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.

I can’t think there can be any UK doctor worthy of the title who isn’t sickened by what happened to David Gray. But I also doubt there are many who couldn’t have predicted that flying in doctors from outside an area, let alone another country, let alone from another specialty, wouldn’t inevitably, one day, lead to a tragedy like this. After all, any GP could tell you that even the most experienced GP needs all her wits about her to deal with that late night call, the phone consultation with a patient you don’t know, or the anxiety filled home visit when people are in pain, frightened or confused.

The bottom line is that no UK GP has been happy with the idea of drop in a doc, whereby any doc will do so long as someone, somewhere in the EU, has given them that title. The idea that any unit of doctor will do is peculiarly beloved of this government and stems, I believe, from a complete disdain for the concept of professionalism. Sadly, for this government, and for patients, doctors are viewed as interchangeable factory workers, who, much to the irritation of their political masters, think rather too highly of what they can do for patients using their own initiative and creativity.  So, for the government, devising an out of hours system back in 2004, it made sense to reject the doctor’s idea that more GPs be employed so that they could carry on providing both day and night cover and instead they decided to introduce drop a doc, any doc.

In many areas of the country, like my own in North London, the local GPs weren’t convinced of the wisdom of this strategy and so the service is run predominantly by local GPs, and everyone who contributes to out of hours care is adequately trained for the task and given proper support and back up. But not everywhere it seems. By no means everywhere.

So whose duty of care is it to make sure others don’t suffer the fate of David Gray? Well firstly it’s every patient’s doctor’s duty to take care that her actions or inactions do not harm their patients, to ensure that they either provide good out of hours care themselves or to ensure that the out of hours care provided is of a sufficiently high standard.  And it’s every Primary Care Trust’s duty to make sure they have the systems and personal in place to do the same. And I think it is surely every government’s duty of care to make sure they use common sense as well as tried and tested systems and procedures to ensure that when it comes to that most hazardous time to provide care- when the staff numbers are low and tiredness inevitably creeps in-  that the highest professional standards not the lowest common denominator prevail.

Perhaps going to another country is always, on some level, a culture shock. Sometimes the shocks are big but often, when you’re going to a country that is in many ways familiar, the shocks are so small as to barely register. And sometimes they’re all the more profound because they’re unexpected and cause you to change the way in which you understand things that are important to you. What shocked me on this visit, and apologies to you heartier folk for being rather easy to shock, was the lack of curtains or screens between the three elderly woman sharing the hospital room I visited. Or rather what shocked me was the complete lack of care these three otherwise dignified woman paid to the fact that nothing, and I mean nothing, that they did or was done to them or said to or about them could in any way be kept private from each other.

Which brings me back to my students and the earnest and concerned discussion we had as they grappled with the practical challenges involved in trying to hold a confidential conversation with a patient in a four bedded room with only the curtains and little space to aid them in their endeavour. The curtain and the small space between beds had seemed daunting enough until I saw those three beds tightly packed and with nothing to shield their occupants’ modesty.

Like a dazzled tourist in an exotic land I quizzed my relative and her healthier and younger family to try to ascertain if they too felt this lack and if not why not. They didn’t, one and all. Instead they smiled at me, bemused but indulgent, and attempted to placate me by suggesting that it’s all a matter of what you’re used to. And yet patients in the UK were once used to less privacy, expected less respect for their autonomy. But gradually things changed. Expectations evolved, ethicists debated, the profession responded and sometimes led. And suddenly it’s hard to imagine it any other way.

In some ways of course my reaction is just so very English, and perhaps my shock results as much from the way in which the attitudes of these very down to earth Germans challenge my own. What it has done is remind me how easy it is to write for international audiences whilst glibly assuming we’re all lying in the same proverbial hospital bed surrounded by the same thin excuse for a veil of privacy. Clearly we’re not.

Whilst taking part in a documentary with the University of Toronto, he exclaimed: “why would I want to see when I can see so much more with my hands?” These words fall upon us at a time where medicine is advancing through producing images of our body that otherwise we are blind to, such as fMRI, X-Rays, CT scans. We are looking into how we can perceive the human body in its finest detail. Our direction of what it means to achieve the fullest understanding of the internal physical world of the body is engaged with finding what is hidden.

What happens when the Hidden - like Esref - begin to see? And begin to see in a way that we did not think was possible? How can someone perceive, draw and reflect a tree or the ocean or mountains without ever having experienced the contrast between light and dark, or seen the beginning or ending of boundaries and horizons?

There is another story that reigns from nearly 2000 years ago, from Baghdad in AD 286. This is the birth of al-razi, probably the most famous Muslim physician. Al-Razi is often dubbed as a “polymath” to describe his superior knowledge across different disciplines including music, philosophy and medicine.

Al-Razi moved away from previous opinions that illness had been caused by God and advocated rationalism. He believed illness had a scientific basis for its cause and his observations about the human body became his legacy.

Towards the end of his life, al-Razi became completely blinded by cataracts. Even at this time, it was possible to have cataracts removed although one slip of the hand could cause permanent damage or even death. Al-Razi refused to have his cataracts removed because he claimed to have seen enough of the world.

Both these stories indicate something special for the practice of medicine especially in our modern world where technology often becomes “our eyes”. Every patient sees the world differently and radiates perception from sources other than those which we consider empirical and thus as valid. Sometimes, we do not know where our visions come from or where our observations lay upon. Here is where the uses of poetry and art and literature in medicine are illuminated: as a tool for excavating the depths of human experience.

To see the documentary for Esref Aramagan please go to:

http://http://www.youtube.com/watch?v=8QUOy83po60

We have been discussing the role of the humanities in medical education, and the need to account for what one of us calls ‘medical paranoia’. By this we mean the tendency that medical students (and practising doctors) have to think that they have developed serious illnesses, making self-diagnoses frequently based on vague suggestions rather than hard evidence. We feel that it is time to reflect on the significance, meaning and potential utility of this phenomenon.

Hypochondria among medical students is common, and the butt of jokes among those who talk and write about the experience of being a medical student. A middle-aged woman who had survived bowel cancer once said during a research interview that she no longer developed flu: it was always metastatic cancer. In the same way, medical students tend to develop acute leukaemia rather than viral sore throats, cancer or HIV (depending on the term they happen to be doing) instead of natural fatigue. One of us (ML) convinced himself during his medical course in the 1950s, that he suffered from tuberculosis, bone cancer, stomach ulcer, bronchiectasis, several kinds of leukaemia and lymphoma, hepatitis, thyrotoxicosis, hypothyroidism and Addison’s disease. There were many other conditions. All systems were affected at one time or another during the six years of study.

ML’s hypochondria was not unique. Almost every medical student we have both known has been convinced that he or she had developed something potentially fatal at some stage. What makes it worse is that the occasional person is right. Real tuberculosis, real depression, bowel cancer or inflammatory bowel disease among contemporaries tend to reinforce the need for fearful vigilance.

Does hyphochondria serve any useful function? The experience can be very unpleasant. Vague symptoms preoccupy the waking hours, interfering with enjoyment of life, with relationships, with one’s optimism about the future, sometimes with one’s ability to sleep. Fortunately, most hypochondriacal illnesses among medical students seem to be self-limiting, and to run their courses in a few troublesome weeks.

Actual major illness changes one’s perceptions of the world, and often changes the sense of identity. It forces confrontations with mortality and the fragility of being human. It may make the sufferer lonely, because it’s impossible to communicate the nature of the experience. It also makes the doctor who has been ill more understanding of the anxieties and sufferings of others.

Clearly, medical education can’t enforce organic illness on its trainees. The current fashion for role playing may help to sensitize students to issues of communication and intersubjectivity. But role playing is no substitute for the deeper personal involvement of the hypochondriac. In the grip of the imagined disease, he or she reads the relevant literature with the greatest attention, seeking the clinical nuances that might confirm or rule out the current threat to life, welfare and identity. Such subtleties stay in the memory, and help the recovered valetudinarian to understand, question and advise patients and their families with real and imagined illness.

Hypochondria may not be a bad attribute to look for in medical students – not too much of it, mind you, because it can be inhibiting for the hypochondriac and deadly boring for his or her colleagues. It might be a little difficult to quantify at interview for entry to medical school, but we should remain open to its potential virtues. We should certainly not exclude candidates who examine their own potential to become ill, and imagine themselves, at least temporarily, into a world of virtual illness.

Miles Little MD, MS, FRACS and Claire Hooker, PhD

Centre for Values, Ethics and the Law in Medicine

University of Sydney

Corresponding author: Emeritus Professor Miles Little

Centre for Values, Ethics and the Law in Medicine

Building K25

University of Sydney

Sydney, NSW 2006

Australia

e-mail: milesl@ozemail.com.au

Telephone: 61290363405

http://www.timesonline.co.uk/tol/news/world/ireland/article6950950.ece

Finding this story, for the second time, in The Times took me a while as I vainly searched in the ‘News” section only to realise I needed to look instead in the “World News”. An indication perhaps of how close the people of the UK and Ireland are in so many ways despite our shared and troubled history. A reminder also of how illusory that sense of closeness is, reflected all too starkly in the different approaches adopted by the UK and Ireland to the issue of abortion. And timely, as, by sheer coincidence, I facilitated, on the same day that the case came to court, a discussion amongst eleven first year medical students about legal, professional and moral rights and duties.

The UK is often said to have the most liberal abortion laws in the world and Ireland one of the most restrictive. Interestingly, the British Pregnancy Advisory Service and the Irish Family Planning Association are supporting the women’s legal fight. Which doesn’t surprise me too much, after all they’re the ones who faced with the task of helping these women, women who are already facing decisions that are difficult enough. Like millions of women before them, both in Ireland and around the world, some of those denied access to abortion in Ireland will take desperate measures to meet their unhappy need. Some will be able to travel for help but may find themselves back in Ireland with complications that have been aggravated by unnecessary travel. Others may try some of the homemade methods that everyday takes lives around the world and, in the past, in the UK. Still others will be forced to live lives that are not of their choosing.

Faced with such a woman, in a doctor’s surgery in Ireland, I wonder how my students might, in the future, draw on their teaching. They will have been taught about the duty of care they owe patients: the duty to take care that their actions or inactions do not harm the patient. They will have been encouraged to be aware of how their own values, experiences and upbringing, and the moral values they hold, influence the way in which they view the woman’s request and whether they consider the prevailing legal situation with regard to abortion to be a good or not. They will have been ‘brought up’ in a system in which the General Medical Council and the UK Law expects doctors to meet any emergency needs of women seeking an abortion and, at a minimum, expects doctors to ensure they do not actively block a woman’s access to abortion. And they will have learnt about human rights and by then, I anticipate, the ruling that follows from today’s case will form part of that teaching.

All that and more and it’s only term one along the long road to qualification as a doctor. So if any of you are reading this and wondering where next for help I suggest two things: first keep an eye on this case because the judges ruling and arguments promise to be instructive, and second, and here comes the medical humanities bit, watch the film Vera Drake, just to remind yourself what it used to be like in the UK, before the liberalisation of our abortion laws.

The border is still protected by UN peacekeepers and unfortunately, violence and ethnic clashes are daily. However, the country is also fighting for its re-growth and development. On the motorway not far from the border is a state-of-the-art service station complete with a widescreen TV in the forecourt. On entry to Pristina are scores of newly built houses.

We headed straight to the hospital. Set on a huge compound, the buildings are deterioated and very tired. Here is the heart of the people’s trauma where ethnicity must be overlooked. I wandered around and came across the paediatric department. The conditions were very poor. Patients often need to travel to neighbouring countries for treatment if they can afford it. Whilst medical care is, in theory, free, there is anecdotal evidence that some doctors expect payment for their services. It is difficult to locate ethics in the midst of so many conflicting battles for survival.

The country’s exterior is flourishing but what about its health? What about the body of the country? The effects of war and divided ends can only serve to spread through a new generation a fractured picture of what health means. Is health the same as survival? Is health the standing amongest the dead? Is health ever restored once the mind has experienced the destroying of humanity? The hospital certainly presented a negative picture and I left feeling very bleak. Health is as much about the past as it is about the future. I wondered what may be in store for a generation being born after the conflict has ceased but are being nursed in the living grave of a country trying to grow into independence.

I had come to the hospital to find humanity. Amongest all the suffering that the people of Kosovo had endured, would there be some shards of the human spirit still shining through? Would the hospital be the place to find this treasure? We often hear of the victim’s story. The families who have been blighted by the injuries of war and of the trauma that follows in the aftermath. And the doctors who have saved them. Somehow though, perhap as another casualty of our privileged distance, we fail to collect a complete picture of the paradoxes of war.

At the hospital, I was reminded by all the different battles I was observing, of a passage from a book called “War Hospital”. This memoir recalls the journey of a group of young doctors during the war in Bosnia-Herzegovina. In one passage, one of the doctors asks a psychiatrist “What am I doing here in all this violence?” She returns the question with the answer “When people are in violent situations, it’s usually because they’ve been there before.” Then, the reader observes the doctor’s reflection: “Now he realises what he is doing, he knows that any changes he is going to make as man must come from the inside, not the outside. His past does not condemn him to a violence-saturated future. He doesn’t need a warzone to catalyse his personal growth - he can resolve his emotional issues in other ways” (p. 209).

Medicine is even more than saving lives. There is a world within each doctor and each patient, sometimes embroilled in as much an internal conflict as there is externally. It is these wounds which a doctor can heal from through healing, that a patient can recover from through experiencing peace from another person and a country can learn how to grow again. In Kosovo, there is suffering but there is growth. In its hospital there is humanity and there is internal conflict. These paradoxes are the working of medicine and the working of the nature of survival.

Reference: War Hospital. By Sheri Fink. PublicAffairs Publishers, 2003.

http://mh.bmj.com/content/35/2/76.abstract

Drawing on the work of Michel Foucault, Geneviève Rail and Marc Lafrance argue that Nip/Tuck can be understood as a crystallisation of the dominant discourse surrounding fat bodies. Through an examination of an episode involving morbidly obese Momma Boone, they show how Momma’s story is used by the programme’s makers to instructs its viewers in how to think and feel about the fat body. To quote these authors “Foucault’s formulation of the confessional is seen to be useful to theorise the ways in which biopedagogy leads subjects to believe and ultimately take part in processes leading to salvation” with ““confessions of the flesh”, that is, confessions aimed at revealing her obese body so that it can be rescued, rehabilitated and saved.” They also argue that ”Momma Boone’s body is made to inspire fear and panic in so far as it provides constructed “evidence” regarding the consequences of the obese subject’s failure to convert to the truth of obesity discourse.”

Every so often newspapers and radio shows feature discussions in which fat people talk about the discrimination they experience, and about the prejudicial way in which they are perceived by others. Rail and Lafrance’s carefully argued and challenging paper provides a refreshing perspective on some of the reason’s that might be so.

In this guest posting, Dr Ravi Shankar tells us how a FAIMAR Fellowship help him to develop and deliver a medical humanities curriculum in Nepal. Ravi writes…

Dr. Badyal, my good friend during my postgraduate residency e-mailed me in late January 2007 informing about a FAIMER fellowship in South Asia. At that time my knowledge and ideas about FAIMER were nebulous. I knew that it was an American organization involved in international medical education. FAIMER Regional Institutes: The Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia in 2007 was in the process of starting regional institutes in Latin America, Africa and Asia. In Asia they were primarily focusing on India and the South Asia region and three regional institutes were started in India at Ludhiana in the north, Mumbai in the west and Coimbatore in the South. The PSGFAIMER Regional Institute at Coimbatore was inviting applications for a two year part time fellowship in medical education.

Curriculum Innovation Project: The application called for the submission of a Curriculum Innovation Project (CIP) and the quality and nature of the project would play an important role in the selection process. I was thinking about the project I would like to carry out in the institution I was working in at the time, Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal. I have a keen interest in literature and the arts. I am a frequent trekker and a keen amateur nature photographer. I often write about my treks, other travels and medical issues for Nepalese newspapers and magazines. I and my colleagues had been conducting problem-stimulated, small group learning sessions in Pharmacology for over five years in 2007.¹ We had gradually come to like this method of teaching-learning. The students after some initial problems also liked this method of active learning.

Selection for PSGFAIMER: It was in the third week of February that I was informed of my selection as one of the sixteen fellows for the 2007-2008 session. There were certain assignments which I had to complete and take with me when I went for the first on-site session in Coimbatore, India in April 2007. I was excited! The program seemed to be a good mixture of small group presentations, mini lectures and activity-based sessions.

First on-site session at PSGFAIMER: From Pokhara it was a long bus journey to the Nepalese border town of Sunauli. Crossing the border in the afternoon at the peak of the April heat was an unnerving experience. I then took a bus to the Indian town of Gorakhpur. From Gorakhpur it was a long train (two and half days) journey to Coimbatore. Luckily FAIMER was providing fellows with air-conditioned sleeper tickets. The food at Coimbatore was excellent and being very fond of South Indian food I was having a great time. Our faculty members introduced us to a number of tools which would be helpful for completing our projects and for conducting small group learning sessions.² One idea I really liked was selecting a group leader, a recorder, a time keeper and a presenter for each group activity and rotating the roles from one session to another. The faculty introduced me to a number of questions which I had to answer before I could start work on my project. As I had suspected right from the beginning my project still needed a lot of work! Dr. Janet Grant from the Open University, United Kingdom (UK) was especially helpful. She had a lot of material on curriculum planning and design and was kind enough to share them with me.

Initial days of the module: I decided to have the sessions in the evening so that we did not encroach on the time of other subjects in the curriculum. However, it also meant that students had to come and participate in the sessions during their leisure time and at odd hours. My colleague, Mr. P. Subish, a clinical pharmacist was very helpful. He helped me with the logistics and kindly provided the meeting room adjacent to the Drug Information Center (DIC) in the teaching hospital for the sessions.² He was also very interested in the subject and was one of the first faculty participants. Initially the sessions were a touch and go affair. Certain students came for one or two sessions and then stopped coming. Some others were irregular and attended when they could. The module was voluntary, would not be assessed summatively and did not carry any marks in the final examination. The only course of action open to me was to make the sessions as interesting and informative as possible to attract students and retain them in the module. Certain faculty members were also very interested in participating, learning about MH and acting as cofacilitators.

The module is established: We had interacted with many students but many of them were not convinced about devoting time and effort for something which was not in the curriculum. In the Clinical Science campus, the tide turned when a sixth semester lady student expressed interest in the module. She stated that she will come and attend a session and if she finds it interesting then she would strongly recommend the module to her friends. All six of them (she and her five friends) would then attend the sessions regularly. She and her friends added strength, interest and variety to the module. I especially remember their creative contributions and enthusiasm for role-plays, group activities and debates. The sessions were very interesting and used a variety of learning methods to explore MH. Literature and art excerpts, role-plays, debates and group activities were used.

The second visit to PSG: I resigned from MCOMS in October 2007 and joined a new medical school in the Kathmandu valley, KIST Medical College in Imadol, Lalitpur. The college management was very supportive of new ideas and we decided to start MH sessions for the faculty members and medical, dental officers. Soon it was time for my second visit to Coimbatore in April 2008. A new batch of 2008 fellows had joined and we were now ‘seniors’. The second on site session was less intensive than the first and I felt we learned less but I liked the methods FAIMER employed to increase interaction between the 2007 and 2008 fellows and their method of poster presentation. The 2007 fellows explains his poster to a group of 2008 fellows and one 2008 fellow explains the poster to a larger audience using a flip chart. The 2007 fellows were given the responsibility of guiding and helping the 2008 fellows in their learning and project work. I think our faculty wanted us to act as role models for the 2008 fellows. We were expected to demonstrate to the junior fellows that it was possible to plan and carry out a CIP.

MH module for faculty at KISTMC: I had started MH sessions at KISTMC from March 2008 and Dr. Piryani, an Internal Medicine specialist joined as cofacilitator. The topics and the learning modalities used were similar to the first module at MCOMS. The sessions were conducted for about two hours on Sunday afternoons and used literature and art excerpts, case scenarios, small group work and role plays to explore various aspects of MH.² Feedback was obtained from the participants at the end of each session using a semi-structure form and on completion of the module.

Talk to faculty members at KISTMC: I gave a talk to faculty members at KISTMC about MH and its present situation around the world. I stressed on the need to develop MH in Nepal. Dr. Shapiro and Dr. Deborah Kirklin from the UK were kind enough to offer comments on the initial draft of the presentation. Around this time, we were planning a MH module for undergraduate medical students. I was discussing with my cofacilitator, Dr. Piryani about the modalities of the module. Considering the problems previous participants had with literature excerpts we decided not to use them in the student module.

MH module for students at KISTMC: In early February we started the module for students at KISTMC. The module is being held in the college auditorium on the top floor of the hospital. Topics like empathy, the patient, the family, the doctor, doctor-patient relationship, the healthcare team, the medical student, breaking bad news are to be discussed. Many of these topics are similar to those discussed in previous modules while some are different. The students are divided in to six groups and each group has been named after a famous personality in medicine, medical humanities. We use the LCD projector to link together various topics and organize the various tasks and activities in a logical and orderly sequence.

The sessions: The learning modalities are similar to those used previously. The session is held every Wednesday from 8 am to 9.30 am. Each topic is being covered in two parts called ‘bytes’ and six faculty members from the clinical and paraclinical sciences are acting as cofacilitators along with the two of us (I and Dr. Piryani). Dr. Huw then at the Patan Academy of Health Sciences occasionally acted as a guest facilitator and guided us with the module. Student feedback is obtained at the end of each session and groups are formatively assessed by the facilitator. Participant feedback has been positive.

Thus the FAIMER Fellowship has been a wonderful learning opportunity. I was introduced to many ideas and concepts in medical education and educational leadership. I have learned to use the power of the listserv to stay in touch with other fellows, to moderate electronic discussions, and to share ideas and information. The fellowship introduced me to many new concepts in small group learning and I was able to improve my facilitation skills considerably. It was wonderful getting introduced to MH and being able to take the first steps to develop the discipline in a small, developing country. I sincerely hope the discipline of Medical Humanities will become common in other medical schools in Nepal and South Asia and more and more South Asian medical educators take advantage of the wonderful opportunity offered by FAIMER.

References:

1) Shankar PR, Dubey AK, Mishra P, Upadhyay D, Subish P, Deshpande VY. Student feedback on problem-stimulated learning in pharmacology: a questionnaire based study. Pharmacy Education 2004; 4: 51-6.

2) Shankar PR. Medical humanities: sowing the seeds in the Himalayan country of Nepal. Literature, arts and medicine blog. Posted April 14^th, 2008.

3) Shankar PR, Piryani RM, Karki BMS. A Medical Humanities module for faculty members and medical/dental officers at the KIST Medical College, Imadol, Nepal. In: Souvenir, Research Conference on Health Science, Kathmandu: Institute of Medicine 2009: pp.70.

Address for correspondence:

Dr. P. Ravi Shankar

KIST Medical College

P.O. Box 14142

Kathmandu

Nepal.

Phone: 977-1-5201680

Fax: 977-1-5201496

E-mail: ravi.dr.shankar@gmail.com

Over forty years later, not so far out of view from this hospital, is a tin shack where over 20 patients visit per day for treatment of various ailments from infertility to HIV. As I entered, the African sun disappeared abruptly and I was immersed into a stark darkness. Only a flicker from a lone candle in the consulting area lit up my surroundings. In contrast to the white, bright clinics in the West, I could barely take in all I could see. There were fur coats from many animals draped over the walls, dried snake skins dangling from the ceiling, various plants and herbs drying soon to be made into potions and join the many bottles on tables, on floors and on shelves on the wall. The Sangoma offered me his hat which had been used by his forefathers in their medical days. I asked the Sangoma how he gained his knowledge about the human body. He answered, “From my great-grandfather”. I noticed that on occasion, the Sangoma would briefly close his eyes and then his head would jerk up and he would be alert again. I asked if he was okay. Again, he replied in reference to his ancestors with ”I talk to my great-grandfather during the night for advice, having little sleep as a result”.

In his culture - Zulu - illness is not a segregated pathology of the body. Illness is instead an aspect of a person’s lifestyle and a reflection on their moral character. Moreover, the body is not owned by just one person. This means that the body, the person, and their spirits are possessed by their ancestors. Perhaps the only instance where medicine in the UK can resonate with the unifying experience of illness that is evident in Zulu culture is in palliative medicine. Increasingly, over the last decade or so, palliative care has focused on the experience of the ending of a person’s life both for the individual but also for the whole family. We are beginning to learn that the body is not confined to its physical boundaries of where it begins and ends.

This is a difficult lesson for us because of how our cutting-edge technology can introspect in minute detail the hidden world of inside our body. My visit to the Sangoma, however startling and also rather intimidating, clearly revealed the importance of releasing illness from beyond cells and organs and seeing illness not solely as pathology but part of what provides the human experience.

By Ayesha Ahmad.

It isn’t often that medical humanities stories make the news around the globe and so it was with considerable pleasure that I’ve been noting the mounting number of reports and the headlines that accompany them. We’ve everything from ‘Jane Austen killed by cows?’ to ‘Cause of Jane Austen’s death not universally acknowledged’ to ‘New light on Jane Austen’s Final Chapter’. Not necessarily high brow but clearly enthusiastic and presumably responding to public interest in this sort of work.

To read the original article go to

http://mh.bmj.com/content/35/2/98.abstract?sid=1741a89e-7656-4fca-b0cd-5d50be5a71e9

If you want to see more of what the world’s journalists and headliner writers make of this offering from Medical Humanities click on the link below.

http://news.google.co.uk/news/story?pz=1&cf=all&ned=uk&hl=en&ncl=drsfU0SnIrmn9NMQ2gNWlBG7BTy4M