Literature, Photography, and Social Justice in Medicine

1. Literature, Photography, and Social Justice in Medicine Martin Donohoe

2. 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”

3. Outline • Background • History, Literature, Public Health, Social Justice • Teaching Medical Humanities • Special Topics: War, Minimata Disease, Mining • Conclusions

4. “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

5. Luke Fildes“The Doctor”

6. Medicine and Public Health • Schism between the fields • Patients vs. Populations • Witnessed victims vs. “statistical” victims • Medical ethics / public health ethics • Activism

7. Causes of Environmental Degradation and Social Injustice Overpopulation Pollution Deforestation Global Warming Unsustainable Agricultural/Fishing Practices

8. Causes of Environmental Degradation and Social Injustice Overconsumption / Affluenza Militarization Maldistribution of Wealth National and Global Political and Economic Institutions Exploitation Corporate Profiteering

9. Causes of Environmental Degradation and Social Injustice • International Non-Cooperation/Isolationism • Poor education • Media manipulation and inaccurate reporting • Money in politics • Citizen apathy

10. Consequences of Environmental Degradation and Social Injustice 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

11. Mahatma Gandhi “You must be the change you want to see in the world”

12. 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)

13. 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*

14. Important Literary Figures in Public Health and Social Justice • Charles Dickens • Anton Chekhov • Upton Sinclair • George Orwell • William Carlos Williams

15. 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

16. 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

17. 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

18. Rudolph Virchow • Passed hygiene standards for public schools • Set new standards of training for nurses • Improved local hospital system

19. 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…”

20. 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.”

21. 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)

22. 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

23. 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

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

25. Stigmatization John Updike “From the Journal of a Leper.” Am J Dermatopathol 1982;4(2):137-42

26. Homelessness Doris Lessing “An Old Woman and Her Cat” From the Doris Lessing Reader (New York: Knopf, 1988)

27. 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

28. 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

29. 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.

30. Jacob Riis

31. Dorothea Lange

32. The State of U.S. Health Care 41 million uninsured patients 48,000 deaths/year due to lack of health insurance

33. Headline from The Onion Uninsured Man Hopes His Symptoms Diagnosed This Week On House

34. 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

35. 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

36. Income Inequality Lower life expectancy Higher rates of infant and child mortality Short height Poor self-reported health AIDS

37. Income Inequality Depression Mental Illness Obesity Crime Diminished trust in people and institutions (↓ social cohesion)

38. Voltaire “The comfort of the rich rests upon an abundance of the poor”

39. Hudson River, 2009

40. 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.”

41. 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

42. 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

43. James Nachtwey

44. Domestic Violence Michael LaCombe “Playing God” In LaCombe M, ed. On Being a Doctor. Philadelphia: American College of Physicians, 1994

45. Human Subject Experimentation / Human Rights Abuses Shusaku Endo The Sea and Poison (New York: Taplinger Publishing Co., 1972)

46. 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)

47. War and Peace

48. “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

49. Famous Novels of War and Peace 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

50. Christopher ColumbusUpon 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.