The Yale Journal for Humanities in Medicine    

The Medical Humanities in Nepal

P. Ravi Shankar, M.D.
ravi.dr.shankar@gmail.com

Nepal does not have a history of education in the medical humanities. The ‘humanities’ (as a course of study) are taught all over the country and there have been many research studies carried out in the humanities. But medicine and the humanities have not been brought together. Ethics is taught occasionally in medical schools. I attended a course on biomedical ethics organized by the Nepal Health Research Council and became convinced that medical students should have knowledge of ethics. Traditionally, however, ethics has been taught in a dry, didactic fashion and I resolved that if I do teach ethics, it would be in a more interesting manner. The method of teaching often serves to turn many students off the subject.

I am a clinical pharmacologist and I started teaching in the traditional didactic way which is in vogue in South Asian medical schools. Gradually I got more interested in problem-based/problem-stimulated learning. My friend, Rakesh Biswas, was beginning to use narratives in medical education. He did some interesting work and is further developing the same in Malaysia.

I have had a life long interest in literature and am a keen trekker and photographer. I love to write and often pen poems, short stories, and travelogues. There have been many reports of the decreasing humanistic values of doctors who are graduating from medical school. At the Manipal College of Medical Sciences (MCOMS), we have students from Nepal, India, Sri Lanka, and also from other countries. I started thinking about whether I could combine my interest in the arts and literature with new learning methodologies and may be teach medical humanities to the students.

Pokhara at the foot of the magnificent Annapurnas must surely rank as one of the most beautiful places on Earth. The city of lakes is bisected by the glacier fed Seti River which forms a series of spectacular gorges and canyons along its course. This beautiful setting attracts tourists from all over the world and has served as the inspiration for spectacular dances, a rich culture and some passionate outpourings of literature, painting, sculpture and music. Pokhara serves as the base for treks in the famous ‘Annapurna’ trekking region.

The wonderful setting of Pokhara is a powerful stimulus for the sense and for creative pursuits. Sitting out on a clear, balmy winter’s day in warm sunshine with a cup of coffee in hand and watching white, fluffy clouds play ‘hide and seek’ among the snow capped Annapurna Himalayas can be a wonderful experience. Pokhara is a city of Lakes and Phewa Lake is the most famous among them all. Lakeside is the main ‘tourist’ area of the town and abounds with second hand book shops. In addition, our college has been farsighted enough to include novels, biographies, poem anthologies, travelogues and general magazines in the library. These have served as a powerful stimulus for the humanities.

An artificial division has been created between the ‘humanities’ and the ‘sciences’ right from junior college and this division persists into medical school. Even in non-professional colleges, students of the ‘arts’ (humanities) and the ‘sciences’ rarely mingle or interact!

I came to know that the medical humanities are an established concept in many Western countries. Medical humanities programs are successfully running in the United States, United Kingdom, Israel, Argentina, New Zealand, Scandinavia, Switzerland, Canada, and other countries. In many countries, the medical humanities have obtained formal status and are a required course of study. I began thinking why not do the same in Nepal! Why maintain the artificial divide between the ‘science’ and the ‘arts’ and disregard the universality of knowledge?

I along with my colleagues had carried out two studies, the first on student attitudes towards science and the scientific method and the second on the reading habits of the students and the student attitude towards the medical humanities. These studies and the literature review introduced me to the theoretical concepts regarding the medical humanities.
A few students with a literary inclination got together and started a wall magazine called Vibes. Vibes and the traditional college magazine Reflections became an outlet for the literary talents of the students.

Vibes usually comes out every fortnight. Poems, paintings, sketches, quotations, interviews with faculty members, comments on current events, jokes and cartoons are all welcome. Reflections is brought out by the batch of undergraduate students who are finishing their course of study and are graduating from the college. The magazine has short biographies of the graduating students, short stories, descriptions of college events and photographs.
The column ‘Medicine and the Arts’ (MATA) in the journal Academic Medicine was and continues to be very interesting. Academic Medicine introduced me to the different medical humanities programs conducted in the United States. The HINARI initiative allows researchers in Nepal and other developing countries to access over 3500 journals free of cost. The HINARI initiative allowed me to access Medical Humanities Online published by the BMJ group. The journal has some very interesting articles on the medical humanities.

Anne Farmakidis, the editor of MATA was kind enough to send me a wonderfully produced compilation of MATA articles over a ten year period and this got me really interested in the medical humanities. The Literature, Arts and Medicine database maintained among others by the New York University (NYU) serves as a wonderful introduction to the humanities. The database (http://litmed.med.nyu.edu/) has paintings, poems, films, short stories and is freely accessible online. The online journal, The Yale Journal of the Humanities and Medicine (http://yjhm.yale.edu/) has a wonderful selection of articles dealing with the humanities. The journal, Cell2Soul (www.cell2soul.org) has a good collection of articles and the Cell2Soul blog is a ‘different’ concept allowing for quick publication of articles and dissemination of ideas.

My colleague, Dr. Pranaya Mishra, completed his Ph.D. from Denmark where a course in philosophy is mandatory for all health science students. He was fond of describing the benefits of learning the philosophy of medicine and slowly got me interested in the subject. Dr. Mishra has introduced many new concepts in our department. He was among the first to introduce communication skills learning for students. He took the first steps towards problem-stimulated learning. He was always saying that students should have a basic knowledge of the philosophy of medicine and got me thinking along those lines. He was among the pioneers of drug information services and of pharmacovigilance in Nepal.

Thus I had a very ‘round about’ introduction to the medical humanities. Maybe the lack of a tradition of teaching and learning medical humanities in Nepal and South Asia was partly responsible! At present I am conducting a voluntary module on the medical humanities in my institution. The lack of a history of education in the medical humanities in my institution in Nepal and in South Asia may be a ‘curse’ or a ‘blessing’.

Published: July 24, 2007