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Stacy Brody is a Master of Information. Literally. That’s what it says on her degree from Rutgers University School of Communication and Information, at least. And she is using her skills to contribute to the fight against the COVID-19 infodemic.
Stacy was warmly welcomed to the Himmelfarb Library team three months ago. Like many of you, she isn’t sure whether those are short or long months - her perception of time seems to have been affected by the pandemic.
As a member of the Himmelfarb team, she supports the work of clinicians and researchers by conducting literature searches, compiling resources for the weekly Intelligence Reports, and maintaining the COVID-19 Research Guide.
Keeping up-to-date with, and searching for, COVID-19 literature requires some creativity. The research is coming out in torrents. New publications are posted on preprint servers and publisher websites, then picked up on Twitter and by the news media before the research community has had the opportunity to evaluate them. The quality of research described in scholarly articles is variable. Original research is showing up in Commentaries and Editorials for rapid dissemination. The delay between publication and appearance on PubMed and other databases is becoming more apparent and more critical. The norms of scholarly communication and publishing are being challenged in a big way.
Finding and evaluating the evidence to support evidence-based medicine is more difficult when it comes to COVID.
Which is why, when Stacy saw the call on the Medical Library Association’s listserv to support the global response by indexing COVID-19 research publications, she signed up. She hoped that, by applying topic tags to articles, she, in her small way, could make the evidence more findable and usable to the global audience of responders, clinicians, and researchers.
As she hit the Reply button, she didn’t know that she would become co-lead of the Librarian Reserve Corps. She hadn’t yet met her Librarian Reserve Corps co-lead Sara Loree, a medical librarian at St. Luke’s Health System in Idaho, or the visionary Librarian Reserve Corps founder Elaine Hicks, Research, Education and Public Health Librarian at Tulane University. Hicks, reflecting on her own professional experience in public health and emergency preparedness, recognized that the need of Tulane University epidemiologist and GOARN (Global Outbreak Alert and Response Network)-Research lead Dr. Lina Moses, was one no librarian could meet alone. Members of GOARN, a WHO network of 250-plus agencies, institutes, and universities organized to respond to outbreaks, need the literature to support evidence-based public health response efforts. As described above, that evidence is hard to find in an infodemic. For evidence-finding at a global scale, you need an international army of librarians. Hicks, seeing this and dreaming of just such an army, put out a call to the Medical Library Association listserv. The newly formed Librarian Reserve Corps, modeled after the Medical Reserve Corps, supports evidence-based response efforts by providing resources for evidence-based public health.
The initial efforts to tag articles quickly grew - not only because the number of COVID-19 research articles has grown but also because we have learned more about the skills and expertise of our volunteers and the needs of GOARN-Research! Librarian Reserve Corps volunteers continue to index articles on a daily basis and have since expanded their services. Volunteers now conduct literature searches and monitor the media. They work to connect groups working on systematic reviews and meta-analyses.
Librarians have the skills needed to fight the infodemic and help our public health and medical professionals fight the pandemic.
Stacy recognizes that many of the Librarian Reserve Corps’s volunteers contribute to the infodemic-pandemic response at this global level and at the local level. They provide search support for clinicians and researchers. They help students and faculty access the library resources they need to continue their work virtually. They help professors transition to online instruction. As librarians, Stacy acknowledges, we are often in behind-the-scenes roles. She is honored to be part of this amazing, talented, dedicated team of volunteers making librarians famous.
I recently finished grading presentations by our first-year medical students in their Clinical Integration Sessions. As you might assume any good librarian might do, I reviewed their references and made sure they correctly formatted their lists. I also looked for other skills built into their curriculum, skills like interactivity and timing.
One of the first skills they learn in CIS, and one that is reinforced in each round of student presentations, is their introduction. As presenters, they need to tell me - their audience - who they are, what they’re talking about, and why I need to listen up.
The “why I need to listen up” piece is critical. It’s how they get my attention and keep it, for the whole five minutes they are presenting.
If they need inspiration on how to do this effectively, they might look to Dr. Neelu Tummala, a clinical physician with GWU’s MFA and a member of the inaugural cohort of Public Voices Fellowship on the Climate Crisis at the Yale Program on Climate Communication. Her class includes political activists, researchers, and consultants. Many of her classmates describe an interest in advancing human health, however, she is the only doctor in the group.
When I asked about the connection she sees between her work in medicine and climate change, Dr. Tummala told me that her medical lens helps her communicate to broader audiences about climate change. “No one,” she says, “is immune from the health effects of climate change.” By relating a grand problem to personal experience, she can hook in an audience that might otherwise not have “listened up”.
Several of my CIS students have started their presentations with case studies. They’ve shown radiographic images, told stories, and introduced scenarios. Dr. Tummala often does the same thing when presenting information - she provides examples of patients seen in Emergency Rooms and clinics, patients who have been affected by climate change and other environmental issues. This concretization of the abstract, this story-telling, captures our interest.
And it is not only the story-telling that is important. It is the basic science behind these stories, the mechanistic reasoning and research that explains why climate change impacts our health. Dr. Tummala keeps up with the latest literature in NEJM and The Lancet and stays abreast of environmental reporting with The Guardian. By following conversations in both scientific research and the news media, Dr. Tummala is able to evaluate sweeping claims and participate in the conversation.
A year-and-a-half in to the GWU community, Dr. Tummala is engaging in these important conversations at the local level. Though she acknowledges it was initially a slow process, she has now found other colleagues interested in addressing climate and health, through whom she has engaged in clinical research and teaching, including Dr. Hana Akselrod, Assistant Professor of Medicine, GW SMHS and Dr. Rachel Harold, Infectious Disease Fellow, GW SMHS. In addition, she is also planning on working with collaborators across traditional disciplinary boundaries including Dr. Susan Anenberg, Associate Professor, GWSPH. Their grant proposal, “Advancing GW Cross-Disciplinary Collaboration in Climate Change and Public Health Research”, written by Drs. Anenberg and Akselrod, was recently awarded monies from the GWU Cross-Disciplinary Research Fund.
And what is one of the keys to getting a grant? Writing a good proposal, which should tell your potential funders who you are, what you’re going to research, and why they need to listen up.
Interested in Learning more about Climate Change and Medicine? Check out these resources
As Dr. James Griffiths noted in his recent Grand Rounds presentation, trauma shifts how the brain processes information, and we lose our capacities to reflect and to relate and to maintain our sense of identity. When faced with the fear and uncertainty of a medical illness - or a global pandemic - we lose our ability to concentrate. We cannot sit still to read the books we once loved. We pick up our pens and put them down again. Each time we try to explain what we are going through, it seems like we aren’t being clear enough, like there is no language adequate to encapsulate our experiences. Patients, family members, health care providers, we are, each of us and in our own ways, experiencing these strange times. Providers on the front lines - to whom we extend our sincere gratitude - may not be able to separate themselves from their work. Others of us, working from home for over a month now, may have established a schedule, but we still cannot bring ourselves to concentrate on the novel on our bedside table.
The New England Graphic Medicine conference was among the many that moved online this spring. The organizers added a COVID-19 comics panel discussion to the agenda. In this discussion, presenter Alice Jaggers described how the comics appearing - online, on social media channels, and via other platforms - provide a sampling of how graphic medicine is used [see: https://www.graphicmedicine.
Even when we cannot focus, especially when we cannot or do not want to focus, this rich medium, with all its layers, accomplishes through the synergy of drawing, words, and dialogue, that feat of connecting us. The space between the comic panes allows us to pause and process as we encounter traumatic events and difficult emotions on the page or screen (Williams, 2012).
Graphic medicine has been accepted and embraced by long-standing institutions and publishers. The Annals Graphic Medicine Channel includes comic strips that bring to the surface struggles healthcare professionals face. In comic format, these stories are human, relatable, and non-threatening. Since 2016, JAMA has issued an annual “Best Of” list for graphic medicine. (remember to access JAMA via the Himmelfarb Library’s website; check out their medical humanities section for articles about graphic medicine and more).
A search for “Graphic medicine” in PubMed returns 155 results, with most appearing within the last 5 years. Recognizing the growth in this area, two MeSH terms were added: in 2016, Graphic Novel as a publication type was introduced and, in 2018, “Graphic Novels as Topic” with the entry term “Graphic Medicine as Topic” was added. This is defined as “Works about book-length narratives told using a combination of words and sequential art, often presented in comic book style.” Graphic medicine is a diverse and growing field, with, as described, a broadly inclusive definition. Graphic medicine is at the intersection of the already blurry spheres of health and medicine and comic style. Graphic medicine can come in the form of an Instagram post or a strip on the Annals Graphic Medicine channel or a 200-page graphic novel. The topics range from anxiety to spanish flu (both pertinent to these times). The perspective may be that of the patient or provider or the family members and friends of those affected.
The National Library of Medicine collects graphic medicine materials for several reasons, including to “record progress in [medical] research, especially from the perspective of the patient patient”, contribute to medical education, describe “policies that affect the delivery of health services” in a straightforward manner, and depict “the public’s perception of medical practice” (Tuohy & Eannarino, 2018) As they go on to state, the perspectives and stories found in graphic medicine are unique from those found in technical and research literature.
According to Dr. Griffiths, to be resilient, we must step into adversity. We can use graphic medicine to reflect, cope, and connect and to ultimately help us step into adversity.
Myers, K. R., & Goldenberg, M. D. F. (2018). Graphic Pathographies and the Ethical Practice of Person-Centered Medicine. AMA Journal of Ethics, 20(2), 158–166. https://doi.org/10.1001/
Tuohy, P., & Eannarino, J. (2018). Reading graphic medicine at the National Library of Medicine. Journal of the Medical Library Association: JMLA, 106(3), 387–390. https://doi.org/10.5195/jmla.
Williams, I. C. M. (2012). Graphic medicine: comics as medical narrative. Medical Humanities, 38(1), 21–27. https://doi.org/10.1136/