Professor Steve Reid, Glaxo-Wellcome Chair of Primary Health Care, University of Cape Town

“Med students… get, in second year, bombarded with huge amounts of information. … I get them halfway through and they’re kind of punchdrunk – and quite negative, actually … most of them I would say describe this sense of transformation through getting involved in medicine as artists – as artists. And seeing … for the first time I think, the possibility that they can be both. That it’s not one or the other.”

Interview with Professor Steve Reid, Glaxo-Wellcome Chair of Primary Health Care, University of Cape Town

VH       Maybe if you could just talk about what you do, in the area of ‘medical humanities’, very briefly?

SR       It’s a term that we’ve used, but we call it into question: is it the right term? Are we just borrowing a north American/European idea of what we think medical humanities might be? But that sort of semantics aside… it’s a bit more than semantics – it’s the paradigm group and, you know, what do we mean by that?

VH       And everybody that I’ve spoken to seems to mean something slightly different by it, so –

SR       Yeah. So, broadly: there’s an education part to it; there’s research; there’s a practice part to it; and then there’s a networking, advocacy part to it. Which this conference [Medical Humanities in Africa, Cape Town 2014] is about.

So to begin with the educational side of things: that I divide into undergraduate and postgraduate – in the Health Sciences, specifically, but increasingly in the crossover between Humanities and Health Sciences ­– in formal education programmes. So we’ve got a couple of things going in the undergraduate medical programme and the undergraduate allied health programmes – the physios and OTs – that are specifically arts-related. That’s within the Faculty of Health Sciences [at the University of Cape Town]. And we run special study modules; so that’s always quite fun. And then we run electives for various groups of students. So there are large numbers of undergraduate students; there’s quite a lot that goes on each year, and that gets repeated or developed to a certain extent.

And then there’s a masters-level ‘medicine and the arts’ course that we ran this year for the first time and are developing into an online course – a massive online, open-content course – in 2015. So we’re doing the filming in the next month, for that, and developing the whole package online.

And we wanted to give it a sort of specifically South African flavour; we don’t want to just be another offering in competition with Harvard or something. We want to say ‘OK, what does’ – along the lines of this conference – ‘what are the particular features of it in an African context?’ And we’ve just appointed a senior lecturer in medical humanities. So she would be able to supervise up to PhDs in medical humanities.

So there’s a whole educational set of offerings, and we’re developing the capacity to supervise, to develop courses, using this label, this title, of medical humanities.

Plus we have existing courses in various programmes, various health science programmes, that address some of the issues – not specifically arts, but medical humanities more broadly.

VH       And what was the impetus behind all this?

SR       For me personally? I’m a musician and a medic, and I always assumed that the two worlds had nothing to do with one another. Until I started in about 2008 taking music more seriously. Because I had always just played [piano] as a hobby – chamber music – and was challenged to actually – ‘if you’re gonna do this, why don’t you do it properly?’ Well, that meant a clash with my university work in terms of the time and attention that I could give it. [And] I just started reading in the area of the overlap, and talking to people; wrote an article, wrote another article, got some collaboration going; specifically in the University of New Mexico:

I’d been to a conference where they presented the arts and medicine programme at the University of New Mexico; and I was fascinated by it; how they’d actually managed to do what I’d vaguely thought about in theory – they had been doing it by that stage for ten years. This group of 30 artists worked in the big central teaching hospital in Albuquerque; they did all sorts of extraordinary things: the harpist who plays in the emergency room waiting area, and the visual artist who works in the oncology ward, and – just extraordinary juxtapositions of artists and medicine. So I was quite stimulated by that. But it wasn’t very theoretically grounded; it was practice, really. And I said to them, this is great in America where you’ve got lots of money, you know, relative to us – although they always said they didn’t have enough funding, but – relatively – they had everything that opened and shut. So I said ‘if these principles are more universal, come and make them work in an African setting.’ Specifically in a rural South African environment, because that was the nature of my work.

And so they came. And they worked in a rural hospice set-up, in the era of large numbers of deaths from HIV/AIDS. And the intervention, with the hospice workers mostly – nurses and nursing assistants ­– was singing. Singing with the carers, and the carer singing with their patients as well. And it was fascinating – it was really, really fascinating. The nurses said things like – and they were Zulu-speaking nurses, who love to sing anyway, but they said things like ‘we thought that when we put our uniforms on, we weren’t allowed to sing.’ It wasn’t permissible at work, to sing – it was supposed to be serious. But they sang a lot for funerals, they sang in the vehicle travelling to home visits… and the facilitator encouraged them to develop their singing in their work, as part of their work –and presented it as an acceptable thing to do[1].

VH       So how much of the work that you do – because you’ve already mentioned the distinction between the practical stuff and the theory stuff – is related to health – actually to projects in healthcare settings, or specific health outcomes; and how much would you say is more kind of ‘meta’? I mean is it a mixture of the two, or – ?

SR       It’s a mixture of the two; there’s a lot of application in the HIV/AIDs world, and community arts-type projects – collective things: choirs, for example, very successful choirs of HIV-positive people; or various arts interventions with support groups. So there’s – there’s a lot of what you might call either complementary medicine, or psychosocial support, or that kind of thing.

VH       Or health promotion…

SR       Or health promotion.

VH       And the stuff that you’re doing with the SSMs and the MA – is that more theory-based, or is it more about assessing what’s in the field, or – ?

SR       Yeah, it’s more theory-based. But – both of them actually start with a literature review and, but they’ve got to refine a question and try and answer from their own experience; you make it as experiential as possible – so we get them into hospitals, playing music or singing or whatever they do. They’ve got to reflect on that, in the light of the literature, and try and answer their research question; so the learning experience is within a research paradigm, or an academic –

VH       But it usually involves some kind of – some thing happening in a hospital setting.

SR       Yeah, yeah, because it’s the whole theme of embodiment, of actually doing what you’re talking about, and not just talking about it. But they really get involved – they’re in the wards, they –

VH       And this is med students?

SR       Yeah, this is med students. I get them to prepare what they’re going to sing, or play. They must think about it; I take them to the wards and say ‘here’s the setting;’ introduce them to the ward sisters and the patients, so they’ve got an idea about the context: one- or two-bedded, or six-bedded patient areas. And then I say to them ‘you must think about how you’re going to offer what you’re going to offer. Is it on a one-to-one basis, or will you bring people into a common area and do a group thing? How are you going to do it?’ They have to work through that; and then they go and spend a whole day there; then we have a debrief; they try it again a couple of days later, and we have a debrief; they go back a third time. There are various iterations, various attempts to refine what they might – how they might be in that space.

VH       And in a non-clinical way, I suppose.

SR       Well, they’re also med students, you know?

VH       That’s what I’m interested in, because I’m used to doing stuff exactly as your describing, but working with musicians – training musicians to work in hospital spaces, for example. But you’re describing a very similar process with medical students.

SR       With med students, yes. They’re in their second year, and they get, in second year, bombarded with huge amounts of information: anatomy, physiology – it’s really a very heavy year, and I get them halfway through and they’re kind of punchdrunk – and quite negative, actually. And they’re wondering about their motivation and if they chose the right course, because actually they feel like – the one is a dancer, and the other one’s a singer, and actually that’s the source of their energy, and what are they doing in medicine, and … most of them I would say describe this sort of sense of transformation through getting involved in medicine as artists – as artists. And sort of reigniting that – seeing, for the first time I think for some of them, the possibility that they can be both. That it’s not one or the other. As I experienced it – I just assumed it was one or the other.

VH       So with you it’s more about bringing out the artist in the medical practitioner, rather than necessarily working with professional artists in a medical context?

SR       Yeah; I think that’s a whole other – I’d have to get funding for that; I’d love to do that. It is a different angle on it though.

VH       Very different. But I think part of what I’m interested in is how – I suppose I have a slight bugbear about artists and – and valuing professional artists for their skills in the same way that one would value a professional doctor for his or her skills. And the importance of bringing those people into a hospital environment, for their particular skills, because they’ve spent years acquiring them. But then that sits awkwardly with the other feeling I have, which is that it’s kind of ridiculous to say that you are either an artist or a doctor … But I do think that there’s something about developing more respect between the two disciplines.

SR       The other example is the masters MA class, where we aimed for a 50/50 health sciences and non-health sciences group. And I think of the 16, seven were medical and nine were not: some anthropology students, some film and media students … and some qualified doctors, some specialists, an obstetrician. So we got that mix within the class, and then of course there was a whole lot of – as happens with postgraduate level ­– a whole lot of peer-group interaction and the students formed quite a cohort, so there was a lot of interchange. That was a very productive situation.

VH       That’s great; that’s the sort of thing that really shifts the way people think, I think.

It’s a broad question, but I’ve been working a lot with an organisation called London Arts in Health Forum, and then with the National Alliance [for Arts, Health & Wellbeing]; and one of the one of the things that we’ve struggled with is how we make our voices heard and how we encourage health commissioners to bring artists into the health space, and how – you know, how do you justify money being set aside for the arts, in a health context where everything’s under pressure? So a lot of it is about trying to influence policy-makers.

The anthropologist [Anna Versfeld] who spoke today, who was working in [DP Marais Tuberculosis] Hospital, with the relationship between addiction and TB – I thought it was interesting that she had managed to get what she was doing to a ministerial level, pretty fast. And as an anthropologist in a health setting. That was quite impressive. But do you feel that the sort of work that you are witnessing or working with – is it, do you feel like you have a relationship with those kinds of people, who affect policy?

SR       Not yet, no. I suppose in the HIV/AIDS world, because that’s a whole – a whole world in itself, and the TB world, increasingly people are recognising the reasons we’re not getting on top of the TB epidemic is because we don’t understand the – the behaviours of people, and the – and the sense that they make of their worlds. So we need ethnography to understand that.

VH       And diabetes presumably, too.

SR       Yeah. And ebola, and … you know, whatever. You know, it’s – I mean it screams out at me, but to get that message across is – it’s difficult.

VH       But then you have interesting organisations here, like Section 27, who use – in a way they’re using the arts, they’re using whatever tools they can lay their hands on, but they’re –

SR       So I’m very involved in Section 27 with – with my other hat on. My whole career has been in rural health – the access of rural communities to health services ­– and in various ways. One example would be the access of rural people – this is really deep rural, far away – to things like antiretrovirals. That was a specific project focus for quite a while. We said we would get further if we influenced policy directly, and we set up a project and got funding for it for a group of activists and lawyers to help us, in Johannesburg, because that’s where a lot of that activity takes place; and so we got a few people in the offices of Section 27 to form the Rural Health Advocacy Project. And so we work with them all the time on rural health policy issues. But it corresponds very much to biomedical model, I suppose; and – it’s interesting that you ask that question, because I hadn’t thought about the engagement of the arts in that space, as such.

VH       Well they [Section 27] use, I suppose, agitprop stuff; and I think there is a tradition in South Africa – there’s a much more solid tradition of using the arts as a form of protest than there is in the UK, for example.

SR       That’s true.

VH       And that in some way ties in with all this work. This sort of paradigm-shifting business about medicine and – how one thinks about treatment, and – and Section 27 for me are somewhere in that hinterland between those areas, because they’re using artistic techniques, sometimes ­–

SR       Yeah. But I mean – the arts can be used – what’s the word? – instrumentally. You know, you use graphic design, or you use marketing tools, to achieve your aim, whatever it is…

VH       So do you think there’s a relationship between what you’re doing in medical humanities, let’s say, and mainstream arts practice? What sort of distance do you think there is between the two?

SR       There’s still quite a distance. I wish there wasn’t such a distance, and I’d like to have more direct collaboration. It’s not in the mainstream – of arts. It could be. And what [Prof] Susan [Levine[2]] and I did was to get our respective Deans [of Anthropology and Health Sciences] to talk to one another; and agree that this area of medical humanities needed to be a joint effort between the two faculties. That’s just within UCT. [The University of] Stellenbosch has also got this interdisciplinary studies thing going – which is a step in the right direction.

VH       Just getting the two Deans to speak to eachother is pretty much a miracle.

SR       [laughs] Yeah, that helps, yeah.

VH       Actually there’s one thing that’s really interesting about today. I’ve been conscious of the – that recently at some of the stuff I’ve been to that it’s been very gender-biased towards women. I’ve talked to [Prof] Cath [Burns] about this [in this earlier interview] and she talks about a tendency for the women within disciplines to be more interested in this kind of cross-disciplinary work; and it’s certainly true of arts and health in the UK – very female-dominated. But today it seems very mixed, which is great, actually.

SR       And I was very pleased to see a lot of my medical colleagues here as well. You know – a couple of GPS, anaesthetist, obstetrician, paediatric oncologist.

VH       But you see having a medic – you, basically – makes a huge difference, because it just –

SR       Well it gives it a bit of credibility – in our field.

VH       Yeah, it does. It’s incredibly important.

SR       But what – what’s really interesting is how my medical colleagues tacitly accept that this is a really important thing, but won’t often – admit it, you know?

VH       And this is exactly what I struggle with – within the hospitals that I’ve worked in, that – a lot of the doctors, specifically, are very pro what you’re doing, but they won’t get actively involved.

SR       Did I tell you about the psychiatrist friend of mine who’s written an opera. And yet he presents it so apologetically…

VH       And also that that sometimes doesn’t apply to the – to the patient… There was somebody speaking today – it was a quote from somebody talking about medicine as their ‘wife’ and literature as their ‘mistress’. And I think that is the attitude that comes through quite often; that it’s a sort of guilty pleasure. And – and is something for clinicians, to help them process their stuff. Which is absolutely valid and necessary, but that doesn’t necessarily translate into patient care.

SR       There’s also another angle to it – it’s a research angle at the moment, but it could be something else – and that is the link between creativity and the originality needed to generate new research ideas; to think of the new questions – the inter-disciplinarity that will spark the new ideas that will lead to significantly new breakthroughs. There’s a whole unit at UCT that has its origin in biomedical engineering, for example, which is a crossover with health and engineering, mechanical engineering mostly, and they’re very hot on this ‘innovation’ thing. So you give it the label ‘innovation’ – don’t call it creativity, just call it innovation – and you say ‘OK, so where’s your next new idea gonna come from?’

Even the lab scientists say to us ‘I’ve got this whole lab full of PhDs, and they’re working on – some infinitely small area – and they know all the literature on it but they don’t look left or right.’ We’re not going get anywhere like this, we have to infuse different ways of thinking – we have to disrupt their thinking actually, provoke new possibilities. And that’s going to come from interdisciplinary work. One of the interesting studies that’s been done is looking at universities that have created an environment that is conducive to interdisciplinary work, research specifically. And when you look across the world at universities that have managed to incentivise and make possible interdisciplinary research, their research output has gone up exponentially. As opposed to the guys who’ve just stayed within their disciplines and continued ploughing the same old furrows; their research output increases linearly.

And so the push is on to – to create that more interdisciplinary view – and I use that a lot, in a lot of different ways.

VH       As a tool to kind of –

SR       As a tool to say look we need to be – you two Deans need to be promoting this because –

VH       It’ll help your outputs, apart from anything else.
[1] An assessment of the project was published here in 2013. Repar, P.A. & Reid, S. (2013) ‘Creatively Caring: Effects of Arts-Based Encounters on Hospice Caregivers in South Africa’ Journal of Pain and Symptom Management; 47:5.
[2] Profs Steve Reid and Susan Levine (Department of Social Anthropology) are co-founders of Medical Humanities at the University of Cape Town.

Damien Schumann, freelance artist

“people know a lot of facts – but to the point where they’ve almost become quite numb to a lot of the realities we have around us. I think that’s where our work starts becoming very influential. If we’re clever, or innovative with what we produce, then that’s what will get people to respond to it in a productive way. If I see another statistic on a death rate from a disease … it’s meaningless; I don’t flinch at all”

Interview with Damien Schumann, freelance artist

30^th August 2014

VH       Could you just tell me something about your work? What your practice is?

DS       I work as an artist; mostly photography is my medium, but I’m not restricted to that – I’ve also ventured into installation art, a little bit of video, writing and audio. And all of my work is focused on social and humanitarian issues; and ideally I try to structure exhibitions that can be used for advocacy communications and social mobilisation purposes.

VH       And how much of your work … would you say is associated specifically with health issues within that?

DS       The projects I took on in the beginning of my career were all focused around tuberculosis and HIV… if I was to look at the span of work it would probably cover about half of my projects. And then I’ve looked at other work that is not directly related to health, but there is some sort of link – like looking at stigma, and then stigma related to HIV and tuberculosis, and schizophrenia, those kinds of things.

VH       Do you think that the work that you do has an impact on people’s health – a direct impact in any way? Do you aim for a health outcome, or is it more about a social outcome?

DS       I suppose it’s a little bit of both. The catch is that it’s very difficult to have a measurable outcome. So, to give an example, I’ve done some advocacy campaigns where we’ve managed to raise money that’s gone towards the cause, but then it’s very difficult to track how much of that money actually ends up influencing the cause itself. And then, on another scale, I’ve worked with individuals that have come to me afterwards and spoken about how they were moved and influenced by the work and project, but it could also just be their opinion, there’s no hard evidence to prove it. But I definitely like to strive to create work that has some sort of impact and feeds back into the cause that I’m working with.

VH       But you’re not taking a therapeutic approach when you start out with a projects; it’s much more about a political approach I guess?

DS       Yeah. And there’s also a personal motivation. A lot of the work I take on is because I’ve got a thorough interest in the topic – I want to know what whatever I’m looking into is all about. But essentially I find it’s very difficult to entrench yourself in content like that and only be a consumer – it feels wrong. You want to give something back.

VH       What relationship do you have to research and academia in the work that you do – if any?

DS       It definitely forms a strong part of my work; just because I feel the better you know a subject, the better you can represent that through your visual medium. My background isn’t very strong in the academic sense so I don’t personally have a very elaborate history of research; but what I have done in the past is collaborate with experts in the field that I’ve been working in, so I’ll gather my knowledge from them and then interpret it. And I just finished a Masters in Documentary Arts; it was an RPL [Recognition of Prior Learning] programme, so based on my work experience. And that had a research component to it. So in the last two years I’ve started doing academic research; but to be honest I don’t like it very much [laughs].

VH       Is there anything useful about it? Is it a way of documenting what you’re doing for another audience, or…?

DS       There’s definitely relevance in it – the knowledge and the findings that come out of it are very important. But I’m very lost on the conformity of it, and the regulations. I love creative writing, but academic writing would literally drive me to suicide [laughs]. But the content I find very interesting; well, at least qualitative; quantitative I don’t think I could get into.

VH       It’s interesting that creative writing is something that we’re ready to absorb, but that academic writing is so often so bad, actually, that it’s quite off-putting.

DS       I think it is. I almost get the feeling that nobody wants to get caught. So they’re trying to cover their footsteps so much all the time that there’s very little that one can find intriguing in it.

VH       I’m interested in what people feel is useful evidence, and how it gets presented; I feel quite strongly that the work that both of us do is evidence.

DS       Yeah, but I think evidence is only worth what you do with it. What’s the point of knowing that you’ve got a 10% murder rate in the country if you’re not going to say ‘let’s try and drop it to 5’? I think maybe more than evidence, I’m starting to go into statistics and results now. I just feel, in general, people know a lot of facts – but to the point where they’ve almost become quite numb to a lot of the realities we have around us. I think that’s where our work starts becoming very influential. If we’re clever, or innovative with what we produce, then that’s what will get people to respond to it in a productive way. If I see another statistic on a death rate from a disease … it’s meaningless; I don’t flinch at all.

VH       So do you feel the work you’ve done has had any influence on policy?

DS       Yes. It has had influence on policy; but not independently. So, I can’t take credit for a policy-maker seeing my work and thinking ‘bloody hell I need to change this’. But I’ve been in collaboration with activists and lobbyists, and – not taking out of account the fact that they could have seen a related campaign on something the week before, or heard something at a dinner table – yeah, we’ve definitely had an impact. The Shack exhibition was definitely the most successful.

That assisted policies relating to HIV in two countries. In Holland I was working with the KNCV Tuberculosis Foundation, and they managed to get the Dutch government to increase their spending by 50% over three years; so it went from 40 to 60million Euros. And then in Australia I worked with Results International. And with them we managed to get the Australian government to agree to one of their Millennium Development Goals, which was the Debt2Health swop with Indonesia: the agreement there was that Australia would drop a $70million debt owed by Indonesia on condition that 50% of that was spent on public healthcare through the Global Fund for TB, Malaria and AIDS. I think that that’s probably the biggest achievement we’ve had so far.

VH       I associate campaigning often with quite narrow concepts being presented in quite a narrow way. But what struck me about the art that you make is that it’s not didactic. It’s more about representing the whole experience of being somebody living in a context where they are likely to contract TB. And the reason it seems to work is that it’s not a narrow concept – its success is about the fact that it embraces a much broader understanding of the condition.

DS       A lot of my work really just presents what is there. But I present it to people that are not familiar with that environment, and I think the trick in the media is just to present it in a way that holds someone’s attention – and doesn’t get lost in the flood of other media which is around us every moment of every day.

VH       And how do you feel your work sits with the mainstream of arts practice, if there is such a thing?

DS       It hasn’t sat very well at all [laughs]. I find I tread a very awkward line. In the sense that – if you’re going to go into the fine art world, particularly the high art world, they don’t, very often, want to have a cause associated to the work. They’re far more interested in the concept and methodology behind the work. And particularly in Cape Town (not necessarily internationally), I find that the art world is quite insular, so it’s a bit of a competition to outsmart, outwit, claim something as yours …

VH       Within a peer group?

DS       With an extended peer group, yeah. And it also comes down to exclusivity; your work gets judged based on where you show it, who’s buying into it – and very little of my work gets shown in the confines of a white-walled gallery. It doesn’t appeal to that kind of audience. That said, I do still approach the industry and try and get stuff out there but it hasn’t been greatly successful. Particularly locally, actually. It’s had more success overseas, for some reason. I think South Africans are exhausted with social issues and history.

VH       But it’s interesting to hear that, because I was struck when I came here by the fact that you have a tradition in South Africa of social engagement in the arts which I think is different from the UK tradition. People like Kentridge, Goldblatt – the big stars – are very socially engaged …

DS       Well the names you mention have come out of the struggle period, the 80s. And I think at that point it was a form of rebellion. But if you look at the artists today … a lot of artists are starting to look more at identity now, which I think is the birth of democracy kicking in, people trying to work out where their footing is. But – just thinking offhand – with the exception of Zanele Muhole, I can’t think of anyone[1] that’s really pushing a cause at a high art scale. They’re all about making statements and expressing their opinions but there’s no real driving cause …

VH       The argument against that is that the arts are there not to be presenting a cause but to be challenging all assumptions; it could be said that your job is to represent the fact that none of these politics are exclusive, and the truth. When you are very specifically attached to a cause I suppose that’s what you lose – that distance. But on the other hand when there are so many important causes to be fought …

DS       Yeah, I think so; otherwise it’s maybe it’s just a lack of empathy, if you’re not attaching yourself to a cause, if it’s all self-involvement. Maybe running with the theme of identity, that’s all about me, me, me …

VH       So the mainstream of arts practice is not comfortable?

DS       It’s just difficult because I think these ‘streams’ encourage a mould; if you look at most of the artists that are significant – particularly in Cape Town but also throughout South Africa – they’ve all come through a very specific institution, and got the same education, and they’re producing quite similar concepts of work. And I don’t really fit into that – I’ve got a different history and background; and I don’t have much motivation to conform [laughs]. Which sometimes works against me. I think it’s just a different objective, as well, that we’re exercising.

The other line I walk quite fragilely is with journalism and documentary, because I’m telling stories, but I also don’t conform to the conventional forms of pictures and stories that find themselves in newspapers or magazines. It’s a similar thing I’ve experienced there – a little bit of a clash, where the more journalistic media forms find me too abstract, too arty, and the art world finds me too journalistic. So I’ve kind of lost myself in the middle [laughs].

VH       And do you feel you sit with health practice in a similar way? Do you feel your work is accepted in health circles? Do you think that there’s an openness to it, or…?

DS       The people I’ve had the best buy-in from are more advocates and activists, people that are really trying to get something across. I’ve definitely got more commissioned work for advocacy campaigns which are using my work to secure resources, whereas I’m actually far more passionate about doing more community-based social mobilisation programmes, but there’s not a lot of money in preventing an issue, only in resolving it.

As far as health goes, again the more conservative circles within healthcare don’t really buy into it, but more and more I’m finding people that do find interest in the work – and in quite a broad spectrum. So I’ve been collaborating with the UCT pathology museum a lot recently, and they love the idea of creating media to get people more engaged with pathologies; and it’s fascinating stuff. I’ve been working with tic [crystal meth] addiction, as an example. The stereotyped visual of someone smoking crystal is of sitting in this dingy room with this ‘lolly’ – and down-and-out … Very few people can relate to that environment and that image; but I think that’s why it’s been so popular – it’s striking but it separates you. Whereas what I’m finding in pathologies is stillborn foetuses from mothers that were smoking tic during pregnancy. And when you start looking at these expressions, you can see pain on their faces. My thinking is that more people can relate to parenthood than they can the dark dingy room, so this visual, in theory, although it could really be sensationalised, could potentially have a stronger impact.

[1] Damien later adds that ‘Mikael Subodsky started off in social issues but his newer work is more focuses on himself and his experience as a South African. An interesting move considering this conversation…’

Susan Harrop-Allin, head of Community Music, University of the Witwatersrand

“… the traditions of singing, or music, are already integrated; and the notion that you use that as therapy, and even the notion of therapy, I think is quite a Western idea …”

Interview with Susan Harrop-Allin, head of Community Music, Wits School of Arts, University of the Witwatersrand

13^th August 2014

VH       If you could just talk a bit about what you do, and … the context of your work – so you’re a community musician, primarily?

SHA     My primary work used to be in NGOs. I suppose as a ‘community musician’, although that’s definitely not a term that’s used here. I’ve worked a lot starting music projects in (mostly) township areas; mostly with the Johannesburg Youth Orchestra. I would say that that’s a version of community music – because it’s really looking at how to bring kids together [through] music education, but also has social interaction, community, and connecting people – that kind of ethos – behind it.

VH       So ‘community music’ is just a term that you’re using in the context of the University [of the Witwatersrand] – it’s not something that you’ve used to define your work up to now, particularly?

SHA     Not really until the field itself, internationally, had become a lot more defined … it’s only for the last, I would say, ten years, that there has been a field – a field of scholarship, a field of theory – that has distinguished itself from more formal music education.

[I’ve also worked] with arts therapists in a community setting in a project that ran for about three years right at the height of the AIDS crisis, working with home-based care workers.

And music teacher training for a number of NGOs – which is formal music education in the sense that it’s training teachers how to teach arts and culture, but it tends to be outside of the university, or a formal course.

My experience is more in facilitating projects … and then becoming more involved with the international community on the side of trying to build the field in a way. The academic journal, writing, and then devising this [community music] course – that only [began in] 2011.

VH       So – just going back for a moment to the project you were talking about that at the height of the AIDS crisis, what were the intentions of that project?

SHA     It was through an NGO [Dedel’ingoma Creative Arts Healing] that was set up by a British woman [Nancy Diuguid] who had worked at the ENO [English National Opera] … who wanted to use the arts for ‘healing’. But the project was identifying the need to care for the carer – to support people who worked in the caring industry, or in health; who were working with a trauma organisation, or a counselling organisation; places like Childline and organisations that work with women, or abuse. But in a recognition that they themselves may need support. And it was an introduction to how they could use aspects of creative arts in their own work.

But in the case of the Mpumalanga project it really turned much more into supporting them, and caring for them; because the care workers themselves were incredibly traumatised.

It wasn’t a very long project, and it was very complicated; … it was the usual NGO story here: it didn’t have enough funding, then the founder of the NGO died, then the therapists split up; … but we ran about three or four different training sessions that lasted just over a week – for people who worked in a range of organisations here, in Johannesburg; it was called Voices. We also worked with social workers and home-based care workers in Thohoyandou, in Limpopo, about three times.

My role was setting up the project, working with the organisations in that community – so I was involved in the music-making to some extent, but it was more working with the art therapists … They were the top arts therapists – Hayley Berman – the art therapist here, [music therapist] Mercédès Pavlicevic, a clinical psychologist, Kirsten Meyer – a drama therapist, and a massage therapist. In hindsight that work should have been documented very carefully. There was one piece written by Mercédès in her Community Music Therapy book[1].

It was a sort of extraordinary experience; partly because of the time – so it was about 2003, 2004, which was before any kind of recognition of AIDS, or rollout of ARVS; there was no medication available, there was no anything. Nobody understood the disease – people were literally just dying. And it was in an area called Nkomazi, just near the Swaziland border, that was particularly ravaged by this. And I somehow connected with a woman who was running an organisation that was for home-based careworkers [Thembalethu], and looking after children.

It was actually horrible, to be quite honest; horrible.

It needed to be sustained, and for all sorts of extremely complicated NGO-like reasons, it couldn’t be. But while it was there it was extremely interesting to see how all of those art therapies could work together, and what you could actually do with these groups of women. And I worked very informally with a group of children, but it wasn’t really part of the project – I just played with them, actually. In retrospect there was such multiple trauma going on that we all needed our own counselling – they needed counselling, and then we needed counselling, and they needed counselling from us needing counselling… and – it was kind of extraordinary …

VH       It’s interesting to hear about a project where all of the different therapies were being used together; that’s really quite unusual.

SHA     I think it was very unusual.

VH       And d’you think that had a specific value?

SHA     Thinking back on it the value was really [in understanding] that people’s own experiences of the arts, in communities – the traditions of singing, or traditional music that’s used in various settings – are already integrated; and the notion [that] you use that as therapy, and even the notion of therapy, I think is quite a Western idea.

But if you use everything together you’re connecting a little bit more with people’s own experiences of music, storytelling, visual stuff, singing …

VH       It’s interesting about the business of terminology … that there are all these divides that we give our work: community music, music therapy, music in health, applied drama, this, that and the other; … all of us I suppose understand the need for those brackets in a way, but at the same time they are often much more relevant to the practitioners than to the people that we’re working with. I mean if you join a choir, you don’t care whether you’re being subject to an applied music practice, or whether it’s a community choir – you’re just in a choir. The terminology can be quite a divisive thing, I think, in some ways – because it separates the practitioner from the participant, perhaps.

SHA     It can – so, for instance, one of the latest versions of the International Journal of Community Music is about ‘Community Music Therapy’ [2013 edition] and it’s about what links the practices, rather than what divides it.

For me, the distinctions need to be made only in terms of how you frame work, how you hold work. And what’s important is not to get into this idea that we’re all magically therapists – and a little bit of a glib thing about because you do the arts then therefore we’re all going to be healed. Because it doesn’t necessarily work like that. And it’s not a magic fix. And sometimes when you use artistic processes and music, as you were saying, it can actually make something worse in a way, if you don’t know how to hold it. So your intention in the way that you’re framing the work needs to be very clear.

So – have I got a music education goal? Which the [Johannesburg] Youth Orchestra does. I suppose the goal there is to enable children to be able to play an instrument in an orchestra, so that they have an experience of the group and of the group performance. So it’s fairly formal in that way, but it happens to be working across communities. Normally youth orchestras and string programmes and that kind of thing are always in a community. I think the Joburg Youth Orchestra is one of the only organisations that might have a very privileged kid sitting next to a child from, say, Sebokeng.

VH       How much of your work intersects with health, and ‘wellbeing’? Including things like the orchestra perhaps?

SHA     I’ve never considered it as that at all – it’s much more connected with ideas of social development. Or – building people in a particular way. But as soon as I say that I realise ‘but who are you to say that you build people through music?’ – which is a bit of a problem. [It’s] a kind of – enabling of particular experiences; or of learning experiences, because I’m much more on an education bent, I suppose. I’ve never really conceptualised anything in those terms, except for that Mpumalanga work.

VH       Wellbeing is such a sticky term. Mike White talks about resilience[2], which I thought was quite an interesting idea because it relates to one’s capacity to cope with adversity I suppose, whether that be economic, or circumstantial.

SHA     The therapists will always talk about resilience. When I did a presentation on the haMakuya arts community engagement project [undertaken with Tshulu Trust in Venda, Limpopo and part of Community Music at Wits] – it may really just look like some nice fun music activities in a school that draw on the musical resources that are already there. But the response from Tammy [Gordon-Roberts] as a drama therapist was partly about what those experiences do for those children (who really don’t have any teaching and learning experience, nothing substantive) – which is a resilience-building exercise, that I’d never thought of before.

So it’s difficult to talk about wellbeing and health I think in the way that it’s conceived of in the UK, because here it’s much more basic – it’s like have people got food? Have they got a roof over their heads, does a child have a parent? Are they going to be hurt when they walk out of their house? What is the teacher doing to them? It almost feels, I think, in some circumstances, that wellbeing and happiness and all this is a – sort of privileged thing to even consider, when you’re looking at basic needs.

So then what might the place for any kind of the arts or music be there?

Well, it’s very integrated into many people’s lives anyway – it wouldn’t even be considered as something separate, it’s just something that you do. You sing in church on a Sunday; you sing a song for – something; you play music …

The other thing to consider is this whole idea of the extent to which musicking is so much part of religious, spiritual practice, which is also seen as healing practice; so, going to a sangoma, a traditional healer (which is huge, and it’s not something that just exists in some remote area at all) always has music in it – always. So it’s not articulated as a field of ‘music and healing’, or ‘music and wellbeing’; it’s just a practice. So – if a sangoma is playing her drums, that’s the calling of the ancestors, or that enables some kind of healing of sickness, or finding out, or is a diagnostic tool (but it’s not going to be called a diagnostic tool). I don’t know a lot about the way that traditional healing works, but I happen to know a traditional healer who is also a musician; and as far as I can tell that’s very, very common. So the main guy who produces music and CDs and performs and knows the most about music in haMakuya is the traditional healer. So … it’s not a profession, you’re not a music therapist, the notion of therapy is very odd, but people would consult a – a traditional healer for many, many things.

VH       And music would just be integrated into that anyway? It’s just part of a process?

SHA     I think so, yeah. Because it’s all tied up with religious stuff, spiritual stuff; sickness or not, how that happens, how you fix it – which is also tied up with whether or not you’ve made ancestors angry or not, which is also tied up with how you talk to ancestors; and the Christian religion and the ancestral [beliefs] are completely one in the Zionist churches here as well.

VH       But in a way it complicates the whole notion of the arts as therapeutic tools. I suppose a lot of the time in the UK these things have been very much separated out into silos – which is what we’re working against – but [the separation] does mean that they’re not freighted with quite as much stuff to do with – certainly to do with religion. It’s interesting.

SHA     Yeah, I mean even the words ‘music’, ‘singing, ‘song’, ‘playing a drum’ – as far as I understand it are completely different, for instance, in the Nguni languages. So when you take the idea of training as a musician, or learning about music, or ‘I’m a teacher and I must now learn something about music so that I can teach music,’ it’s separated out from the practice of what those very people that I’m talking about – teachers that I’ve trained – were doing every single day.

And then there’s a language thing around music and song. So I would ask teachers: ‘what music do you do?’ ‘Oh no, no, no – none of us know how to do music.’ ‘But do you sing?’ ‘Oh yes, of course – we all belong to this choir and that choir and we’re in this gospel group…’ and it’s usually around churches, and every Sunday this… and this one listens to jazz… ‘But is that making music?’ ‘No, no, no, no – that’s singing’. Then we had long discussions about ‘well do you think everybody is a musician then? Can everybody sing?’ ‘No no; it’s just the black people who sing … white people can’t sing’. So there are odd conceptions even about what is ‘arts’? what is ‘music’ – as opposed to the thing that you do when you’re in a group, for a purpose, for praise, at a funeral, for protest, for … I think even that’s different.

VH       But I think actually there is a parallel there with the UK – I did an exercise once at a conference … I was talking to people who were mostly hospital workers – healthcare or administrative. I started off by saying ‘how many people in the room would consider themselves to be involved in the arts?’ and – I don’t know –one person stuck their hand up, but of course by the end of the process it transpired that all of them went to the cinema, or read books, or did this, or did that, or the other. But there is this notion of ‘the arts’ as this thing that only professional artists do, or people that get paid to do it.

SHA     From an education point of view, it’s very set up like that by our crazy curriculum. I could go on and on and on about the way that music is conceived of in curriculum here, that has caused us – that – that actually causes the separation.

VH       But also you could make the same case about medical learning. Inasmuch as it’s – it’s all about the consumption of a particular kind of knowledge, but it’s not about perceiving every aspect of your life as part of your health, including culture …

SHA     I mean I think it would be very interesting – I’m not sure if there’s work that’s been done on this or not – to look at the conceptions of health, culture, wellbeing, music-making. Because in that whole health/culture thing, I think is … this nexus of music-making, healing, what it means to be sick or not sick, where does sickness come from; how does cultural stuff impinge on that or not? What is the practice of making someone better? How do they conceive of themselves as better? And it will be different in different places – as I said, sometimes ‘better’ is ‘can I feed my children?’ Certainly in the place we work in [haMakuya]. So it’s also quite complicated, for me, to think about ‘well, what are we actually doing there? seven years later …’ How can the arts be working there?

VH       … there’s a value, I imagine, that you see about you, as it’s happening?

SHA     I do, yes. Difficult to articulate it, and also not to get into this ‘oh music-making makes everybody happy and everybody’s so much better after it.’ I see a little bit too much of that, especially in research in this area. I’ve read stuff, recently [along the lines of] ‘I’m going to find out if singing is good for children, so then I go into the school and then we all sing and then my conclusion is that singing is good for children.’

VH       It’s tricky I think in this area because so much research and evaluation is bound up with advocacy.

SHA     Exactly.

VH       And we haven’t quite got to the point of confidence where we can critically assess what we’re doing.

SHA     Because we’re trying to promote it so much …

VH       … to funders. And to the institutions we’re trying to work with.

SHA     There’s a very interesting article in the Community Music Journal about the difference between intrinsic value, and applied value. And how we need to – as musicians, music educators, community musicians – be focusing on intrinsic values and not just saying that music is for something: ‘because it’s going to make your maths better.’

VH       We’ve swung so far in different directions. I mean at one point, certainly in the UK, there was a real thing around ‘art should be for its own sake, and it’s degrading if you think of it as having an application’; and to a degree I agree with that because if it becomes too applied then it becomes part of the system it’s trying to critique. Or runs that risk. But the problem with that is that then you can never use the arts in a setting where they engage people who sit outside the kind of ‘professional elite’, in a way. So … how you break down the barriers around the arts – that sense of ‘we sing, but music is over there’ – how you break down that barrier without devaluing the capacity of the arts to sort of sit outside things a bit?

SHA     … for me it’s still important to emphasise – and I guess that this is at the heart of what community music is, does, its intentions – that anybody can participate in music. But participate in music for the sake of making music; not only because it’s going to allow me to co-ordinate my left and my right hand. Well, it may do that, and it probably will – and it will build your brain connections, all that stuff; and it’s got cognitive this and affective that and whatever – but emphasising that the actual act of music-making, especially with other people, and in synchronising with other people, is valuable on so many different levels for its own sake. Mostly because it’s an innate human activity. Biological, according to Blacking.

VH       On research – so, obviously you sit within an academic institution; do your [community music] students research what they’re doing?

SHA     Yes, so the idea is that from the second half of the year, they are in a placement in a community music or community arts organisation. So they’ve been with the Youth Orchestra, with the Eyethu Soweto project (which is a project I started a long time ago). And they then research it as a project …

It’s a case study of: what is this organisation? what are its intentions? how does it work? how does it fulfil its mission? what kind of pedagogies are used, why? who are the participants? And then, as they begin to work with a group of children in that organisation, to document also what they’re doing and reflect on their own practice. So it’s their exam-equivalent, with a practical assessment as well. Because I don’t really think you can write an exam about community music.

VH       And the intention … is of publishing stuff from this department in the future?

SHA     Yes. I’d very much like one of those or a combination of those to be published – exactly as a case study.

VH       So the places for this kind of work are probably community music journals, and sociological publications.

SHA     And music education.

VH       And – this is a funding question – I’m always interested in organisations working in this area, because funding’s always so tricky, and difficult to sustain – you referred to it earlier with the NGO. Do you feel that the bulk of the work that you’re doing now – does it feel fairly stable, does it feel – can you imagine it still happening in ten years’ time?

SHA     I can only really speak for the Youth Orchestra… yes, in NGOs that have been structured, that have fantastic governance, that are quite formalised, that have built up funders over a long time, and then who have happened to get the big lottery funding. But that’s so hit and miss. I got lottery funding for the community music course for the Limpopo work, completely by default, three years after the application. So the lottery is at least three years behind. Possibly four.

So the administrating organisations themselves are a bit dysfunctional; and give money to the most extraordinary places; actual development and training is less supported than one-off concerts. And the other thing, especially in the music world here, is the extent to which people build little empires … and all the funders say ‘so why aren’t you working together?’ And it’s been like that for the past 15, 18 years that I’ve been in this game.

So I would say that NGOs that have got their governance right, have got their systems, their HR, their – all those things really working very very well, and quite professionally, are going to be the ones that continue.

VH       Yep. But that’s feasible, for those people?

SHA     Yeah, I think it is feasible. But an NGO’s life in South Africa apparently is about three to four years. You need to find ways of accessing government and international funding. But there isn’t the same kind of what I hear or feel like is a very substantial, ongoing funding from something like the Arts Council in the UK … the possibilities [there] are just a lot – there’s a lot more. There’s no strategic plan here. The Department for Arts & Culture likes to fund a concert. And a big celebration. Or a competition. And that’s it. There’s no capacity to really manage that kind of funding. It’s a lot about making people look good, I’m sorry to say. And the National Arts Council and others will say ‘no, you must be self-sustaining’. How can you be self-sustaining? The kids who are going to a violin lesson – what? They’re gonna be able to pay for that violin lesson – really? [laughs]

VH       Speaking of which, what do you feel the relationship is between your work and, if you like, the mainstream of arts practice. Or is it the mainstream of arts practice?

SHA     What’s the mainstream of arts practice?

VH       Well, I suppose what I’m asking is partly something to do with audiences; so would a South African audience regard the Youth Orchestra differently from how they would regard – the so-and-so Symphony Orchestra?

SHA     It might overlap. But yes, I think they would. … Yeah, I think it’s very separate. I mean every now and then you would get the odd ‘professional’ musicians – whether they are pop, or rock, or hip-hop, or kwaito or whatever – who might do community work, or be involved in a community music project. But in terms of – that work and its performance, I don’t know … it will happen in the Youth Orchestra, [or] a project like Buskaid; but it has to do with what’s perceived as very, very high quality music-making in that practice. I mean the better the Youth Orchestra gets the more it would be perceived as even in the same realm as a professional orchestra.

VH       So what’s Buskaid?

SHA     Buskaid is a string project that was started by a woman called Rosemary Nalden … It’s a kind of a … flagship community music project. It’s only in Diepkloof, it’s only in Soweto; and she uses a very specific string training method. It’s called Buskaid because the funding was initially generated through musicians busking in London. The quality of music-making is absolutely extraordinary.

So, you get these little bits – that are going and they have their little bits of funding. But that could really be hugely sort of substantial, El Systema-ish, if people would really just work together. So there’s politics, power; and the competition over resources I think impinges quite a lot.

VH       Yeah; the competition over resources question is really interesting I think. How damaging that can be –

SHA     And that’s damaging right through a whole society. You know, down to people getting angry and cross with each other if one person gets this job and another one doesn’t get that one. In the community I’m working in. Very damaging. It’s a very contradictory place; as I’m sure you are finding out.

[1] Pavlicevic, M (2004) ‘Learning from Thembalethu: Towards responsive and responsible practice’ in G. Ansdell & M. Pavlicevic (Eds), Community Music Therapy, London: Jessica Kingsley Publishers.

[2] White, M. (2011) Arts in Health: A New Prognosis. Ixia, Public Art Think Tank (online at http://ixia-info.com/new-writing/arts-in-health-%E2%80%93-a-new-prognosis-mike-white/)

Dr Jennifer Watermeyer, Health Communication Research Unit, University of the Witwatersrand

“communities and patients seem far more open to arts as a tool for allowing their voice to be heard, allowing them to become empowered”

Interview with Dr Jennifer Watermeyer, member of the Health Communication Research Unit and a Senior Lecturer in Speech Pathology & Audiology, University of the Witwatersrand (6^th August 2014).

VH       Maybe if you start by telling me a bit about your organisation or the work that you do within your organisation…

JW       OK. So the Health Communication Research Unit started off in about 2004; I was an undergrad student, and Claire [Penn – Director of the Unit] had started her focus on qualitative research in healthcare contexts. I think that really came out of a frustration that she had with her own discipline, of Speech Pathology, and just wanting to – extend beyond the boundaries of that discipline, and really use what we know about communication, and particularly about interpreting, to get into healthcare contexts and make a difference.

So she started with a couple of projects looking at interpreting – and looking at it from a linguistic angle, and then the project really – grew into something more, and then we started [thinking about] ‘OK well, we’ve had a look at doctor-patient interactions, what else can we look at? So, I came on board as a postgrad, and looked at pharmacy interactions; other people started looking at other interactions; and we found that we built up this collection of … different healthcare fields. And then once we’d looked at a number of professions and healthcare interactions, we started to branch out a bit further, and say ‘well how can we turn this into training, or – something meaningful, that would actually impact on practice in clinics?’

And that has really been our primary focus in the last few years. And out of that has grown [work with] for example, Drama for Life – working in an interdisciplinary way with specific clinics, with specific people from other university departments … With a focus on disease-specific, site-specific training, research, recommendations to sites.

Essentially what we are doing is trying to empower health professionals and teams in particular – rather than saying ‘OK we’re going in to fix these nasty doctors’ [laughs] or ‘deal with these lazy nurses’ (because I think that is often the perception out there); so we’ve looked at the team, and done training with teams.

Out of that basis grew this focus on – almost an action research approach to what we do. And – from that has grown funding support, so we have a lot of funding from various organisations, we’ve grown our postgraduate numbers, we’ve grown our outputs. And one of our goals has really been … not only to support and empower clinics locally and health professionals throughout Africa, but to actually focus on establishing a research area in South Africa, because ‘health communication’ didn’t really exist. There were a couple of splinter people doing research here and there but nothing really focused.

So, a lot of the work of the unit has been around trying to establish that niche. And also a commitment to quality research, and trying to publish internationally. And trying to showcase our work at international conferences, in international publications etc.

VH       You were saying something quite interesting about conferences before …

We were talking about … perhaps a lack of communication between South African and scholarship from parts of Europe, or the rest of the world.

JW       Yeah, I mean we’ve gone to a number of international conferences over the past decade. And it’s been a hard journey. We often find that we are the only ones from outside of Europe and the US and Australia. Those seem to be the strong regions in terms of health communication research. And we’re usually the only South Africans; the only Africans, often. … I think our issues are very different, but in a way we have such strengths – in our diversity, and in our approach. And South Africans are known for making a plan, and making things work when we don’t have resources. And being cut off from the world during sanctions and apartheid really taught us that. But it’s meant that now, as we enter into an international arena, people still look askance and they say ‘oh, it’s the South Africans … oh shame, they’re trying hard…’ And that is really the attitude that we’ve found in a lot of contexts.

And especially if you mention the word HIV there’s an attitude of … ‘it’s got nothing to do with me. It’s not a European problem.’ So we’ve learnt to hide the South African bit, we’ve learnt to hide the HIV bit; and although we present on those topics, we don’t flash it around in the title, in the abstract, to the same extent as we used to; because we found that when we did, the response was often not wildly enthusiastic.

VH       Would you say it’s a failure of imagination, something to do with not being able to apply the concept of AIDS as a chronic disease to – what might be thought of as a ‘European’ chronic disease?

JW       Yeah, I think it’s partly that. I think it’s also a lack of understanding of the South African context. I think people really don’t know enough about us. And it’s only after many, many years of really trying hard, and going to the same conferences, and building up research links and collaborations, that people have started to see that our research has value. And that the research that we’re doing is in some ways much more advanced and further down the line than what some of our colleagues in other countries are doing.

… It’s hard to get that recognition. … We’ve had [similar experiences] with publications – and I know it’s not just us, it’s [also] other researchers around South Africa who’ve had the experience of being told by journal editors that we need to get our language edited. I think any time the word ‘Africa’ pops up, there’s an assumption that it’s not good enough, it’s not – of interest.

VH       That’s shocking.

JW       It is shocking [laughs], but it’s kind of – it is part of our role, too, to go out there and educate people, and that’s why we trek across the world to these conferences, that’s why we pay huge sums of money and stay in dodgy youth hostels etc. In order to showcase our work.

VH       There’s a kind of interesting comparison with the arts and health world in a way … I think people in that world have also invested quite a large proportion of scant resources on pitching up at conferences where they wouldn’t be expected. And trying to demonstrate that it is possible to have a sophisticated concept of health that doesn’t come from a clinical, pharmacological model. I mean it’s a different issue; but it’s all to do with prejudices about what constitutes valid intellectual thought, valid academic work, valid – stuff that could potentially feed into policy.

JW       Yeah, and I think ultimately what it really says is that medicine is still so dominated by – a medical point of view, by a quantitative background, by clinical trials, and that mindset is really what we’re [up] against.

I was talking earlier about instances of supervising students where you put together a beautiful qualitative project and then you have to defend, and fight, and go through a whole process of trying to get it through some committee who’ve decided that they don’t think qualitative research is something that medics should be doing. So that has been difficult. I’m dealing with an issue at the moment with a student who’s put together a lovely project that’s qualitative and quantitative, and no, they don’t want the qualitative bit, they’re prepared to approve the quantitative bit but not the qualitative. And my argument was it’s actually not a project without both elements. We’ve had to prove … that I’m somebody who has qualitative experience, I’m coming on board with this project, I’ve worked on projects before at the clinic. And even with that kind of argument, they’re still saying No. Not interested. So that’s the mindset.

VH       And it’s unfortunate because there obviously are individual doctors who feel very differently about that – individual researchers who feel very differently about that.

JW       Yes, and I’ve come across some wonderful people out there. I’ve done research for example with [people like] Ashraf Coovadia, who’s at Rahima Moosa Mother and Child Hospital; who heard me speak at a conference and came up to me and said ‘I love the work that you’re doing and I want you to do research at [my] clinic, and I’m completely invested in learning about qualitative research, having qualitative studies done at the clinic…’ And that process that has opened doors for other students to start qualitative projects, for other staff members at that clinic to learn about qualitative research. But that’s – that’s the exception, not the rule.

VH       How much of the HC unit is focussed on health outcomes … Is it more about – behavioural change, or do you have a sense that you’re having a direct impact on the health of communities or individuals?

JW       That’s a very tricky topic to answer and it’s something that we’ve grappled with tremendously over the years … essentially what we are working with is the premise that if we improve communication between health professionals and patients – if we improve understanding, if we improve relationship, rapport, trust, all of those elements, then we are hopefully promoting … improved adherence to treatment; because if you have buy-in, and you have a relationship or a sense of trust between a patient and a health professional, that patient is more likely to adhere to that treatment. But then how do you measure that? And that’s the issue that we’ve grappled with. How do you measure for example going in and doing a training workshop on communication skills? How do you measure whether that has impacted positively, caused change etc.?

So, we’ve had a number of big projects over the years where we’ve tried, sometimes quite ambitiously, to look at the micro aspects of interactions and communication. And do a sort of a pre-/post-intervention assessment. With mixed results. Because communication is so complex, it’s not something that you can very easily measure. And so what we’ve been doing over the last few years is working on the basis that this is our premise: we are anticipating that it will lead to improved adherence, improved health outcomes, improved patient follow-up, patients actually arriving for consultations etc. But we can’t measure it [very easily].. And there are studies out there, for example in the States – people have done work looking at things like the link between communication and adherence. And so we’re building our research on what other people have done.

VH       Again there’s quite a lot of parallels with arts in health – I think it’s that thing of quite a complex intervention that’s working on a number of levels, and how do you disentangle one aspect of it from another aspect of it…

JW       [with the arts] … I think there are huge opportunities for getting involved with communities. And what we’ve found through some of our work is that communities respond very positively when you bring the arts in. So for example drama; or other people have done projects like memory boxes, which involve drawings, and narrative. And allowing people to feel that their voice is being heard. And I think the arts are brilliant tools for enabling that to happen.

VH       So it’s primarily to do – for you – with finding ways of hearing the patient’s perspective, voice, narrative, all those things…

JW       Yeah. And to be honest I think in terms of getting an in, and getting the buy-in, communities and patients seem far more open to arts as a tool for allowing their voice to be heard, allowing them to become empowered etc. … And that’s been a very positive way of getting involved.

VH       Why do you think that is?

JW       I think its because the medical fraternity are so entrenched in their ways, in what they’ve been taught, in how they’ve been taught – and it’s only through experience that I think some of them have their eyes opened to the fact that the arts have a place. But I think communities come without those preconceived ideas. And I think [that in] a lot of our communities in South Africa, diversity brings with it an attunement to things like arts, music. Storytelling is something that is very much entrenched in some of our African cultures, for example. So they’re far more open to that.

VH       So it’s a way of tapping into something which is already an accepted form of communication rather than imposing something which isn’t?

JW       Absolutely, yeah.

VH       And [do] you have an example of a project where you think that’s worked particularly well, and where there’s been a specific intervention that you think has done something that couldn’t have been achieved [otherwise]?

JW       I think the project that I would think about most is the one that we did in a clinic in Mpumalanga, where we spent quite a long time doing preliminary interviews with patients, community members, staff, about some of the challenges at the clinic, what was working well – and based on that research we went and designed an intervention programme that involved drama techniques … things like role-playing difficult situations, communicating with children for example. And our aim with that was really to empower the staff and develop a sense of teamwork.

And that was a very successful workshop … over two days; and out of that came a follow-up study where we went back six months later and said ‘OK, how did that workshop impact on you, and your practice?’

And what we saw was that staff were then able to take those techniques and implement them in the way that they practised. So, for example, some of the staff had developed songs – there was a song about handwashing, there was a song about TB – and then taken them into communities. … one of the staff members [also] had an adolescent group where she started working on developing a film about the community, about the challenges that they faced.

So that workshop and the introduction of drama techniques … actually empowered the staff to use those same tools, or similar tools, to reach out to communities. Which was great.

VH       I think it’s quite easy for artists to be – protective of their methodology … I feel very strongly there’s a case for the professional artist in a lot of these situations, but it’s interesting … in a way one of the greatest values is handing over those tools; so they’re not – really yours to keep in the end …

JW       Yeah, ultimately surely that should be the point – that we empower other people to run with it, and to take the tools that we teach them; and take those into communities to effect change? Because we can’t possibly be doing all of this prevention and promotion and educating and empowering; so I think that’s a big component of an action research approach – to actually train people to then carry it out themselves.

VH       Do you have any sense of the relationship between that kind of art intervention and the mainstream art world? … Does it feel like a continuum or does it feel like they’re completely distinct practices?

JW       For me I think it feels like it’s quite distinct. And certainly in the academic environment, and from my experience of having worked with the drama department for example, it seems to be quite disconnected. So we have programmes where people, for example, go in and do education on a health topic in schools and prisons, in clinics. But that is very different in some ways to what they would be doing on a stage, as a theatre production. Although I think their aim is to try and bring the two together, and to train students and enable students to be able to do both, I think there is quite a disjuncture between mainstream arts and what we’re doing in healthcare practices.

And perhaps that’s just because it’s a fledgling field, in terms of what we’re doing in those healthcare contexts; … Catherine Burns [in her interview here] spoke about trying to establish a medical humanities focus in South Africa, and because we’ve never had that, I don’t think there’s ever really been much of an interface between mainstream arts and healthcare contexts [in South Africa]. And so by actually establishing fields like medical humanities and health communication in this country, that gives us opportunities to – to go forward. And start to interface with – the arts.

VH       How do you feel you sit in terms of mainstream health practice at the moment?

JW       … It does feel a bit like a starfish approach sometimes: that through your research, you have the opportunity to educate a couple of people, and to open a couple of people’s eyes to this world of looking at healthcare in a different way. It’s not something that you can reach out to the masses with – at this point. [laughs] The medical masses are not necessarily receptive; so it’s very much … changing one health professional’s perceptions, or one clinic’s perceptions, at a time.

VH       [Do you have a] sense of whether there is such a thing as ‘arts in health’ in South Africa? I’m aware that it’s not really used as a term, but – but do you think it’s a practice that exists and is established … in terms of what’s happening ‘on the ground’? Are you aware of stuff when you go to clinics?

JW       On the ground, I would say for the most part no. But you do find … people like us, people like DfL [Drama for Life], for example, who are actively going into healthcare settings and doing small projects based on the arts, or bringing in qualitative research. And I think the arts and the qualitative side of things very much go hand in hand – the humanities, the arts, qualitative [research]. But for the most part, no – I don’t think there’s a field or a – an established – ‘anything’.

VH       But it creeps into conferences in strange ways; you were talking about Section 27 and the work that they do –

JW       Yeah – there’s a very strong activism base here in South Africa; so the Treatment Action Campaign, Section 27, and other organisations, are very, very vocal, and it’s really because of their hard work that we have, for example, such a big ARV rollout programme. So activism has always been something that’s very strong in this country. But how that interfaces with the arts would be an interesting thing to look at – and I mean certainly my experience recently at this TB conference in Durban was that [laughs] the interface between the activists and the medics was not a particularly easy one. … a lot of the medics were not particularly happy to have the activists there. … So [laughs] – there’s work to be done, I think.

VH       It struck me that [in the context of health activism] perhaps that the arts are just one of a range of tools, rather as they are for you, that can be used to – to push an idea or to change a way of thinking, something like that?

JW       … I was interested along those lines to see that at this TB conference there was a lot of focus on films, for example, and – and actually showcasing films that tell narratives of people who have experienced diseases.

My sense is that we have a very big job, and a – responsibility – as artists, as humanitarians, or as qualitative researchers – to focus on quality in the way that we introduce the arts into medicine. So if we have quality productions, where there has been research underpinning it … really fantastic production … not just a group of [laughs] fluffies coming together and putting something on … that is when I think the medics really listen, and are interested.

So that would be my point of view: that I think we need to have a commitment to quality; because we are – we are very much still seen as the fluffies [laughs]; and unless we actually work on changing that … there will always be resistance to getting the arts into healthcare, and medicine.

Emma Durden – Theatre & Health Consultant

“something like 82% of the audience went for HIV testing – within a week of having watched the theatre piece”

Interview with Emma Durden – Theatre & Health Consultant (11/8/2014)

VH       Could you describe your work briefly…?

ED       I suppose my work is predominantly summed up as ‘theatre for development;’ or it’s a bit broader – I would say ‘communication for development.’

So although most of it is theatre-based work that looks at developing communities – either through addressing health issues or through addressing other issues – other work is far more focussed on health communication, and understanding what problems there are in particular areas that prevent people from taking up messages, and therefore taking up health services.

VH       And you come from a theatre background, your training is in theatre?

ED       Yeah. My training is particularly in educational theatre. So although I do quite a lot of writing and directing of applied theatre work, my focus of study was very much on using theatre to educate, as opposed to learning how to act, and direct, and so on…

VH       And how much of your work now would you say intersects with health and healthcare, or wellbeing?

ED       I would say all of it is related to wellbeing of some sort. So if it’s not particularly health then it’s looking at gender-based violence, or xenophobia, or other social issues. So when I work for example with community-based theatre groups with Twist Projects, the main focus of my work is to help develop those groups to a point where they are sustainable as organisations on their own; but the work that they do is all very much focused on social issues.

VH       Would you say that that’s a broad trend in South Africa, within community theatre?

ED       For anybody who wants to sustain themselves with funding, they know that applied theatre is where the funding is; it’s not in creating theatre, but in using theatre as a vehicle to get to some other objective. So – we’re kind of actively encouraging it amongst theatre groups, [by] saying ‘if you want to survive, this is one of the things that you need to look at.’

VH       D’you think that, funding aside, there’s a desire within those community groups to address social issues anyway?

ED       Yeah, definitely. I did some research in 2012 … I interviewed 15 community theatre groups, and they all felt very strongly that they had a responsibility as artists … to talk about the things that others don’t talk about, in their communities.

So they are doing that work regardless. But they’re not making the connection between the health industry, or the health field, and the particular issue that they’re working with. And a lot of the time it’s quite sensationalist. So there was a project that was artistically really interesting – it was a piece called ‘The Seed’ by a theatre group from Umlazi township, south of Durban … It was on HIV, and the idea was that HIV was the seed and it grew into AIDS; it was kind of allegorical in that way. But it was very sensationalist; the guy who got HIV and passed it on was a worker, who went to town to work, and he got it from sleeping with a prostitute…

So the problem with community projects looking at those issues is that they’re really looking at stereotyped ways of, say, infection, in this example. And it doesn’t leave space for people to talk about the fact that it’s far more mundane than that, and far more ordinary, and it affects everyone. As soon as they sensationalise it, people start to stereotype types of people who get HIV, rather than types of practices.

I watch that kind of theatre coming out of communities, and I feel anxious for the messages that it contains, or that it’s passing along. So … I think there’s space for intervention, from – people like me, who are … thinking more about the consequences of sensationalising it into theatre, rather than seeing theatre as a way to interrogate those issues.

VH       There’s quite an interesting parallel with a woman I met at a conference in Australia [whose] … organisation worked with the media to try and de-sensationalise representations of mental health in television [drama] and advertising … And it’s – it was exactly the same issue. Well, in a way it wasn’t quite the same issue, because I think there it was about tackling something that was being used as a dramatic device –

ED       Yeah, it makes for a good story to have a madman in it.

VH       Whereas it’s interesting that you’ve got – the slight contradiction of wanting to be honest about what’s happening in your community, but at the same time turning it into something that scapegoats certain members of that community, potentially, or –

ED       … I think there’s a huge scope for research in that area as well. What theatre should do is allow for exploration of all of the grey areas; but what people tend to do in theatre is make it black-and-white. So that it contrasts, and it has dramatic … viability. But then the audience has no space to negotiate what it means, because they’re being told that this is what it is.

… Apart from in the design of the theatre, what a lot of the community theatre groups don’t do is facilitate discussion after theatre; so people will come and watch and go. And they know that [it has a] kind of agenda-setting function, and people will go home and talk about the play, but there’s no mediated discussion about the play, which I think is more useful.

VH       So there’s no counterbalancing information being given?

ED       Yeah.

VH       And in your work; how much would you say is to do with, if you like, measureable health outcomes? Do you think you are – do you feel aware that you’re having an impact on individuals’ and communities’ health? I’m thinking now more specifically about the kind of work that you do with AIDS –

ED       We did a project years ago in a factory – I do a lot of theatre in factories – and this particular project was the first time we actually were able to measure it. And something like 82% of the audience went for testing – HIV testing – within a week of having watched the theatre piece.

But there’s no control group to compare that to. So everyone in the plant – there were 1,200 people – everybody there at the factory saw the play, and 82% of them went and got tested in the upcoming five days.

And that’s a real measureable; but most of the time we don’t have the chance to do that, so everything’s anecdotal afterwards … Particularly with the stuff we do in factories, clients come back to us and say ‘people are still talking about it,’ or ‘… they’re still singing that song at the end of the play,’ or ‘they still refer to that character who did this or that,’ but we haven’t really been able to measure whether there’s an uptake of messages – or a reduction in injuries, or whatever the key objective is.

We could find that out, especially with the injuries – because we do a lot of the work in factories with health and safety officers, so they’ll come to us and say ‘we’ve had seven hand injuries in the last month, can you do a play on hand injuries;’ and we could go back to them and say ‘well, what are your injury rates for the next six months?’ But we don’t usually do that.

VH       I suppose in a way the proof – in terms of that kind of industrial work – is in the continued employment of theatre practitioners in the field.

ED       Yeah … with that theatre project that we do in factories, we have about four clients who have used us consistently for ten years. And almost every year they come back, sometimes a couple of times a year … So they obviously are convinced that it works. And I’m convinced that it works [laughs].

VH       What about things like wellbeing, because this is becoming quite a big deal in the UK at the moment – I suppose an idea of moving away from health and illness and thinking more about people’s quality of life? Do you think that the work that you do has an impact on quality of life, wellbeing, resilience, capacity to cope with illness, that kind of thing?

ED       Definitely the industrial theatre stuff that we do does have an impact, because we focus a lot on what they call ‘employee assistance programmes,’ so we encourage people to get counselling if they’re stressed, or we provide a list of potential coping mechanisms; … so we’ve done quite a lot of work focusing on stress. [And] other work on kind of slowing down, checking your numbers: your blood pressure, and cholesterol, and your BMI, and those sorts of things – which I think fall into that wellness category, specifically health-related wellness. But beyond that – beyond industrial work – I don’t think much of the work that I do focuses on that.

Although having said that, last year I worked on a campaign particularly for women, and a big focus of the campaign was on self-esteem, and knowing yourself, understanding your boundaries, understanding how to communicate in relationships; and I think … that had a real impact on women that we did workshops with, and they loved that campaign, because it was very much about being a woman, and understanding yourself, before starting to look at health-related issues. So it was essentially a sexual and reproductive health campaign, but the getting-in was ‘who are you, and how do you define yourself?’ And people don’t get the chance to explore that very often, and I think that they really appreciated the space to do that in the workshop that we did. So that Zazi Campaign runs in partnership with the Department of Health and JHHESA [Johns Hopkins Health and Education South Africa]. Zazi, which means ‘know yourself,’ or ‘to know.’

VH       And what about research? Your academic links are pretty strong, but what relationship would you say that your work has with research, and how do you present your work in a research context?

ED       Some of it is based particularly on recent research in the area. So … because I supervise students, and I have links with the university, I do read recent stuff and I think this gets assimilated into what I’m writing for theatre or what I’m talking about when I’m working with theatre groups, although it’s not particularly researched in that context, but is more general … That kind of baseline research, or prior research – we don’t do that directly, we just pick up on what’s been done around the area (the area not geographically, but the field of discussion). And then research into impact or whatever – we’ve done very little of that.

VH       But you do use theatre as a research tool – which is interesting.

ED       Yes, in an un-formalised way. So when you do what they call ‘process theatre,’ which takes people through a process of creating a play, then that would be seen as theatre for research – or theatre as research, because then, in the process of creating the play, you are seeing how people respond to or frame a particular problem. And I don’t do very much of that process theatre, or that participatory creation of theatre. I have done in the past, so my PhD is a lot more on that, but recently I haven’t done much of that work.

VH       And … the MAs [you supervise], for example, they’re theatre students … ?

ED       They are in the Centre for Communication in Media and Society [at the University of KwaZulu Natal], so they’re more about communication and development studies, and less about theatre. But … their undergrad degrees or their honours degrees would be in theatre; and the work that they do most days is theatre: participatory theatre, and role-play-related work.

VH       And they use those techniques to gather information about a particular topic, which is often health-related or social development-related?

ED       Yeah. So they’ll do role plays on – negotiating condom use; and the result of that role play would inform how they know young men are thinking about condom use. But it’s not really well documented, so that work is often done far more as an intervention than as research. So there’s a lot of space for research in those areas, I think, too.

VH       I find it interesting that you’ve got theatre undergrads going into social research … and using their theatre techniques. So rather than a social scientist bringing in a theatre practitioner, you’ve got theatre practitioners working as social scientists.

ED       Yeah. I think that’s definitely the trend, far more – that it’s the people with the skills who are applying them in a particular context, rather than the people from the context coming out and trying to find the skills.

VH       … I’m not sure but I would say it tends to be the other way around in the UK. Or at least that the concept of using a theatre practitioner or an artist as a social scientist is not particularly popular, or well-developed. There’s much more of a sense of people working in silos in that way.

ED       Quite often we have to fight for recognition in the field. So I know it happens quite a lot with the medical field – that they don’t see this kind of social science as valid enough research to make any impact on what they’re saying about HIV, or whatever the issue is. Yeah, so I suppose there have been times when it’s been more difficult to negotiate that; but I think now everyone’s kind of fairly clear that this is how it works; these are the people who have the expertise in this area. I think also a lot of the work is very much about the interventions and who can access those communities; and theatre groups or theatre practitioners can access those communities far more easily than just pure researchers can.

VH       That’s interesting – because they already have a relationship there? Or because theatre is a more accepted –

ED       Yeah, a more popular tool, or a popular pastime.

VH       Related to that – do you feel like some of the work you do is having an impact on policy in any way? Either locally or nationally, d’you think it’s getting to the right people?

ED       I think that … particularly with work that’s funded through JHHESA and PEPFAR and UNAIDS, that kind of thing – because they have a very close relationship with the Department of Health, when we do work in that field, the Department of Health takes notice.

So for example last year I did quite a bit of work with a large group of people with different disabilities, on sexual and reproductive health. The Department of Health has a Disability Unit, which is supposed to consider how disabled people can access health services, or how health services can accommodate people with disability. But they hadn’t considered a whole lot of stuff, and so some reports that I wrote last year based on a day’s workshop, including role plays and drawing posters and things, was really leapt on by the Department of Health; and then they were very happy to come on board as a co-sponsor of pamphlets – braille pamphlets particularly for blind people, and – and just looking at … alternative ways of communicating. … Quite a lot of suggestions, as well, in terms of how health workers are working with people with disabilities. I don’t know if those have been taken up, but they’ve certainly all been sent to the Department of Health and read by them. So I think, depending on who’s funding the project and what their relationship is with the Department of Health, that’s what impacts on whether or not it’s going to influence policy.

VH       And from another angle: arts practice. How do you feel you sit within, or you sit against the mainstream of arts practice in this area?

ED       I would say that ten years ago people would consider you outside the arts field if this was the work that you were doing. But I think there is a greater recognition that this is theatre, and this is art … it’s just different from what they’re doing.

… I don’t think people who don’t do this kind of work know how to value it … they don’t know the impact that it has, but they do think that it is slightly less artistic, or that you’re not quite a proper artist if this is the work that you’re doing.

VH       You think that’s still the case?

ED       I do, but it’s amongst a smaller group of people, because the theatre community in particular is just getting smaller and smaller; and more people are realising that you have to do this kind of work to survive in this field. That’s not why I do it; I do it because this is the work that I like to do, and I would rather do than plays in theatres. But yeah, I think there’s a recognition that this is a way for people in theatre to survive, and that’s not the recognition that we want. We want the recognition that this is a valid artform, although slightly different from theatre ‘at the Playhouse.’

VH       At the talk you gave the other day you were making some really interesting distinctions between community theatre, applied theatre, and – I don’t know what you’d call it – ‘High theatre,’ I suppose –

ED       I think I called it ‘professional theatre;’ I was thinking of originally calling it ‘artistic theatre,’ but really there’s as much artistry in applied theatre and in community theatre as there is in that. So … the art of professional theatre is what slightly distinguishes it, the purpose of applied theatre is what slightly distinguishes that, and then the community of community theatre – so the recognition between audience and performer – is what differentiates that from the other two. But there are … so many crossovers, and – they’re become less distinctive, I think; as artforms, they’re becoming less distinctive; and it’s a case of geography, really. Geography and the funders at the bottom of the programme notes, or on the banner that’s outside the clinic.

VH       There was an interesting point about community theatre and how you could have a community theatre production in the same space as a ‘professional’ production and the only difference really would be that the community theatre wouldn’t be able to charge as much of an entry fee.

ED       Yeah … that is really the only difference. And I suppose it’s how people see themselves – how the people who are involved in those projects see themselves. So the community theatre groups will … say ‘we are artists, and we are a theatre group.’ And it’s only when they have greater exposure to ‘professional’ theatre that they then start to say ‘oh, well we’re a community theatre group.’

VH       That’s interesting.

ED       Yeah, it is. It’s a funny thing because you don’t want people to stop thinking of themselves as artists, because I think it’s a valuable thing for them to feel that they are artists. But unfortunately community theatre is seen as lesser than by people who go to the theatre.

It’s interesting. When you look at the National Arts Festival programme – when you apply … you have to note yourself either as a professional production company or a community production company. And I know people who … say ‘we must go and see some community theatre.’ So they choose what to go on the basis of ‘is it community theatre, or is it professional theatre?’ rather than what the content of the theatre is.

VH       It makes it seem a very arbitrary division. I had a – related conversation when I was working with a group of ‘outsider’ artists, who were mostly people who had long-term mental health issues, but they were artists, primarily, in the context of the organisation that I was working for. And we had a conversation about the business of being an ‘outsider’ and how they defined that. And one of them said ‘I’m never going to get into the Tate,’ and I thought ‘well yes, but that doesn’t make you an outsider,’ that’s 99.9% of all artists in the world, ever! So your access to those sort of ‘higher’ bits of the mainstream doesn’t really determine whether or not you’re an outsider or an insider.

ED       … if that’s set as the benchmark, if the Tate is the benchmark, is that what they aspire to? Because you know here if you ask a lot of community theatre artists ‘what do you really want to do?’ they want to go on an international tour. So Mbongeni Ngema was really responsible for finding people from communities who had talent and no training, and then putting them in a big production that went around the world. And … that’s what a lot of young community theatre artists aspire to. So while they say that … they’ve got important messages for their community, and they have a responsibility, they also would really just love to go and sing in ‘The Lion King’ in Tokyo for two years.

VH       Yeah. But I think that’s probably common to most young performers – I think it’s slightly different with visual art. I mean you’d have the same with a group of musicians – if you talk to a bunch of 20 year-olds in a band, anywhere, they’re gonna want to go on a world tour …

ED       Yeah, and headline at Glastonbury –

VH       Exactly …

I’ve got two more questions: one is about funding – because this is the kind of eternal panic that anybody working in arts in health is in: do you feel that the work that you do in a South African context is sustainable financially? You said before that … people are choosing to do this work because it is the financially stable end of the spectrum, but do you think that your organisation and the work you do can be funded, can you imagine it carrying on in perpetuity?

ED       You know, I hate funding. I feel that it’s – I feel that it creates a sense of panic and dependency in organisations that shouldn’t be there. And I wish that there were other models that we could look at.

The work that I do with the PST project, which is all the industrial theatre work, is paid for – it’s a product that is paid for by a factory; … it’s supply and demand, and it’s ordinary economics, and it is completely sustainable. And I feel that that should happen in all of the health spheres. So I feel that somebody – the Department of Health, or whoever it is – should say ‘we need people to know about diabetes, and we therefore need to buy a diabetes play.’ But given the government’s propensity to spend money on other things, I can’t see that happening.

I really struggle with funding, so I don’t really know how to answer that, because more and more … funding from outside South Africa is drying up, because people don’t really see South Africa as a priority country any more; it’s no longer a developing country … – or it’s no longer an underdeveloped country. So it doesn’t classify for all sorts of foreign funding any more.

[And] arts funding is so small, that it is less used on this kind of work, and so the funding that is accessed is health funding or social development funding.

I was talking to somebody who runs a project in Kenya; … what they do is that they sell carbon credits … it’s a water project; … they supply a person in a village with chlorine in a bottle; and you squirt a squirt of chlorine into your bucket of water collected from the river or the well … and then it makes that water safe to drink. And because the product saves so much on shipping in water, or bottling water … they mass up carbon credits, and then big multinationals, who need to buy carbon credits because they’ve just used 40 million carbon credits to build a factory, can offset their costs. So it’s this whole alternative economy… And they’re just starting a new one on social development credits …

VH       So sort of corporate social responsibility stuff?

ED       It is, but it’s beyond corporates that are doing it – it’s governments and it’s all sorts of things. … I think she called it ‘social cohesion credits.’ So if you … do something that causes social cohesion, or brings people together, and helps people solve problems, then you get social cohesion credits. And that’s where we would really be able to tap into that kind of trading. So it’s international trading – it’s like a Stock Market in carbon credits, and now [a] … Stock Market in social cohesion credits.

VH       That’s totally fascinating.

ED       Yeah … because I think it could really revolutionise the way that these kinds of projects are funded. Because it then doesn’t become just about CSI [Corporate Social Investment] funding; it actually is a need on the part of those companies … So that’s what I wish we could get more towards, this kind of trading, rather than – asking for funding, asking for money.

Emma’s new book, co-written with Roel Twijnstra: Theatre Directing in South Africa: Skills and Inspirations, is available by emailing info@twistprojects.co.za.

Medical humanities at WiSER – interview with Professor Catherine Burns

No-one is saying ‘this research is not worthwhile, or it’s not dignified, or it’s too – Ivory Tower-ish;’ and why? Because we’ve had 15, 20, 30 years of people researching, let’s say, the harder social, political, economic questions related to, say, mining, and we’re making very little headway …

… I didn’t feel this 15 years ago at all. People would have said ‘oh that’s just a waste of money … this is just playing at the edges of the critical need – we have to feed children.’ The choices were: do we feed children? do we inoculate? … do we work out … resources for an AIDS vaccine? Or do you … play around with drama? I don’t think people are making those kinds of distinctions any more.

Professor Catherine Burns, WiSER

Full interview (8 July 2014)

Victoria Hume (VH) [Could you give] a very brief summary of your role at WiSER?

Catherine Burns (CB)           Right, so WiSER [Wits Institute for Social and Economic Research] is a research entity at Wits [University of the Witwatersrand], and our primary focus is the humanities, construed of in the broadest sense; which in South Africa includes the social sciences, education and economics. And … a new staff member who’s a professor of law. So we have a fairly wide remit – we have people who are literary and cultural studies experts, all the way through to people who do some quantitative work, in sociology, applied law, and economics. So it’s – it’s pretty wide.

We’re actually the largest humanities unit at the moment in South Africa, and I believe on the African continent, although CODESRIA in Dakar, Senegal – which is supported mainly by Francophone resources – would be a close second.

We’ve got a fairly small permanent staff cohort. In fact a lot of what we do is a smoke and mirrors show, because there are only six or seven of us, but we have a large number of postdocs; and then doctoral students from all over. And then people come here for fixed terms, often on sabbatical from their institutions; some of them are from African institutions – people even on sabbatical inside our own university – and then a great number of people from abroad; and they do projects with us.

And we have a number of projects which happen every year – one of them is the Johannesburg Workshop on Theory and Criticism (JWTC) … One of them is called Public Positions, and it’s around law, economics and society … and then the one that just really kicked off last year in September has got five years of funding from the Mellon Foundation … and that is Medical Humanities in Africa.

We have a strong link to UCT [University of Cape Town]; we applied for a Research Foundation Award last year, which we shared with UCT, and we ran the first conference on Medical Humanities in Africa here, last September … called Body Knowledge: medicine and humanities in conversation. And the second one of those is being run at UCT at the end of August this year …

And … we have begun a series of reading groups, research projects, and smaller symposia, including one that happened last week … called Age and the Body. And these are going to be happening over the next five years. We’ve got a number of sub-themes … ageing; transplant and tissue; what counts as evidence in medical knowledge; neuro-plasticity and work on mindfulness; a project that links to a wellness institute (on human and physical development) at Wits; and then a theme on the elderly – octogenarians – and their sexual wisdom, over the 20^th century. So an oral history-based and archival project …

We’ve also been approached by a number of entities at Wits, and in the city of Johannesburg, to work on projects that link us to city life and migration: to the fragility of mine-workers’ health, and silicosis in particular – lung pathologies. And these include relationships with the University of Michigan … and Sciences Po University … we only got our major grant at the end of April, so [laughs] we’ve kind of hit the ground running with a lot of projects.

VH       … how would you say that your work intersects with health and healthcare, or wellbeing, perhaps?

 

CB       We’re seeing how that happens; … there’s this big School of Public Health at Wits, and they do some anthropological and sociological work around care; and then there’s the Health Communication [Research] Unit [interview coming soon] that Claire Penn has directed for many years now, which has an extraordinary array of interfaces between … discursive, psychosocial, and some art and drama work, and the caring professions, particularly the allied medical professions – nursing, speech pathology. And we’re trying to see how we will all be working together into the future.

We haven’t set up any boundaries to what we do, but because we’ve received funding that isn’t directly intervention-linked, we’ve got perhaps a little bit more freedom and scope to go off in directions that don’t have to immediately show therapeutic or clinical focus.

So if I was to put us on a spectrum, with public health having to constantly justify what they are doing around caring and around therapeutic work in the humanities that will improve patient experience and wellness immediately in South Africa (so they’ve got a very direct, frontline healthcare focus), with Health Communications maybe somewhere in the middle, we’re perhaps out in leftfield – with some strong connections, but with the possibility of a person, for example, doing a project on poetics, or a project on transgender … or a legal project that doesn’t have an automatic ethical application in the health field. So it’s a spectrum.

VH       Having said all that … what proportion of your work is related to healthcare, let’s say, in a very broad sense – not in a kind of immediate, interventional sense? …

CB       I would say all of it, in this project. All of it. Because although … a lot of people are working on health in a paradigm that medicine wouldn’t regard as its own clinical practice – so, for example, the way that migrants in the city set up healing centres; or the way that people think about trauma, and history – we think of it as all having a health-related focus.

And the reason that we’ve chosen ‘medicine’ in the title Medical Humanities – rather than Health Humanities – is because, of all institutional spaces of healing in South Africa, medicine and medical practice, medical education, medical schools, medical jurisprudence is unbelievably powerful. It has a statutory power that far exceeds even the power of, say, organised accountants, or organised engineers, or the organised legal profession. And every single civil servant in South Africa –which includes every teacher and nurse, and street-sweeper working for a municipality; as well as the highest paid people such as our President – they all have access to medical aids, that are all controlled in a statutory way.

In addition to that of course we have a vast, plural system of religious-based and traditional-based healing and health-seeking behaviour. And that’s only very, very gradually, imperfectly and in a very complex way, entering into a statutory space. And we’re also in the middle of a massive new experiment – the first really since the Second World War, in organising South African health and clinical practices in a more equitable way [National Health Insurance]. And that’s a project that we are very concerned with and interested in; so that’s a long answer to your question.

In other words, all aspects of this medical humanities project.

VH       I think you’ve already answered this question, which was about … how focussed you are on health outcomes; … you’ve explained about being on a spectrum where public health are much more concerned with immediate outcomes, but – do you feel nonetheless that some of the work you do has an impact on communities’ wellbeing, or health?

CB       We’re hoping it will … For example, let me just take one of them, which is the question of the large number of people in the city of Johannesburg who come from all over the subcontinent – and who also come from all over South Africa – who are struggling with their sexual identity.

… [T]his also includes a large number of people identified by themselves and by clinicians as transgender, as intersex. And Johannesburg has some of the only clinical facilities on the continent for – assisting people in this journey; but there’s a large art community, there’s a large performative, drama, music community, a large religious group of people, and a large group of legal support and activist people that are organised in and around Wits. And we’re trying to give intellectual, social, cultural, critical resources … sharing with that community.

And there’s a large amount of trauma and suffering that that community faces, especially people who come here from other parts of the subcontinent. So … there is the … increasing criminalisation of people who live gay and lesbian lives, but also people who live trans lives of any sort.

So for example, a whole new influx of migrants from Cameroon, Nigeria, Uganda, and so on, are finding support and succour in this region.

And so this – our project – is growing a particular area of focus; and one of the agendas of that is to ameliorate social suffering, stigma and trauma, and to support clinical, psychological, religious, traditional community groups around that. And a large area of that work is opening up conversations between pathologising of trans identities at birth – in the medical community and medical education and nursing – through conversations with art, with poetry, with different forms of psychological intervention.

So that’s one example.

Another is the work that we’re doing around the Chiawelo Community Centre, which is an outgrowth of Chris Hani Baragwanath, the biggest hospital in the region. They have a number of very important community health centres which have clinical facilities: day hospitals, pharmacies, psycho-social support, maternal and reproductive health, abortion facilities, contraceptive services, wellness clinics for men … one of the largest of these is Chiawelo, on the far western side of Soweto, which borders the traditionally Indian area of Lenasia. And at this centre (which is trying to create a best practice form of community-oriented primary healthcare, along social medicine lines), there is a strong emphasis on the elderly, and on ageing … in that group, we are focussing on a number of projects, one of which is an oral history of people’s sexual lives; as a resource that the elderly are trying to contribute towards with their own life histories. A resource, not only for historical research on how sexuality is transformed in South Africa over the 20^th century, but also a very specific resource that they’re hoping that young people will be able to use, as a kind of living archive.

And we believe that that does contribute to people’s sense of self-worth and wellbeing.

VH       I think that’s a really interesting example … I’ve been doing some work with a theatre-based project in Durban [DramAide], and a lot of their work is around sexuality, and there’s clearly a … generational gap that’s exacerbating all sorts of issues to do with knowledge and contraception, and the way that people perceive sexuality.

CB:      And relationships. So – we can see this all over the country. I mean there’ve been … honestly thousands and thousands of studies … of youth sexuality. But there’s almost a complete lacuna about the sexuality of people from 70 to 100. So we’re really trying to address that.

And then a third theme that emerged over the conference, that Tina Sideris (a clinical psychologist) and June Fabian (a nephrologist) are leading, is based at the Donald Gordon Hospital. It’s a very interesting medical centre, because it’s a state and private institution, with facilities that wouldn’t be out of place in London, but which also serves the uninsured poor of South Africa, including a lot of people who live in informal settlements who don’t even have regular electricity and water supplies. And what they’re doing is they are embarking on a – a large transplant and dialysis project, which ultimately – and they have a number of goals – would allow dialysis of people living in informal settlements, and not in middle-class housing. And would offer living-donor kidney and partial liver transplants; and this is because of the huge burden particularly of kidney disease … growing … in South Africa, particularly amongst HIV positive people …

And that project, obviously, has psychosocial, economic, ethical, religious, and of course constitutional, legal, as well as – very, very high-end acute, as well as chronic – medical services implicated in it. ICU care, high-level surgical care, and so on and so forth.

…

VH       And the work that they’re doing with WiSER around that is what, specifically?

CB       We’ve set up a big archive project, where we’re archiving nearly 60 years of data on patients.

VH       Because there’s a big lack of data on this, isn’t there?

CB       There’s – nobody here’s published on this … South African surgeons – let’s just take nephrologists and transplant surgeons – have published hardly anything on their work. So their work is not known outside this country, really. And it’s an extraordinary gap. So we need to help them create an archive of material so they can publish retrospective[ly] as well as prospectively with more confidence …

And then there’s a huge amount of work to do on the sociology, anthropology and history – of transplants, and of donor groups, and of recipients. And there’s a lot of psycho-social work that can happen that would really bring in public health, anthropology, sociology, history, philosophy, ethics.

… [W]e have just put in a huge project at the Wits Human Ethics Committee … to follow a cohort of people who are receiving kidney transplants now over the next ten years. And this will look at all aspects of their psycho-social journey, as well as their physical and clinical journey. … mainly children and young adults, from now until perhaps they’re in their late 20s, early 30s …

VH       So … there’s quite a strong relationship between all of the work you do and research. [Could you talk about] … how you gather evidence, and where you present it?

CB       That’s what we’re just beginning. So this symposium we’re hoping to get a special edition of a journal out of, around transplant themes, ageing, tissues. Which would be extremely cross-disciplinary. We’re hoping to get two books out over the next three or four years. One that will focus on age, and sexuality; and one that will focus on trans issues. It’s possible at the end of the cycle that maybe one will come out specifically on transplant …

We’re all starting to try to go to conferences [laughs]. I went to the huge one in Aberdeen last year – which was a world conference on medical humanities, and presented on the field as it’s emerging here. About 15 people are publishing papers from our conference last year; the Cape Town conference is also geared towards giving people a platform to present ideas, to share, and to publish. And we’re trying to get as many postdocs as we can into this project, so that they can publish monographs, and … research work. And then of course we’re tackling really complex ethical issues … around how to do research on people who are undergoing clinical and other interventions, across disciplines. It’s much easier, as you know, to get ethical clearance if you … have got people already in a drug trial, or a clinical trial – but when you try to do cross-disciplinary work, there is huge caution, and a sense of much greater – breaks that get put on. So for example if a person is undergoing kidney transplant surgery, they obviously get asked a lot of questions, in the normal course of clinical events, about the psycho-social support they have in their family. But what about if you want to ask people about dreams; about their sexuality; about their fear of – of the changing profile of their personality? That is a much more complex field, and that’s the one that we’re entering in. So we are exploring the boundaries of what has been considered ethical research in South Africa as well.

VH       [How do] you feel this sits with conventional medicine, and do you feel that you have a sufficient ‘in’ with the medical community? … leaving aside Tina and June, and that specific project, how do you feel you – sit in terms of the conventional medical world?

CB       We sit awkwardly; and that’s a huge struggle. We tackled it perhaps the wrong way around 18 months ago … I went straight to the then Dean, of Health Sciences, and tried to work through all the Heads of Schools, and the Senior Deans of research, and we were really stonewalled.

Then we stepped back, and we started [to work with] the people who were struggling in their own fields; particularly psychiatrists, people working with a lot of therapeutic interventions, and people working – interestingly enough – in HIV, and blood transfusion work, who’d already opened up, more, to the social sciences and humanities (because of the whole drama of the story of HIV in this country). And there we’ve had much more success; and now we find we’re going up the pipeline again, with their help, but it’s still stop-and-start. Let me give you just an anecdote as an answer rather than an analytical response:

We worked with an artist called Gabrielle le Roux, and a photographer called [Zanele] Muholi, on an exhibition that Wits Art Museum ran earlier this year … [Muholi’s work] was a series of portraits of people living as lesbians in South Africa that did everything it could to not pathologise this community. So to describe in an arc the fullness of their lives as mothers, and as workers, and as sexual persons, and as free persons; but also their vulnerability … it included a series of – of portraits of people who subsequently were killed, by people in their communities, because they were out lesbians … so … a very traumatic series of criminal acts …

… le Roux … worked with a number of people who live as trans people, in South Africa, and in Turkey. South Africa apparently legally support[s] and protect[s] their identities as out trans people, [while] in Turkey [they are] very much in the interstices of law. And yet in Turkey, in the community that some of these people live in, they are able to be out in a way that people in South Africa are not.

Now these portraits were all done after enormous amounts of time with the subjects of the portraits, and with co-operation between portrait-giver and portrait-taker … [they] often took weeks … and after the portrait-maker, Gabrielle, had spent a lot of time with the subject, the subjects also inscribed their own words and text onto the portrait, so very, very intimate …

… [W]e brought as many people as we could from Health Sciences, particularly the medical school and the nursing school … There was a profound reaction. And they wanted to have the portraits … displayed inside of the Health Sciences building, right near to the Adler Museum of Medical History … [and to] use them as part of pedagogic interventions. And we began a series of discussions between Alison Bentley (… a Professor of Medicine [with] international expertise around sleep) [who was] really, really interested in challenging the boundaries of heteronormative sexuality and the pathologising of trans people inside of the medical school in particular.

And … eventually it broke down for two reasons: first of all, most of her faculty of medicine were not at all ready to open themselves up to this; so they were very rejecting. And the rejection fuelled the anxiety, as you can understand, of the artist and of the people in the portraits [about being] pathologised and placed in a space in which they’d be seen as a ‘freak show’. So that’s an ongoing discussion which we will be returning to early next year. And it’s indicative of these much bigger struggles.

VH       So … do you see the arts … as part of a sort of panoply of tools that you have at your disposal in addressing health issues … because you’re looking at things from sociological perspectives, through the arts, through lots of different other ways – is it just one of many approaches that you take?

CB       I think there’s contestation over that, because for some people in our group, art is a therapeutic tool; it’s a sort of methodology for reaching – an end; a goal. Other people – on another extreme – will regard the arts, and this would include poetry, writing, literature, music, physical and dramatic arts, theatre, film-making, sound work – as practices of healing in themselves; as practices of self-making. And they are extremely cautious about what they see as a reductionist view of art as therapy …

We heard a lot of those voices on the second day of [Age and the Body] … Ashley Masterson … the deputy editor of Medical Humanities, the [BMJ] journal … made a very important intervention around metaphor: metaphor as a place of human critical thought … of metaphorical discourse, and analytic, as central to the human intellectual project. And [of] the spheres of human academic work called ‘the arts’ as being, at their highest point, primarily about the work of metaphor.

In that space, a person who is a speech pathologist employing certain artistic or embodied art techniques is perfectly entitled to call what they do ‘art therapy’. But … that is not higher or lower an intervention than a person who is writing the experience of throat cancer; or a person embodying a completely different, fantastical world that they imagine, set thousands of years into the future, around – human cloning. And that all of [this] spectrum is what the arts are about.

People who [are] in that approach to the arts: cultural theorists, people working in drama and the body (for example Benita de Robillard, with her work on trying to think about the ‘crip body’, and unpacking what she calls heteronormativity, and doing a lot of work on heuristics and on hermeneutic analysis of discourse) – they don’t feel that they’re offering any less to this intellectual project. But there are people … that feel that being much more involved with the suffering body of the small person, or of the vulnerable elderly person, in an interdisciplinary group that would include a clinical psychologist, a nephrologist, a body massage artist, and a person using visual art therapy with a small child – that that is what we should spend our resources in a developing country on.

And we allowed that debate to … be fully fleshed out … it even became very acrimonious – because we have to get those voices out. And spent a lot of time allowing people to put their issues on the table and then to develop sort of more respectful speech again.

That arc of opinion is not going to disappear. But we have to find ways to manage that … So we’re – staggering on. And the whole spectrum is – evident. And there are – definite tensions, which we’ll have to manage productively, and which we can’t erase, because they exist, as they are, in social theory.

VH       Funding. You did talk a bit about your – about the grants that you’d achieved; this huge grant from the Mellon, which is fantastic … but … funding is always a tricky thing for people working in this area, because it often falls between two stools … occasionally the arts – if you like the established art world – doesn’t regard this work as being serious because it’s not purely art; and the medical world has issues for exactly the same reason. So – funding can get tricky sometimes. Do you feel your organisation is sustainable, does it feel stable at the moment, does it feel like something you can see still being here in ten years, and thriving?

CB       I think it’s stable, and will thrive – because the university’s current leadership have identified that Wits has got a number of strengths, particularly say for example in applied clinical fields; but it’s really lacking in developing research and higher critical thinking in those fields. And … external people – people in France, people in the UK, people in the United States, international funders and our own National Research Foundation (NRF) … – have identified some of these vulnerabilities.

Some [projects] seem very pragmatic, and political, at the outset; say for example, the health of miners … the vulnerability of miners’ bodies, their social vulnerabilities; and the … question of: if South Africa can’t get this better organised, so that there is more of an even playing field, what kind of hope is there for DRC Congo, for Cameroon, for Gabon, for Guinea-Bissau and so on?

But when … we tunnel into that space … we allow ourselves to, and nobody’s stopping us from asking a huge variety of questions, from pathological stuff around how human tissues are kept; how people get compensation … to the keeping of archives, records; constitutional law; to people’s experience of mining; to the people who are the partners and the children of miners’ experiences of masculinity, and of the life of mineral extraction; to their place in South Africa’s political economy; to their world around tradition and the invented tradition, and modernity; to ideas about value, and how people imagine themselves on the continent of Africa as actors in their families; to … what sustains them in their lives: their world of music, their world of prayer, their world of ritual, their healing practices. So this whole spectrum is being allowed in each one of these research projects; and no-one is saying this research is not worthwhile, or it’s not dignified, or it’s too – Ivory Tower-ish; and why? Because we’ve had 15, 20, 30 years of people researching, let’s say, the harder social, political, economic questions related to, say, mining, and we’re making very little headway. The Farlam Commission – which is being held into the Marikana massacre in 2012 – will hear days and days of commission evidence on the dreams, and the … prophecies of the traditional healers that miners went to, and the medicine that they placed all over their bodies, which is why they faced the police in a certain way. And the commission has no expertise, and no way of dealing with this evidence; which is deeply felt by the miners, and is very, very much part of the story. And most recently in the last couple of weeks, the police – who are being examined as well for their motives and their methods of policing – have brought forward their sense of collapsing autonomy, their sense of a crisis of faith in their profession. And they’re – they are using the language that anthropologists are better-placed to analyse than criminal, forensic, juridical people.

So … we’re at a moment in South Africa’s history where HIV scientists are pleading with people who work in literature, in media studies, in cultural theory, to come much more to the table even than anthropologists and sociologists, to try and understand human sexuality. And where people working on miners’ health and on trade union issues in the mining industry and the rights of workers are asking for more insights, and for more research, and for more sharing, around what it is to be a human being; and how it is that we age, and how we make decisions around our vulnerability and safety. So think this, the zeitgeist, that we’re in in South Africa at the moment – when we’ve achieved some of the goals of political struggle, and we’ve achieved some of the benchmarks of, say, citizens of the west; but where we’re evidently so caught up in so much trauma and so much social suffering – is forcing itself onto the research agenda, even of people in the clinical, engineering and economic sciences. So I think for those reasons, the issues seem urgent to our university leaders, and to the national … decision-makers in our research foundations, right to the centre of government.

Maybe I’m sounding too optimistic, but I didn’t feel this 15 years ago at all. People would have said oh that’s just a waste of money … this is just playing at the edges of the critical need – we have to feed children. The choices were: do we feed children? do we inoculate? … do we work out … resources for an AIDS vaccine? Or do you sort of play around with drama. I don’t think people are making those kinds of distinctions any more.

VH       … So, relating to what you were just saying – in terms of policy … Do you feel that government is listening to you? Do you feel that … you have a local influence? Do you feel that the work that you do is reaching the right ears?

CB       Not yet, I think it’s going to take longer. And we’re going to be working mainly through clinical intermediaries, which is good, and bad … [T]hose that are open to what we’re doing, inside of clinical medicine, which of course is already a minority group, are activists. And they have the ear [of], and are constantly speaking to municipal, provincial and national health people. So we do feel that we’re having some impact with them. But … we’ve got to – I think – stand behind them, and support them. Because there are already structures, there are statutory bodies … that they work through.

Maybe we’ll regret this decision in years to come, but I can’t really see how else we can reach the ear of government. In another way, we’re also aiming our arrows … at the top; because we have, here at WiSER, been holding a number of these public policy interventions … [led by] Jonathan Klaaren … around the National Health Insurance scheme, and also the National Development Plan. Which is supposed to entangle more social approaches to healing and to complex issues in South Africa than hitherto would have been allowed …

So we’ve got a number of people working on very pragmatic policy issues, say for example around social grants; and around gender and violence; and around trauma and rape – in which we’re trying to place a lot of our humanities-type critical thinking. And we are starting to have a couple of people – not the … cabinet ministers – but people who advise Directors General in departments – that have been coming to some of our sessions, and are interested in what we’re doing.

The Public Positions part of what WiSER … [has] social theory informing an intervention in a crisis issue. We’ve held three of these in the last two years … [A session on] the courts, and the judiciary [was attended by] several Supreme Court judges. The heads of the legal firms. And people running articled clerkships. As well as a lot of legal NGOs, like Section 27 and the Treatment Action Campaign, and the Legal Resources Centre. So we are trying to do that. But that is going to take a long time …

VH       We’ve talked a lot about sitting within the mainstream of health practice and how you relate to that. How do you feel your position is in relation to the mainstream of arts practice? Perhaps the more conventional gallery world, and VANSA, people like that…

CB       We’re getting there. We’re very closely associated with the Wits Art Museum. A lot of people from the [Wits] School of Arts are coming to our events. Last year I think the most successful part of our conference was our engagement with the life work of Colin Richards – a very famous South African art professor – and now, because of our intervention, seen also as a medical illustrator and medical anatomist. And a book will be coming out later on – with Penny Siopis, his widow, who’s a very well-regarded artist in her own right, and … Sarah Nutall, who is the Director of this institute … on the way that they discovered Colin Richards’s archive of medical illustration. Which links back to Steve Biko’s death; because he [Richards] was a young, technical medical illustrator working in the morgue in South Africa when he was called by Philip Tobias and lawyers working on behalf of the Biko family, to carefully illustrate all of the injuries on Steve Biko’s dead body. Which became part of the most important medical ethics case in South African history. (And that actually is what propelled him to study fine art, and eventually to become an art professor.)

… We’ve had another very interesting engagement [with] … a big exhibition … on the life of migrants and on their physical vulnerability, their health journey, their own traditional health practices …

And then next year we want to return to the questions of he bone, of skulls, of forensics – when we hold our big conference on Philip Tobias. And that will be a very interesting exploration – we’ll be working with people in fine art.

And we’re just beginning our journey with people in drama and theatre … Obvious lacunae that we need to work with more are film, people in voice, people in music; we’re getting there …

VH       I noticed at your seminar the other day that it was probably about five men and about 30 women. Would you say that was typical?

CB       It’s unbelievably focused on women … far more women are drawn to this field; we’re not exactly sure why, but it’s true across – in philosophy, it’s mainly the women philosophers, the women historians, the women sociologists, the women anthropologists, the women ethicists. There are a few exceptions, but it’s extraordinarily obvious.

And the second thing is that a lot of people of South African African descent are putting a lot of their time and energy – often they’re first or second generation, but usually first generation university graduates – into more traditional, more accepted, more immediately … vocational fields … ones where there can be a more obvious career path, and where they can also generate resources for themselves and their families. So getting into the more esoteric interdisciplinary fields takes a lot of confidence for young academics …

We’ve got three people of African descent very centred in our project: … Thabisani Ndlovu, who was born and raised in Zimbabwe, who is a PhD in English Literature, and who has gone into the human rights field as a sort of critical analyst, into gender work, on masculinity; and now into the Diversity Centre here at Wits … He is very, very unusual … The cohort of people around him are not drawn to these topics, and are … regarding him with some – caution. Then there’s another woman … also … of Zimbabwean descent … Kesia Batisai – who wrote a really beautiful thesis … Shona-speaking women in Zimbabwe [and South Africa] and … their idea of ageing and facing death …

And … Julian Mthombeni … she [has] a masters in pathology; she’s got laboratory credentials; she’s got diplomas. But her PhD is in public health, and what she’s really interested in is [the] rights that miners have … to compensation for physical illness … But there is huge reluctance about, and many, many psycho-social problems around, accessing those rights. So she’s moved more and more to looking at critical problems of anthropology, of self-identity. And I think it’s because of her very strong background in science, the fact that she’s a high earner … and she’s got a strong university position, that’s allowing her to have [that] space.

So we’re hoping to really really build on that into the future. But it’s a – it’s a long journey. And it’s going to be tough; we’re – I’m not underestimating how difficult it is. We’ve put out adverts for people applying for postdocs and docs, and the majority of people, who are working in this field, who are of African descent, come from other African countries. Congo, Zimbabwe, and francophone-speaking countries. We are really battling to generate interest, so I’m now starting a new project of drawing honours students – fourth year students – … in and giv[ing] them a sense of confidence in this field.

A quick update

It’s taken me a few weeks to work out how I might start to write about a small part of the hugely diverse work being undertaken here – and in a way that might be useful to people working in this field in the UK and elsewhere.

 

My solution for now is to use interviews with key practitioners across the country – and to ask a set of questions that embrace practice, and its relationship with research and policy.

 

The first of these will be appearing here soon, but in the meantime, here’s link to an amazing project I’ve been introduced to via Drama for Life, one of the participants in this multinational project which ‘tells the story of HIV/AIDS at the end of the third decade of the epidemic, when potent antiretroviral medication has been devised, but when treatment access is far from universal’: Through Positive Eyes.

First post

I’ve been living in South Africa for two and a half months now. For about thirteen years before that I worked as an arts manager in NHS hospitals, and more generally in the field of arts and health in the UK – from which I’m taking a brief break.

This blog is founded on the premise that (in the UK) we are largely ignorant of the breadth and depth of innovative practice in what we might call ‘arts and health’ in South Africa. If (as is extremely likely) you know more about this than I do, please feel free to comment and add any news and information.

Last August I attended a conference in Potchefstroom – a small town with an ambitious university (NWU), and met a Malawian academic who told me that as a music student 15 years before he had been sent into psychiatric units as part of his BA. Malawi is not South Africa, but to my shame, this was something of a wake-up call. I would be hard-pressed to name a UK music course with such strong health links dating back to the 1990s. And the context for this conversation was a conference on Music & Wellbeing held by a newly established niche-research group at NWU (North-West University). NWU also has Musikhane,a long-established programme of community music education allied to social development. One part of Musikhane, I was told, involves university students learning musical traditions from the elder members of local rural communities, then teaching these back to their grandchildren, along with an offering of ‘Western’ techniques – and precious access to expensive instruments. The teaching aims to cross one of the many chasms created by the complex, deep-running consequences of apartheid and capitalism, which together pushed employment into mines and urban centres and stripped rural communities of a generation of work and identity. The strange circularity of elder-to-student-to-child makes for a complex, mediated kind of traditionalism – and in a country where the idea of traditional racial identity remains hugely, actively problematic it is not without problems, but it represents nonetheless a real immersion in the local community, and a challenge to students’ sense of social responsibility.

But the notion of social responsibility in the arts is – I would contest – more embedded here than in the UK. The arts played a large and public role in the Struggle – music in particular is associated strongly by non-South Africans with South African politics, but so here is the visual art of luminaries like William Kentridge and David Goldblatt. The importance of art as documentation and protest (see for example the 2010’s The Bang Bang Club) is constantly reiterated; and the country’s most iconic artists are overtly political. South Africa lacks the embarrassment we have had to contend with for years in the UK around engaged practice. This is at last changing in the UK, thanks in part to artists like Grayson Perry who engage with the politics both of their practice and of the society around them. Grayson was once acerbically critical of hospital-based art, but now his work graces the UCH Macmillan Cancer Centre and Harefield Hospital; for me he represents a shift in thinking in the world of ‘high’ art, about how heath, art and society might interact.

 

But there remains a vestige of the notion of art as a pure form, as something necessarily disengaged, self-referential, high-brow, exclusive. Something bouncing off four white walls back at itself, and accruing wealth as an investment – for me an idea epitomised in events like Frieze, where non-buying visitors have their own day-at-the-fair, charged to feel awed by displays of wealth and untouchability. And of course the high-end gallery system is as exclusive and monied here as anywhere, yet even an organisation as successful as David Krut Projects, which represents some of the priciest artists around, sets its centre in Maboneng, an ambitious, fashionable and partially successful reimagining and reclamation of inner city space to create a healthier Johannesburg.

The Maboneng phenomenon is itself problematic – to a certain extent it serves to emphasise its own barriers, to make people more wary of the areas around it which, like the meniscus around a bright light, seem darker and less ‘known’ by comparison. Artist Vaughn Sadie used his brilliant Streetlights project to challenge the way its architecture creates a hipster bubble inside a poor area, disrupting (for example) the routes taken by the large number of people engaged in ‘informal recycling’ (pushing huge cubes of the city’s rubbish to recycling centres for a small fee). But it remains a brave choice to put an expensive art studio in the centre of (this) town, to pull people in from the wealthy suburbs, students from the local universities, artists from all over the world – to present a real challenge the city’s compartmentalisation, to start the conversation that Sadie continues.

So – even if it is in reaction to its limitations – perhaps this engagement on the part of the big-hitters contributes to the fact that community-based arts practice is thriving in South Africa. The Outreach Foundation, for example, works in Hillbrow – one of Johannesburg’s most challenging areas, “with high incidence of HIV/Aids, women abuse, refugee influx, urbanisation and degradation of urban environments, drug dealing, prostitution and crime” – to give “children, youth and adults the opportunity to engage with arts, culture and heritage activities that facilitates communication, participation and community building”. It is notable that almost all the charities offering support to young people living in the most challenging circumstances imaginable – orphaned, homeless, sick – offer the arts. No-one seems to ask what the point of creativity might be in these extreme situations – it is taken for granted that they have a central role to play.

In the UK we have described an ‘arts and health’ sector as a means of supporting work across a range of disciplines which broadly address issues relating to health. As the Outreach Foundation’s statement of intent demonstrates, the junction between health and society is more obvious in a country which struggles with such extremes of access to wealth, power and education. This work might not be called ‘arts in health’ here – but it is happening, and at an astonishing level. South Africa, moreover, is moving in a different direction to the UK. It is in the process of establishing its first National Health System – based on National Health Insurance – while the NHS slides ever-closer to fragmentation and privatisation.

Here you can see the impact of a two-tier system. Two-tier in fact becomes a misnomer; for many there is no tier. Access to (conventional) healthcare is sporadic, limited, sometimes non-existent – dependent on rural clinics miles from homes or overcrowded public hospitals. There is the norm, which is poverty, and there is Medicare and Medicaid, which I am told means slick service, as well as access to complex health interventions like transplants (only kidney transplants can be carried out in the public health system). The new NHS here will seek to address this gross imbalance. There will undoubtedly be problems with its institution, but the direction, for now, is clearly towards better access for all, while UK health (and, for that matter, arts) systems are undoubtedly moving towards limited access for the poor and (notional) excellence for rich. Local hospitals are under threat, small arts centres close, but major established institutions survive, to be pushed as business-generating centres of excellence.

Underpinning this approach is the idea that a concentration of wealth at the ‘top’, into clearly segmented, saleable disciplines will drive innovation – new drugs, new procedures, new technology. It could be argued that this kind of innovation has led us straight to a health industry profiting now from the healthy paranoid.

Real innovation, certainly of the kind needed to address how we live with chronic disease and our own fear of ageing in a culture which prizes youth and ‘growth’ above everything, is demonstrably inaccessible to these intellectual silos. It will come rather from collaborations, cross-disciplinary work, from imagination and lateral thinking, from working together to make things new.

South Africa, for all its current political frustrations, still buzzes with this sense of making things new. Yesterday I learnt of two brilliant projects: The Kieskamma Trust, a community organisation based in the rural Eastern Cape, which “strive[s] to address the challenges of widespread poverty and disease through holistic and creative programmes and partnerships”; and the Memory Box Project, based out of the University of Cape Town, which has expanded from the original memory boxes (you can hear all about them here) into other avenues, including a projects using body mapping and personal narratives to address body-perception and isolation in people living with HIV or AIDS.

I am very new here; these are only the very first things I have heard about – the definition of scratching the surface. But arts/health practice is everywhere here, and it engages with everything that is most challenging, and most awe-inspiring about this country. It could teach us much about the growing health inequalities we face in the UK, and how the arts might address them. I hope to add more projects as the year continues, and to open our eyes a little to the wealth of knowledge and experience in this country.