Language: English

Worlds Apart Facilitator’s Guide

This is a thorough facilitator’s guide on how to facilitate class discussions on the cross-cultural healthcare documentary Worlds Apart (a detailed summary can be found in the Search for Stories tab). In brief, Worlds Apart is a documentary split into four 10-15 minute sections that each focus on a different cross-cultural health experience, including a Muslim man’s journey with stomach cancer, a Lao woman with a hole in her heart, a Black man waiting for a kidney transplant, and a Puerto Rican woman with diabetes, hypertension, asthma and depression. This documentary showcases narratives that illuminate the limits of Western medicine and expand our ideas of how the American medical system can grow to be more inclusive, equitable, and sensitive. The facilitator's guide provides background on the filmmakers and their intentions. It includes suggestions for facilitators such as setting ground rules for discussion and asking students to jot down notes during the documentary. The four-part narrative-driven documentary is summarized, and then each section is broken down in great detail, so even someone who did not watch the film could understand the exact circumstances of each family and individual being featured. After each synopsis we also receive medical background information and a variety of discussion questions specifically tailored to different issues discussed in the stories. Each section has a separate “focus” also outlined, ranging from language barriers to explanatory modules to informed consent to racial/ethnic healthcare disparities to non-adherence to medications. This guide was created “to give health care professionals an engaging experience through which to explore ideas about cross-cultural issues in health care and to learn from the actual experiences of both patients and clinicians,” but could also easily be adapted to a university classroom setting to guide student discussions. The guide does not include any assignments, but any of the issues headlining the discussion topics could work well as research essay prompts.

Pain hustlers

There are many film narratives that relate to opioid addiction, some documentary and others, like this one, "based on true events." Run time is just under 2 hours and there's little sexual or violent content (though plenty of strong language), so it could be used in many undergrad classes: health communication, media studies, pre-health professions. The focus is on a mythical small pharmaceutical company that hits a goldmine when a bright young woman figures out how to market their brand of fentanyl to greedy, unscrupulous doctors. She tries to keep the men in charge of the company within ethical and legal bounds, without success, and the epidemic of addiction follows its well-known course. At the end there is footage of real pharma executives receiving real prison sentences, reminding the audience this isn't just a fable. Advantage of a drama over documentary - or perhaps in tandem with one - is opening questions of sympathetic portrayals and power differences based on sex and class. Available on Netflix.

The Phone Call

“The Phone Call” by Melissa Fournier is a short narrative retelling the author’s experience in giving birth to an infant on the edge of viability and, in the face of low odds of survival and extreme neurological impairments, signed a DNR. She recounts her experience as it is compared with others’ experiences of earlier stage abortions, and how public perceptions of varying kinds of difficult parental choices can be laced with bias, even when well-meaning. This would be useful in a class about reproductive rights and abortion. It is not long enough for an entire assignment, but it could be a good example to challenge abortion stereotypes and assumptions include in a lesson on the many nuanced situations in which termination of life occurs.

Cultivation Also Starts With C

“Cultivation Also Starts With C” by Jess Skyleson is a poem that uses the invasive, difficult to remove plant Japanese knotweed as a metaphor for cancer without ever saying the word, "cancer." Skyleson switches back and forth between describing the beauty and tenderness of the plant itself with the devastation it wreaks on the environment to ultimately center the story within a doctor’s diagnosis. This poem could be used in a variety of health humanities courses to, for example, encourage students to consider alternative metaphors for thinking and speaking about cancer. It could also fit in a course that explores the intersection between human and environmental health.

Mercy

Through beautiful description and comparison Selzer writes about an interaction between a patient, his doctor, and his family at the end of his life. In the story, the patient is in the hospital, suffering and in pain. This piece serves as the doctor’s narrative, as he, too, suffers in deciding how to ease his patient’s pain, which can only be done by euthanasia. The doctor deliberates back and forth about the options and ultimately gives the patient what should be a fatal dose of morphine, yet still, he does not die. This piece raises questions about medical ethics, listening to patients, listening to families, and making informed decisions in healthcare. This narrative could be used in courses regarding medical ethics, death, medicine, and narrative medicine. This piece could prompt discussion about medical ethics, who gets to make choices, and why certain choices are made in healthcare. It can be used to show the place of creative writing in medicine, as it provides a creative account of an interaction between a doctor and a patient.

Hyperbole and a Half: Unfortunate situations, flawed coping mechanisms, mayhem, and other things that happened.

This is a graphic memoir written by a comedic blogger, divided into chapters that retell various life experiences in words and digital drawings, ranging from sibling relationships to unruly dogs to childhood memories to unconventional methods of dealing with depression. Brosh has experienced depression throughout her life, and this is a topic she digs into candidly in her book. Selected chapters of this book could be used as brief, accessible readings in a class on mental illness or in a training for health care providers. A follow up assignment could invite students to make graphic narratives of their own and could invite discussion of how humor can be used to make difficult topics less taboo.

The Immortal Life of Henrietta Lacks

This book is a biography of Henrietta Lack, a black woman who died of cervical cancer in 1951. Before her death, Henrietta Lacks’ cells were harvested from her cervical tumor without her knowledge or consent. The HeLa cell line originates from these cancerous cervical cells, and it is the cell line most used for any study on human cells. Neither Henrietta nor her family were consulted nor informed about the mass distribution and use of her cells until decades later when her cells were already the cause of many medical discoveries and breakthroughs. This book was the first to paint the whole picture of the human behind the most famous cell line. This book might be used in courses on research and medical ethics, on health (in)equities, or on narrative medicine. For example, it sheds light on all of the factors, both medical and societal, that led to a lack of adequate or ethical care. Her story shows the importance of health stories for humanizing medicine. It allows for reflection on the history of healthcare as it relates to women and people of color (specifically black people and black women).

Love in the Time of Cholera

Originally written in Spanish, this is a novel about a relationship over the course of a lifetime, where due to a father’s taboo, the lovers must be apart. It characterizes lovesickness and heartache as a literal sickness. It also destigmatizes love and passion in old age by showing the two protagonists finally getting to be together fifty years after they were torn apart. However, it does point to the limitations of societal expectations because in order to be together the lovers must stay on a ship pretending to be in cholera quarantine. This could be useful for teaching about elderly relationships and the stigmas around sex and intimacy in old age, as well as how real health crises, like cholera, permeate deeply into a society. One could draw parallels between cholera and COVID and the social impacts of epidemics and pandemics.

Mary Jane: A play about caregiving for a young child with serious health conditions

Mary Jane is a single mother of a young child with cerebral palsy, seizure disorder, and lung disease. The play portrays her caregiving, both in ordinary times and during a health crisis that eventually takes his life. We see her build a support network, including professional caregivers and others with whom she gives and receives support. She is a fierce advocate for her son and her descriptions of him and her life with him make clear the value of disabled lives. I plan to use this in class as an example of a caregiver narrative that shows the ways in which family members are impacted by illness and the significance of their support and advocacy. It is a powerful statement about the joy and the pain of caregiving (at one point in the play, Mary Jane states that one of the more useful things someone said to her early on was that there would be good days and bad days). It also portrays ways that our healthcare system and society often fail to support caregivers. There are scenes in which healthcare providers address Mary Jane only as “mom” and the only staff member in the hospital who addresses her by name is a chaplain.

He was not the first dead man I X-rayed

The author had this to say about the poem: “I have X-rayed thousands of people over thirty years, but this one still come backs to me. It’s the story I tell when people ask me for ‘hospital stories,’ so it’s no surprise that I eventually wrote the story in a poem. I can still so vividly see him and me alone in that cold room.” " Content warning : Gun violence, some graphic descriptions of bodily harm This is a short poem written from the perspective of the author as a X-ray technologist. It describes one particular experience he had caring for a man with a gunshot wound who dies during the treatment and the poem. Provides an opportunity to talk about death and the impact experiencing death may have on healthcare providers. The brevity and personal quality of this piece leaves room for students to interpret and discuss their own thoughts and reactions. There is a complex story in a brief poem, with lots to unpack, accessible to all audiences.