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Impact of Climate Change on Human HealthI 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.

Neelu TummalaIf 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

Staying at home for a month sounds easy. But in real life, it is a very hard thing to do.
By Weimankow, 6 April 2020

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.

In our virtual meetings and phone calls, there is a tacit understanding that these are not normal times. Where do we start the conversations we need, and do not necessarily want, to have? How can we express ourselves and find the connections necessary to cope?

 

Graphic medicine comic creators often grapple with these and other questions. How does one illustrate both the events and the emotions of coping with the pain, fear, and hope that accompany medical crises?
Because so much about what's going to happen next is uncertain, everyone will be caught in a whirlwind of emotions
By Weimankow, 6 April 2020

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.org/covid-19-comics/].  While no comic fits neatly into a single category, they can be generally divided by a main tone or aim. Some provide educational information about diseases and treatment or various medical conditions and can thereby improve health literacy. They can provide historical information or context. Others address difficult ethical questions such as triage or end-of life care. Patients and providers alike draw comics as an outlet for expression, taking the time to reflect and cope during difficult times. These comics can be heartwarming and hopeful, or they can achieve the ironic synergy of humor and sadness unique to the comic medium.

I am not surprised that I find myself turning to COVID-19 comics. Comics “provide companionship through shared experience” (Williams, 2012). When we are socially distancing, physically isolated, reading a comic strip that encapsulates the quarantine experience can make us laugh, make us cry, and remind us that we are not alone (Myers & Goldenberg, 2018).

 

Let's remember to wash our hands frequently and thoroughly, so we can stay safe from virus infections together!
By Weimankow

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.

References:

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/journalofethics.2018.20.2.medu2-1802.

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.2018.449

Williams, I. C. M. (2012). Graphic medicine: comics as medical narrative. Medical Humanities, 38(1), 21–27. https://doi.org/10.1136/medhum-2011-010093

"All comics in the infocomic series about COVID19 are free to use for educational purposes with credit. If you would like to support me through donations, it would be greatly appreciated."