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/)