Rubina Naqvi
Karachi, Pakistan

There is a need for increasing the education of medical students through the use of literature, so that physicians can become knowledgeable about and eager to confront the social, economic, and cultural contributors to illness. This is particularly important when one considers the great differences in economic, environmental, and health-related resources between developed and developing nations. Millions of people lack access to clean drinking water and adequate sanitation services. Tens of thousands of children die daily from malnutrition, malaria, and diarrhea; and many women die during childbirth. This wide gap of resources provision between poor and rich has been addressed in literature both from east and west.

Literature, medicine, and public health share a fundamental concern with the human condition. Through literature, readers experience new situations, explore diverse philosophies, and develop empathy and respect for others. Reading about the experiences of those who suffer from poverty, racism, stigmatization, and impaired access to health care can help medical students to identify more closely with their patients, whose complex lives they glimpse only during periodic clinic visits.

Some specific examples of valuable literary works are:

• George Orwell’s essay “How the Poor Die”³ and Anton Chekhov’s short story “Ward Six”⁴ offer timeless descriptions of the abysmal conditions once prevailing in public hospitals.
• Doris Lessing’s, “An Old Woman and Her Cat,”⁵  a moving fictional entrée into the world of society’s dispossessed through its description of the daily struggles of an aged gypsy and her adopted alley cat trying to cope with life on the streets of London.
• In William Carlos Williams’ brief tale, “The Insane,”⁶ a young pediatrician shares with his physician-father his frustration over the long-term effects on a child’s mental health of witnessing violence and of emotional neglect
• Rabindranath Tagore, Nobel Laureate in literature, his poem from a collection “I Won’t let you Go”
• A poem of Rabindranath Tagore:

Go not to temples to put flowers upon the feet of God,
First fill your own house with the fragrance of love …
Go not to temple to light candles before the altar of God
First remove the darkness of sin from your heart …
Go not to temple to bow down your head in prayer,
First lean to bow in humility before your fellow men …
Go not to temple to pray on bended knees,
First bend down to lift someone who is downtrodden
Go not to temple to ask for forgiveness for your sins,
First forgive from your heart those who have sinned against you

• Faiz Ahmed Faiz’s poem, suitable for lyrical groups (Laal band)
• Pastor Niemoller’s poem, “First They Came for the Jews,”⁷ powerfully inspires us to speak out on behalf of the disenfranchised.

Useful selections relating to the partition of India and Pakistan (1947) are Krishan Chandra’s short story, “A Letter from a Prostitute, (addressing to Pandit Jawaharlal All Nehru and Mohammad Ali Jinnah),”⁸ which portrays the horrors of partition and excoriates the hypocrisy of those who pray for victory in that situation; Saadat Hasan Manto’s short story, “Khol Do,”⁹ describes the harrowing experience of a seriously affected father of a young beautiful lady.

The medical profession has made important contributions to literature through the works of Anton Chekhov, Somerset Maugham, William Carlos Williams, Francois Rabelais, Thomas Campion, John Keats, and contemporary doctor-writers like Lewis Thomas, Dannie Abse, and Richard Selzer from the west and Ali Sharieti, Shafiq ur-Rehman, Asif Farukhi from east.

Medicine stands in a peculiar relation to society. Often understood as its own culture, it is seemingly apart from, but also intimately involved in, our lives. Yet physicians have an obligation, borne of their privileged status, the public’s investment in their training, and their roles as stewards of the public’s health, to be politically active and ensure that our leaders provide for the sickest among us. They also have a responsibility to oppose, individually and collectively, the forces which contribute to the spread of poverty; over-consumption; the misdistribution of wealth; the economic, political, legal, and educational marginalization of women; environmental degradation; racism; and human rights abuses. One educator’s approach to augment public health training and encourage physician activism is through the use of literature. The experience of suffering on behalf of others afforded by reading the powerful stories of great authors can enhance trainees’ attentiveness to their patients’ needs and motivate physicians to become more active in addressing the health care needs of their communities and the world.

References

1. Donohoe, MT, Bolger J. Student and faculty responses to the addition of literature to the preclinical curriculum. J Gen Int Med 1998;4(suppl. 1):74.
2. Naqvi R. Teaching Bioethics to Medical Technology Students in Pakistan. J Med Ethics Hist Med 2009, 2:8
3. Orwell G. “How the Poor Die.” In Sonia Orwell and Ian Angus, eds. The Collected Essays, Journalism and Letters of George Orwell, IV; In Front of Your Nose, 1945-1950. New York: Harcourt, Brace and World, Inc.: pp. 223-233.
4. Chekhov A. “Ward Number Six.” In Chekhov A. Seven Short Novels (New York: Bantam,1976).
5. Lessing D. An Old Woman and Her Cat. In The Doris Lessing Reader. New York: Knopf, 1988.
6. Williams WC. “The Insane.” In The Doctor Stories (New York: New Directions, 1984).
7. Niemoller P. “First They Came for the Jews.” In A Poem a Day. K McKosker and N Alberry, eds. (South Royalton, Vermont: Steerforth Press, 1996).
8. Kirshn Chandra ” Peshawar Express”, published by [email protected] 2004
9. Urdu Short Stories, A Selection, English translation by S.M.Shahid, ISBN No. 978-969-8625-16-0