Representation and Witnessing

In response to Brian McKenna’s “Medical Education Under Siege” and “The Clash of Medical Civilizations”

Consequently, those who resist or rebel against a form of power cannot merely be content to denounce violence or criticize an institution. Nor is it enough to cast the blame on reason in general. What has to be questioned is the form of rationality at stake.

—Michel Foucault, “Omnes et Singulatim: Towards a Criticism of ‘Political Reason’”

In 2012, Brian McKenna has published two articles in two different journals—The International Journal of Critical Pedagogy and The Journal of Medical Humanities—focusing on his experiences working at Michigan State University (MSU) (McKenna 2012a, 2012b). His recounting of his involvement in the Community/University Health Partnerships (C/HUP) program and its ultimate demise broaches important questions involving the role of neoliberalism in how medical care is both structured and taught. As a fourth-year medical student deeply committed to care for the underserved and social justice, I find McKenna’s critiques of medical education to be important, but underwhelming in praxis. Despite McKenna’s application of Freire (McKenna 2012a:113; 2012b:16), he does little to represent a key component of medical education and Freire’s philosophy: students. This silence does not do justice to the types of education sought out and created by us at major medical schools nationwide that focus on social determinants of health, social justice and the political nature of medicine.

I first turn to McKenna’s essays. Even though he provides a wealth of observational data, his analysis is curtailed by the fact that, he does not offer more than one or two examples of medical students involved in their own education. They are clamoring to escape the responsibilities of their involvement in C/HUP (2012a:104) “gobbling up” pamphlets on Cuban health care (2012a:105), ignoring the complex social lives of patients in lieu of “preventative care” (2012b:7), or being persecuted for their political viewpoints (2012b:4). Despite the last statement, itself a quote from another paper, McKenna does little to actively engage the student population with his writings. We—at risk of conformity, obedience and dehumanization (2012b:16)—are characterized as passive entities in our own education. The fiction of representation, especially in these passages, does not do justice to the way medical students attempt to subvert, challenge, and independently guide our own education.

I turn here to the concept of witnessing, well described by both Freire (1970:126) and others in the medical and anthropological field (see Scheper-Hughes 1995, Davenport 2000, and Gruen et al 2004). Seeing and caring for individuals suffering the brutality of social, political, economic and gendered injustice force many medical students to create new forms of education. Physician advocacy, understanding socioeconomic inequalities, and becoming political and social leaders for a changing world are not foreign concepts among medical students (see Dubal 2012; Holmes 2006, 2012). As seen at my institution, the student-led creation of a physician advocacy curriculum, specifically to train medical students how to approach dealing with issues of poverty, homelessness, violence, substance abuse, and historical injustice through clinical work, political advocacy, and continuing research, has been both supported by our administration and students (see Dworkis, Wilbur and Sandel 2010). Our basis in training is not merely to identify the theory behind social determinants of health, but to actively engage these issues. Moreover, we are not alone in our interest. Programs around the country, such as the LEADS (Leadership Education Advocacy Development Scholarship) program at the University of Colorado School of Medicine (see Long et al 2011), focus on these very concepts as well.

My commitment as a future physician is one that is rooted in both social justice and the social sciences, namely medical anthropology. While McKenna’s willingness to speak about the issues that plague the medical community is admirable, his representation of medical students does little to further the discussion regarding how to change medical education and how physicians and students are challenging the status quo. However, his work does provide a challenge to students and physicians alike to push the barriers of what is considered medical education, and calls for multidisciplinary education of students and physicians alike to understand medical and social inequality in all its forms. Yet, he fails to illuminate the many ways medical students are rising up to Foucault’s challenge in the epigraph—questioning the rationality of medical education and seeking out new routes to improve the lives of our patients though understanding injustice, violence and suffering.

Ashish Premkumar is a fourth-year medical student at Boston University. Ashish has a vested interest in medical anthropology research, and has previously published research in journals such as Culture, Health, and Sexuality. Ashish can be reached at ashprem1@bu.edu.

Interested in writing a column for NASA? Contact Keri Canada at keri.canada@gmail.com or kcanada@unr.edu.

via Anthropology-News http://www.anthropology-news.org/index.php/2013/04/30/representation-and-witnessing/