Called to Be: Health & Environment

Title:The power of lore

Author: Jane Varner Malhotra
Date Published: July 11, 2024

A new collaboration between Georgetown and Howard universities offers a path toward health justice through the medical humanities

Stories about birth are as old as humanity itself. They are universal, crossing every culture as they mark the breathtaking beginnings of new life. People tell these tales, from celebratory to tragic, as lessons, historic markers, memorable moments to help us understand the human condition. The accumulation of storytelling holds wisdom. Can this lore guide and improve health care?

After a traumatic experience with her first birth, Imani Cabassa-George knew she wanted to do things differently for her second one.

“The first time, I was in labor for 36 hours and it ended with an emergency C-section,” she recalls. The next time, she enlisted the help of a doula, who brought alternative pain relief methods and comforts like soothing aromatic oils to counter the normal hospital smells. The doula also helped Cabassa-George advocate for herself during labor, reminding her that she could ask medical providers to step out of the room when needed so that she and her husband could speak privately.

“I’m extremely thankful for doulas and doula programs that help Black women and any women navigate uncertainty in birth,” says Cabassa-George, who identifies as Afro-Latina.

Last year she served as the first graduate research assistant for the newly founded Georgetown–Howard Center for Medical Humanities and Health Justice (MHHJ). The unique center formed by the two Washington, DC, universities launched in 2023 with a 3.5-year, $3 million grant from the Mellon Foundation, which supports communities through the arts and humanities. The center seeks to reduce health disparities in Washington by leveraging the critical inquiry methods at the heart of the humanities.

A Ph.D. candidate in Howard University’s Communication, Culture, and Media Studies program, Cabassa-George was a perfect fit for her new role with the center. “I was extremely interested because medical humanities involves storytelling. As a communications scholar, the combination of storytelling and health is important to me.”

Her research looks at how Black women use social media and storytelling to prioritize Black maternal health. High maternal mortality rates for Black women have plagued the nation—and the Washington, DC, area in particular—for decades, and Cabassa-George sees the potential for digital communities to help make a difference. Whereas in the past, people might have sat around the hearth or the well to share their birth stories, today many people are finding community online and swapping wisdom there, wisdom that can be lifesaving.

“I’m really interested in the agency that Black women use to navigate the maternal health crisis,” she says. “A lot of times, we hear stories about how providers just aren’t listening to Black women. There’s a lot of systemic injustice behind this problem. But also we’ve seen a lot of Black women take agency over their situation by turning to social media for answers.”

Storytelling in the virtual sphere can have a major impact on health care, she notes.

“This is where digital humanities and storytelling come in. You see Black women going to social media and saying, ‘Hey, this is what happened with me and my provider. And here’s how I navigated the situation.’ These instances are really powerful for Black women, offering alternative birthing practices, and giving them what they need to face the uncertainties of maternal health.”

Lakshmi Krishnan, M.D., Ph.D. (left) and Dana Williams, Ph.D. (right)
Dana Williams, Ph.D. (left) and Lakshmi Krishnan, M.D., Ph.D. (right)

Partnering beyond the clinic doors

The field of medical humanities emerged on medical school campuses in the 1960s as a way to humanize what had become in many cases an overly clinical relationship between patient and physician. Since then the goals of the medical humanities have broadened, bringing together a variety of disciplines to offer a different, more complete picture of what is going on in health and health care. Medical humanities aims to understand health and medicine in a wide social, cultural, and historical context, through the lenses of ethics, philosophy, history, literature, cultural studies, religion, psychology, medical anthropology, and the visual and performing arts.

“Medical humanities is a field that teaches us that health and health care do not begin and end in the clinic or at the hospital doors,” says Lakshmi Krishnan, co-executive director of the center and founding director of the Georgetown Medical Humanities Initiative. “Health touches every aspect of our lives, and the medical humanities help make meaning out of that.”

A Georgetown University professor who specializes in cultural history of medicine and a board-certified physician in internal medicine, Krishnan co-leads the new center with Dana Williams, Howard University professor of African American literature and dean of the Graduate School. The two executive directors of the center were introduced several years ago by a mutual friend, and as humanities scholars they felt an immediate connection through personal and professional interests. A 30-minute meeting became a two-hour conversation as they shared stories of everything from literature to health care challenges faced by friends and family to the history of medicine uncovered in their archival work.

Soon after this memorable meeting, Williams invited Krishnan to participate in an annual Howard event called Disciplines in Dialogue.

“Health touches every aspect of our lives, and the medical humanities help make meaning out of that.”

—Lakshmi Krishnan, M.D., Ph.D.

“We intentionally put the STEM folks in conversation with the humanities folks, to mix things up,” says Williams. With interdisciplinarity at the heart of medical humanities, the successful event deepened the pair’s commitment to keep the channels open and see what would unfold. When last year’s Mellon Grant opportunity emerged, they knew that through their friendship and shared expertise and values, there would be a way to build something transformative.

“Given her background in literature and medicine, it was a no-brainer for me to work with her on this project,” notes Williams, a former English professor. “We also share an interest in archive and narrative medicine and diagnoses. I knew we could make a difference in the way that people think about health and health justice. In that first conversation, we shared stories that were familiar in terms of misdiagnoses and delayed diagnoses. Often health providers are not informed enough by culture and by an understanding of how to take all people seriously.”

An important aspect of the MHHJ is impact. The co-founders and their teams are looking to understand and solve health problems creatively through the medical humanities, which is why “health justice” is part of the organization’s name. The center focuses in particular on health in Washington, DC, where the need is great.

“We’ve got a limited amount of time and multiple obligations,” says Williams. “So we picked the thing that will impact the people who need it most. We can’t think about the whole world’s health problems. But we see DC as a good example of what’s possible for a localized community. What are the data sets? What’s the methodology that you can use to begin to solve these problems? And for us it’s important for it to be transferable.”

Imani Cabassa-George, MPH
Imani Cabassa-George, MPH

A model for collaboration

The center hopes similar collaborations can be duplicated in other places, and the staff is carefully documenting how they are establishing themselves to help make this possible.

Neither university is predominant; both are equal participating partners in the collaboration. Some team members are employed through Georgetown and some through Howard, which ensures a balance between schools, Williams explains. The grant was divided equally. Each university offers four types of fellowships annually—community, postdoctoral, graduate, and faculty. Linking the two universities, the unique endeavor focuses on reducing health disparities in DC and the surrounding area by leveraging the strengths of and differences between Howard, an historically Black college or university (HBCU), and Georgetown, a predominantly white institution (PWI).

“What does it mean for an HBCU and a PWI to be in conversation, both schools having med schools, both places having changing demographics, both places grappling with the changes in medicine?” Williams asks. In conversation with the Mellon Foundation through multiple iterations, the codirectors determined that an impact could be made through undergraduate education and medical schools. “Working on the grant forced us to sit and have that conversation to think about it structurally,” she says.

“A big part of what we see the center doing is putting together all of those people, all of those disciplines, all of those communities, all of those traditional and non-traditional aspects of wellness,” Williams adds. “We see ourselves as a confederating space. How do we put all of those aspects together and then make better health decisions?”

Georgetown currently offers a medical humanities minor, and Howard is setting up an interdisciplinary major in the field. The center is developing parallel undergraduate courses at the two universities with a potential for overlapping sessions held both virtually and at Georgetown’s Capitol Campus.

“Our downtown location is ideal for bringing together students from both Hilltops–Howard’s and Georgetown’s,” explains Alisa Byers, chief of staff at the MHHJ.

Students are involved with an ambassador program, assisting in the center’s communications, project management, research, and grant work. Faculty serve as research mentors and ambassadors as well, with 40 affiliated faculty members and university leadership from across disciplines at both institutions. An advisory board includes leaders from the DC area’s media and arts communities, as well as faculty and leadership from Georgetown and Howard’s schools of health and medicine. Coordination between the two universities is critical to the success of the joint venture.

“We want to make sure we operate as ONE,” Byers underscores.

DC lore

This year the MHHJ is hosting events and establishing fellowships for faculty, graduate students, and community members to develop and present projects around the theme of lore: uncovering and understanding the collective, generational wisdom around health in the community.

The center describes lore as that which is taught, and notes that lore contains “serious commentary, vital information, wit, imagination, and wonder.” These latter attributes are not normally associated with Western medicine, but the MHHJ makes the case that they are critical to community health and well-being.

“Sometimes we, as health care providers, dismiss this idea of lore or stories as being not scientific or not evidence-based,” says Krishnan. “And the point we are making is that lore absolutely constructs our reality, constructs our meanings. Lore is evidence.”

“And if anyone says that health care professionals don’t have lore, they’re lying,” she laughs. “We talk, and we have stories.”

To explore this topic with a health justice focus on the local community, the center asks, “What record does lore create and keep? How does lore influence health in Washington, DC, from the way Washingtonians conceptualize the history of health in the District, to stories circulated in communities, to shaping belief systems and health-related behaviors and offering multifaceted approaches to healing?”

Krishnan underscores the importance of health justice for the center.

“I knew we could make a difference in the way that people think about health and health justice.”

—Dana Williams, Ph.D.

“The justice piece is what really drives us; it’s the basis of what we are trying to do with all of our work. Health justice is also our orienting principle for how we build a team for the work that we are supporting and will support in the future. It’s our bat signal. Let’s bring folks into our big tent to do this kind of work.”

The work of the center includes measuring short- and longterm impact of the medical humanities on improving lives and enhancing health outcomes based on three pillars: research, public engagement, and education.

“These are not stand-alone pillars,” notes Byers. “They’re leaning on and integrated with each other.” For example, all research endeavors will include public engagement before and after the projects to help shape the work and ensure it is valuable to the community.

The fellows will be exploring the theme of lore to see how rich, expansive, and diverse ways of knowing can be used to improve policies for better health, Byers says. These changes might include adjusting clinical practice guidelines, or helping people think differently about how diagnoses are conducted and written.

“This is why it’s so important to amplify the stories of our community.”

Mystery, history, and justice

Georgetown School of Medicine fourth-year student Lizzie Torrez (M’24) first became interested in medical humanities through an elective course during her second year called Medicine and Mystery.

“Dr. Krishnan led the course and it was my first exposure to all of the other things that go into medicine that we don’t necessarily get in the typical pre-clinical or medical curriculum,” she recalls. “Things like patient narrative, medical history, ethics, and even visual arts and poetry—all of these things that make medicine the art that it is.”

alyssa byers
Alisa Byers, DHSc, MLAS

These are not stand-alone pillars. They’re leaning on and integrated with each other.”

—Alisa Byers, DHSc, MLAS

The course helped shape the kind of doctor she hopes to be, centering the Georgetown values of care of the whole person and health justice.

“For people who do diagnostic workups of patients, it’s a lot of detection and mystery solving,” says Torrez. “Being a detective is a good synopsis of what the physician has to do well, going far past the physical and superficial levels of a disease to really be able to treat someone. That ties in nicely to what the humanities allows us to do for patients. It’s taking care of who they are: their culture, their history, what their living situation looks like, and all of those things that allow us to put cura personalis into practice.”

Uncovering some of the troubled history of medicine, the course still inspires Torrez to prioritize health justice in her current and future work. As part of the course, Torrez created a podcast on the Mothers of Gynecology, recentering the stories of enslaved Black women who were used against their will for surgical research in the 1840s by J. Marion Sims, a white doctor who became known as the “father of gynecology.”

“We know some of their names because they were included in published reports: Lucy, Betsey, and Anarcha,” Torrez notes. “The Mothers of Gynecology movement was started to reclaim that narrative of the women who were used and brutalized and experimented on to create this entire field.”

Torrez credits the medical humanities for opening up a broader picture of health and health justice and how she can make a difference as a future physician. She has high hopes for the Georgetown-Howard collaboration to offer this experience to others. She plans to specialize in OB-GYN in part because she sees the field as a place to have a big impact in health justice.

“If we fail to understand how deeply rooted systemic racism and injustices are, we will only solve the superficial issues. We need to recognize and to push ourselves to understand how deeply intertwined and ingrained these issues are in order to really start to uproot them.” Cabassa-George believes that medical humanities and lore hold a key to unlocking liberation and ending injustice.

“We all can learn by seeing how Black women are able to navigate oppressive forces. It’s like the saying that when Black women are free, all women are free. The work is there and will benefit everyone.”

The Georgetown-Howard Center for Medical Humanities and Health Justice offers some suggested resources for exploring the medical humanities:

Brotherless Night by V.V. “Sugi” Ganeshananthan

The Death of Ivan Ilyich by Leo Tolstoy

Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee

Expressiveness of the Body and the Divergence of Greek and Chinese Medicine by Shigehisa Kuriyama

Fatal Invention: How Science, Politics and Big Business Re-create Race in the Twenty-first Century by Dorothy Roberts

How Cancer Crossed the Color Line by Keith Wailoo

Illness as Metaphor by Susan Sontag

The Man Who Mistook His Wife for a Hat by Oliver Sacks

Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet A. Washington

“Patients Are Humans Too: The Emergence of Medical Humanities” (essay) by Keith Wailoo

Radium Girls (play) by D.W. Gregory

Wit (movie based on a Pulitzer Prizewinning play by Margaret Edson)

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