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Literature, Photography, and Social Justice in Medicine

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Literature, Photography, and Social Justice in Medicine Martin Donohoe G nter Grass The first job of a citizen is to keep your mouth open. – PowerPoint PPT presentation

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Title: 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 worlds 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 civilizations
    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 youre doing. It shows you
    possibilities you havent thought of. It enables
    you to live the lives of other peopleIt 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 19824(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-America
ns
  • 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 2004942078-2081

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. Martins
    Press, 1993.

30
Jacob Riis
31
Dorothea Lange
32
The State of U.S. Health Care
  • 51 million uninsured patients
  • 51,000 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 Columbus Upon meeting the Arawaks of
the Bahamas
  • Theybrought usmanythingsThey willingly
    traded everything they ownedThey do not bear
    armsThey would make fine servantsWith fifty men
    we could subjugate them all and make them do
    whatever we want.

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Josef Stalin
  • The death of one man is a tragedy. The death of
    millions is a statistic.

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Horace Odes (III.2.13)
  • Dulce et decorum est pro patria mori
  • It is sweet and fitting to die for ones country

63
"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

64
"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.

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2012 U.S. Federal Discretionary Spending
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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.

69
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.

70
Martin Luther King, Jr.
  • Darkness cannot drive out darkness only light
    can do that. Hate cannot drive out hate only
    love can do that.

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  • W Eugene Smiths Photos of Minimata Disease

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  • More W Eugene Smith Photos

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Sebastiao Salgado Photos
  • Gold Mining

87
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.

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Advice for Students
  • 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

97
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.

98
Günter Grass
  • The first job of a citizen is to keep your mouth
    open.

99
African Proverb
  • "If you think you are too small to have an
    impact, try going to bed with a mosquito in your
    tent"

100
  • Public Health and Social Justice Website and Book
  • http//www.publichealthandsocialjustice.org
  • http//www.phsj.org
  • martindonohoe_at_phsj.org
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