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The Anthropology of Emory and Ebola: Emory Healthcare Thinks Outside of its “Concrete Box” by Laura Jones

23 Dec, 14 | by BMJ

 

 

Two days after Halloween, I met with Dr. Bill Bornstein, Chief Medical Officer and Chief Quality Officer at Emory Healthcare.  I am a cultural anthropologist who has been conducting field work at Emory University Hospital (EUH) for three years, and Dr. Bornstein and I meet monthly to discuss hospital culture, specifically that of the operating room.  I asked him if I could write about Emory’s experience with Ebola, and he said yes but was curious about my angle.  I said I was unsure.

 

Before leaving, Dr. Bornstein asked about my Halloween. I told him I went as Natalie Portman’s black swan.  He replied, “Have you ever heard of Nassim Taleb’s Black Swan Principle?…” He explained that people once believed all swans were white, and had never conceived of a black swan simply because no one had ever reported seeing one.  The metaphor suggests that we have endless assumptions about finite evidence.  Outliers are rarely predicted, but always seen in hindsight as glaringly obvious.  Dr. Bornstein and I locked eyes and smiled, knowing I’d found my angle.

 

The Ebola virus was named the Lingala word “Ebola,” or “Black River,” for a waterway near where it first surfaced. I sought to understand how Emory predicted the black swan that had emerged from the Black River.  However I soon learned that it didn’t–the isolation unit, or what its associate director Angela Hewlett calls the “Concrete Box,” was built with tuberculosis in mind, not Ebola.  But it wasn’t because of luck that Emory has been able to successfully treat four Ebola patients.  The M.O. of Emory Healthcare is that it’s better to be over-prepared than underprepared.  This had me thinking–has paranoia been key to the survival of our species, and will it ultimately cause our demise?

 

When I conduct behavioral observations at hospitals, my research subjects–the clinicians, not the patients–understandably wonder if there’s a chance I’m going to ultimately get them into trouble.  I am often called “the spy” and sometimes “the interloper.” During the height of the recent media frenzy over Ebola, I was once called “the Liberian.” In what seemed like every surgical procedure I observed, clinicians were agonizing over other people’s stressing about Ebola. Despite being in the same hospital as the disease, I didn’t overhear a single conversation about Ebola in the operating room. Maybe EUH wasn’t paranoid?

 

When Thomas Eric Duncan died in Dallas, my postdoctoral advisor, primatologist Frans de Waal, and I had a few impromptu conversations about empathy and socieoeconomic status.  Never a light discussion, it definitely wasn’t so with the man who has repostulated our understanding of the evolutionary foundations of morality (they’re not in humans).

 

This led to a conversation with Emory Healthcare President and CEO, John Fox, about empathy in the medical community.  When I asked if he’d lost any sleep in recent months, he said generally no. “I think we did the right thing by our mission and values.  [We asked ourselves two] basic moral ethical questions. Can we do it better than the alternative? …Can we manage it [and keep our community safe]? He continued, “We adopted the highest standards from day one. There were ideas and discussions of adopting lower standards; we had people who said we could do this more cheaply … We just said no. If we’re going to err, we’re going to err on the side of being too cautious. I said it very clearly–this may have a bad outcome. We have to be able to accept that.”  So from the operating room to the executive suite, there was a sense of responsibility and confidence at EUH that the rest of the country seemed to lack.

 

“The media attention was off the charts,” President Fox lamented. “We thought it would be X. turned out to be 10X.  It was major sideshow [on campus].”  He explained a few of the public’s divergent perspectives, “Some had a vision of the Ebola patient coming in on a concourse at Hartsfield, getting off the plane , getting on the trains, sitting there at baggage claim, and getting in a cab and then coming here.”

 

The public imagination is boundless. It hungers for black swan stories and even apocalyptic plagues. We have become what sociologists Anthony Giddens and Ulrich Beck call a “risk society.” I call it an “obsessive-compulsive” society.  As both a social scientist and someone who has been professionally diagnosed with mild OCD since childhood, I do not apply the label lightly.  One of the ways I have managed my tendency to speculate ad nauseum is to stop ingesting sensationalism.  Simply by replacing toolbar links to websites that cover celebrities and shootings with those that feature healthier interests, like discoveries in archaeology and neuroscience, I have stopped visiting the damaging sites altogether.

 

People are always surprised that as an anthropologist, I work with hospital executives.  I give major credit to these leaders, especially Director of the Emory Center for Critical Care Dr. Timothy G. Buchman, for understanding the need to explore the culture of biomedicine, and the broader culture in which we practice biomedicine.  Emory may not have been able to predict the black swan from the Black River any better than anyone else, but the hospital understood that Ebola does not mean the Black Death.  It was prepared but not paranoid, unlike the unprepared and paranoid public.  Rather than entertaining irrational fears and compulsively consuming news that exploits those fears, we need to look to intelligent, informed leaders like those at Emory Healthcare–who prepare for the worst but expect the best.

 

Laura Kathryn Jones, PhD

Postdoctoral Fellow

 

Emory University

Department of Psychology

36 Eagle Row

Atlanta, GA 30308

 

lkjones@emory.edu

 

 

 

Sleeping with the Enemy: Arab Doctors Struggling with Personal and Professional Dilemmas

7 Mar, 14 | by Deborah Bowman

A review of “The Attack” and “The Last Man” showing at the “Discover Arab cinema”- British Film Institute- London 2014

“The Attack”, National Film Theatre (‘NFT’) London 23rd and 25th February 2014

“The Last Man”, NFT London 3rd and 8th March

 

London is expanding its cinematic and cultural horizons and the British Film Institute (BFI) is showing the best of Arab cinema in a year-long season https://whatson.bfi.org.uk/Online/default.asp?BOparam::WScontent::loadArticle::permalink=discover-arab-cinema.

 

Two Lebanese films screening at the event explore the current political and social upheaval in the Middle East and its impact on doctors.

 

The first film “The Attack”, directed by Ziad Doueiri is a sensitively-told doctor story mixing several genres: a political thriller, a character study and a romantic love story. Using a compelling narrative, including flash backs, we are introduced to Dr Amin Jaafari (Ali Suliman) a renowned Arab surgeon who is given the highest accolade of a career achievement by the Israeli government – the first time such an honour is bestowed upon a Palestinian surgeon. Socially, he is happily married to a beautiful wife Siham (Reymonde Amsellem). His peaceful life style is shattered when he is called to identify the remains of his wife Siham who was killed in a bomb-suicide attack in Tel Aviv. To make matters worse, the Israeli police suspect that his dead wife was the actual bomber. Traumatised and shocked, Dr Amin is brutally questioned by the Israeli police about the motivations of his wife. He cannot believe that his loving wife could have done such an atrocious deed. In his quest for the truth, Dr Amin travels to the Palestinian city of Nablus to find an explanation, and this brings him in contact with several religious and political figures whose motivations are far from clear.  As a doctor upholding the sanctity of human life and condemning all acts of intentional murder; he realises that he was “sleeping with the enemy” – his own wife.

The second film “The Last Man” directed by Ghassan Salhab” deals with another successful doctor struggling with a different type of enemy: his own psychopathic and criminal tendencies. At the beginning of the film Dr Khalil (Carlos Chahine) is a caring doctor, popular amongst his patients and friends who enjoys diving. The political background of the doctor’s story is closely observed with daily bombs and torture of civilians in Lebanon and Palestine by the Israeli state. Still life goes on in Beirut with loud music blasting away from the clubs that Dr Khalil frequently visits at night. Alongside this volatile external environment, Dr Khalil is slowly changing into a repulsive character who engages in sexual relationships with the mother of one of his patients. The narrative gets more bizarre and disturbing when he becomes a nocturnal creature living off the blood of innocent victims who he preys on from the streets of Beirut. Trying to resist his “vampire” urges for human blood, Dr Khalil still has insight into his own “criminal tendencies”; as a doctor he should be saving lives, not taking them away to feed his nocturnal addiction. On some level, the film can be seen as a study of “obsession, addiction, a moral and psychological decline” of a successful professional who is troubled by his own demons.

Raising several ethical questions, both films suggest that doctors are the products of existing turbulent times and conflict. Ghassan Salhab (director of “The Last Man”) describes his main character Dr Khalil as a “mutant ghost of the city” born out of the social and political disorder in Beirut.

Both films are a timely reminder that the society and media are experiencing a significant shift in their views of the “doctor” as a flawed human being as well as a professional: the “personal and professional boundaries” in doctors’ lives can be blurred resulting in ethical and moral dilemma at a universal manner. Doctors can not remain “oblivious bystanders” in their countries’ changing social and political demography, and if they do they end up losing their identity and closest members of their family such as Dr Jaafari in “The Attack”. Dr Jaafari’s was ambitious to reach the highest academic and professional recognition amongst his peers, but in the process of doing so he alienated himself from his wife and family. His trip back to Nablus proved to him how much he was unwelcomed in his own mother’s house because he made peace with the Israeli establishment.

Recent media attention has focused on doctors in Arab countries such as Egypt, Tunisia and Syria where some doctors collaborated with the oppressive regimes in torturing political opponents. Supporting a dictatorship in such crimes against humanity also violates the basic principles of medicine where a doctor’s primary role is to “never do harm to anyone” as worded in the “Hippocrates Oath”. On a global level, the situation is not all “doom and gloom” as there are several shining examples of altruistic doctors such as those from “Medicins sans Frontieres” who work in disaster areas such as the Philippines. How some doctors choose to be in either group is “food for thought”.

These two films portray doctors as fallible human beings living with their “enemies”. The “enemy” may be external such as a government or family, as in “The attack”, but, more disturbingly, in other situations such as in “The Last Man” the ultimate “enemy” may be a doctor’s own “internal demons”.

Correspondence: Dr Khalid Ali, senior lecturer in Geriatrics at Brighton and Sussex Medical School

Khalid.ali@bsuh.nhs.uk

Feel yourself slipping down that slippery moral slope? Then take our online poll!

26 Jun, 11 | by Deborah Kirklin

The Editor’s Choice for the June issue of Medical Humanities is an original article by medical student Jason Leiboqwitz entitled “Moral erosion: how can medical professionals safeguard against the slippery slope?” Following his participation in a Fellowship at Auschwitz for the Study of Professional Ethics program, Jason concludes that physicians are as vulnerable to corruption of their guiding principles today as they have ever been, and he poses an important question, asking what, if anything, they can do to stop themselves sliding down their own morally eroded slippery slope.

http://mh.bmj.com/

Do read his article. Its free to download. And then please take part in our online poll about any slippery slopes of your own. As always we’d love to hear you thoughts.

Clinical Ethics Conference: London 8-9th July 2010

13 Jun, 10 | by Deborah Kirklin

On the 8th and 9th of July 2010 the Faculty of Health and Social Care at London South Bank University will be hosting a pioneering conference focusing on Best Practices in Clinical Ethics Consultation and Decision Making. For the first time in the UK, this conference will bring together an international and inter-professional dialogue between different stakeholders with the aim of fostering and developing best practice in clinical ethics consultation and decision-making across all sectors of healthcare. more…

The Landscape of Lesotho

10 Apr, 10 | by Ayesha Ahmad

Lesotho is one of the highest countries and is entirely landlocked by South Africa. 40% of Lesotho’s population survives on less than $1.25 a day. In centuries gone by, the people of Lesotho were driven high up into the mountains by the Xhosa and Zulu people and have repeated a solitary and isolated life, mainly farming, ever since. However, Lesotho is also experiencing one of the highest rates of HIV/AIDs infection rates in the world. This is their modern day crisis. What does survival mean in this situation? How can we conform to a meaning of being human when our human situations differ so dramatically?

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Roboticism: Sima Barmania reports on a worrying new pandemic affecting the UK’s junior doctor

1 Mar, 10 | by Deborah Kirklin

After spending some time away from medicine, I return to find that there seems to be a surreptitious, mysterious pandemic infiltrating the junior doctors that practice medicine in the United Kingdom. The cause of this pandemic has largely been overlooked but recent research can now confirm the existence and rampancy of the condition, which can now be revealed as Robotisism. Although the mechanism remains unclear it is thought that Robotisism metamorphose human doctors into machine like –robots programmed to solely perform tasks. They may look like the epitome of the healthy doctor, but closer inspection reveal that they are far from this. more…

Why David’s Gray death was predictable

5 Feb, 10 | by Deborah Kirklin

A lot has been written recently about the 2004 contract that allowed GPs to opt out of  providing care to their patients at night or on the weekend. And about the fact that GPs are now paid more for doing less than ever before. I’m old enough to remember doing nights and weekends on-call and visiting elderly patients on a regular basis in their own homes with the aim of keeping them well.  And then I had a few children, and worked part-time for a while, and then the new contract came in, and GPs no longer did their own on-call, and the requirement to provide enough appointments in surgery, along with the obligation to ensure that every action and thought was entered on the computer meant there was less and less time to do other things. Things like visiting elderly people who weren’t ill as a means of keeping them well and providing them with the human contact we all need to thrive.

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In Sickness and In Health

10 Dec, 09 | by Ayesha Ahmad

Crossing borders always presents the potential for a hold-up. When I prepared to cross the border from Macedonia (or Skopje if you are Greek), into the tiny nation of Kosovo, preparation was the key. I had one mission: to visit the hospital in the capital, Pristina. I travelled by car to the border where a contact of mine in Macedonia had arranged for another car to meet me and drive me across to the other side. I would be travelling with an ethnic Albanian who was well-versed in dealing with the officials. Macedonia has experienced its war wounds in recent years but in Kosovo these wounds are healing but very visable. Lines of hardship tell the story of the past across many faces that I saw. more…

District 9 and Man’s Inhumanity to Man: a filmic guide to dehumanisation

28 Sep, 09 | by Deborah Kirklin

I am fortunate enough to count Professor Jonathan Glover, a world renowned medical ethicist, amongst my former teachers. A very modest and thoughtful man, Jonathan Glover spent a number of years writing a similarly thoughtful book in which he tries to understand what he terms man’s inhumanity to man (Humanity: a Moral History of the Twentieth Century. Pimlico, London 2001). His starting premise is that, given the wrong circumstances, we are all capable of doing evil things to other human beings. At the heart of his efforts are a desire to understand, for all our sakes, what it  has taken in the past, and by extension what it would take in the future, for people- just like you and me- to be willing to take part in our own equivalent of the Holocaust and the Rwandan genocide.

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The beauty of the beast that is Australia: unforgiving and unforgettable

10 Jun, 09 | by Deborah Kirklin

Half a lifetime ago I went to Australia for my medical elective, a joyous interlude just before finals that allows doctors-to-be to savour, for one last time, the freedom of life as a student. Eight weeks is barely time to get over the jetlag let alone to adjust to the stark and breathtaking landscapes that unfurl in any journey across this large and mystifying country. Yet long enough to leave the lasting impression that no matter how impressive the delights of Sydney and Melbourne and Australia’s other cities and towns, this is a country only a blink away from submission to its own awesome forces of nature.

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