Report on Rural Family Medicine Café – Arts and Rural Health
By Mayara Floss
By Mayara Floss
In 7th of Aug of 2016 we have the
Rural Family Medicine Café about Arts and Rural Health. It was present Mayara
Floss (Brazil), Amber Wheatley (Virgin Islands/UK), Amanda Howe (UK), Bianca Silveir
a(Brazil), Shailendra Prasad (EUA) and Jesse Rockmore (EUA). Also on the social
media we have we have a good engagement with feature to Dr. Smruti Mandar
Nikumbh-haval (India). Watch it entirely at the link: https://www.youtube.com/watch?v=nY4LboJtIn0
. Further is possible to find at the end of this document more links to
all the content that we shared.
Specially this Rural Café was really
interesting bringing a Broadview of arts and its interface with rural health. We
discussed about a lot of types of writing. Shailey said that the academic
writing is a “boring one” but still being a way of sharing ideas, also blogs,
short stories and etc. Amanda complemented that writing (even academic) is a
way of expressing ourselves and experiences – we write in different ways is for
different reasons. I talked about the bool “The Quilt: Experiences of Health
Education League” (A colcha de retalhos: vivências da Liga de Educação em
Saúde) in a community based project with medical students to write together a
book. Also, the Rural Health Success Stories project were mentioned.
How arts could influence medicine, medical students?
Art can be healing, it is not specific to rural
but could be therapeutic - a way of care and promoting health. We use arts to
show what we do. Amanda mentioned a Photograph Exhibition in her university were
it shows the different perspectives in rural areas and made it very visible:
travel, distance, seasons – showing the different rural situations and
challenges. Also the learning/teaching importance of arts expanding students
perspectives. Writing could help to debrief a self-reflective piece on the day
by day – how do you feel? How to deal of this? Arts express the joy of
connecting with people, how we link and learn to going forward. Burnout is one
of the aspects that arts could tackle. In
USA were is being trained a highly sophisticated professional that it few years
is a professional in burnout. One of the answers to fight burnout is finding
joy, joy in the work, people that you interact, finding the sense of community
and arts have a central role in it.
In India, they use scenarios created with help
of idols sculpture, ancient dance and drama form as health promotion tool to
convey live healthy message. Also they have an art form named “kirtan” in which
presenter tell a story mixing mythology and also give good incites in between
the story relevant to today's era. These presenters are like God to rural
population and this is best time to teach them good habits healthy living
methods.
Arts is part of the life-learning, we are not a
defined project, it is a way to improve ourselves, in rural areas this become
more important because mechanisms of expression. Amber and Bianca, brought the
idea that simulation of clinical consultations into medical education the arts
have a central role in the theatre, expression and creating empathy. It is a
way to understand people, being creative, invent a scenario, acting
skills. Also, Amber said that she could
learn from one of the simulation scenarios not just communication but that
people react in different ways in different contexts – and this shows that
things have different meanings of our meanings for it. As she said: “Showing the body is more then just flesh
& bone, working beyond perceived limitations”.
Arts and medical
education: Would there be some prejudice that makes students think that it is
not important?
It was discussed the still poorly interaction
between arts and medical curricula, were it was said that we should bring more
to the clinical modules, inside of it arts, not an "optional module"'
– changing the interface between arts and medical education. Arts do not should
be into a module it should be day by day: how we could bring arts in the core
module? In addition, it was mentioned
the Narrative Based Medicine and the role of doctor as “anthropologist” and
taking/telling stories in medicine. The urge to explore arts more consistently
into the curricula. The importance of reading others stories, sharing
experiences in arts. Amanda shared her experience into university were students
refused an optional module that “it is not ‘medical”, and preferred to just
study “medical modules”. Sometimes arts
could not feel like “real medicine”. It exists a parallel with Family Medicine,
“it is okay it is about real people, but the specialist is doing the technical
stuff”, the prejudice and marginalisation is the same that happens in Family
Medicine in general. Amber brought her
experience of doing one module that it is “not medical” with the module
“medical, health and society” and other modules in psychology area were some of
students liked it and other hated it.
This varies by the background of the students, and in this context arts
is much more the orthodox root. Also, the postgraduates students usually have
more control of their education and they could bring it more to their
curricula.
The inclusion of arts into the curricula is
much more about working smart and not working hard – building relations with
artistic expressions, also listening the patients experience – “the patient
story”. A lot of time students couldn’t get the whole picture of the value of
not doing things that are purely medicine/scientific/textbook and the professor
should have the wisdom to guide. However much of the art part that makes you a
doctor, having insights in the unknown feeling.
Jesse is studying in a osteopathic school which
understand a person as a mind, a body and a spirit. Non traditional science
students and some of the students and how he could visualise anatomy with his
background in visual arts versus other science students. And Jesse have a
background course in piano improvisation so he could see the patterns, having
the ability to see this patterns in medicine. Students are more than scientific:
they are eclectic.
The entry criteria in the context of USA, UK and
Australia focus more in the potential of the students and not just the
scientific background. However the selection for medicine in Brazil is
quantitative and by a test. Bianca said about her experience in her diversity
and the burning out in students agenda were a new module will not be welcome
and the need to broke the conservative way of learning without arts.
Does EMR (Electronic Medical
Records) reduce the narrative / personalised perspective of the doctor?
Shailey said that the Electronic Records is
taking the soul of the narrative, we are expected to be very reductionist in
our documentation which are “dry” – it is a challenge for the reduction of the
new generation of GPs - we are becoming reductionists. EMR reduces eye to eye
contact and reduce doctor patient interactive sessions. It is a doubled sword
it will have a bounce of students that will look at it and will say: “Oh my
God, what do I need to do this” and will not participate at the same extent
that we would like them. Therefore, this
bring the question: “do we open it to everybody or do we deliberated keep to
the once who want that” and at the flip side how do we emphasize if you don’t
get support of higher ups in the medical education (deans, coordinators), how
do we emphasize arts importance? Then, how can we functionally come up with the
best curricula to do it?
What is special about
rural and arts?
It is the need to discuss more, as an example
we have few literature on rural health (not academic one) bringing more arts
point of view to show stories and experiences. Arts in rural is a way to share
experiences, not formal but has a lot of
impact in the learning process compared to clinical stuff. We should use arts to bring people together,
like a quilt, and by arts we can be together as a quilt. Mayara said “You do
not need to be connected on internet to feel connected with the ‘Fortunate man’,
you can connect with a song, a poem, and arts can do exceed and make you feel
connected with other people” – which is fundamental in places isolated like
rural and remote areas.
Arts could link physicians and decrease
isolation of physicians also helping the patients. It is possible to use arts
to empower communities, to transform their health, to understand themselves. Amber
showed the contrast between her hometown and Wales, saying that she need to
adapt to patients reality, not just in communication and the different ways of
communicate and comparison, humour to make people to relax – the way that we
communicate in rural is much more personal than the way that we communicate in
a urban area. Amanda raised the idea that communicating, engaging through arts
could be really similar in urban and rural areas giving to people voice and
understanding their own lives. Maybe
what is more special about rural angle is that it is less visible and arts have
the power to bring people together and think together. Mayara brought the
experience of the Indigenous Seminar were a doctor use a clay to made models of
women parts and the experience of the Health Education League to draw the parts
of the women body in a white paper, so people can show how they perceive they
own body, arts is part of cultural competence and physician role.
Arts is also a way to deal with burnout in
rural areas. Jesse stated that arts is also a possibility to treat and monitor
the patient, bringing the example of patient with dementia that was monitored
by her GP by their capacity of understanding a film and draws. In addition, the
therapeutic use of music, were people with dementia respond to it. Further,
arts is able to show realities like the movie Amour that showed the violence
and the difficulties of caring. Also, the project of the Twitter/Facebook
brought the #RuralWomenGP project.
In today's brand factory era arts could be an
old fashion thing but once you provide a good example this thinking may change.
Read more:
Indication by Shailey - The Country Doctor
Revisited : https://thecountrydoctorrevisited.wordpress.com/
Indication by Amanda – A Fortunate man : https://www.amazon.co.uk/Fortunate-Man-Country-Vintage-International/dp/067973726X
Indication by Mayara - The Quilt: Experiences
of Health Education League (Selected chapters translated into English): https://www.academia.edu/23681181/Selected_Chapters_translated_into_English_of_the_book_The_Quilt_Experiences_of_the_Health_Education_League_
Indication by Mayara – Balsa 10 Blog: http://balsa10.blogspot.com.br/
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