Health and healthcare humanised
Building on last year’s ground-breaking conference, Body Knowledge: Medicine and the Humanities in Conversation, hosted at the Wits Institute for Social and Economic Research, the University of Cape Town (UCT) recently hosted a second conference, Medical Humanities in Africa.
These conferences, which we hope will become an annual tradition, brought together a diverse group of scholars, health practitioners and artists working at the intersection of the medical and the humanistic traditions in South Africa and on the African continent.
In 2013 the National Research Foundation in South Africa recognised the “medical humanities” as a new knowledge field. But what is this new field? And what might it offer?
Quite simply, the medical humanities is an attempt to move beyond the binaries that have separated the worlds of the medical and the scientific from the domains of the personal and the humanistic.
Patrick Randolph-Quinney, based in the school of anatomical sciences at the University of the Witwatersrand, argued: “I am sure Da Vinci would not have approved of this artificial (and unproductive) dichotomy; for him painting was a science, and to see was to know,” (Getting Ahead supplement, Mail & Guardian, September 6 2013.)
From disciplines and practices as diverse as cellular biology, fine art, anthropology, public health, performance art, theatre, poetry, music, oncology, comedy and family medicine, the conference worked to bridge these historical divides between medicine and the arts.
Song and medicine
Paediatric oncologist Mark Hendricks, for example, accompanied by acclaimed jazz performer Amanda Tiffen, composed and sang a song about the emotional aspects of bearing witness to children dying.
The offering opened up a space for medical practitioners and humanities scholars to talk about medical pedagogies, and what is too often left out of the curriculum, namely how to cope with human emotions.
With emerging programmes and course offerings in medical anthropology, the medical humanities, global health and the health social sciences at UCT, the University of the Western Cape, Wits and Stellenbosch University, South Africa is in an excellent position to facilitate conversations that are emerging in medical humanities across Africa.
The pressing issues to be addressed are in the fields of hospice care, access to primary healthcare, rural health, HIV and Aids, tuberculosis, as well as the rise of noninfectious diseases, including cancer and diabetes.
They include how medical practitioners are trained and supported, how patients are supported more holistically, how bodies and body parts are conceived of, made use of, and disposed of, how new ways of understanding mind and body are informing the humanities, as well as public understandings of self and other more generally.
Using a “stream”-based format, the recent conference was designed to facilitate in-depth engagement around core themes in the medical humanities, and to form potential research clusters.
The four cross-disciplinary streams were: paradigms, pedagogies, practices and potential. Each stream involved participants who met for the duration of the two-day conference.
Healing and the human
The paradigms stream tackled questions about what informs how we think, speak and act in relation to health, medicine, the body, healing and the human.
We also explored the diverse forms of thinking we each bring to the medical humanities table, asking: What are the medical humanities? What are the medical humanities in Africa, and are they different from elsewhere? What kind of paradigm does the medical humanities offer for knowing about and acting in the world, for navigating suffering and joy, health and debilitation, in body, mind and spirit?
This stream invited provocations and reflections on ways of understanding how the medical humanities have been framed, what they are and what they might one day become. We were interested in thinking about how this transdisciplinary space of medical humanities might be understood as both a local project, with local actors, agendas and perspectives, and as part of a broader global effort to bring together fields of experience and knowledge that have historically been forced apart.
Participants in the paradigms stream included students, doctors, public health researchers, historians, anthropologists, writers, ecologists, biologists, musicians, botanists, gynaecologists, sport scientists and poets. During the two days of discussion that ranged from tuberculosis masks to herbal healing traditions, a few key themes emerged.
One was the tension between our goal of building medical humanities in Africa as part of the bigger project of developing “theory from the South”, and the complexities of speaking to, for or about “the African”, especially from positions of relative privilege in South Africa.
Another theme involved the powerful ways in which the dominant forms of teaching and of producing evidence determine the ways in which healing is performed and experienced, and the difficulties in shifting these habits.
Finally, we discussed the need for medicine and the medical humanities also to move “beyond the crisis” and better address the daily, the chronic and the mundane aspects of our lives that shape our wellbeing and our thriving in the world as much as emergencies and epidemics do.
Building the medical humanities in Africa will require revising the way health sciences and the humanities are introduced to undergraduate and postgraduate students.
For instance, the recent appointment of medical historian Dr Carla Tsampiras in the health science faculty at UCT will help to ground students in the historical and political context of medicine and medical practice.
The pedagogies stream explored imaginative ways of teaching at the crossroads of medicine, the arts and the social sciences.
As philosopher of education Karin Murris argued, we as teachers need to acknowledge the ways in which we contribute to “epistemic injustice”, whereby one discipline claims authority over another. She argued that, in educating young people, we need to move towards “epistemic modesty” across the fields.
Across the stream, this emerged as requiring transgressive methods of teaching, such as using peer narratives to prepare students psychologically for the shock and intensity of their first labour ward experience.
In her paper The Rocky Horror Labour Ward, Dr Chivaugn Gordon outlined her transgressive use of “in your face” pictures, audio and videos to insult the senses of students and to produce emotional discomfort.
Connected was the notion of how to facilitate (not necessarily teach) those rituals of transformation that are not damaging to the students or us as teachers, and all felt discomfort was a productive pedagogical technique.
Finally, there was consensus that we needed to step away from a deficiency model that hinges on the idea that you can train better doctors by adding and stirring in the humanities. This was described by one participant as the “masala approach”, which should be replaced by the kinds of innovative programmes in transdisciplinary health and development studies on offer at Stellenbosch University from 2015.
In the practice stream, we considered what difference the humanities make to the practice of healthcare in our context. Specific processes and tools for expression were presented through the fascinating provocations in this stream, including narratives, heritage, storytelling, objects, body mapping, “embodied imagination”, music, visual art, photography, movement, radio and memory work.
The intention of or motivation for the practice of these methods of expression are varied, and include advocacy, research, healing, education and art.
Creative narrative involves a process of storytelling and witnessing, which allows for a reimagination and healing process to occur, sometimes collectively. Stories are authentic, complex and ongoing, and rely on memory. They are based on a dialogue, but the ownership of the story rests with the storyteller, for whom power and vulnerability are involved.
Interdisciplinary collaboration depends on a balance between theory and research (as seen in universities) on the one hand, and practice (as seen in nongovernmental organisations and individual practitioners) on the other.
University-based projects attempt to address societal issues, but are often slowed by ethics procedures. Processes that bring the two worlds together include the development of a common language and discourse, and a capacity for reflexivity.
The Medical Humanities in Africa conference marked a significant step forward for “theory from the South”, speaking to the collective humanising of health and healthcare practice that is a mark of the African experience.
Creating an interdisciplinary space that balances the need for all participants to feel equally comfortable and uncomfortable, while maintaining the disciplinary rigour that generates robust critique and creates a new discourse, is a difficult task. But it is an exciting space, and there now seems to be a sufficient critical mass to maintain the momentum of development of the field.
Dr Susan Levine is a senior lecturer in the school of African and gender studies, anthropology and linguistics at the University of Cape Town, Professor Steve Reid is director of primary healthcare in UCT’s faculty of health sciences and Dr Christopher J Colvin is head of the division of social and behavioural sciences in UCT’s school of public health and family medicine.