I was planning to blog about my trip to Petra, but us MSIH students are so good at blogging about our travels (and we are awfully well located for travelling) that I didn’t want to give the impression that we never learn anything. So instead, I am going to write about my Anthropology final project.
The Anthropology class that MSIH students are required to take has had its ups and downs. There have been some fascinating, eye-opening discussions, some lectures that students left many students frustrated, and an unexpected change in professors part way through. But as the Professor explained our final assignment to read and review an ethnographic account, I found myself getting quite excited. There was a book, called Tally’s Corner, by Dr. Elliot Leibow, that I had been itching to read for years, since a physician I worked with recommended it, and I was pretty sure it was an ethnography. About ten minutes later, I realized that I had missed a particular detail that the book had to be an ethnography of the body, or relating to how a different culture views issues relating to bodies. After a few minutes of disappointment, I decided to ask the teacher to make an exception.
After class, I stayed behind to speak with the professor about this book. I told her how I had come across this book. While talking with Dr. H., who was spending his retirement providing free primary care for the homeless, the topic came up of how sometimes it was difficult to understand where our patients were coming from. Being fresh out of college, an awful lot of what I knew came (and probably still comes) from lectures and books, so I described how I thought a book I had once been assigned called “Tell Them Who I Am: The Lives of Homeless Women,” by Dr. Elliot Leibow, had given me insight into some of the forces at work that lead to one becoming homeless, and make homelessness particularly hard to escape. One point that stayed with me was his observation that while homelessness was often caused by substance abuse and/or mental illness, it was also common for homelessness to cause these things.
I tried to imagine what it would be like have my life fall apart until I was living in a shelter or sleeping in the streets, and it was hard to imagine not becoming paralyzingly depressed and anxious from such an experience. More and more I felt a deep respect for the patients who could cheerfully come into the clinic and wish everyone a”blessed day,” and empathy for those who came in and were cantankerous or combative.
When Dr. H borrowed that book from me, he returned it with the recommendation that I read “Tally’s Corner: A Study of Negro Streetcorner Men” by the same author. While a bit dated, he said, the book provided insight into the lives of poor men working jobs that paid well below a living wage, which was a population that had large overlap with our homeless patients.
So what do two books describing people’s relationships with their families, their jobs, their friendships, where they live and how they pass their days, have to do with Medicine?
That was what I discussed, albeit in less detail, with the anthropology professor. (As you may have guessed, she allowed me to use the book for my final paper.) It gave insight into why one woman, at high risk for cervical cancer, could not be reached for a reminder to get a Pap smear: her cell phone service had lapsed, and under the two listings for emergency contacts, she had heart-breakingly filled out “no one” each time. His description of how some might have a well founded belief that their life would not improve, leading them to blow any money they saved, or casually quit a job, gave context to the patient who had a job but could not afford the co-payments for their medications.
But while the above lessons were useful, they are not the main value in Leibow’s work. Leibow’s style is to give voice to peoples’ stories, and in doing so, the caricatures and stereotypes fall away, unveiling people who are often flawed, often generous, and trying to do the best they can in a difficult world. I believe that no matter how compassionate and open-minded a doctor is, having a starting point for understanding the complexity and humanity of a patient will lead to a more empathetic relationship with the patient, greater trust in the doctor, and more appropriate care.
A criticism sometimes levelled at Leibow’s work is that as an outsider, there is only so much he could really know about the lives of the people in his book. Yet, John Kelly from the Washington Post reported that when Leibow died of cancer in 1994, “[h]is funeral was attended by people he had written about in both books.” (27 Feb 2011.) While a white Jewish man with a post-graduate education may by definition be an outsider in the communities he studies, the relationships he build through the course of his research were strong enough to last for decades. So here’s to hoping that we, as future doctors, develop a fraction of that rapport with our patients.
Tally’s Corner: A study of Streercorner Negro Men. by Elliot Leibow
Tell Them Who I Am: The Lives of Homeless Women. by Elliot Leibow.
P.S. Going to Petra, Jordan, is also highly recommended. - blogger of the month, Sarah Meyers