, special conferences

• Audience: health professions students, residents, faculty, even patients

Stigmatization

John Updike

“From the Journal of a Leper.”

Am J Dermatopathol 1982;4(2):137-42

Homelessness

Doris Lessing

“An Old Woman and Her Cat”

From the Doris Lessing Reader (New York: Knopf, 1988)

Race and Access to Care

Ernest J Gaines

“The Sky is Gray”

in Gray, Marion Secundy, ed. Trials,Tribulations, and Celebrations: African American Perspectives on Health, Illness, Aging and Loss. Yarmouth, Maine: Intercultural Press, 1992

Poverty

• Orwell, George. How the Poor Die. In Sonia Orwell and Ian Angus, eds. The Collected Essays, Journalism and Letter of George Orwell, IV; In Front of Your Nose, 1945-1950. New York: Harcourt, Brace and World, Inc: pp.223-233.

• Eighner, Lars. Phlebitis: At the Public Hospital. In Travels with Lizbeth. New York: St. Martin’s Press, 1993.

Domestic Violence

Michael LaCombe

“Playing God”

In LaCombe M, ed. On Being a Doctor. Philadelphia: American College of Physicians, 1994

Human Subject Experimentation / Human Rights Abuses

Shusaku Endo

The Sea and Poison

(New York: Taplinger Publishing Co., 1972)

Conflicting Responsibilities of Physicians

Pearl S. Buck

“The Enemy”

In Far and Near: Stories of Japan, China, and America (New York: The John Day Company, 1934)

War and Peace

• All Quiet on the Western Front, Erich Maria Remarque

• Johnny Got His Gun, Dalton Trumbo

• A Canticle for Leibowitz, Walter Miller, Jr.

• Poems by Wilfred Owen (Dulce et decorum est”) and Siegfried Sassoon (“Survivors”)

• Mark Twain’s “The War Prayer”

Promote Peace

“The role of the physician … in the preservation and promotion of peace is the most significant factor for the attainment of health for all.”

- World Health Organization

The BibleBook of Matthew

All they that take the sword, shall perish with the sword.

Josef Stalin

The death of one man is a tragedy. The death of millions is a statistic.

Dwight D. Eisenhower

Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and not clothed.

Martin Luther King, Jr.

Our only hope today lies in our ability to recapture the revolutionary spirit and go into a sometimes hostile world declaring eternal hostility to poverty, racism, and militarism.

Martin Luther King, Jr.

Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.

W Eugene Smith’s Photos of Minimata

Disease

More W Eugene Smith Photos

Sebastiao Salgado

Photos

Gold Mining:The Reality

Suggestions

• Use literary selections, photography, and art in courses and community work

–Interdisciplinary education

• Share stories with colleagues, patients/clients

Suggestions

• Create dedicated reading and writing groups, art groups

• Push for curricular change• Mix serious readings with some

humorous ones• Encourage reading of journals,

including non-medical activist-oriented publications

Nurse Margaret Sanger

Books have been to me what gold is to the miser, what new fields are to the explorer.

“First they came for the Jews”by Pastor Niemoller

“First they came for the Jews, and I did not speak up, for I was not a Jew.

Then they came for the communists, and I did not speak up for I was not a communist.

Then they came for the trade unionists, and I did not speak up, for I was not a trade unionist.

Then they came for me, and there was no one left to speak up for me.”

Günter Grass

“The first job of a citizen is to keep your mouth open.”

Anita Roddick

"If you think you are too small to have an impact, try going to bed with a mosquito in your tent"

Contact Information

Public Health and Social Justice Website

http://www.phsj.org

martindonohoe@phsj.org