I have just returned from Dar Es Salaam in Tanzania where I have been working with the women on the Fistula Ward of CCBRT hospital (Comprehensive Community Based Rehabilitation in Tanzania). I felt very privileged to be accepted as I was, with sketchbook in hand, on the ward.The experience as a whole was challenging and I would go so far as to say life changing. The culture ‘shock’ was so profound that I found myself having to redefine many of my perceptions of what it is to be – let alone what it is to be ill.  The project is deeply affective and I and here follows a post from my wordpress blogsite for the Drawing Out Obstetric Fistula project. Please feel free to check it out as there is a lot more information and visual work there about the project as a whole.

Operating across the cultural divide

DSCN0271The theatre clothes are the same but the environment is very different. I feel strange as I enter the operating theatre at CCBRT, a room not unlike those I have been in in the UK but equipped quite differently.

The most obvious difference was the type of operating table. It was shorter than usual and could come apart in the middle so that the patient lay supported only up to the hips with her legs in stirrups. This was a fistula operation.

The first patient is already on the table having had an epidural to numb everything below her waist. She is to be fully conscious throughout the procedure. Her notes show that she has a very small fistula which it is hoped will be easily repaired. She is a young girl barely into her twenties and she has had four deliveries already, all still born. The operation begins after the anaesthetist repositions the table so that the patients head is now lower than her hips. The surgeon inserts a speculum into her vagina and locates the fistula. I am invited to come close and see for myself, and the surgeon explains the procedure to me every step of the way as he gently and carefully cuts around the fistula and brings the tissues over it to cover the opening. The patient remains silent and very still even in spite of the anxiety and fear she may well be feeling. She coughs obediently when asked some way through the procedure.

All is going very well. There are two surgeons now and the nurses attending. Everybody seems to be very pleased as the fistula is repaired and the last is stitch cut off but then, a problem appears, urine is still leaking into the vagina. The two surgeons work quickly and accurately together to find where the second fistula must be. It is deep and there is nothing they can do vaginally. The patient will need a second, abdominal operation.

The second patient walks into the theatre. She looks afraid, confused by the strange surroundings. She is helped onto the operating table and asked to sit up, she is to have an epidural, and injection into the spine. She sits obediently, her face now expressionless. When the needle enters her spine I watch for a reaction, but she doesn’t flinch, her expression doesn’t change at all. She is lain down on her back and her feet are put up into the stirrups. The surgeon goes to talk to her, just a greeting I think and some reassurance. She murmurs a response but does not meet his gaze and on returning to me he lets me know that “they are unused to people talking to them. They don’t know how to react.” I feel that this might be a little harsh considering the situation that the girl is in, semi-naked and strapped to a bed that is so angled that she is virtually upside down. Holding a conversation with anyone, let alone a white man in authority, is clearly the last thing on her mind.

The operation begins and it becomes clear that it is going to be problematic. Once the surgeon inserts the speculum and opens up the vagina to view the extensive scarring in the tissue becomes obvious. This ensures that the fistula, although easily located is difficult to close because of the lack of elasticity in the surrounding tissue. The surgeon works quietly and confidently. Through his years of experience he has developed the impressive precision and delicacy of touch that is obviously necessary in such an operation. There is lots of bleeding and the second surgeon continuously mops it up using the swabs that I saw the women folding just the other day on the ward. They fold hundreds of these light textile squares which are then sterilised for use in the theatre.

The operation continues for a long time but there is never a sound or movement from the patient. Only at the end, when the table is once more flat and the straps are taken off her legs does she ask for water. The surgeon looks tired, it was a difficult operation but he is not unhappy with his work.

There are two more women waiting outside.

In my work on the various projects in medical settings the making of the art, for me, is a creative act that goes beyond documentation. It is an act of empathic witness and the art itself becomes both agent and advocate of patient autonomy through its unique capacity to engage the subjective sensibilities of the viewer. This goes far beyond Alan Radley’s concept of the asymmetric relation – it is a complete immersion of one subjectivity into the world of many others and the results that are derived from such a conflagration serve only to further blur the boundaries between objective rationalism and the passionate human need to co-exist and share experience.

IMG_1690

So, for the last two weeks I have been immersed in the culture, and the sheer dynamism of the Oncology Department at Singleton Hospital in Swansea on the first stage of the Medicine Unmasked project. You can find out more about the project and follow its progress here: medicineunmasked.wordpress.com

I have been shadowing four students who are now two weeks into their five-week  ‘oncology apprenticeship’ on the Graduate Entry Medical program at Swansea University College of Medicine. Through shadowing, observing, taking notes, engaging in and recording one-to-one conversations with students and medical professionals, and generally getting the feel, from my artist’s perspective, of the students own experiences in terms of learning and teaching of their placement on the department, I have amassed copious notes, sketches and ideas that will all be used as ‘data’ for when I  return to the hospital for a further two weeks in January. During this second stage of the project I will work on a body of artwork, drawings inspired by  the process as a whole, but until then, and in the meantime, I will offer a series of posts on this blog that relate to the project both directly, as the experiential nature of the project demands, and more theoretically, as the same experiential nature of the project has encouraged! Needless to say I would appreciate any comments/feedback for the posts on this site as all such content potentially impacts on the process of the research as a whole and is therefore very valuable.

“As an experienced doctor you may have seen twenty patients who, say, have had a heart attack. But this patient has only seen one. It’s their first experience so I think that’s what we have to bear in mind.” (2nd year Student)

I want to begin by expressing my deep appreciation and gratitude to everybody I have been working with; the students themselves, the consultant oncologists that are working alongside, specialist nurses, all nurses on the wards, radiologists, staff in the hospital library, in the cafe, and indeed all hospital staff who I have met and who have been so wonderfully accommodating of someone who –  let’s face it –  must seem a slightly strange presence in the day-to-day dealings of the hospital as I sit quietly and watchfully with sketch-book or dictaphone in hand! I also owe huge thanks of course to the patients who have been so willing to let me be a witness, alongside the professionals and the medical students, to their experiences during consultation, examination and, in one case, of having a ‘shell’ made of his head in preparation for radiotherapy.

As a small group of two boys and two girls, three in their second year and one in her fourth and final year the students have enthusiastically welcomed me into their world as they tackle the demands both professional and personal of working in the department, and in the process my own learning curve has been close to vertical! As much as I have been learning about the student experience both in the specific terms of the apprenticeship model, and in the more general terms of the GEM course as a whole, I have also had the fantastic opportunity to engage with the theory, and most directly the practice of oncology in a way that has had a profound impact on my perception of myself and my practice as an artist working in medicine. It has confirmed, in a very visceral way, that this is the right place for me to be in terms of how I understand my art and what it can do.

Its going to be a fast moving few weeks I think, now the Illness begins with I exhibition is over. It turned out to be a successful show, especially in terms of the generous and sometimes humbling feedback I received. Most importantly for me it validated once again that what I am doing is worthwhile.

Now I am off to Glasgow to meet with my colleague at the University there to discuss my visit next year, and then I am very pleased to be going to Birkbeck College in London where I have been invited to present my work at the Visualising Illness workshop this weekend. http://www.bbk.ac.uk/art-history/research/visualising-illness I will be writing a review of the event on the  blogsite for Durham University Centre for Medical Humanities. This by the way is a fantastic resource for anyone interested in the Medical Humanities and well worth a visit.

On Monday I will be beginning the Medicine Unmasked project as artist in residency at Swansea University and next weekend I fly to Tanzania to begin the Drawing Out Obstetric Fistula project

Finally – at least for now! – In the new year  I am delighted to have been invited to give a talk about my work and a masterclass in drawing with cadaveric material with students on the Medical and Forensic Art PG courses at Dundee University http://www.dundee.ac.uk/study/pg/medicalart/

I will be posting on the relevant websites as well as here as these projects develop…I hope you will follow to see how art and medical science continue to interrelate and it perhaps goes without saying that all comments and feedback on the work is greatly appreciated.

IMG_1569

Here is the link for a new project that I am beginning with a ‘pilot’ study research visit to Tanzania in December. http://drawingof.wordpress.com/

Entitled Drawing Out Obstetric Fistula: exploring the ramifications of maternal birth trauma through art, the project is intimately related to Drawing Women’s Cancer in terms of the methodology and the primary aims. I am very excited about developing this work and optimistic too about the potential for visual art to cross international, cultural and linguistic borders, especially given language  itself is such an important factor in the philosophical framework of all my work that is rooted in the art-medicine relation. You can read more details about this new project by following the link and I hope you will follow the progress of the work on the associated artist’s blog page.

sig image crop 2

The final preparations are being made and I want pass on here my warmest appreciation for all the support and help I have received from many, many people throughout the preparation for this exhibition. The official opening is on Friday 24th October but over on the Illness begins with ‘I’ page on this site you get a sneak preview of the works and texts that make up the show.

I have just published a new page on this site. It is to become the online home of the Illness begins with “I” art exhibition. There will be a gallery of all of the artwork including some extras  along with notes, quotes  and narratives that relate to the theme as a whole. I hope you will enjoy the page as it develops and maybe share your thoughts…….

 

wellcome_logo

 

Diagnosis

The excellent news I have just received is that The Wellcome Trust have approved my application for funding for a three-month research visit to Glasgow University Medical Humanities Research Centre! For March through May next year then I will be staying in a city that is very dear to my heart working on the Drawing Women’s Cancer project. The award is a fantastic recognition of the value of the project as a whole and to say I am pleased, proud and excited is not really enough!

Alongside Drawing Women’s Cancer I am about to begin a three month artist residency at Swansea University College of Medicine. You may be interested to follow its progress and if so, please follow the link http://medicineunmasked.wordpress.com/ or click on Medicine Unmasked in the list on the left hand side.

Page1Here is the poster for a new exhibition of work entitled Illness begins with “I”.

So, if you are in the area on October 24th you are more than welcome to come along  to have a glass of wine and view the paintings, drawings and sculptures which I hope will give some  further insight into how I am using art as a way to promote and extend understanding of the profound existential impact of illness. And if you can’t come in person please watch this space as very soon I will be putting up an image gallery of the whole show.

On my other research site – Drawing Women’s Cancer: drawingcancer.wordpress.com - I have posted a series of recent drawings I made in the operating theatre while attending a gynaecological operation. I have put a couple up here too in the hope you will be interested to see more. The project is growing in terms of its impact and resonance since its inception in 2012 and it is my constant aim to ensure that this continues.

Scan 6 Scan 5

I have attended various operations during the course of the project and all of the women who have allowed me to witness this part of their experience do so with the conviction that it will help me understand more profoundly what they are going through. Having, to borrow a term from legal channels, an ‘appropriate adult’ seems also to help sometimes as they try to deal with the natural anxieties that such an experience brings on.

In the true spirit of interdisciplinary practice in the Medical Humanities, the Drawing Women’s Cancer project offers a direct challenge to the rationale of an uncompromising ‘art-science’ dichotomy by demonstrating that, in practice, neither can be disassociated from our understanding of humanity and the manner in which we engage or disengage with the society in which we are a ‘person’. Art, medical science and philosophy, at least for me, seem inescapably entangled in a web of our own being and are constituent parts of the same overall human project, but visual art perhaps has the more obvious capacity to ‘bear witness’ to the trials that are often borne in the pursuance of being…in our physical enactment and psychological representation of life. Drawing Women’s Cancer is not only about disease, or medical intervention, or suffering, or the impact of illness; it is about all of these things. It is about, as Radley notes, what it feels like when ‘all sense of normality, and all the expectations of a future that accompany good health, suddenly become less real’. It is about the experience of illness, where that experience overrides all others. It is about creating a language that has the power to speak, not necessarily for the women whose personal stories are taken as the point of departure, but rather because of them, so that they may return.

 

Follow

Get every new post delivered to your Inbox.

Join 84 other followers

%d bloggers like this: