Five Questions for… Ana Carden-Coyne

For the latest contribution to our series introducing MedHumLab members, Dr Ana Carden-Coyne, Senior Lecturer in War and Conflict and Co-Director of the Centre for the Cultural History of War, talks about her understanding of medical humanities and her experience of curating the exhibitions The Sensory War at Manchester Art Gallery (2014/15) and Visions of the Front 1916-18 at Whitworth Art Gallery (until 20 November 2016).

Timothy Greenfield-Sanders Dawn Halfaker 2006 Digital archival pigment on paper matt cotton rag © Timothy Greenfield-Sanders

Timothy Greenfield-Sanders, Dawn Halfaker, 2006, digital archival pigment on paper matt cotton rag © Timothy Greenfield-Sanders. This work was on view as part of the exhibition The Sensory War, Manchester Art Gallery, 11 October 2014-22 February 2015

How does your research relate to the field of medical humanities?

My recent research has been on experiences of pain among the wounded of the First World War, with a particular focus on patient and practitioner encounters. I am interested in how social relations (class and gender) bear out in those interactions of how treatments (both emergency acute and prolonged or chronic) were delivered and received.

When I give talks, a lot of people end up discussing their experience in the NHS, so this is very telling about how medical humanities can have an impact on understanding and communicating our feelings about the world we live in today. We can talk about emergency procedures and triage (ambulance services or A & E, which were significantly developed in the context of WW1). We can talk about experimental surgeries and drugs, and ethical issues and patient rights. We can discuss nursing and rehab quality and care; both patients’ expectations and practitioners’ expectations, and the pressures both are often under to rapidly cure or rehabilitate the patient. We can think about the impact on families of chronic pain, when the hospitalisation ends and the family takes over. And we can look at the continuities and changes in wider social attitudes to pain and disability, and how they impact on health and wellbeing, and on medical practice itself.

My latest interest is in chronic pain suffered by wounded servicemen and women. And I am working on two projects on occupational therapy in the asylum and in military hospitals, with a major focus on men’s embroidery. I also have a new project on visual art, war and humanitarian disaster, which engages with suffering and medical intervention.

How would you define the term ‘medical humanities’ in a few sentences?

Medical humanities is an umbrella term that brings together many different arts and humanities disciplines with the medical and social sciences. What appeals to me most, is the focus on humanising medicine and enabling the patient experience through dialogue and communication, and especially through engagement with arts practitioners.

What, in your opinion, is the value of interdisciplinary research (and research networks such as MedHumLab)?

There is a great deal of inspiring work being done by creative practitioners, academics and artists who approach medicine and medical science in highly useful ways for society and for human benefit. As a historian, curator and heritage scholar, the people who work in this broad field inspire me every day.

You have curated the exhibition The Sensory War at Manchester Art Gallery (2014/15) and contributed to other exhibitions in the past. Can you tell us a bit more about your work with objects and visual material?

My research fundamentally responds to the cultural phenomena that medicine creates; whether it is diaries and memoirs, surgical technologies and devices such as prosthetics, or infections and rehabilitation treatments. For me, artists’ reactions to war medicine and surgery, and patients’ experiences of military medicine, have been one focus. But I am also interested in humanitarian medicine and its cultural field of representation. And how artists interact with the concerns of patients, cultural imagery, and big questions of human health, crisis and wellbeing.

Otto Dix Der Krieg: Sommeschlact (Fleeing wounded Man, Battle of the Somme, 1916) 1924 Etching 25.7 x 19 The British Museum

Otto Dix, Fliehender Verwundeter, Sommeschlacht, 1916 (Wounded Man Fleeing, Battle of the Somme, 1916), from Der Krieg (The War), 1924, etching, 25.7 x 19 cm © The British Museum

The Sensory War exhibition explored how artists have communicated the impact of modern war on the mind and body, the human sensory experience, and the environment. It considered these themes in relation to each other, or what we might call, synaesthetically. It was a huge show over two floors with 247 artworks, and it took over 3 years and 3 curators to bring it to fruition. One of the sections was called ‘Rupture and Rehabilitation’. We looked at so many inspiring artists, some of whom had acted as theatre orderlies in military casualty hospitals (such as Harold Sandys Williamson’s hauntingly clinical work, The Human Sacrifice of 1918), or were commissioned to document operations during the Second World War, such as a remarkable large scale painting by Alfred Reginald Thomson, Grafting a New Eyelid (1943). Or representations of saline baths used to treat burns patients.

Rosine Cahen, Hospital Rollin (October 1918) 1918 Black charcoal, pastel and white highlights on laid paper © Jean-Yves Martel

Rosine Cahen, Hospital Rollin (October 1918), 1918, black charcoal, pastel and white highlights on laid paper © Jean-Yves Martel

Then there were real discoveries, like the French woman artist Rosine Cahen who went around to the hospitals in France doing very intimate and immediate sketch-portraits of French soldiers recovering from severe wounds, in their beds and some wearing their medals. And we also had the extraordinary opportunity to bring to the UK for the first time The Cripples Portfolio (1919) – a set of lithographs by German artist Heinrich Hoerle – in which the daily experiences, losses and dreams of the war disabled are explored. We could compare this with Timothy Greenfield-Sanders’ large-scale glossy portraits of Iraq veterans and their prostheses, and discuss this significant twentieth-century symbol of medical modernity and the ideal of restoration from violence, yet the lingering experience of emotional pain.

I have a small exhibition that I co-curated with David Morris at the Whitworth Art Gallery at the moment, Visions of the Front 1916-18, for the Somme centenary. Medical interventions and representations are a major feature of this too, such as Henry Lamb’s painting Advanced Dressing Station on the Struma, 1916 (1921).

Henry Lamb Advanced Dressing Station on the Struma, 1916 Oil on canvas Manchester City Galleries © The estate of Henry Lamb (c) Mrs Henrietta Phipps; Supplied by The Public Catalogue Foundation

Henry Lamb, Advanced Dressing Station on the Struma, 1916 (1921), oil on canvas, 183.6 x 212.3 cm, Manchester City Galleries © The estate of Henry Lamb

The scene of a dressing station focuses on the relationship between a wounded man and a stretcher-bearer, who attends him with a cup of water, a great relief that many soldiers wrote about as the comfort given between men. Thirst and cold were understood much later in the war as signs of hemorrhage and shock. The bearer’s hand gently touches the wounded man’s head, providing comfort symbolic of the pietà (Christian iconography of Mary cradling Jesus’ corpse). Indeed, the pietà was often used in war-time humanitarian images of nurses caring for wounded men. But Lamb transforms the theme into an effigy of masculine care and the intimate brotherhood of shared suffering. Placed on the ledge of a shallow trench, the stretcher resembles an altar. In the right hand corner is a Thomas splint used for compound fractures, from which soldiers could die. Pathos is also created by the figure on the left, head in hand, perhaps affected by malaria, a common disease of this front, or perhaps a reference to psychological suffering. The central figure stands over the patient, staring pensively into the distance. Made three years after the end of the war, the composition of this painting symbolises the pain and succour of the entire conflict.

Henry Lamb was educated at Manchester Grammar School and studied medicine at the Manchester University Medical School. He left his studies for Paris, to attend the Académie de La Palette, where renowned modernists Jean Metzinger and Henri Le Fauconnier taught. The war compelled Lamb to finish his studies. He received a commission in the Royal Army Medical Corps and was with the Northumbrian Field Ambulance Unit in Salonika from August 1916 to March 1917.

And finally, how do you relax and unwind away from the office or seminar room?

Er… gosh… I have a toddler so it’s go go go…

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Five Questions for… Sarah Collins

Dr Sarah Collins is Senior Lecturer in Communication, Lead for Clinical Communication, Co-Director of the MSc in Medical Humanities, and Lead for Year 3 Patient-Centred Consulting at Manchester Medical School. In today’s contribution to our Meet the MedHumLab Members series, Sarah shares with us her interactive and creative approach to teaching communication to medical students.

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Patrick Birch, medical student, performs a one-man play about homelessness in the Consultation Skills Learning Centre, Manchester Medical School

You are the co-director, with Carsten Timmermann, of the MSc in Medical Humanities. How do you see the role of medical humanities in medical education?

The practice of medicine is founded on the relationship between the patient and doctor. This relationship is formed and played out through the consultation. Trust, a genuine interest in the person and their everyday concerns, and an understanding of the social and medical context of their illness and disease, are key in effective, patient-centred care. To be able to understand and engage with the patient requires scientific knowledge and artistic imagination. Every individual doctor or medical student carries their own unique capacity for entering into the worlds of their patients. These acts of understanding require creative thinking, self-expression, and all the senses. In these respects, medical humanities provides a sounding board for students to appreciate the lives of their patients, and to develop their own capacities for expressing and responding to emotion, acting intuitively and with sensitivity, and learning to look after their patients, their colleagues and themselves.

Dr Sarah Collins

Dr Sarah Collins at the opening of the Consultation Skills Learning Centre with Dame Nancy Rothwell and Professor Doug Corfield

You have designed, with a number of colleagues, the Consultation Skills Learning Centre in Stopford Building, which opened in 2012. Can you explain what makes this facility unique and how it helps students to gain confidence in communicating with patients and medical staff?

We designed the Consultation Skills Learning Centre on a principle of combining open, public areas with private spaces. This reflects the way in which health care is organized and delivered, and allows students to navigate themselves and their simulated or visiting patients through different areas of a clinic. Our design was inspired in part by my research on the geography of communication in head and neck cancer outpatients. This research has also found its way into our teaching.

We turn the Centre into ‘Stopford A&E’, for example: in which spontaneous, dramatic events as well as informal conversations happen in the corridor and waiting room; the students are suddenly called on to answer the phone; while the side rooms provide opportunities to gather clinical information, listen to patients’ stories and carry out physical examinations.

In delivering teaching, the open central areas and the more private consulting rooms allow tutors to share ideas and co-teach during a session while at the same time delivering their own teaching to students in a side room. We have ‘acoustic curtains’ to close off the private space – thick curtains which block out sound (and which are therefore more effective than hospital curtains) – but which can also be opened to provide for all the ‘patients’ and the teaching and learning activities to be open and seen.

Sarah

Sarah engaged in conversation with students

As the winner of a Teaching Excellence Award in 2012/13, can you tell us a bit more about your approach to teaching communication skills to medical students?

My approach to teaching communication is student-centred, creative (drawing on different theories and concepts and applying these in imaginative and new ways) and multidisciplinary. Although ‘communication skills’ is the standard term used to describe what students need to be able to practise effective communication with their patients, there is of course more to this than ‘skills’ – it is also knowledge, attitude, intuition, reflection. We use the terms ‘consultation’ and ‘patient-centred consulting’ to reflect the broad array of influences and dimensions that all come into play in an interaction between an individual patient and the doctor or medical student.

I make a point of learning all the students’ names and remembering details about their lives. The relationship with students in teaching is essential in order to foster open discussion and critical thinking. I involve the students’ ideas and contributions in our curriculum – for example, students have written dramatic dialogues which we now perform on a regular basis for all students, e.g. ‘In the Waiting Room’ in our session ‘Mental Health Stories’. For ‘Stopford A&E’, I asked final year students to write the session, and they now teach this session each year to the second year students, with support from my clinician colleagues. And I draw on different media – spoken, written, visual, art, photography, music – to set the scene for an individual session or to create an interlude within it for everyone to share thoughts and ideas.

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Music, Literature, Art and Medicine: an evening of performances by medical students at the Anthony Burgess Foundation, November 2015

How does your interdisciplinary background in languages and linguistics, communication, social science and education, and creative writing inform your teaching?

I use my interdisciplinary background to create the content and form for every session I design: the combination of disciplines allows us to represent the consultation and the doctor-patient relationship in its multiple and diverse forms. In terms of teaching and learning activities, we incorporate drawing, listening to music, creative writing of dialogue and narrative, ethnographic observation of clinical settings, and discussions about educational methods, into both tutor development and student learning.

Sarah

Creative approaches to teaching and learning communication: Sarah and colleagues at the International Conference for the European Association of Communication in Healthcare, Heidelberg, September 2016

And finally, how do you relax and unwind away from the office, CSLC, lecture theatre and seminar room?

I love cooking, gardening, writing poetry, wandering around art galleries, walking long distances, going to the cinema, and most of all spending time with my family.

Five Questions for… Wendy Gallagher

In this week’s contribution to our regular series introducing MedHumLab members, Wendy Gallagher, Arts & Health Partnership Manager at The Whitworth and Manchester Museum, talks about all things ‘museums, health and wellbeing’.

Wendy Gallagher, Arts & Health Manager at The Whitworth and Manchester Museum

Wendy Gallagher, Arts & Health Partnership Manager at The Whitworth and Manchester Museum

What does your role as Arts & Health Partnership Manager at The Whitworth and Manchester Museum entail? Can you describe what ‘a typical day at the office’ looks like for you?

My working days are always varied as I work in museum and gallery, clinical and community settings at local, regional, national and international levels.

Can you tell us a bit more about the Health & Culture partnership between Whitworth Art Gallery, Manchester Museum, Manchester Art Gallery and Central Manchester University Hospitals NHS Foundation Trust? What kinds of events and initiatives does it support?

The partnership began in earnest in 2008, with a regional research programme of arts and health activities called Who Cares? Museums, health and wellbeing. We have a long and successful history of working with local communities, such as users of community centres in surrounding wards, older people in residential and care homes, and adults with mental health problems. We provide activities and events for all ages from Parents to Be to Coffee, Cake & Culture: a programme for people living with dementia and their carers.

ArtMED is a collaborative programme between the Faculty of Biology, Medicine and Health, the Faculty of Humanities, the Whitworth Art Gallery and Manchester Museum. The programme involves students and professionals from medical and healthcare backgrounds visiting the museums in small groups to explore works of art and objects in relation to areas of their curriculum or professional specialisms. They also undertake object based lectures in relation to biomedical research, ethics, law and human rights. The ArtMED programme encourages the development of visual literacy for a group of students and professionals whose observational skills will be essential in their future medical and nursing careers. At a deeper level, a visit to the Museum broadens their awareness of the value of culture, enriching their understanding of the world in which we live. The visit demystifies the Museum and affirms the potential for arts and heritage to intersect with the medical world.

‘Museums and wellbeing’ seems to be a burgeoning field of engagement and research. How does your work fit within this wider context?

Arts for health programmes and initiatives are being rolled out in museums and galleries in a number of countries, with networks and partnerships developing between museums and galleries and the health care sector. As we continue to strive to improve access to our collections and provide programmes that promote wellbeing through engagement, evidence is beginning to emerge of the benefits that participation in cultural activities can have for people’s health, wellbeing and quality of life. We know that museums and art galleries are full of objects and artworks of historical, social and personal significance and have developed programmes and resources to engage a wide range of audiences who may not traditionally have visited us. In 2012 the Whitworth Art Gallery and Manchester Museum were recognised by the Royal Society for Public Health with two awards for outstanding and innovative contributions to arts and health research and practice.

How would you define the term ‘medical humanities’?

I would define the medical humanities very loosely as the use of arts and humanities within the medical curriculum.

And finally, how do you relax and unwind away from the office?

I’m learning to play the guitar, and I spend a lot of my free time socialising and travelling with friends. I also like long walks with my border terrier and regular glasses of good red wine.

Five Questions for… Julie-Marie Strange

Julie-Marie Strange, next in our series introducing MedHumLab members, is Professor of British History and currently Head of History.

Julie-Marie Strange, Fatherhood and the British Working Class, 1865-1914, Cambridge University Press, 2015

Julie-Marie Strange, Fatherhood and the British Working Class, 1865-1914, Cambridge University Press, 2015

Your research and teaching interests are wide-ranging, including Victorian cultures of death and bereavement, fatherhood and attachment in late Victorian and Edwardian working-class culture, and historical representations of menstruation, puberty and the menopause. How do they fit into a medical humanities context?

The unifying theme of my research is the history of emotions which bear a close relationship with bodies, wellbeing and mental health, and of inter-personal relationships.

How would you describe the field of medical humanities from your disciplinary perspective as a historian?

As a dynamic field that invites us to historicize core questions about society, culture and individuals.

Julie-Marie Strange, Death, Grief and Poverty in Britain, 1870-1914, Cambridge University Press, 2006

Julie-Marie Strange, Death, Grief and Poverty in Britain, 1870-1914, Cambridge University Press, 2005

Where do you see the benefits of interdisciplinary research?

The fusion of ideas, methods and practices from different perspectives invites us to view things – often familiar things – through new lenses and to be surprised.

What are your expectations for MedHumLab for the future?

That a cross-fertilisation of ideas and practices will lead to fruitful but focused collaborations on research themes.

And finally, how do you relax and unwind away from the office or seminar room?

Outdoors, preferably with a horse and/or a hound.

Five Questions for… Jane Brooks

Next in our series introducing MedHumLab members is Dr Jane Brooks, Lecturer in the School of Nursing, Midwifery and Social Work, Deputy Director of the UK Centre for the History of Nursing and Midwifery and Editor of the UK Association for the History of Nursing Bulletin. She talks about her research on the history of nursing during the Second World War and the value and challenges of oral history projects.

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Sister Winifred Mountford, a nursing sister with the Queen Alexandra’s Imperial Military Nursing Service in a tented operating theatre in the desert in the Second World War

How does your research on the history of nursing play into the field of medical humanities?

My research into the work and practices of nurses in the 2nd World War identifies them as critical players in the 2WW medical services, both in the clinical work that they undertook and their presence as women, which appears to have supported the healing process and beliefs in a homeland to secure. Nursing in many ways is the human link in the medical / technology / patient triad. The history of nursing seeks to illuminate how the place of nurses in healthcare was developed out of this postion.

How would you describe the importance of humanities in medical education and patient care?

On the BNurs at Manchester, we begin the first year by introducing the students to critical aspects and events in the history of the nursing profession. The evaluations from the students demonstrate that this enables them to situate themselves in their chosen profession and develop a more political and critical eye on the health services and their place in it. By introducing students to the history of ethical and unethical practices, they are able to begin to formulate a moral compass through the safer gaze of historical enquiry.

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Sister Emily Soper, also of the Q.A.s, outside the 66th General Hospital, Assam, just before night duty

One of your preferred research methods is oral history, alongside qualitative and quantitative historical research. Can you tell us about the value of oral history for your research? Are there any challenges?

Grassroots nurses have not always been a profession of writers. Although there are a number of leaders who wrote ideas about nursing, there is little from those nurses who engaged in patient care on a daily basis. Oral history allows us to develop an understanding of their work and their attitudes towards it. The challenges are the same as with oral history in general, but with some additional ones. In my oral history project with nurses who cared for older patients in the 20th century, the limited engagement with ethical practice, the frequent dehumanisation and the lack of resources and poverty of leadership caused distress to several participants. It is therefore vital, in oral history projects that deal with potentially sensitive data, for the interviewer to be alert to these difficulties.

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Jane out riding on her mare, Elsie

What are your hopes and expectations for MedHumLab for the near future?

I hope that the Lab continues to develop cross-disciplinary work. I should like to see collaborations between students of all disciplines.

And finally, how do you relax and unwind away from the office or seminar room?

I ride my horse and run with my young and completely tireless border-collie.