Transcript Using Literature to Teach Activism for Public Health

Literature, Photography, and
Social Justice in Medicine
Martin Donohoe
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”
Outline
• Background
• History, Literature, Public Health, Social
Justice
• Teaching Medical Humanities
• Special Topics: War, Minimata Disease,
Mining
• Conclusions
“No matter where I might find
myself, every sort of individual
which it is possible to imagine in
some phase of his development,
from the highest to the lowest, at
some time exhibited himself to me.”
- William Carlos Williams
Luke Fildes
“The Doctor”
Medicine and Public Health
• Schism between the fields
• Patients vs. Populations
–Witnessed victims vs. “statistical”
victims
• Medical ethics / public health ethics
• Activism
Causes of Environmental Degradation and
Social Injustice
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Overpopulation
Pollution
Deforestation
Global Warming
Unsustainable Agricultural/Fishing
Practices
Causes of Environmental Degradation and
Social Injustice
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Overconsumption / Affluenza
Militarization
Maldistribution of Wealth
National and Global Political and
Economic Institutions
• Exploitation
• Corporate Profiteering
Causes of Environmental Degradation and
Social Injustice
• International NonCooperation/Isolationism
• Poor education
• Media manipulation and inaccurate
reporting
• Money in politics
• Citizen apathy
Consequences of Environmental
Degradation and Social Injustice
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Increased poverty and overcrowding
Famine
Global Warming
Weather extremes
Species loss
Human morbidity and mortality
– 40% of world’s yearly deaths linked to water, air,
and soil pollution
• War
• Malthusian chaos and disaster
Mahatma Gandhi
“You
must be the change you
want to see in the world”
Important Historical Figures in Public Health and
Social Justice
• Dr. Thomas Hodgkin (abolitionist and
opponent of British oppression of native
populations in South Africa and New Zealand)
• Nurse Margaret Sanger (founder of the family
planning movement in the US)
• Dr. Albert Schweitzer (won Nobel Peace Prize
in part for developing a missionary hospital for
the poor in Gabon, Africa)
Important Historical Figures in Public Health and
Social Justice
• Florence Nightingale (feminist, founder of the
modern nursing profession, and advocate for
hygienic hospitals)
• Dr. Salvador Allende (assassinated president of
Chile and promoter of better living conditions
for the poor and working classes).
• *The quiet and unknown*
Important Literary Figures in Public Health and
Social Justice
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Charles Dickens
Anton Chekhov
Upton Sinclair
George Orwell
William Carlos Williams
Rudolph Virchow
• Founder of modern pathology
–Thrombosis, pulmonary embolism,
leukocytosis, leukemia
• Member of state and local government
for over 30 years
• Founded journal Medical Reform
Rudolph Virchow
• Argued that many diseases result from
“the unequal distribution of civilization’s
advantages”
• Advocated public provision of medical
care for the indigent
• Promoted universal education
Rudolph Virchow
• Worked to outlaw child labor
• Improved water distribution and sewage
system
• Enhanced food inspection process
• Published study of skull volumes to
dispute myth of larger Aryan brains
Rudolph Virchow
• Passed hygiene standards for public
schools
• Set new standards of training for nurses
• Improved local hospital system
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…”
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.”
Why Use Literature
• Helps to develop reading, analytical,
speaking and writing skills
• Promotes ethical thinking (narrative
ethics)
• Allows identification with doctor authors
(e.g., Keats, Chekhov, Maugham,
Williams)
The Role of Literature
• Vicarious experience
• Explore diverse philosophies
• Promotes empathy, critical thinking,
flexibility, non-dogmatism, selfknowledge
• Encourages creative thinking
• Allows for group discussion/debate
Why Study Literature?
“Why live? Life without literature is reduced to
penury. It expands you in every way. It
illuminates what you’re doing. It shows you
possibilities you haven’t thought of. It enables
you to live the lives of other people…It
broadens you, it makes you more human. It
makes life more enjoyable.”
M.H. Abrams
Nurse Margaret Sanger
Books have been to me what gold
is to the miser, what new fields
are to the explorer.
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
Racial Disparities in Health Care:
African-Americans
• Equalizing the mortality rates of
whites and African-Americans would
have averted 686,202 deaths
between 1991 and 2000
–Whereas medical advances averted
176,633 deaths
• AJPH 2004;94:2078-2081
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.
Jacob Riis
Dorothea Lange
The State of U.S. Health Care
• 41 million uninsured patients
• 48,000 deaths/year due to lack of
health insurance
Headline from The Onion
Uninsured Man Hopes His
Symptoms Diagnosed This Week
On House
The State of U.S. Health Care
• US ranks near the bottom among
westernized nations in life expectancy
and infant mortality, and most other
health indicators
Poverty and Inequality in the U.S.
• 22% of children live in poverty
• Food insecurity common
• Gap between rich and poor widening,
largest of any industrialized nation
Income Inequality
• Lower life expectancy
• Higher rates of infant and child
mortality
• Short height
• Poor self-reported health
• AIDS
Income Inequality
• Depression
• Mental Illness
• Obesity
• Crime
• Diminished trust in people and
institutions (↓ social cohesion)
Voltaire
“The comfort of the rich rests
upon an abundance of the
poor”
Hudson River, 2009
Primo Levi
“A country is considered the more
civilized the more the wisdom
and efficiency of its laws hinder a
weak man from becoming too
weak or a powerful one too
powerful.”
Care for All Equally
“A society should be judged not by
how it treats its outstanding citizens
but by how it treats its criminals”
-Fyodor Dostoyevsky
Meanwhile, Outside the US…
• 1 billion people lack access to clean
drinking water
• 3 billion lack adequate sanitation
services
• Hunger kills as many individuals in
two days as died during the atomic
bombing of Hiroshima
James Nachtwey
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
“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
Famous Novels of War and Peace
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War and Peace, Tolstoy
Red Badge of Courage, Crane
All Quiet on the Western Front, Remarque
Johnny Got His Gun, Trumbo
A Rumor of War, Caputo
A Canticle for Leibowitz, Miller
Christopher Columbus
Upon meeting the Arawaks of the Bahamas
They…brought
us…many…things…They willingly
traded everything they owned…They
do not bear arms…They would make
fine servants…With fifty men we
could subjugate them all and make
them do whatever we want.
Josef Stalin
The death of one man is a
tragedy. The death of millions is a
statistic.
Horace
Odes (III.2.13)
Dulce et decorum est pro patria
mori
It is sweet and fitting to die for
one’s country
"Dulce Et Decorum Est"
Wilfred Owen, 1917-18
…
In all my dreams, before my helpless sight,
He plunges at me, guttering, choking,
drowning.
If in some smothering dreams you too could
pace
Behind the wagon that we flung him in,
And watch the white eyes writhing in his face,
His hanging face, like a devil's sick of sin;
"Dulce Et Decorum Est"
Wilfred Owen
If you could hear, at every jolt, the blood
Come gargling from the froth-corrupted lungs,
Obscene as cancer, bitter as the cud
Of vile, incurable sores on innocent tongues,My friend, you would not tell with such high
zest
To children ardent for some desperate glory,
The old Lie: Dulce et decorum est
Pro patria mori.
Discretionary Federal Spending (2013)
World Military Spending (2012)
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
Colonial Exploitation
• Cecil Rhodes (Rhodesia, Rhodes Scholarship,
DeBeers Mining Company):
“We must find new lands from which we can
easily obtain raw materials and at the same
time exploit the cheap slave labour that is
available from the natives of the colonies. The
colonies would also provide a dumping ground
for the surplus goods produced in our
factories.”
Advice for Students
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Appreciate the privilege of practicing medicine
Be humble / know your limits
Contemplate life and death, comfort the grieving
Take care of yourself
Cherish your relationships
Continue your lifelong education
Strive for justice
“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.”
African Proverb
"If you think you are too small
to have an impact, try going to
bed with a mosquito in your
tent"
Public Health and Social Justice
Website and Book
http://www.publichealthandsocialjustice.org
http://www.phsj.org
[email protected]