Using Literature and Photography to Teach Social

Justice and Encourage Activism for Public Health

Martin Donohoe

Medicine and Public Health

• Schism between the fields• Witnessed victims vs. “statistical” victims• Medical ethics / public health ethics• Activism

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.”

Martin Luther King

“Injustice anywhere is a threat to justice everywhere”

Important Historical Figures in Medicine/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 Medicine/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 Historical Figures in Medicine/Public Health and Social Justice

• 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…”

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

Why Use Literature

• Encourage appreciation of non-medical literature

• Develop reading, analytical, speaking and writing skills

• Promote ethical thinking (narrative ethics)• Identification with doctor authors (e.g., Keats,

Chekhov, Maugham, Williams)

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.

Readings

• Oliver St John Gogarty• Keats• Chekhov• Maugham• WC Williams

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

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.

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)

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.

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.

“Mother’s Day Proclamation, 1870”Julia Ward Howe

Arise then...women of this day!Arise, all women who have hearts!…Say firmly:"We will not have questions answered by irrelevant agencies,Our husbands will not come to us, reeking with carnage,For caresses and applause.

“Mother’s Day Proclamation, 1870”Julia Ward Howe

Our sons shall not be taken from us to unlearnAll that we have been able to teach them of charity, mercy and patience.”…From the bosom of a devastated Earth a voice goes up withOur own. It says: "Disarm! Disarm!

“Mother’s Day Proclamation, 1870”Julia Ward Howe

Let women……promote the alliance of the different nationalities,The amicable settlement of international questions,The great and general interests of peace.

W Eugene Smith’s Photos of Minimata

Disease

More W Eugene Smith Photos

Sebastiao SalgadoPhotos

Gold Mining

Suggestions

• Use literary selections, photography, and art in courses and community work–Interdisciplinary education

• Share stories with colleagues, patients/clients

Suggestions

• Create dedicated reading and writing groups, art groups• Comedy• Encourage conferences• Read activist journals

“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.”

Anita Roddick

"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.orgmartindonohoe@phsj.org