Tag: health humanities

Creating Change

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Part of the timeline of slavery, racism and related issues. On the wall at entrance to UW Hogness Auditorium for the Health Sciences Service-Learning and Advocacy/Common Book Kick-off event, 10-6-15.

This past week at the University of Washington Health Sciences Common Book kick-off event, I heard a moving speech by Benjamin Danielson, MD. Dr. Danielson is Medical Director at Odessa Brown Children’s Clinic, a Seattle Children’s community-based clinic in Seattle’s Central District, an area which because of ‘redlining’/racial segregation in Seattle’s history, had been a predominantly black neighborhood. (see the excellent short video “A Really Nice Place to Live” by Shaun Scott). Odessa Brown is co-located in a building with its sister clinic, Carolyn Downs Family Medical Center, a clinic I worked at for five or six years. I had the pleasure of working with Dr. Danielson while coordinating care for a teen with sickle-cell anemia, and I know first-hand what an exquisitely competent and compassionate physician he is. But this week was the first time I’d witnessed his powerful public speaking abilities.

Our UW Health Sciences Common Book this year is Michelle Alexander’s The New Jim Crow: Mass Incarceration in the Time of Colorblindness (The New Press, 2010). This is the fourth year we have had a UW Health Sciences Common Book, with interprofessional activities based on the book’s theme interspersed throughout the academic year. Previous books have been Anne Fadiman’s The Spirit Catches You and You Fall Down (a classic if not a bit ‘overdone’ by now), Gabor Mate’s In the Realm of the Hungry Ghosts: Close Encounters with Addiction (great topic but his book is in need of heavy editing–he rambles), and last year’s book was Seth Holmes’ Fresh Fruit, Broken Bodies: Migrant Farmworkers in the United States (great topic but read like a doctoral dissertation–which it was). The New Jim Crow is written in an accessible, non-academic and powerful style, and is, of course, on a painfully current topic in the U.S. and one pertinent to health care inequities: racism.

Dr. Danielson started his talk by acknowledging the history of the Central District where he works, and the ‘strong black women,’ of the neighborhood’s past, Odessa Brown and Carolyn Downs, for whom the two community clinics are named after. Both women advocated for quality and accessible health care for their communities. Odessa Brown, who had experienced racial discrimination in accessing health care, was active in starting a children’s clinic in the Central District before she died at age 49 of leukemia. Kudos to the Odessa Brown Children’s Clinic for including information on Odessa Brown (the woman) on their front webpage, in ‘Our History,’ right under ‘Our Mission.’

Carolyn Downs was part of the Seattle Black Panther movement, who with the financial help from people like Jimi Hendrix and James Brown (both from the Central District), in 1968 opened what was then the first health clinic in the community. Less of her history is included on the webpage for the clinic, but I know from having worked there and taking care of the daughter and granddaughter of Carolyn Downs, that she died young of breast cancer–and at least partially because of disparities in access to breast cancer screening and treatment.

I provide some of the history of both Odessa Brown and Carolyn Downs because I admire the work they did during their too-short lives, and because–as Dr. Danielson said in his speech–this can become another example of “black people being deleted from history.”

What to do about the continued, pervasive, and destructive problem of racism in our society, including in our institutions ranging from prisons to hospitals and clinics? The main message from Dr. Danielson and Michelle Alexander (through her book) is that it will take both individual and collective action for us (for the U.S.) to create positive change. During his talk, Dr. Danielson spoke of using the companion community organizing guide to The New Jim Crow, titled Building a Movement to End the New Jim Crow: An Organizing Guide by Daniel Hunter (Veterans of Hope Project, 2015).

In chapter one of this guide, “Roles in Movement-Building,” Hunter references the terminology used by Bill Moyer in his book Doing Democracy: The MAP Model for Organizing Social Movements (New Society Publishers, 2001) This work divides people’s roles into four main groups: 1) Helpers–direct service providers, 2) Advocates-who work to make systems work better for those in need, 3) Organizers–who bring people together to change systems, and 4) Rebels–who speak truth to power and agitate for radical change. The key is to recognize our own strengths and roles–where we are most comfortable working– but also to see the value in the rage of roles played by different people, because an effective social change movement requires people working in all of these roles.

This is similar to the “Bridging the Gap Between Service, Activism, and Politics” group activity from the Bonner training curriculum that I have used for many years when teaching community health. But (of course!) I like the addition of the category ‘Rebels’ to the mix and plan to add that the next time I use this in teaching.

On a very sobering (as if we weren’t already very sober) note, Dr. Danielson ended his talk Tuesday night by adding that for all the good work and innovative community outreach programs of the Odessa Brown Clinic, he often asks himself if they aren’t keeping children healthy enough that they too can end up in our country’s prison system.

Empowering Healthy Communities Through the Arts

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Mural by a student in the Henderson South Studio MPHS (after-school art program for young people ages 9-18). Photo credit: Josephine Ensign/2015

“Art is the outward manifestation of human experience in the world. Art is necessary for survival. To be human and alive is to be an active art maker. Everything that humans create in their act of living is art.” -Tamati Patuwai, MAD AVE ‘Healthy and Thriving Communities’ Glen Innes, New Zealand

It was a happy accident, an unintended yet very welcome consequence of studying ‘how the Kiwis’ do community health from the ground (literally) up, from the community members’ perspectives. The recent experience has changed how I think about community health, has deepened my respect for the power of art (and libraries) to change lives, and has even altered how I view my own community back home in Seattle.

First, a brief recap of the experience to provide some perspective. What I’m referring to here is the recent University of Washington Study Abroad in New Zealand 5-week immersive program I co-led with Jim Diers, a social worker and internationally-acclaimed community development expert. Here is what our course description said about the study abroad program:

“Empowering Healthy Communities is an interdisciplinary Exploration Seminar in New Zealand, focusing on how various communities organize and advocate for overall health and wellbeing. In this seminar, we will combine community-engaged service-learning, community case studies, readings, reflective writing, student independent projects, and immersive living experiences, to challenge students to think more broadly and creatively about participatory democracy, civic engagement, sustainability, and the social determinants of health. This course is grounded in an international, community-engaged, service-learning format aimed at creating opportunities for transformational student learning. We will address the meanings of ‘diversity’ within global and local communities; issues of power and privilege; social justice; what it means to be civically engaged at the local and global levels; and the tensions and differences between tourism vs. travel, and community service vs. engagement.

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“The Oarsmen” wall mural on K-Road by Miriam Cameron, 2006. Part of the ‘Visual Artists Against Nuclear Arms’ series. “The idea is we’re all in this together.” Photo credit: Josephine Ensign/2015

New Zealand is an ideal location for this Exploration Seminar. The country has a unique blend of indigenous and immigrant cultures, and its people have a rugged, “number eight wire” can-do, and highly creative approach to solving individual and community problems. In 2014, New Zealand ranked number one in the Harvard Business School’s Social Progress Index for overall wellbeing, while the U.S. ranked number sixteen, just above Slovenia. New Zealand spends one-third less per person on health care than we do in the U.S., yet they have much better population health outcomes. How do they do it? That is one of the main questions we will ask and explore through our work and study in New Zealand. In addition, as New Zealand is a world leader in environmental sustainability efforts, we will challenge ourselves to go ‘as green’ as possible: living in youth hostels, recycling, walking and taking public transportation, and eating a mainly vegetarian diet for our group meals.”

As we discussed with the students at the beginning of our program, New Zealand slipped somewhat in the 2015 Social Progress Index, but is still in the top tier/top ten of the 133 countries with sufficient comparison data to include. In 2015 for the ‘Health and Wellness’ category, New Zealand ranked 9th and the U.S. ranked 68th. And somewhat ironically in light of our study abroad program, the U.S. ranks first world-wide in the Access to Advanced Education category, and is weakest in Health and Wellness and Ecosystem Sustainability. I tried to remind students of this fact, especially when some of them grumbled about the vegetarian meals and relying on public transportation.

Using connections through the amazing New-Zealand group Inspiring Communities, we focused our time on a variety of local community groups working to empower and improve the places they call home. The Central Business District/ Karangahape Road in Auckland. The Avondale and Henderson communities on the outskirts of Auckland. Devonport and Waiheke Island, both more affluent communities. The Ruapotaka marae in Glen Innes. Then south to the Wellington area communities of Porirua, Bromphore School, and Epuni. Consistent through all of these communities was an emphasis the community members placed on the use of the arts to catalyze positive change and to enable community wellbeing. That and public libraries, which community members treasured as being the heart and soul and ‘mind food’ of their communities. Places where true democracy happens. Places to “dream up and enact crazy ideas.” Places that nurture “the freedom to change.”

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Mural by schoolchildren at the true ‘community-building’ Berhampore Primary School, Wellington. Photo credit: Josephine Ensign/2015

Art, including literary art, was literally everywhere we turned in these communities. And not just the typical government-sanctioned commissioned public art we are used to seeing in the U.S., but also much more grassroots , low barrier, “anybody can participate” community art shown in my photos in this post.

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A new version of “Girl with Balloon” street art by Bansky. On building on Karangahape (“K-Road”) Road, Auckland. Photo: Josephine Ensign/2015
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P1010020 First photo is of poetry by young people at the Te Oro youth community arts center in Glen Innes. Second photo is a ‘cast off’ (in the trashcan) poem by a rough sleeper/Auckland Central Library ‘Poetry Corner.” Photo credit: Josephine Ensign/2015

This sort of art not only beautified the communities, it also built community identity and promoted wellbeing. Walking around my hometown of Seattle this past week, I’ve been searching for similar sparks of community wellbeing through art and have had a hard time finding them. Yes, we do have some great bus shelter artwork, as well as some building and wall murals–and our public library system has been one of the best in the country (and hopefully will remain so despite a very silly rebranding effort), but I cannot find the same level of  empowering healthy communities through art. Perhaps this is an important ‘take home’ message, one we could use to improve community health and wellbeing in the U.S. More art, less guns.

 

 

The Exquisite Corpse Hits the Hospital

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“Imprint of the Intangible” Mixed media, 2000, Heather Hawley. University of Washington Medical Center.

The exquisite corpse is a French surrealist parlor game named after one of their first nonsensical collaborative sentences, “The exquisite corpse will drink new wine.”  There are written and arts-based (including drawing, collage, sculpture, theater, and dance) versions of the exquisite corpse. They all emphasize elements of unpredictability, collaboration, and tapping into unseen/subconscious sources of creativity. And just plain fun.

This summer I adapted the written version of the exquisite corpse for use in the hospital-based narrative medicine/health humanities course I am teaching. I first had students divide themselves into groups of 4-5 people, each person with a clean piece of paper. Then, I asked them to write one sentence across the top of the paper and base the sentence on one concrete observation about their classroom. I gave them 30 seconds to write the sentence and then asked them to pass their papers to their right. They had another 30 seconds to write a second sentence in response to the first. Before passing the paper again, they were asked to fold down the paper in order to hide the first sentence. We repeated this exercise a total of five times. At the end, they could unfold their papers, read, and share with the class what the group had come up with based on their initial sentence. Much laughter ensued. Then, I had each student write a short reflection on what the experience was like for them.

I learned this classroom version of the exquisite corpse at the 2015 Chuckanut Writers Conference from two writers/creative writing teachers, Brenda Miller and Lee Gulyas, who both teach at Western Washington University in Bellingham. Miller and Gulyas have a recent collaborative essay, “Come Closer,” published in Sweet: A Literary Confection (vol. 7, issue 3, 2015) and an intriguing interview by Carmella Guiol with them about this essay and their collaborative process (July 16, 2015). In their workshop, we were all writers of various sorts, and the prose/poetry pieces our groups came up with were quite funny, creative, and profound.

As were the pieces that my students produced, although they mostly were much more matter-of-fact and not as fanciful as I expected them to be. These were nurses after all–nurses tasked daily with life and death decisions. Flights of fancy and parlor games are typically frowned upon among health care providers. But, since teaching is in itself a creative endeavor, I try to take calculated risks in the classroom and try new things. For this one I’d give myself a B+ for effort.

Feedback from the students (from their written reflections) ranged from, “this felt like a drinking game” (note: no alcohol was consumed in the auditorium as far as I know), through “I don’t understand why we did this exercise,” to perhaps more insightful, critical thinking responses including these:

“Even though we are talking about the same topic we said or have different points of view about our classroom. How we described it is different person-to-person. This is common in workplaces, like when we have to write up patient care plans, we hardly agree on them.”

“I enjoyed the spontaneity of doing this exercise. So much of our class work and assignments has been related to following directions exactly and making sure we are doing everything right.”

“I’m thinking this would be a good tool if I was leading a patient support group or leading a class. Patients with chronic illness get told all the time about what it the right thing to do and this could be used to let them tell their stories a different way.”

In thinking over how this went–my first attempt at doing the exquisite corpse exercise with a group of hospital-based nurses–I’ve realized I probably need to fine tune it for this setting and for these ‘parlor game’ players. Next time I would keep everything the same with the exception of the initial sentence writing prompt. Instead of having them write about their classroom, I’d ask them to write a sentence about a recent frustration at work–and that it can be a minor and seemingly frivolous frustration (in oder to keep it from getting too deeply emotional for this collaborative writing exercise). My aim would be to have it more directly pertinent to their work as nurses, while maintaining the fun, spontaneity, and collaborative nature of the exercise. As physician-educator and innovator in the health humanities Alan Bleakley says, “health humanities creates a serious play space.”

The Art of Nursing

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“Array” 1999, cut and fabricated aluminum, by Irene Pijoan. Harborview Medical Center. Photo credit: Josephine Ensign /2015.

Entering week seven of a nine week narrative medicine/health humanities course I’m teaching to a group of nurses at Harborview Medical Center. This is my third summer teaching this course, but my first time teaching it in a hospital setting. This is also the first time I have taught it to a class of experienced and currently working RNs.

I’ve always focused on introducing students to the practice of narrative medicine, of learning to apply Dr. Rita Charon’s close reading drill, and of expanding that to include my ‘closer close reading drill‘ to various forms of literature. This year I kept those elements, but have added art to the course.

It helps that we are surrounded by amazing artwork throughout the Harborview Medical Center complex. Even in (and outside of) the otherwise functional-looking Research and Training Building where our classroom is located, there are the art installations shown in these photographs. “Array”depicts cerebellar neurons, tied to a Harborview research emphasis of neurology and also “metaphorically mimics the scientific process itself”–according to the placard beside this piece. At the building’s entrance is “Integument” representing the leadership of Harborview in the treatment of burns and trauma. And, according to the placard, “The integument motif also metaphorically references the cutting through the outermost surface of the building, implying that it too functions as an extended body.”

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“Integument” 1999, cut and fabricated aluminum, by Irene Pijoan. Harborview Medical Center. Photo credit: Josephine Ensign/2015.

As part of their small group presentations on topics such as death/dying, disability, and racism in health care, I have students include a piece of Harborview art that speaks to them about some aspect of their topic for their class presentation. I also had my colleague, poet, psychotherapist, and educator Suzanne Edison lead the class in an exploration of ekphrastic poetry.

While the students have been open to the inclusion of art in this health humanities course, there is one in-class art activity I added this year that seems to have engaged them the most. It was a blind contour drawing activity that I learned from Drs. Catherine Belling and Martha Stoddard Holmes in a workshop at the Health Humanities: The Next Decade conference this past May at the University of Colorado Center for Bioethics and Humanities. As Belling and Holmes pointed out, this activity includes art (the doing/drawing) and humanities (refection/writing).

Here’s how it works: 1) have students pair up and sit face-to-face, 2) each student has a blank piece of paper and a pen/pencil, 3) each student looks at their partner’s face for two minutes, while drawing their face on their paper–without looking down at the paper, 4) after drawing (and laughing) and then showing their portraits to their partner, each student writes for 4-5 minutes–reflecting on what the experience was like for them, and exploring whether they were more more uncomfortable being observed or doing the observing–and why.

This in-class activity led to much laughter, but also to a rich class discussion of the experience and its connections to their work as nurses. The best kind of classroom learning activity: fun, engaging, profound.

Just Like Us

IMG_4517This was the first in my summer reading challenge (with a health humanities/social justice slant): Just Like Us: The True Story of Four Mexican Girls Coming of Age in America, by Helen Thorpe (Scribner, 2009). I ran across this book last month at Denver’s lovely downtown ‘LoDo’ Tattered Cover Bookstore (a highly recommended indie bookstore). I asked the helpful information desk woman to direct me to books by local authors, and this was one she recommended.

I give it a one (sunny peace symbol) out of five–also known as ‘I did not like it.’ While it is generally well written, I found it to be too superficial in its treatment of the complex issue of immigration. At one point in the book, Thorpe likens her struggles to be taken seriously as a journalist (while being known mainly as the wife of the Mayor of Denver) with the Mexican young women’s struggles to assimilate to life in the United States. Really? How did that statement get past the book’s editors? In addition, the author lost credibility to me when she admitted to not speaking or understanding Spanish, when the families of the four girls she highlights in the book are mono-lingual Spanish-speaking.

Summer Reading Challenge with a Health Humanities/Social Justice Slant

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Bookshelf at the Green Dragon Inn, Hobbiton

Time for some serious summertime reading. Time to join in on the ‘summer reading challenge’ as posted by one of our PNW writers, Oliver de la Paz (a wonderful poet). He has the full list of reading challenge criteria on his blog post, along with his own summer reading list. And for more ideas, one of my current writing teachers/mentors, Wendy Call, has her summer reading list posted here. My own list is slanted towards topics having to do with health humanities and social justice. I realize they aren’t exactly ‘light’ summertime reading, but what can I say…Here is my current reading list (with the last three books being ‘borrowed’ from his list):

  • The New Jim Crow: Mass Incarceration in the Age of Colorblindness by Michelle Alexander (This is our University of Washington Health Sciences Common Book for academic year 2015/16).
  • The Politics of Aesthetics, by Jacques Ranciere
  • Capital in the 21st Century, by Thomas Piketty
  • The Aesthetics of Resistance, by Peter Weiss
  • Raw Data is an Oxymoron, by Lisa Gitelman
  • On Such a Full Sea, by Chang-rae Lee
  • The Bladerunner (book–not the movie one) by Alan Nouse
  • Intern, by Doctor X (Alan Nouse)
  • Urban Alchemy: Restoring Joy in America’s Sorted-Out Cities, by Mindy Thompson Fullilove (lovely last name!)
  • Just Like Us: The True Story of Four Mexican Girls Coming of Age in America, by Helen Thorpe (currently reading this one)
  • Graphic Medicine Manifesto, by MK Czerwiec, et al.
  • Mirrors: Stories of Almost Everyone, by Eduardo Galeano
  • All the Light We Cannot See, by Anthony Doerr
  • On Looking, by Lia Purpura
  • Rivers of Shadows, by Rebecca Solnit

The Color of Hospitals

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Detail from “The Truth and Nothing But the Truth” mixed media installation, 1989, Gayle Bard. Main lobby of the University of Washington Medical Center.

What is the color of hospitals? For most people it’s that peculiar, putrid-green of hospitals we now associate with the movie One Flew Over the Cuckoo’s Nest and other nightmarish, disorienting places of illness, distress, disease, and death. The fact that Martha Stewart has revived the shade, renaming it ‘Sea Glass Green,’ and making it oh-so-hip-retro mixed with ‘Jadeite’ green, doesn’t make it much better.

I did a bit of historical research into ‘hospital green’ for an essay I am writing called ‘Medical Maze,’ about the disorientation caused by our modern health care system for patients, families, staff, and students. Over my years working and teaching and researching within health care, I had heard rumors now and then that the hospital green had something to do with blood. Turns out, these rumors were correct.

Much of our modern health care system–especially the growth and technological advances within health care–come from wars. Hospital green, originally called ‘spinach green,’  was invented during WWI by the American surgeon Harry Sherman. At the time, most all surfaces of hospitals and clinics were painted white, the color associated with purity and cleanliness. Dr. Sherman, who was busy doing numerous surgeries in St. Luke’s San Francisco hospital, found the contrast of blood against the white sheets and walls and staff uniforms to be too glaring. He couldn’t discern the fine detail of the anatomy of patients necessary for successful surgeries. So, using color theory, he experimented with different colors and in 1914 he came up with the ‘spinach green’ as a complement to blood red. He convinced the hospital to help him create a totally green operating room–walls, sheets, and the surgeon’s uniforms. I imagine though, that the St. Luke’s nurses kept their white hats and uniforms. The ‘spinach’ hospital green quickly spread to other hospitals across North America.

At around the same time, the East Coast-based hospital architect, William Ludlow, also advocated the use of ‘calming green’ within hospitals, as well as other ‘colors of nature’ including “…the glorious golden yellow of sunshine.” (Note, this is not the sickly jaundiced yellow of the hospital and health sciences complex I currently work in.) Reading some of what Ludlow wrote about hospitals, I’ve discovered a strong liking for the man. In an article he wrote in 1918 in The Modern Hospital, he states, “the word ‘hospital’ brings to mind a huge caravanary of austere aspect without and glaring white sterility within, a pile without cheer and without welcome.” He goes on to point out that hospitals at the time were built around the mass casualty wartime hospital model, and thus were not designed with individual health and well-being in mind. The title of his article (and speech before the Twentieth Annual American Hospital Association meeting) was: “In Time of War Prepare for Peace–War Time Psychology Forced Us to Think of Men In Terms of Groups, But it is Individual Soul That Counts In Every Sphere–Including Hospitals.”

 

Crip Time Lessons

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“On Listening to Wagner” collagraph by Ruth Singley Ensign, 1983

True confession: I had no idea what ‘crip time’ meant until I heard the term used in the recent International Health Humanities Conference plenary session response by David Serlin, Associate Professor of Communication and Science Studies at University of California, San Diego. I wasn’t sure I heard him correctly, and wrote down ‘crypt time or crib time or crip time”‘ in my notes.

From the context within which he used the term, I figured out that it was crip time, as in ‘crippled time,’ a term used within disability studies. Serlin used crip time almost interchangeably with the more familiar (and to me, overused) term ‘slow time.’ The Australian disability rights advocate Anne McDonald wrote this beautiful passage to describe crip time:

I live life in  slow motion. The world I live in is one where my thoughts are as quick as anyone’s, my movements are weak and erratic, and my talk is slower than a snail in quicksand. I have cerebral palsy, I can’t walk or talk, I use an alphabet board, and I communicate at the rate of 450 words an hour compared to your 150 words in a minute – twenty times as slow. A slow world would be my heaven. I am forced to live in your world, a fast hard one. If slow rays flew from me I would be able to live in this world. I need to speed up, or you need to slow down. ~from the Anne McDonald Centre website.

Serlin also spoke of the ‘non-modal subject’ and challenged the linearity that is built into academia. That last point I can relate to, what with our straight railroad ‘tenure tracks,’ our straight and largely isolated/isolating silos of academic disciplines, and our straight and bewilderingly complex academic buildings and medical centers. And I can wax ranting-ly lyrical on the proliferation of the straight-laced Microsoft PowerPoint slide decks used in teaching and in presenting academic research. Serlin did begin his talk by stating that “PowerPoint corrupts absolutely,” although he then used PowerPoint slides…

The non-modal subject, as in the outliers, the freaks, the ‘not normals,’ the ‘not averages’–where do they fit within all of this and what lessons can they teach those of us who ‘pass’ as normals? Because, we should remember, that we are all either disabled or ‘not yet’ disabled in one form or another.

~note: “On Listening to Wagner,” the collograph by my artist mother, Ruth Singley Ensign, is a representation of some of her synesthesia (‘colored hearing’), a perceptual condition of mixed sensations. A handicap or a gift?

Watching the Corn Grow: Health Care in America’s Rural Heartland

IMG_4416Rural health care is an important and oftentimes overlooked topic in discussions of health policy. It is also a sorely neglected topic within the education of health professions students. Since all the major academic medical centers in the U.S. are by necessity located in larger urban areas, the course content and clinical rotations for health science students focus on the urban or suburban health care contexts. Also, as a colleague of mine pointed out recently, any health researcher/academic wanting to focus on rural health would be committing career suicide. That reminded me of what an academic advisor told me early in my career–that focusing on the health of people experiencing homelessness was a dead-end career move. News alert: no one in positions of power and privilege (including NIH grant reviewers) really care about health issues of marginalized people. Perhaps my advisor was right, but I’m glad I didn’t listen to her.

Ignore your roots at your own peril! I grew up in rural Virginia, in a house on a dirt road that was connected to a dirt ‘rural route’ road with no name. In a house with no curtains on the windows since the nearest neighbor lived several miles away. In a house surrounded by woods and corn fields. I got my occasional health care from a country doctor in his country clinic with its 1940s-era medical equipment. Not unlike many young people who grow up in more isolated rural areas, I could not wait for the day I could ‘legally’ move to a city and never look back at what I saw as the stiflingly -limited scope of rural living. Backwards and bucolic. ‘Watching the corn grow,’ as my city friends used to tease me. Rural areas anywhere in the world are, to me, both of these because they are typically socially and politically conservative, as well as being in lovely and peaceful settings.

Imagine my surprise yesterday when I accompanied an interprofessional health sciences rural health course student field trip to the rural hinterlands of Eastern Washington. I try to challenge myself to go outside my comfort zone on occasion, and yesterday was one of those times. In the twenty or so years I have lived and worked in Seattle, I have only ventured east of the Cascades (within my state) once before, and that was just barely over ‘the Pass’ in Ellensburg for a public health Medical Spanish intensive course. Yesterday we visited several community health clinics, a public health clinic, and a community ‘critical access’ hospital in the tiny crossroads towns of Mattawa (supposedly an Indian word for “where is it?” population: 4,437 ) and Othello (population: 7,364). These were both dusty, semi-arid, almost desert places where I expected tumbleweeds to blow through town along with Wild-West shootouts.

‘Downtown’ Mattawah, Washington

 

But here, in the middle of this dusty, no-stoplight, tiny town of Mattawa, was this gorgeous state-of-the-art, wrap-around, one-stop shopping, culturally-relevant clinic, Wahluke Family Clinic, part of the Columbia Basin Health Association. The Association’s motto is “Keeping healthy those who feed the world.” The outside/front entrance of the Wahluke Family Clinic:

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And the front desk/lobby/check-in area of the clinic: IMG_4387 (1)

 

A tour of the clinic, which has an amazing array of primary health care services including family medicine (physicians, physician assistants, nurse practitioners, RNs), dental/orthodontics, vision care, behavioral health (mental health and chemical dependency services), diabetic footcare/shoes, pharmacy services (including delivery and a drive-through pharmacy), all under one gorgeous roof, with clean, lovely-decorated facilities throughout, a rooftop, sunny staff lunch/break-room and outdoor patio, a fully-equipped indoor gym for all staff members, and original artwork throughout. It all felt unreal, like, really? is this how primary healthcare can be? and wait! this is part of our safety-net health care system, since they are a community health clinic with federal funding, and serving primarily a Spanish-speaking migrant farm worker and lower-income rural population. Plus, it is out in the middle of nowhere.

Besides the dizzying array of health care services, what most impressed me about this clinic (and its linked clinics in nearby Othello), was the attention to the aesthetics of the patient areas, with use of original artwork, seemingly by Hispanic/Latino artists–such as the one in the first photo included in this post.

In stark contrast, were these patient care hallways (mental health services at the Adams County/Othello Public Health Department–why does public health have to be so perpetually, well, frumpy and unappealing?): IMG_4422

and this (is it really even artwork?) hanging on the walls of the small community hospital in Othello (with 90% of its patients being Latina women giving birth):IMG_4426

 

 

 

 

Although I realize I do not know enough about the health care in these small towns/rural areas, I wonder if the quality/cultural appropriateness of a clinic or hospital’s artwork is a good indicator of the facility’s overall healthcare quality. Perhaps in addition to Dr. Paul Farmer’s two indicators of healthcare quality–gardens and bathrooms–could be added artwork/general aesthetics.

I’m not planning to move back to a rural area anytime soon, but after yesterday’s field trip with health science students, I have a greater appreciation of what well-run community-based primary care services in rural areas can look like.

The Ugly Underbelly of the Health Humanities

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“Release Your Plans” oil on canvas by Denver-based artist Daniel Spricks.

Ugly, as in ‘unpleasantly suggestive, causing disquiet, likely to involve violence of some sort, repulsive.’ Underbelly, as in ‘beneath the surface, hidden, vulnerable, corrupt, sordid.’ Health humanities, as in the relatively new transdisciplinary field linking the arts and humanities with health and healthcare. Health humanities is both the term and the international movement intended to widen the more traditional field of medical humanities with its focus on physician practice and physician education. (See The International Health Humanities Network for more information.)

I have just returned to my life in Seattle after four days in Denver spent pondering the ugly underbelly of the health humanities. I was a participant-observer at the 4th Annual International Health Humanities conference, Health Humanities: The Next Decade, held at the University of Colorado School of Medicine Center for Bioethics and Humanities. The stated purpose of the conference was to “…bring together scholars, educators, clinicians, health advocates, students, patients and caregivers in an effort to identify the core issues and guiding values as well as define the expanding scope of the health humanities.”

Out of 100 or so conference participants, I believe I was one of only three nurses. Professor David Flood from the College of Nursing and Health Professions at Drexel University served as a conference committee member, but there were no nurses (unless they were deeply closeted nurses) who presented at the conference. The third nurse was Jamie Shirley, PhD, a terrific nurse ethicist and lecturer at the University of Washington Bothell campus. At the risk of adding to the tiresome ‘whiny nurse syndrome/trope in academese,’ I can’t help asking, “Where were the nurses?” As this was hands-down the best, most thought-provoking conference I’ve ever been to–and was, correctly I think, proclaimed as a historic conference with far-reaching consequences–why weren’t there more nurses at ‘this table?’

What I most loved about the conference was that the planners, speakers, and participants all openly acknowledged and explored the ugly underbelly of the health humanities. Not just who/what groups of people are included and excluded within the theory and practice (and international conference) of the health humanities, but other and perhaps more uncomfortable questions, such as:

By attempting to train medical, nursing, and other healthcare professions students in ‘narrative competence,’ are we turning this into yet another skill to include on a checklist? (The ‘tyranny of competencies’ as it has been called.) And, as Katie Watson, JD of Northwestern University Feinberg School of Medicine pointed out in a session on narrative advocacy, is a focus on narrative competence ignoring the fact that perhaps this is intrusive, itself a form of violation–of violence? Do we as teachers of the health humanities understand what it costs our students (as well as ourselves) to be opened up/made more vulnerable to the emotional pain of patients, of families, of communities, and of the world? Do we do enough to help our students ‘learn how to carry’ (or perhaps how to carry and then let go of) traumatic patient/community stories? Where does the ‘enterprise of narrative medicine’ fit within the health humanities? What are the professional consequences of doing radical art, radical writing, radical practice, and I’d add, radical teaching? By attempting to widen medical humanities to health humanities, are we adding to the cult of healthism?

And an ‘ugly underbelly’ question that I asked in a session yesterday (when I stepped outside of my observer role): why is religion/spirituality seemingly a taboo topic within the health humanities? Throughout the conference people tip-toed around religion and spirituality. Don’t people see that the privileging of secular humanism, the marginalizing–or worse, belittling–the role of religion and spirituality within our world, within healthcare practices, within health policy, within our own lives, is a grave danger? I’m not referring to a grave danger to our ‘souls,’ whatever that may mean, but rather to our lives together in communities, to the common good, to the civil discourse necessary for democracy.