Using Literature and
Photography to Teach Social
Justice and Encourage
Activism for Public Health
Martin Donohoe
Medicine and Public Health
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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
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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
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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 Columbus
Upon 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 unlearn
All that we have been able to teach them of
charity, mercy and patience.”
…
From the bosom of a devastated Earth a voice
goes up with
Our 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 Salgado
Photos
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.org
martindonohoe@phsj.org