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
- 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.
- Naqvi R. Teaching Bioethics to Medical Technology Students in Pakistan. J Med Ethics Hist Med 2009, 2:8
- 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.
- Chekhov A. “Ward Number Six.” In Chekhov A. Seven Short Novels (New York: Bantam,1976).
- Lessing D. An Old Woman and Her Cat. In The Doris Lessing Reader. New York: Knopf, 1988.
- Williams WC. “The Insane.” In The Doctor Stories (New York: New Directions, 1984).
- 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).
- Kirshn Chandra ” Peshawar Express”, published by nigarishat@wol.net.pk 2004
- Urdu Short Stories, A Selection, English translation by S.M.Shahid, ISBN No. 978-969-8625-16-0
RUBINA NAQVI, MBBS, MD, works as an adult nephrologist and transplant physician at SIUT, which is the largest center for live renal transplant in Asia. He has a special interest in bioethics and the humanities and teaches bioethics to medical technology students and nurses.
Highlighted in Frontispiece Volume 6, Issue 2 – Spring 2014
One response
NeoAbiogenesis – Origin of Life Hypothesis.
By Kevin Reuter (the ‘ctrl-h text macro indi app dev) NY
Abstract:
Nucleic acids form spontaneously in certain chemical and atmospheric conditions without biosynthesis (Nat. Commun 2016, DOI: 10.1038/ncomms11238). The first nucleic acid catalysts were most likely binary two-complementing nucleotide pairs as the likelihood of all nucleotides being biologically synthesized is an order of magnitude less likely than just 2 encoding base pair partners. Nucleic acids form phosphodiester bonds with other nucleic acids spontaneously in the presence of sufficent energys, thus creating RNA strands spontaneously. These strands of spontaneously and randomly encoded RNA then find their corresponding base pairs spontaneously in no particular order by forming hydrogen bonds in the presence of or lack their of energy. The 40th nucleic acid, for instance, in the RNA chain can find its corresponding nucleotide 40th before the 10th nucleic acid, for instance, thereby creating a reverse copy of the original RNA molecule piecewise non-linearly. This newly formed RNA pair, commonly known as DNA, then goes through a spontaneous physical split down the hydrogen bonds (the weakst bond in a dna structue) of the DNA, like a “zipper,” thus creating 2 copies of RNA. The new RNA strand being a mirror image of the original RNA molecule with possible mutations. This split doesn’t have to happen all at once and can be done in parts, promoting a DNA strand with multiple split sites. This process then repeats from there, with the ongoing repeating process for an indefinite time, and the newly RNA molecule performing its first replication, thus explaining the beginning of self-replication and the evolution of biomolecules.
Furthermore, I hypothesize that RNA would replicate in branches if RNA/DNA as a cobweb/branches of genomic information self-relocating/mutating piecewise, not as a whole, breaking off in random RNA/DNA pieces as well anywhere from 1 to N nucleotides. The entire genetic sequence does not need to be completely intact in order to have small segments of RNA/DNA replicate/mutate. This could mean that a huge cobweb/intertwining branches of RNA/DNA could suddenly lead to a mutation/advantageous dna sequence that completely sequesters itself from the huge RNA/DNA cobweb/intertwined branches of DNA in a vast part of and become a self-sufficient small chain of quickly replicating/mutating dna molecule without all the slag of its mother dna conglomerate molecule.
This spontaneous branching process of dna, which needs no precursor genes, catalysts, or enzymes, is purely to point out the fact that genetics don’t need to rely on precursor genes, catalysts, or enzymes to evolve and replicate, as self-replication evolution can occur without large precursor genes, catalysis, or enzymes at all. It would be a messy process.
I believe the fatty cell membrane developed as a result of liquid turbulence from tidal forces forming fatty bubbles around random collections of RNA, DNA, and loose nucleic acids with osmotic stress from salt concentration differentials inside and outside the cell membrane, causing the fatty membrane to pop, then reform around the RND, DNA, loose nucleic acids in a kind of extremely messy cell division with fractions of the whole carrying copies of the mother cells RNA and DNA.
Possible Experiment:
Make a sterile soup of individual nucleic acids via the abiogenesis experiment them at various temperatures and atmospheric conditions that change over time mimicking early Earth. See over time if ANY DNA forms. If any DNA forms without a biological precursor, we know that some RNA/DNA had to have randomly replicated itself using free nucleotides, resulting in a new DNA strand. This DNA, when heated (assuming near 98°C), should unzip down the hydrogen bonds and repeat the replication process with mutations.
Other related thoughts currently held by the belief for the origins of life states that nucleic acids form spontaneously in certain chemical and atmospheric conditions without biosynthesis (Nat. Commun 2016, DOI:10.1038/ncomms11238), yet binary chains of RNA formed without the ability to copy themselves until some random chunk of RNA lucked into a biomechaisum that replicated the RNA strand by nuclaic acid esterfication untill self replication devloped. I think this hypothesis is far more unlikely to be true because this would make self-recall of encoded RNA information an unlikely event.
The alternative hypothesis would be that the RNA molecule that split spontaneously replicated and created a copy of itself. Enzymes are called catalysts for DNA/RNA replication, which implies that DNA/RNA can replicate without enzymes at all, however much more slowly. This implication only goes further with the idea of my hypothesis, meaning RNA turns into DNA spontaneously (however slowly) more than into unique enzymes or without any enzyme catalyst involved.
Conditions That Must Be Met To Prove NeoAbiogenesis:
1. Phosphodiester bonds must form spontaneously without any bio precursor under any physical condition.
2. Hydrogen bonds must form spontaneously without any precursor, forming DNA from RNA spontaniously either due to high or low energys(raidation and or Electrostatic)
3. The newly formed hydrogen bonds must be broken much frequently brokem than any other bonds in the DNA/RNA structure, causing 2 RNA strands to result. It doesn’t have to be completed as a partial decoupling of the DNA allows
for new RNA copies to be split off with the origonal in tact, this allows the new and old RNA to duplicate/mutate further
If all these conditions are met in laboratory conditions, replication of any strand length of DNA/RNA, this hypothesis should be considered true in cases across the cosmos as the actual origin of life and very likely the origin of life on Earth.
Previous Experimental Evidence:
The Miller-Urey experiment has already been proven that DNA can be synthesized in a sterile environment, thus providing my theory with background supporting evidemce. But it has never been postulated that DNA is an RNA molecule replicating itself, thus the “neoAbiogenesis” model. To prove my theory, we must rerun the experiment again and see if DNA strands are made in a sterile jar and never before seen in that sterile model. This is how we will know true “neoAbiogenesis” has occurred.
Submit to more Scientific journals on my behalf