“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.
Arts in Health - a view from South Africa 