Out of the gay rights activism in the 1970s came AIDS activism in the early 1980s. By then, the incidence and severity of AIDS had become evident and caused enough fear to generate social backlash against those with the disease. This, along with federal government insouciance at the time, made it necessary for gay rights activists to extend their remit into advocacy for health care specialization and research advancements for AIDS. The expanded activism was visible on the streets and at governmental research institutions (e.g., National Institutes of Health). Where it was also taking place, and not in such an obvious way, was within certain hospitals.  

San Francisco General Hospital answered the call first in 1983 when it created a special unit for the care of people with AIDS in “Ward 5B.” The unit was in operation through its move in 1986 into Ward 5A to accommodate more patients, and until 2003 when advances in antiretroviral treatment of AIDS made the unit no longer necessary. But throughout, the struggle to maintain and advance the unit medically, socially, and politically persisted. The documentary film, aptly named “5B,” covers the struggles, successes, and failures of the unit, and the activism required of the staff and advocates for its creation and ongoing viability.  

From the Inside 

The story is told from various perspectives through interviews with key figures in the unit’s development and operation, and with archival footage of the unit and AIDS activism in the community. The most prominent among the key figures is Cliff Morrison, a clinical nurse specialist who spearheaded the idea for the unit and then managed it. Several other nurses who served in staff and supervisory positions are also featured. Participating physicians include Paul Volberding, an oncologist at the time who became pivotal in the development of effective HIV treatments, and Julie Gerberding, a physician treating patients on the unit who later became the Director of the Centers for Disease Control (CDC). Lorraine Day, the chief of orthopedic surgery at the hospital when the unit opened, is heard often as an opposing voice. Hank Plante, a local television news reporter, also appears frequently to offer his perspectives on many of the social and political issues swirling around the unit. Among other participants are AIDS activists, volunteers, and family members of unit patients. 

Several storylines frame the documentary including how nurses drove the unit’s inception and then were instrumental in running it. “Nurses were in charge,” said Volberding, admiringly. Interwoven throughout the film are the experiences of the patients and individual nurses, including one nurse who was infected with HIV from a needle stick. “Those nurses were the real heroes,” said one activist.    

Rare is the story, though, about heroes who aren’t confronted with daunting challenges, and thus this documentary includes a storyline involving attacks the unit nurses encountered from inside the hospital. The nurses of this unit practiced in ways they considered safe but not in such a manner that would preclude them from touching patients or require them to don so much protective gear they become unseeable. Nurses and clinicians from other units objected and did not want to be compelled to adopt practices they thought endangered them on the occasions they took care of AIDS patients. The film follows this story through union grievances and public debates to their conclusion, which sided with the unit nurses and their advocates. The spirit of activism among the unit staff was pivotal in fending off the many challenges they faced. 

Keeping in Touch 

The documentary reveals stark juxtapositions that can manifest in the midst of an infectious epidemic, and in particular when an epidemic selects an identifiable group that is unwelcome in mainstream society. Two juxtapositions that stand out are the emotion of love with that of fear, and those who are deemed worthy with those who are considered disreputable. 

No treatments for the HIV infection or for the many horrid and lethal diseases resulting from AIDS were available when the unit opened—it was “a very, very unpleasant death” as one nurse put it. The nurses saw a big part of their role as offering love: “Here you were allowed to love your patients.” They offered it through human touch. Morrison’s view was, “If we can’t save these folks, we’re going to touch them.” To touch the patients in this way required that they balance it with the risk of exposure to infection and still comply with universal precautions. Nevertheless, fear was prevalent—some people were “truly hysterical” according to Gerberding—and it touched off conflict among the health care staff. “People were afraid…we found ourselves attacking each other…everyone was so stressed,” is how Volberding described the situation. This balance is one that is continuously negotiated in health care settings, but it was more pronounced during the early years of the AIDS epidemic, and at San Francisco General, it had to be mediated by hospital and union officials. 

At the time unit opened, and for a long while after, people with AIDS were scorned. The gay lifestyle was linked to the disease and so a view held by many was that the gay community deserved to be struck down by this plague. They were not worthy of all the human resources, technology, and money the disease required. The documentary brings this sentiment to life by showing the actions some people took to prevent getting these patients help, and the actions governments didn’t take to help them. Also shown, however, was how the activism of health care professionals and others in Ward 5B helped to overcome these obstacles. Without it in the case of the unit in Ward 5B, the activism in the streets outside the hospital alone may not have been enough.  

But Then 

These fevers abated some when medical advances produced treatments that obviated the need for AIDS units, and changes in societal attitudes led to more acceptance of gay lifestyles. The next epidemic that targeted marginalized and susceptible groups would determine whether lessons learned from the time of this unit had been incorporated in response protocols. That opportunity came the year this documentary was released in 2019 when Covid struck elderly people first and hardest, and especially those in communal living arrangements.  

Note: 

The documentary was featured on the podcast episode, How Terrible It Was: Three Takes on the AIDS Crisis with Dr. Ross Slotten, which can be accessed here on medhum. In addition to the documentary, the podcast episode included the novel, The Great Believers, and the memoir, The Plague Years: A Doctor’s Journey through the AIDS Crisis were discussed. The author of the memoir, Dr. Ross Slotten, joined the podcast as a guest. 

Title image credit: 
James Steakley, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons 

Documentary information: 
Film title: 5B
Directors: Paul Haggis, Dan Krauss 
Studio: Vertical Entertainment 
Viewing source: Amazon Prime 
U.S. release date: June, 2019 
Run time: 134 minutes  

Trailers from 5B Film

In 2019, a prominent obstetrician/gynaecologist in Toronto was found guilty of administering intravaginal medications to his obstetrics patients for the purposes of inducing labour without consent. He was subsequently dismissed from his position at the hospital and his career ended. The story was covered in detail in an exposé published in Toronto Life magazine. 

The details of the case are lurid. In the modern age, most obstetricians do group call. Gone are the days when an expectant mother would have both her prenatal care and delivery done by the same physician. Newborn babies are wont to arrive in the world at any given moment, and the traditional obstetrician who drops everything they are doing to attend these deliveries, often in the middle of the night and often with a full day of office work the next day, is all but extinct. Obstetricians now share call duties with a team of physicians. Now, when you sign up with a certain obstetrician, there’s no guarantee that that specific doctor will be the one to deliver your baby, only that someone from their group will be doing the delivery. 

In Ontario, obstetricians are paid more for delivering babies on weekends than they are on weekdays. It’s a nice little reward for doctors who usually work long and unpredictable hours. But in this one hospital, the obstetrics department began to notice that one of their staff had a propensity for babies being delivered predominantly on weekends and evenings and began tracking the matter. 

In time, they discovered that this doctor was inserting tablets of misoprostol into the vaginas of late term pregnant patients in order to induce labour on specific days that were to his advantage, often when the date in question was a weekend. Misoprostol has the ability to induce contractions and is often used in medical abortions. It is not considered to be a medication safe to use in pregnant women to induce labour on command. Needless to say, the patients did not give informed consent for the procedure, nor were they offered the option to decline.The doctor in question was a prominent member of Toronto’s Chinese Canadian community. He had a reputation for being a doctor to the rich and chic. Famous Hong Kong celebrities flew to Canada to have their babies delivered by him and my own patients flocked to him in droves. 

In Toronto, getting a referral to a community obstetrician of choice to deliver your baby is like trying to get your child into an elite private school–no doubt, these actions are often being done by the same parents, just a few years apart. Obstetricians have a set number of expectant mothers they can carry for any given month and once that quota is exceeded, they can’t accept any more patients. In those years when I first started working as a family physician, Chinese immigrant women in my community knew to race to our office as soon as they suspected they were pregnant, so as to get into the front of this doctor’s queue. They were then told by the obstetrician’s office that they were expected to pay a three-hundred-dollar administrative fee in order to guarantee this doctor would be present for the delivery, which they gladly paid.^⁠1 

At the time, it seemed reasonable. Three hundred dollars and your doctor would buck the modern trends of group call and shared team duties and promise to come in on his night off to personally deliver your baby. It all seemed legitimate and altruistic, a call back to a simpler time. If only. 

When the story broke, there was the expected furor in the local medical community. Certainly, the salacious nature of the case, the prominence of the doctor in question, the #MeToo movement which was also taking place around this time, gave the story its pull. 

In the local Chinese community, the story had buzz as well. Toronto, with its large Chinese-speaking population, has several Chinese daily newspapers and the story made headlines in the local Chinese newspapers and filtered its way through all of us. It felt like everyone’s mother had heard of this doctor; he was that well-known. 

As I spoke to patients and friends and colleagues, I discovered so many people around me had had their children delivered by this doctor in the preceding decades. As they reflected on their obstetrics journeys, the stories were all the same. Yes, it was true, many of their babies had happened to arrive on a weekend. Yes, the labour started soon after an assessment, right on schedule and with what had seemed like fortuitous timing at the time. Now, in retrospect, it all seemed fishy and possibly sinister. 

But one thing that I noticed was that this doctor’s actions were met with largely a collective sigh of indifference by the Chinese Canadian community. The lack of outrage most people had towards the story felt odd. Remember, this story was occurring near the height of the #MeToo movement. The idea of a doctor administering intravaginal medications without consent should have, in the West, been seen on the level of battery. At the very least, I expected people to think of it as a violation of a woman’s body. But in the Chinese community, amongst the population that knew this doctor the best, the reaction was muted. Most of his patients that I encountered shrugged off the story. When the subject came up, they were quick to point out to me that he was an outstanding doctor who had helped many people and were disappointed to hear that the doctor was no longer practising. 

In China, women’s reproductive rights is an issue with a thorny history, especially over the last several decades, most of which I was oblivious to until I started working with my own patients. 

The most blatant and obvious reproductive rights issue is China’s One-Child Policy, which ran from 1979 to 2015. During these years, families in China were limited to having only one child, except in special circumstances. The One-Child Policy was formulated in response to the Chinese government’s fear of overpopulation. 

In my naive understanding of China, I was taught the official narrative, that people who had more than one child were subject to higher rates of taxation, and it was the punitive toll of this taxation that kept parents in line. 

But the truth was more complex. What were people’s expectations about birth control? What happened when people didn’t agree with the government’s policy? What happened to people who had an extra child on purpose? What happened if they had a child accidentally?  

When I started working, I soon noticed that all middle-aged women from mainland China had intrauterine contraceptive devices implanted in their uterus. Mostly, they had had these devices placed after delivering a baby years earlier. In many cases, these IUCDs had been present in these patients’ uterus for so long that many of them often forgot to mention it to me, only informing me about the presence of these devices sometimes when they were in their late fifties or early sixties, long after the device had ceased to perform any useful function. Often times, we’d discover that these devices were present during a routine ultrasound, and the patient would remember that yes, they had been wearing an IUCD for so long that they had simply forgotten about it–it had simply become a part of them. This wasn’t an entirely benign situation. The longer an IUCD remained in, the greater the chance it would slowly embed into the tissue of the uterus. Albeit rarely, there are case reports of it rupturing the uterus of women after decades being left in. 

Even after I realized that so many of my patients were wearing IUCDs, I still didn’t fully understand what this meant. I had in my mind envisioned the Western model of women’s reproductive care, that the mother had informed her obstetrician in China at some point after the delivery that she would have an IUCD inserted because yes, she was certain she didn’t want to have another child for a few years. I envisioned a long conversation where a medical professional gave the patient a series of options about contraceptive care. Did the patient want an IUCD? Or maybe to try the birth control pill? Or did the patient want to use natural family planning methods? It was only gradually that it dawned on me, that these were conversations we only had in the West, not conversations women had in China. They weren’t given the option of having an IUCD inserted. They were simply told what to do, or had it done unto them. 

But my women patients didn’t seem bothered by this. They never expressed outrage at having an IUCD. It was again, the collective shrug of indifference. It wasn’t that different than being told that they had to pay taxes. Or have a mandatory retirement age. It was just another curious aspect of life in modern China.  

I couldn’t envision what it meant for a society to exist where a government somewhere could decree that all women would be forced to have a copper intrauterine device placed in their uterus upon having a baby, whether they liked it or not, and that it would remain in place indefinitely. It seemed even more preposterous that almost all the decisions said government made were made by men–the Chinese Communist Party is well known for being almost exclusively male at its highest levels. 

The actual IUCDs that the patients wear bear mentioning also. In North America, IUCD devices like the Copper-T, or Mirena, are little metal or plastic objects that are inserted into the uterus, with a trailing piece of string that dangles out of the uterus. The device itself prevents either ovulation or implantation of the embryo, depending on the IUCD in question. The little piece of string is designed to allow the device to be removed easily in a doctor’s office, where a doctor can tug on the string with a pair of forceps and remove the device. 

In China, the IUCD device is inserted without a string, making it deliberately more difficult for people to remove, even with proper medical equipment. 

As a result, many of my patients, after decades of wearing the IUCD, found that the device could not be easily removed. Canadian-trained gynaecologists, used to the simplicity of tugging on a piece of string and changing the IUCD every four or five years as per the manufacturer’s instructions, couldn’t always remove the Chinese IUCDs. Sometimes, it was because the Canadian-trained gynaecologists didn’t have the practice grabbing IUCD’s without the string. At other times, it was because the device had been put in place so long ago that it had shifted position and could no longer easily be removed. Some of my patients had to go under general anesthesia to have the device removed. Others got on airplanes and flew back to China to get the device removed there by the experts. All of this, I gradually realized, was part of the long-term consequences driven by China’s One-Child Policy. 

For a more detailed discussion of the One-Child Policy, see Barbara Demick’s Daughters of the Bamboo Grove. Demick, an L.A. Times journalist, chronicles her two-decade odyssey to help reunite an American-raised Chinese adoptee named Esther with her birth family in China. Esther was abducted as a two-year-old and then trafficked to an orphanage during China’s international adoption industry heyday in the early 1990s. As it turns out, she has a twin sister, Shuangjie, who stayed with her birth family and the story provides a fascinating case study of the entire issue of women’s reproductive rights and the issue of international adoption. 

In the book, Demick lays out China’s One-Child Policy and its ramifications on the grassroots level, where neighbourhoods were policed by local government family planning offices. These units were akin to local mafioso-like organizations, gangs of thugs who were given carte blanche by the local governments to cajole, threaten, and beat people into towing the party line. And, to top it off, they weren’t above kidnapping the children who violated the government’s restrictions on family planning. 

When it comes to the One-Child Policy, there is a tendency for us as Westerners to discuss it as tomfoolery–a straightforward story of failed macro-economic policy, that the One-Child Policy was short-sighted and hastened China’s likely imminent economic decline. And while this narrative may be accurate, it only scratches the surface. The reality of what happened to people on a personal level is much more complicated. 

As Demick describes it, in the nineties, the One-Child Policy essentially created the market conditions for international adoption and the trafficking of kidnapped children. It isn’t a huge leap of logic to understand that the One-Child Policy begets well-meaning people from the West wanting to adopt babies from China and being willing to pay good money to do so. Once money is involved, human traffickers realize that if they can get good money for babies, then all they need to do is to get more and more babies. Now, cue the kidnappings and forced baby abductions and we get to where we were. It’s a frightening cycle, which only illustrates yet again how economic policy can trickle down to the level of the individual in thousand-fold ways. 

There’s another aspect to Chinese family planning worth pointing out here, which is the desire to have more male children. The Chinese culture is by no means alone in this. Historically, many groups around the world prized boys over girls. In China, the reasons for this have long been established. Traditionally, Chinese culture has long placed an emphasis on families having male heirs. According to Chinese culture, family lineages pass through sons, and daughters are raised but then handed over to other families when they marry, unable to continue lineages of their own. At its most basic level, this meant that your son could look after you in your old age but your daughter couldn’t. 

Growing up as an immigrant in Canada, I accepted that the preference for boys over girls was probably one of those older, primitive world views that Chinese people held in the past, but, like binding women’s feet, surely not something anyone still believed in modern times. After all, I had grown up in a North America where women voted, moms were entering the work force en masse, and dual-income households were becoming more and more the norm. I took it for granted that modern people everywhere would value boys and girls equally. 

And while I had read in books about the gender imbalance in China, about how the One-Child Policy had created a nation with a surplus of boys over girls, I took it as just another example of primitive, traditional Chinese thinking, something from the old world, not something that I would have to deal with directly as a doctor in Canada. 

So imagine my surprise, when in my early years of practice, patients started approaching me, forcing me to confront some of these gender issues head on. 

One patient, an older woman who was already the mother of multiple girls, discovered that she was pregnant again. At the eighteen-to-twenty-week ultrasound, to her disappointment, she discovered that she was having a girl, again. A few weeks later, despondent, she came to my office, asking for a referral for an abortion. She explained to me that she wasn’t primitive or old-fashioned. Indeed, she wasn’t against having girls per say. But she already had so many that it seemed fair that she really didn’t want another one. 

By this point in the pregnancy, she was already precariously close to the twenty-four-week cutoff for late term abortions. In Canada, abortions past twenty-four weeks aren’t allowed. Would it be possible for me to change her estimated date of confinement to so that she could squeeze in just within the 24 week window?^⁠2 I refused to do this, and she ended up returning to the clinic multiple times in the next several weeks, each time suggesting that, telling us in fact, that she had remembered her last menstrual period date wrong. And that if we used her revised calculation, her current pregnancy actually fit in the twenty-four-week window. Needless to say, I did not acquiesce and eventually this patient drifted out of my practice. I never did find out what happened to her and her family of girls. 

Fortunately, not all the stories are so odd. Some patients from China have told me that they were pleasantly surprised to discover that in Canada, at the eighteen-week ultrasound, doctors could reveal the gender of their future children to them if they wished. Finally, they could prepare for the upcoming birth of their child knowing what colour to paint the child’s bedroom and what colour clothes to buy in advance. In China, I was told, this information was kept strictly confidential because the government was afraid that people would go looking for abortions if they found they were pregnant with a girl. 

Of course, now the situation in China is flipped. After decades of the One-Child Policy, China suddenly finds itself facing an economic slowdown, the prospect of an aging population and a more educated working class that wants no part of having more children. More and more young people in China are choosing not to even marry, not to mention start families. 

In a twist of dramatic irony, those same family planning units that harassed women for decades into having less children, have suddenly been tasked with the job of encouraging increased reproductive rates. 

What will the Chinese government do when it’s time to raise its low birth rate? What will it do when it realizes it can’t convince its citizens to get pregnant more readily by offering tax incentives? After all I’ve seen and experienced, it’s something I don’t even want to think about but could be just around the corner. 

I’ve long struggled to understand this concept of just how powerful the Chinese government is and how much impact it is able to have on its citizenry. Because my grandparents fled China after the Civil War in 1949 and my parents grew up in Taiwan under martial law, I’ve always had a bird’s-eye view of how Chinese politics can affect the lives of everyday people. I have an aunt who I’ve never met because she didn’t make it out of China in 1949 and became separated from our family–she wouldn’t see my father, her brother, for almost forty years. In recent years, I’ve read countless books about government reforms in China. I saw how China handled Covid-19 in the news. I’ve visited China and seen the gleaming new buildings and multi-lane superhighways humming with electric vehicles. But none of it has spoken to me as loudly as this collective shrug of indifference that I’ve encountered from my patients when it comes to women’s reproductive rights. 

Sometimes, I wonder what the psychic toll of a person doing something they don’t really want to do might be. What if they’re forced to get a tattoo that they don’t want? Or forced to cut their hair in a certain way? 

What if they’re forced into a marriage they don’t want? Or forced to have a baby they don’t want? Or forced to give the baby away against their will? 

They don’t even have the option of agreeing to any of these things. What if these actions are just done to them whether they like it or not? 

But then what about this: what is the psychic toll if they’re to wear an IUCD for the next thirty years, whether they would like to or not? 

What’s the toll if they’re given intravaginal misoprostol so that their baby can be born on an auspicious day? 

What’s the toll if they’re given intravaginal misoprostol so that an obstetrician can deliver the baby on a day convenient for him? 

If all of these decisions are simply made for a person by an aggressive husband, we’d call it abuse and everyone would be screaming bloody murder. But if these decisions are decreed by an even higher authority, an all-powerful political party or an all-seeing authoritarian government, then what? Would everyone just accept it as just another cultural fact of life, like using chopsticks instead of a fork? It seems like they would. 

To hear further discussion about Barbara Demick’s Daughters of the Bamboo Grove, have a listen to my discussion about it on Apollo On Call, the podcast of medhum.org. 

1. In Canada, health care is publicly funded but doctors can charge fees for services not covered by the public health care system. This can take the form of administrative fees as well as fees for certain medical and surgical procedures that the government health insurance doesn’t cover. 
2. The estimated date of confinement is the projected due date for a pregnant mother. It can be calculated as 40 weeks from the date of the pregnant woman’s last menstrual period, or estimated using prenatal ultrasounds. 

Web Image by Medhum.org and Fred Moon 

Additional Chapters from A Chinese City Doctor’s Notebook

When Your Body Isn’t Yours 

01.12.26 810

From Tigers to Otaku

09.16.25 1691

The Happiest Couple

07.28.25 1426

The Things We Don’t Talk About When We Talk About Dying 

05.13.25 2008

Agnes recognizes William’s unique potential and supports his choice to leave his family and head off to London to make his name in the theater world. Shakespeare rarely returns home to Stratford, and we only learn of his growing success indirectly. Agnes is forced to raise her children as a single parent and has to deal with her overwhelming grief when Hamnet dies. As she mourns the loss of her son, she is overcome with doubt about the fidelity of her absent husband, and her faith in their marriage is threatened. Ultimately, Agnes is given a playbill featuring the production of a new play written by her husband and she sets off on a trip to London to confront him on his own turf. She arrives uninvited at the Globe Theater in time to witness a performance of the play in which her husband has been able to channel his own grief at the loss of his son into one of the enduring literary works in the Western canon.  

I first became aware of this book in a New York Times article that appeared in the early stages of the COVID 19 pandemic shutdown. It was recommended as a worthwhile book to read in quarantine. I had never heard of Maggie O’Farrell but the two-sentence summary captured the book and author perfectly. I do not think O’Farrell is a prophetess, but she was nothing if not attuned to our times and circumstances. Assuming she was writing this novel well before coronavirus escaped the food market in Wuhan, the way she frames Hamnet’s death in the setting of the bubonic plague in Stratford is inspired. Her story captures the explosive fear that envelops the town as the plague spreads — you can feel the wind in your face as the townspeople slam the door shut in the face of anyone suspected or proven to be infected. The story is written in the present tense which heightens the sense of immediacy of events as they unfold for William and his parents, Agnes and her family, and the people living in Stratford. O’Farrell’s prose feels Elizabethan – in the description of glove making, removing honey from a beehive, preparing shrouds for the dead child. As I read, I found myself looking up many more words than usual; the language itself has the power to transport you back in time.  

But, while the choice of bubonic plague as the cause of death may have been fortuitous for book clubs and book sales in the world we lived in during the pandemic, I do not think it is the driving force in this book. The dominant theme is how we deal with grief from any cause. O’Farrell is not the first author to use the death of a child as a vehicle to explore the myriad consequences triggered by the loss of a loved one, especially for parents who lose a young son or daughter. The steady movement of the plot to the climactic scene in London makes Shakespeare’s response seem the more substantive. His literary genius has enabled him to channel his sadness at the loss of the son he adored into the creation of an authentic character into whom he could project all the hopes and dreams that he had for Hamnet.  

Interestingly, O’Farrell never names Shakespeare throughout the novel, referring to Shakespeare always as “he” or “him” I can only speculate what O’Farrell means to convey with this literary device. I think she is acknowledging that it is the truly rare individual who can accomplish what Shakespeare was able to do in redirecting his grief from personal sadness into a timeless literary masterpiece. We are thus like Agnes who must go through our day-to-day routine, try to find meaning in tragedy and the courage and strength to stay on our feet and continue to move forward. That is Agnes’ accomplishment — that she can summon the will to travel to London to confront William, and by her action have the goodness of heart to realize that her husband shares her loss. She is able to appreciate the gift he has been given to transform his personal grief into a meaningful expression that the world can share. With this newfound knowledge, her marriage will be reinvigorated, and their mutual love will be reinforced. Agnes is thus the named character who occupies center stage as the story unfolds.  

O’Farrell has written a truly beautiful book that brings to life the pain of loss and the capacity of men and women to endure. As we coped with the COVID-19 pandemic as individuals and communities, many were forced to deal with unexpected pain, suffering and death. Hamnet is a book for our time. Physicians and all other health professionals do their best to support families and communities as they deal with untimely loss of loved ones. I only hope that it will not set the bar too high on expectations of how to transform grief into meaning. We are not all going to be Shakespeares but we can hope to be Agneses, who can still find joy and meaning in our lived lives in the aftermath of devastating loss.   

Hamnet
Maggie O’Farrell 
Alfred Knopf, 2020: 384 pages 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database 
Web image by Medhum.org

The modern world is full of inexplicable conflicts. As one who has spent my life developing vaccines against infectious diseases it is puzzling to see the growing opposition to vaccination, which in the United States and other developed countries have eliminated or limited diseases that once decimated populations. I am old enough to remember as a child the deaths of other children, and indeed as a child I suffered three serious infectious diseases, one of which caused temporary paralysis of my face. 

Later in life, I graduated medical school and became an intern at a large metropolitan hospital in Cleveland. One of the common infections I saw in children was due to a bacterium called Hemophilus influenzae type B, which causes meningitis and epiglottitis (swelling of the structure at the top of the trachea that leads to the lungs). I treated those infections with antibiotics, but that succeeded best if the illnesses were in early stages. I remember one night on duty when a 3-year-old gasping for air was brought in to the Emergency Room by his father. The child had been put to bed that evening appearing to be healthy, but became ill hours later. I rushed into the room ready to help but in seconds, before I could do anything, the child died before my eyes. I will not forget the anguish of his father, or the anguish of other parents I saw whose children were ill with infections. Owing to the later development and employment of a vaccine against H. influenzae type B, the disease has disappeared from the United States. 

In part, the current opposition to vaccines can be attributed to the absence of these diseases they cause, which makes people feel invincible, and in part to a society in which communication of lies and fabrications is easy and rife. Modern communication allows dissemination of arguments based on fabrications to masquerade as facts, and to allow some to profit from those fabrications. Another example of a foolish approach to the issue of vaccination is the attempt by the current administration to break up the measles-mumps-rubella vaccine into three separate injections, despite years and years of safe use of the MMR vaccine that has dramatically controlled those diseases. The effects on public health will be awful. 

Although there is no easy way to deal with this situation, I have long thought that including education in statistics for all school children would be one useful step, so that they understand the relations between risk and benefit when they become adults. The fact of the matter is there is no choice in life that is without risk. The question is what is the ratio of risk to benefits in making that choice? All statistical analyses show that vaccination has little risk and great benefit, so why should we let lies about vaccination prevail? 

All licensed vaccines go through a process involving 5 Phases: Phase 1 involves testing a vaccine in a small number of people. Phase 2 involves increasing the number to several hundred. Phase 3 involves thousands of vaccinees, compared to a group of placebo recipients, checking for safety and efficacy of the vaccine. Phase 4 is after licensure, when observations are accumulated in millions of vaccinees. Phase 5 involves collection and analysis by CDC and potentially other organizations of reports by physicians about safety and efficacy of the vaccine. 

Obviously, if a reaction to a vaccine is frequent, that will be detected in the first three phases. If a reaction is uncommon but significant, it will be detected in phase 4. (Actually, a vaccine against rotavirus, an important cause of infantile diarrhea, dehydration, and death, was taken off the market because of phase 4 findings, to be replaced by a safer vaccine developed in my lab.) The problem is that when millions are being vaccinated, bad things are certain to happen by chance. The question then is are they caused by the vaccine? The answer to that question can only be ascertained by careful study, not by jumping to conclusions. 

Web image from Wikicommons.

When he arrives, he finds that the hospital is an expropriated village church overrun by rats and ravaged by typhus, and he is the only physician. The hospital is run by a nun, Sister Margarete, assisted only by orderlies, and the patient load runs the gamut from fractures and gunshot wounds to gangrenous legs and massive head trauma. The front is only a few kilometers away, and the wounded arrive continuously; the quiet and formal Sister Margarete confidently and unobtrusively guides him through rounds, surgeries, and battlefield medicine. Lucius is initially wary of her, perhaps a bit awed by her, and ultimately falls in love with her.  

The transforming event is the arrival of the “winter soldier,” Jozsef Horvath, brought in from the snow mute and shell-shocked, but with no visible wounds. For Lucius, who is fascinated by diseases of the brain and mind, this patient presents a tremendous challenge. Lucius is sure that Horvath has “war neurosis,” what the British physicians of the time were calling shell shock and what we today would call PTSD, and he is determined to understand and heal him. Lucius and Margarete make slow progress with their patient, but his attempts to care for the patient have unintended effects, and Lucius must then deal with the consequences of his actions.

The war, and the hospital routine, go on. One day, while Lucius and Margarete are relaxing in the woods, Margarete runs off; Lucius returns to the village, but Margarete is not there. While Lucius and the staff search for her, Lucius gets lost; he stumbles onto a battlefield and is dragooned into service with a regiment of the Austrian infantry. He ultimately escapes and tries to make his way back to the field hospital, and to Margarete, but Lemnowice has fallen to the Russians. The hospital has been evacuated—and Margarete has disappeared.  Lucius’ search for her will take him across the war-torn remnant of the Empire.

The Winter Soldier is a war story, a doctor story, and a romance, and it also poses a wrenching question of medical ethics. This is a lot to ask of any novel, but Mason pulls it off with aplomb. The writing is lyrical; the author’s descriptions of the variation of the seasons in the Carpathian forests are poetic and beautifully detailed, and his characterizations are finely drawn. We can not only clearly see, but also feel that we know, these people, not only the major figures of the doctor and the nurse, but also the orderlies, the Austrian soldiers, Lucius’ somewhat bemused Professor Zimmer, and Lucius’ parents (who are marvels of characterization: the retired military officer father who lives on past glory and cannot see his son for who he is, and the controlling, clever, acid-tongued society grande dame mother who can only see her son for who she thinks he should be). Lucius and Margarete feel real, and their interaction feels real…and complicated. The historical setting comes alive with detail, and the reader truly feels that they are in that place at that time, whether at a formal dinner in a Viennese mansion or treating war casualties in a Galician backwater. And the medical details are correct, not just the medical terms but even the way in which they are used in dialogue, which is not surprising, as Mason is a physician; it isn’t always easy to get this right, but Mason does.  

But the true heart of the medical story here is the ethical quandary in which Lucius finds himself—the complex nature of the doctor-patient relationship, the motivations which drive it, and the decisions we make. Although this takes up a relatively short page count, its repercussions continue throughout the novel.

The novel has a particular, though minor, resonance for the time of COVID-19 (though it was released two years before the pandemic occurred). The action of the novel is set in motion when, due to a war-induced doctor shortage, medical schools decided to allow upper-level students like Lucius to graduate early and become doctors, and then immediately posted them, often with little practical experience, to field hospitals near the front lines.  Several American medical schools took a superficially similar action in Spring 2020 when doctors were desperately needed to help staff hospital units during the coronavirus pandemic, although this only applied to fourth-years who were but a few months short of graduation and would have already had the clinical experience which Lucius lacked. So while the situations aren’t entirely analogous, the concept of students opting into a trial by fire is.

The Winter Soldier can be appreciated for its historical perspective, its story of human relationships, the ethical dilemma it poses, and the beauty of its prose. Or enjoyed for what it is—a great read.

The Winter Soldier
Daniel Mason
New York, Little Brown & Co., 2018; 318 pp.

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
Web image created by Medhum.org

A few years ago, a patient of mine, a young man, was diagnosed with bipolar disorder. In the middle of university, his grades suddenly nosedived, and he was found talking incoherently by his roommates, who called the police.

Not long thereafter, his mother, distraught, came to see me in the office. She told me the story of their lives. How she had struggled to raise him on her own in North America while her husband lived overseas and how she had pushed them to attend a renowned public school in the area. Now she wondered if she was to blame for the whole thing. Had she done something wrong? Had she pushed them too hard? Was this all her fault?

I’ve been practising as a family physician for Chinese Canadian immigrant patients for almost two decades, and my practice runs the gamut from newborns a few days old right on through to adulthood. Not only that, I grew up as a second generation Chinese Canadian immigrant, the son of two Chinese immigrants from Taiwan. And now I’m a parent myself, raising the third generation of Chinese Canadian immigrants. After all this, I feel like I should know a thing or two about Chinese immigrant parenting but the truth isn’t so simple. It’s probably closer to truth to say that Chinese immigrant parenting is something that I have lived through and have many strange and conflicted feelings about.

There is definitely a playbook that Chinese Canadian immigrant parents subscribe to. The playbook is an extension of the Chinese immigrant workhorse mentality. When you come to a country with nothing but hope and work ethic, you somehow create an ethos built around filial piety, discipline, and a strong sense of duty. This parenting model, tried, tested and true, reads something like this:

• A heavy emphasis on academics and education, with emphasis placed especially on mathematics and sciences.
• A high level of parental expectations.
• Combining the above two points creates the expectation that when it comes to your academics, you will outwork your lazy, North American counterparts
• A carefully curated collection of after school activities, always including some attempt at playing a classical music instrument. Even here, you will outwork your lazy, North American counterparts.
• Going to university. Once in university, you will once again, outwork your lazy, North American counterparts.
• Landing a well-paying job, preferably as a professional in the big three (doctor, lawyer, engineer). If not, then business. In all these fields, you will, once again, outwork your lazy, North American counterparts.

The playbook may sound draconian, but in many ways, it works. Asian immigrant children are known for succeeding academically. They make it into top university programs in large numbers, so much so that some people were worried that certain elite schools were starting to modify admission criteria to decrease Asian students’ enrollment.

Asian Americans disproportionately land jobs in medicine, law and engineering and as adults, do disproportionately well financially. All of this conveniently fits into the model minority myth. The myth says that all Asians are hardworking and reliable. They do well in school, they don’t complain, and they work hard in their upwardly mobile careers.

This heavy-handed approach to parenting gained parlance in popular culture with the publication of Amy Chua’s infamous memoir, “the Battle Hymn of the Tiger Mother.”

Published In 2011, the book was described as a parenting memoir by Yale Law professor Amy Chua and became an international best-seller. In the book, Chua described her parenting journey, as she demanded, insisted, and pushed her children to academic and musical success. Her older daughter ends up performing at Carnegie Hall and eventually, in the years after the book was published, both daughters graduated from Harvard University.

I read the book a few years after it was published. From all the press clippings and popular discourse about the book, I had expected that the book to present a bullet proof justification for tiger parenting.  And indeed, the mother in the book was certainly recognizable to me. She was an amalgam of many of the Chinese immigrant parents I had known growing up, including some aspects of my own.

The book does in fact, describe many classic tropes of the typical Asian American parenting regimen. The disproportionate emphasis placed on learning classical music instruments, the high strung, pushy helicopter parent, the unrelenting expectation of academic success. Chua described booking family vacations only at hotels where a piano was available to be rented.

But what I did not expect was that this was only the setup of the book. In the second half of the book, Chua’s defiant younger daughter, Lulu, decides enough is enough and refuses to give in to her mother’s insistence on playing the violin. In time, she reduces her violin practice time to a measly thirty minutes a day and takes up that most un-Asian of pursuits, sports in the form of competitive tennis, and Chua concludes that the best form of parenting is neither something entirely tiger, but something in the middle, a cross between east and west.

In a culture where few people read but everyone likes to give an opinion, the book’s denouement was lost on most people. Amy Chua and the term “tiger mother” became an avatar for all the aspects of Asian American parenting that were deplorable, but few people chose to remember Chua’s tongue in cheek look at her own parenting.

Instead, the reaction of most westerners to the “tiger mother” phenomenon was one of disbelief, something along the lines of “those crazy Asian parents and their crazy parenting ideas.” But what I found most interesting was Asian people’s response to Chua’s book. Most Asian parents did not see Chua’s style of parenting as harmful or strange. Extreme, maybe, but in principle, no different from any other Asians. In my family, my cousins and I read the book and decided that our parents weren’t really tiger enough. Yes, we had been forced to play the piano and the violin. But not for six hours. Six hours! Can you believe it? Now that is crazy.

As much as I’d like to be critical of Asian American parenting, I must say that in my time with my Chinese Canadian patients, I’ve seen plenty of success stories.

I’ve had patients who find time to play both the piano and the violin while commuting an hour each day to the most elite merit based private schools in the city.

I’ve seen children who are being shuttled between all manner of competitive swimming, gymnastics and ice hockey lessons. Often, just hearing these children’s schedules is enough to make me dizzy but the families somehow make it work.

Sometimes, I’m tempted to ask the parents if it’s possible that they could just let their foot off the pedal and let their kids be kids. That’s the western upbringing in me coming out. But then I remember how in elementary school, one day my teacher asked us to tell the class what after school activities each of us was involved in. This was the late eighties, when over-parenting wasn’t really a thing yet, and I remember how my classmates howled with laughter as I rattled off all the strange extra-curricular activities my parents would be toting me to that summer: piano lessons, swimming lessons, tennis lessons, Chinese school and a cooking class. Most of my classmates were lucky to have one activity to do. I had five. At the time, I laughed along with them, finding the whole thing funny. But now, decades later, when it comes to parenting, I wonder who really gets the last laugh.

At the opposite end of the achievement spectrum, is the Otaku child. The term Otaku is Japanese and was initially a reference to Japanese youths who were obsessed with computers and popular culture. The classic example was the nerdy Japanese boy, imbibing huge quantities of Japanese anime and manga while sitting in their rooms playing video games all day. This was a mostly Asian phenomenon, rarely talked about in the west.^⁠1  In the last several years though, especially since the COVID pandemic, I’ve watched as a growing number of my adolescent patients stopped attending school. I’d find out about these cases from exasperated parents, who would come to the office, often alone but sometimes accompanied by their taciturn child, seeking out a medical solution for what was going on.  

The cases had some similar themes, though none was exactly the same as the others. In most of the cases, the child did not have a strong relationship with their parents. Often they had retreated into an online world on the internet. Sometimes, online gaming was involved, but sometimes the children insisted they just surfed the internet, watching videos or engaging with social media.

Generally speaking, the children weren’t terrible students in the traditional sense of children who were really struggling academically. They were mostly strong students. Several of them were even identified as gifted.

Poor sleep habits were often an issue for these children. They’d often be on their computers into the wee hours of the morning, and then unable to wake up for class, if they bothered to attend at all. Eventually, they’d stop attending classes altogether.

The children tended to spend much of their time in their rooms, rarely interacting with the household, often not joining their families even for meals. As the frustration of the parents grew, so too would the hostilities in the household. The parents would try to break the internet addiction by withholding computer hardware or turning off the WIFI. Such escalations would be met with confrontations, leading to overturned television sets or even suicidal gestures.

The ages of the children varied. Some were as old as high school. But some were as young as middle school.

In all cases, the commonality was that the parents were stuck. They didn’t know how to proceed. And as their family physician, I didn’t know either.

When I went to medical school, school absence was not a medical diagnosis. Neither was video game addiction. But the medical and psychiatric world I was trained in did not have cell phones or social media or Facebook or TikTok. What it had was a few narrow definitions for similar behaviours: conduct disorder, oppositional defiant disorder, and substance abuse disorders. The children in these school avoidance cases fit some of these definitions, but never wholly.

I’ve watched as parents tried everything they could to find a solution for this issue within a medical system that doesn’t really know what to do with these cases. Beleaguered parents bringing their children to see me is only the first step. I’ve sent these patients to see psychiatrists and psychotherapists and paediatricians with mixed results. There isn’t much these specialists can do with an uncommunicative child who doesn’t want to be there. I’ve seen patients call the justice of the peace to issue a community treatment order so that their own child gets ordered by the courts to go to a hospital for an assessment by a psychiatrist. I’ve seen patients drag their child to the emergency room for school absence and read consult notes by well-meaning ER doctors who try their best to persuade the child to resume going to school. I’ve even been called by well-intentioned police officers, who want me to do something about the child they’ve just been dealing with, because they have no idea what they should be doing either.

Of course, school absence isn’t something that’s new or wholly unique to Chinese immigrants. I still remember my first week of high school back in 1992, watching as a classmate of mine was dropped off by his mother at the front door, and as soon as the car disappeared down the road, he turned around and headed away from the school building.

But that was high school and for whatever reason, in those days, we never thought of those kids as being “medical cases.” If you wanted to blow off classes and spend your day smoking cigarettes just off the school grounds, that was your choice. It wasn’t something you dragged your children to see a doctor about.

In fact, the “high-school dropout” has always been a known character trope, around for probably as long as organized education has existed. But there’s something especially jarring when seeing these cases of high school dropouts play out against the backdrop of tiger parenting and the model minority myth. And there’s something even more visceral to it when the issue starts to appear in middle school aged children.

I wish I could say that all of these stories of school avoidance end well. Some of them do: after a few years of feuding with their parents, the child grows up, and some go back to school. But for others, the jury is still out. I’m still waiting to see what happens.

So what does it all mean? How can well-intentioned Chinese Canadian immigrant parenting, produce such a broad spectrum of results? Super successful overachievers on the one hand, and Otaku adolescents who refuse to leave their rooms and are on suicide watch on the other?

I don’t have an answer, except to say that both of these groups of children are products of the same parenting paradigm. And just like when my patients ask me if they are to blame for their children’s mental illness, there is no real answer. There’s no way to definitively connect a line between the Asian parenting model and the types of children it produces.

But just as we can draw a line between pushy, tiger parenting and academic success, we probably can also draw a similar line between pushy, tiger parenting and Otaku children and social withdrawal. It’s easy for the Asian parenting model to claim its successes, but it’s time for the Asian parenting model to also accept some of the damage it has wrought onto its children.

Ultimately, most of my paediatric patients go through to university. The majority are in the typical model minority fields: engineering, computers, medical school and law school. 

But occasionally I’ll meet one who is studying something a bit more off the beaten path: fashion, or design, or cinema or something like that. They may be taking degrees in those programs, or they’ve pivoted after university and are making their way far off the traditional, beaten path. I’ll look at them, I’ll know that in some small way, they’ve broken out of the paradigm. I know they’re putting their parents through agony, but for what it’s worth, I’m proud of them.

1. I remember a lecture in medical school talking about the cultural basis of diseases. Certain diseases were common in the West but almost unheard of in Asia-the example of eating disorders was given. For the opposite example of diseases common in the East but rare in the West, the example given was the Japanese Otaku child.
Web image created by Medhum.org

Photo of the Hsu family in the 80s provided by Dave

Additional Chapters from A Chinese City Doctor’s Notebook

When Your Body Isn’t Yours 

01.12.26 810

From Tigers to Otaku

09.16.25 1691

The Happiest Couple

07.28.25 1426

The Things We Don’t Talk About When We Talk About Dying 

05.13.25 2008

One Patient, Two Systems 

02.24.25 2695

The Secularization of Medicine: Ritual, Salvation, and Prophecy by Nathan Carlin 

New York, NY: Oxford University Press, 2025, 264 pages 
ISBN 9780197574003 

Once upon a time, religion and medicine were quite close. Even now, parallels between the two are notable. Churches often have a spire pointing towards heaven. Modern medical centers are increasingly towering structures that reach to the sky. Churches have an altar, and hospitals contain operating tables. Clerics don distinctive vestments. Doctors have their own traditional attire – a white lab coat or scrub suit. Hearing a confession (whether in a hushed booth or a clinic exam room) is integral to both vocations. Some churches have holy water fonts for spiritual cleansing. Physician offices have readily available hand sanitizer. Carlin (an ordained Presbyterian minister and the Director of the McGovern Center for Humanities and Ethics at UTHealth Houston) explores the relationship between medicine and religion by focusing on secularization theory and the idea of transposition. His aim is to provide “a more critical understanding of the rituals, myths, and stories of and in medicine” (p20). In the book’s best section titled “Ritual,” the Hippocratic Oath (which invokes Greek gods) and the purpose of the White Coat Ceremony (a kind of “ordination”) are considered. “Salvation” examines the process of dying. A brief analysis of Tolstoy’s “The Death of Ivan Ilych” (preoccupied with the soul) and Roth’s Everyman (concentrating on the body) is included. Carlin also spotlights cardiothoracic surgeon Dr. Denton Cooley and muses whether specialty physicians – surgeons, cardiologists, oncologists, psychiatrists – might be today’s “high priests”? “Prophecy” focuses on Stephen Bergman, MD (pen name Samuel Shem) and his novels including The House of God. Regardless of religious preference (or atheism), readers will find enlightenment in this intriguing inspection of the links between medicine and religion.
 

Every One Still Here: Stories by Liadan Ní Chuinn 

London: Granta, 2025, 160 pages 
ISBN 9781803513270 

The protagonists of these six short stories (largely set in Northern Ireland) have so many serious questions. But when they sometimes do get answers, the information is hardly good news. The narrator of “We All Go” is an empathetic teenager who has watched his wheelchair-bound father wasting away (probably from a neurodegenerative disease) and dying. He enrolls in a Human Anatomy class (perhaps to better understand his dad’s condition) but finds the lab itself and the required dissection disgusting. Other characters in these tales tend to be sympathetic, off-beat, or both: a psychic who isn’t adept at predicting the future but instead offers an effective form of psychotherapy, an unemployed woman taking night classes in creative writing who encounters a child (unaccompanied by parent or other adult) riding the same bus as her every week, a man who tries to commit suicide after learning his pet dog has metastatic cancer. Struggle, trauma, grieving, or some secret are prominently featured. A character wonders, “Isn’t the truth that we all do terrible things?” (p64). Indeed, acts of cruelty impact the lives of multiple individuals in these tales. For a few of them, compassion from others and the passage of time might ease the pain a bit but cannot completely erase it. 

Water in the Desert, Fire in the Night by Gethan Dick 

Dublin, Ireland: Tramp Press, 2025, 268 pages 
ISBN 9781915290168 

Long before the onset of Covid-19, Pandemic Lit was already an established subgenre of speculative fiction. For example, The Last Man by Mary Wollstonecraft Shelley was published in 1826. Like most novels about pandemics and other apocalyptic events, fear and hope are tightly intertwined in Water in the Desert, Fire in the Night. But this story’s journey thru the end of the world – about the things we leave behind and the qualities we stubbornly cling to – feels much more optimistic than most. An estimated 90% of the world’s population has expired, and a “raging sadness” has washed over most of the survivors. Details about the contagion are vague. The deaths it causes are devoid of drama or gore: “just a cold, a fever, some difficulty breathing, then no more breathing” (p236). Six people, afraid of being infected, hide in London for two months. Four of them decide to bicycle much of the way to an Edenesque-sounding town in France. The story’s narrator, Audaz is a young woman firmly tethered to memories of her younger life and her mother. She is also pregnant. Sarah, a retired midwife trains Audaz as her apprentice (since someone will have to know how to care for women’s health and deliver babies – if there is to be a future for humanity). Pressure Drop is a weed-smoking mystic, and Adi is a young man who succumbs to sepsis along the way. A variety of challenges test them throughout their trip. Survivors they encounter can be violent, suspicious, or kind. A fisherman transports the group in a borrowed boat across the English Channel to France where they eventually reach their destination. While survival remains their highest priority, these characters understand that compassion, resilience, and childbirth foreshadow a promising new beginning for them and perhaps the rest of the remaining world as well. 

Additional recommended new or soon-to-be published books in 2025: 

Seminal: On Sperm, Health, and Politics edited by Rene Almeling, Lisa Campo-Engelstein, and Brian T. Nguyen  

Replaceable You: Adventures in Human Anatomy by Mary Roach 

Web image by  Rachael Ren 

Alive: Our Bodies and the Richness and Brevity of Existence by Gabriel Weston 

Boston: David R. Godine, 2025, 304 pages 
ISBN 9781567928235 

The physician experience, medical history, motherhood, anatomy, and worries about her diseased mitral valve are tenderly sutured together by ENT surgeon Weston in her exploration of “the poetry of the body.” In thirteen chapters, she eloquently contemplates “the strange, unbridgeable gap that exists between the body science describes and the one each of us is living inside right this moment” (p194). In describing the anatomy of bones, brain, breasts, genitals, gut, heart, kidneys, liver, lungs, skin, and womb, Weston writes with a wit and intense curiosity reminiscent of popular science writer Mary Roach. But the book’s splendor arises from its attention to the art of doctoring. Weston notes how good physicians require a kind of “bifocal vision” that allows them to see the generalities of the human body but also the unique details of an individual patient. She extols empathy and elevates vulnerability: “We are not separable from those we care for, just as our strength is not separable from our vulnerability” (p263). Melding science and sentiment, mixing professional life with personal life, Weston enlivens anatomy and pays homage to the physician-patient relationship.  

The Land in Winter by Andrew Miller 

London: Sceptre, 2024, 384 pages 
ISBN 9781529354270 

Andrew Miller’s remarkable 1997 debut novel Ingenious Pain chronicles the complex life of an 18^th century highly skilled English doctor incapable of feeling pain. Twenty-seven years and many novels (Oxygen, Pure, The Optimists) later, Miller’s latest book spotlights a main character who also happens to be an English physician – but this flawed human being hurts (especially emotionally). Eric Parry is a 36-year-old country doctor having an extramarital affair with a married woman while his wife Irene is pregnant. Next door to their cottage is a farm owned by Bill Simmons and his pregnant wife Rita who suffers from mental illness and enjoys reading science fiction. It is winter (December, 1962 – January, 1963) and for a time the rural community is paralyzed by a brutal blizzard. Happy endings are in short supply here. One of the pregnant women has a miscarriage while sitting on the toilet. Characters get injured. Some patients die. Eric’s infidelity is exposed. Still, compassion and empathy occasionally sprout amidst the bleakness and the cold. Irene is cognizant that her husband’s work is hard as he “had to deal with people’s suffering all day” (p55). Eric excels at examining patients with a manner that “calmed” them. Secrets, loneliness, belonging, complicated personal relationships, and poor decision-making are essential elements of the plot. The story asks readers to contemplate whether virtuousness is a necessary requirement to be a “good doctor.” 

Doc or Quack: Science and Anti-Science in Modern Medicine by Sander L. Gilman 

London: Reaktion Books, 2025, 320 pages 
ISBN 9781836390152 

Bloodletting and purging (“heroic medicine”) employed for a wide array of diseases. Laetrile (a chemical present in apricot seeds) used for treating cancer. Hydroxychloroquine and Ivermectin prescribed for COVID-19. Spanning centuries, the list of wacky, ineffective, and sometimes dangerous remedies for illness is quite lengthy. In this standout history of scientific medicine from the mid-19^th century to the present, Gilman navigates “the ever-shifting boundary between good medicine and quackery” (p15). He reviews the rise of allopathic medicine that resulted from “following the science” as discovery and knowledge migrated from the laboratory to the bedside. He writes about the model of the physician-healer, the placebo effect (along with the morality of deception), superstitions (of both doctors and patients), and the faddish nature of medical practice. Gilman is rightly concerned about physicians experiencing burnout and patients feeling disconnected from their doctors in truncated office visits. He wonders if empathy and efficacy can coexist in contemporary healthcare. Three “case studies” are presented: peptic ulcer disease, the development of ophthalmic surgery, and acupuncture for back pain. A thoughtful study of historically “good” and “bad” medicine and the occasional blurring between the two. 

Additional recommended books published in 2025: 

The Mind Electric: A Neurologist on the Strangeness and Wonder of Our Brains
by Pria Anand 

The Age of Diagnosis: How Our Obsession with Medical Labels Is Making Us Sicker
by Suzanne O’Sullivan 

Web photo by Bermix Studio 

I have been involved in the field of health humanities for more than seventeen years. The field initially focused on medicine but later expanded to involve other health disciplines. I started teaching medical students but have also been involved with nursing and dental students. I have also facilitated sessions for faculty members. My perspective on and comprehension of the practice of medicine have expanded because of this interaction.  

My interest in the field dates to 2007, when I enrolled in the PSGFAIMER Institute’s health professions education fellowship program (https://apply.faimer.org/prog/psg/) in Coimbatore, India. This fellowship comprised creating and carrying out a curricular innovation project (CIP) at my home institution in addition to participating in on-site sessions at the Institute. Combining my passions for teaching, literature, and the arts, I chose to create a medical humanities (MH) module for my CIP. I began by providing undergraduate medical students at Pokhara, Nepal with a voluntary program on medical humanities, which quickly became an area of emphasis for me. My colleague and I also provided a program for all first-year students at a brand-new medical school in Lalitpur, Nepal. I also led workshops on the subject at several Indian universities in 2020, right before the COVID-19 pandemic. We exchanged knowledge, and I learned about the many projects being carried out in Indian colleges. Traditional teaching and learning methods were of course then upended by COVID-19, which also gave online education a boost.  

 In developing nations there are fewer interactions between the ‘traditional’ humanities and the health humanities. Health humanities (HH) is still a developing discipline in India, where most states/provinces have specialized health universities with which colleges offering health courses are affiliated and involvement of humanities faculty in teaching the health humanities is low. In India, the former Medical Council of India developed an attitude, ethics and communication module that has now been taken up by the National Medical Commission. This module has created interest in the humanities among faculty of medical colleges, and there is now greater awareness of the discipline. A retired English teacher, Dr Radha Ramaswamy, and her team created the Centre for Community Dialogue and Change in Bengaluru, India. This organization offers Theatre of the Oppressed workshops for breaking patterns and creating change. They have facilitated workshops at several institutions in India and even in other countries. Workshops have also been offered in medical colleges. The organization offers periodic training-the-trainers’ workshops. Some medical college faculty who have been trained in these training workshops also facilitate Theatre of the Oppressed workshops. Online webinars and conferences have become more common.  

In Aruba, in the Dutch Caribbean, I began teaching medical students through films, and for the past ten years, I have been concentrating on this. We have presented seminars on this topic at various health professions education conferences in collaboration with others. I have written a few articles on the topic, and I recently worked on a module that used films to help undergraduate dental students develop empathy. 

The last two decades have seen a steady growth in health humanities in South and Southeast Asia and in other regions of the continent. Modules and sessions are being offered to undergraduate and postgraduate students. A few institutions are also offering electives in this area for medical and other healthcare students. HH has several benefits in the education of future health professionals. Health is inherently psychological, social, and related to history and culture. Modern medicine is dominated by technology, and the health system is inherently complex. Methods from the humanities and the social sciences using an interdisciplinary approach are required to promote sustainable interventions that can address the complexity of health and disease that may have origins in social, economic and other factors. HH can develop students’ capacity for critical reading and reflection, and they can then examine health and medicine in society, practice and their own lives; it may also inoculate students against the hidden curriculum (a set of norms, values and beliefs that are not explicitly taught but are learned at the institution) and loss of empathy that may occur in medicine. Doctors and other health professionals engage in a social contract to serve society. Health humanities can help to introduce the contract to students, encourage its exploration, and also introduce ethical issues and dilemmas.  

I have gained a deeper understanding of HH and its connection both to medicine and to the general humanities. A year and a half ago I became a member of an online global network for the health humanities, and the group in addition to health professions educators also has individuals from the arts and the humanities. I have realized that like medicine and the health sciences, the humanities have their own terms and descriptors, theories and concepts, and these may be difficult for health professionals to comprehend. The opposite is also true, as humanities scholars struggle with medical jargon. An open mindset and greater effort are required to address the gaps. In the developing world, the humanities and the health sciences diverge right after ten years of schooling and are mostly in physically distinct locations, yet many health care professionals still have a personal interest in the art of medicine.  

A variety of factors must be considered to treat illnesses and maintain health. The physical and genetic makeup of the individual, the socioeconomic status, social determinants of health, access to good quality healthcare, rational use of medicines, cost of healthcare and preserving the power of antibiotics are among these. Through my research and teaching in the health humanities I believe I have gained a more holistic understanding of a human being and of health and illness situated in culture, society, family and moral values. Today we have wearables and other devices that provide a constant stream of data that must be interpreted and converted to actionable insights. However, we have a responsibility to make sure that the essential humanity of our patients does not get lost in a sea of data. The humanities and the sciences can, should, and must work together to improve health and well-being.   

Web image by Giuliano Gabella on Unsplash

This is an edited transcript of the zoom interview.  

JD: Hello, everyone. I’m Jacalyn Duffin at Queen’s University in Kingston, Ontario. I’m a retired hematologist and historian. Kingston is situated on the traditional lands of the Haudenosaunee and Anishinaabeg peoples. And today I’m chatting with my friend and colleague, Darrel Manitowabi, who is a professor at the Northern Ontario School of Medicine University. 

Darrel, tell us about yourself and your job. 

DM: Greetings, everyone. I would say in Anishinaabamowen [indigenous language]. Thank you all for listening to this. My name is Darrel Manitowabi. I am Three Fires Anishinaabe from Manitoulin Island. More specifically, Wiikwemkoong Unceded Territory, which is on the eastern end of Manitoulin Island and Georgian Bay. 

I currently live in Whitefish River First Nation, which is just across from the island on the mainland in the traditional territory of the Robinson-Huron Treaty. And I am currently the Jason A. Hannah Chair in the History of Indigenous Traditional Medicine and Indigenous Health in the Human Sciences Division at the Northern Ontario School of Medicine University. The acronym for short is NOSM [pron: naw-zim]. And that’s who I am. 

JD: Thank you. I’d like to mention also that it’s a very beautiful, sunny, but extremely cold winter day here in Kingston. We’re at minus 16 degrees centigrade. How about you? 

DM: We are about minus 20 Centigrade, I believe the last I checked, I’m in Whitefish River First Nation as I shared and so, it’s rather cold here, and it’s the coldest time of the year thus far. 

JD: Yes, for us too. And for the Americans listening, that’s about zero degrees Fahrenheit. Can you tell us a bit about your job. You started in 2020. That was right in the middle of the pandemic, basically. And you are the inaugural professor in that chair. Can you tell us about what you were supposed to do at NOSM? 

DM: As you stated, I joined in the time of COVID, which is a less than ideal time, especially when you’re starting a new job. There’s intermittent openings, which is very difficult for someone who needs to access a library. 

One of the more recent collaborations I had just by way of example is with Dr. Geoff Hudson, who is a historian of medicine at the medical school, we have a chapter in the book, An Accidental History of Canada [McGill-Queen’s University Press, 2024). And we wrote about Manitoulin Island accidents from settler and indigenous perspectives. And it was the most difficult chapter I’ve ever had to write because I couldn’t access anything. Everything was closed. And when it was open, it was only for a narrow window. It almost felt as though you needed to expedite your process, right? And that’s how I would describe that initial experience just by way of example.  

A lot of my work involves working with elders and traditional healers. My approach to this Chair is quite a bit different than it has been in the past. I’ll just give you another example of that. When I first started this chair, I went to the indigenous community to help inform the kind of work I would do. Typically, an academic embraces autonomy and academic freedom and all those sorts of things and goes about doing things that are in part conditioned by the academy and the expectations of that. I reversed that and I took an approach wherein I am conditioned and in sync with community. And one of the things that community determined to be important is to build capacity in understanding traditional healing and its place within contemporary society and that involves coming together. So, since 2020, I’ve been consulting with elders, traditional healers, and we’ve been determining a pathway forward. And it’s a continuous preparatory aspect of the work that I’m doing, I’ve been focused mostly on that.  

I consider my approach to be a kind of a two eyed seeing, which is this perspective of blending Western knowledge with indigenous knowledge. But the way that I’ve operationalized it is I’m blending university logic and expectations with community logic and expectations. And I try to do enough of the university stuff to satisfy those eyes and I also concentrate the balance of my time with community. So it’s a juggling act. It’s a balancing act, recognizing that there’s an incompatibility in essence with how community sees knowledge production and would like to see it done and how the university does. The university is a hierarchical individualized process whereas in community it’s more of a collective process. We do things together. We are a collective group of authors and collaborators rather than a hierarchical individual leading a group. I’m not leading anyone when I’m in community. I’m working alongside. That’s what I’m doing there. And Indigenous Medicine Stories –what we’re going to talk about here– is the essence of what that means. It’s a kind of bridging of those two worlds. It’s like bridging those two ways of experiencing and practicing knowledge. 

JD: Well, right away you’ve kind of explained to me the origin of Indigenous Medicine Stories they seem to be an extrapolation of what you envisaged your job to be. Did you have the idea before you went for that job or was it something that came to you while you were inventing what you should be at NOSM? 

DM: I’ll come back to COVID. COVID explains a lot. During COVID, we needed to modify our curriculum to reflect remote learning. And given the work that we were doing, we do a lot of experiential stuff, having elders come into the classroom. 

At the medical school in year one, there was even an indigenous placement that that became a bit of a challenge. We ended up doing things like everyone else in front of a computer screen. And that’s a challenge with learning. It’s exhausting. I remember those long days of just staring at my computer screen doing presentations and not having that human connection. And a few of the students had raised a question that we should consider alternative ways of experiencing this learning. 

And one or more (I can’t remember if it was one or two or more than that) mentioned podcasts. And I thought, that’s an interesting idea. And at the same time, I was thinking about a project that involved collections of life histories of elders and healers akin to a book by David Newhouse and Don McCaskill, that was, In the Words of Elders Aboriginal Cultures in Transition [U Toronto Press, 1999). They essentially traveled across Canada and they collected life stories of elders from across Canada. And it’s literally their life story. It’s their narrative that forms the basis of each chapter. And also this other project that took place, the Indian Film Project that was at the University of Regina, the Canadian Plains Research Center. And what they did is they traveled across …or someone traveled across Canada. It wasn’t always the same person. And they sat down with people of significance of indigenous ancestry who might have been an elder or a leader or a healer, and they just asked questions, and they collected a transcript of what their experience was like. And it almost seemed as though it was a bit of a random process that you weren’t quite sure what the purpose of that interview was, but it produced a lot of important information and an important historical record. Many of those individuals are no longer with us now. It’s become an important archive. And so when I was thinking about those three things all at once, the concept of a podcast came about and I thought I could have guests speak about their experiences in their own words. And I could generate an archival record by way of the voice, but also by way of the transcript.  

I was having a conversation with Anne Avery at the Associated Medical Services, and she had mentioned that they had done a podcast. We continued talking and came to the conclusion, why not collaborate? Why not work together on this? That’s how it all came about. But it was it was the intersection of all of those things that were happening that led to this. 

As I thought about it further, and I’ll just expand upon this, one of the things that I consider to be an interesting aspect of the podcast and of the approach that I take is having the guests speak about themselves in their own words, which also reflects back to what I mentioned before in the sense that I try to speak as little as possible and I try to highlight the voice of the person, have the person talk about their life in their own words, on their own terms. And I’m merely a conduit to that or a bridge to opening the door of understanding. 

It also reflects the fact that academia traditionally and in the research that I’ve done, I do a lot of oral history research where I speak with elders. And one of the frustrations I’ve always had is that they have so much important ideas to share. But I must edit things down to one or two sentences or perhaps if I’m lucky, five sentences. And I thought, there needs to be a mechanism or a medium by which that comes to an end. That was also an aspect of it. But it’s also that relationship. I don’t see this as being the authority over. I see this as a visit, a way to learn and to engage. And I also specifically approach it by way of highlighting the life history. Quite often elders, academics, and others are called upon to do something specific to their job, whether if you’re an elder, you’re doing a teaching, or if you’re a researcher, you’re discussing your research. Rarely do we ever have a chance to understand where are you coming from? Who are you? Where did you grow up? Who were your teachers? What was that like? And so it’s really about them telling their story. It became a way for me to to navigate or balance or weave in this interface of the university and the community in a creative way that allows for that outcome. And one of the significant aspects as well is the educational component. And it links to my chair, the AMS chair. One of the features of it is to help –And you might have your own perspective on this, Jackie, because you’ve had a longstanding chair–is to [help] find ways of inserting these kinds of perspectives in medical school curriculum by way of encouraging research with students or advancing curriculum in a particular kind of way. Doing scholarly activities and creative work such as this helps to demonstrate to biomedically inclined future physicians that there is a humanistic aspect to healing and medicine and also an historical aspect. Those are all coming together and are all influencing how things came to be. So that’s a little bit of an insight into the origin. 

JD: Well, for those who haven’t been to look at Indigenous Medicine Stories–and we will certainly explain at MedHum how to find them–they are a wonderful cluster of podcasts. They’re not short. They run up to an hour or so. And right now there’s about 22 of them there You’ve already answered some of my questions about not only where it came from, but how it can be used. I’m interested in if it is difficult to get people to talk. I know you have a PhD in anthropology, and I believe you used oral history to get there when you were writing your thesis. But is it difficult to encourage people to talk, especially if they’re being recorded? 

And one quick question. Tell us about that beautiful image you have behind you, which is the title page of Indigenous Medicine Stories. 

DM: let me get to the title page, the artwork first, then I’ll jump into that. I needed a logo and at the time I was searching for ideas and one of one of the initial concepts I had was to take a picture of medicines. And so I did that but there’s a young community member where I live here, Whitefish River First Nation, a young aspiring artist by the name of Nevada Anwahtin. Nevada had a collection of paintings, and I just was interested in seeing if she had something that kind of really connected. And once I saw this, I knew right away that it was the perfect piece of art that would serve as a logo. And it also represents the future because it’s from a young Indigenous artist who’s a female. 

And also, it reflects ceremony. The image is of us, of what we understand to be a sweat lodge. There’s different words for that word. But anyways, it’s a sweat lodge and there’s a vision that is coming out, this is my interpretation. Nevada will have her own inspiration and interpretation. But this is what I saw when I looked at it. It’s engaging with the spiritual essence of ceremony and it’s in beautiful colors. So I thought, this is the art work that I needed. That’s how that decision was made. And to answer your next question about Is it difficult? I would say in part what I’m trying to do is to capture different stories and experiences. I’m looking for different standpoints, right? you might be a practitioner, or you might be balancing for instance, a social work perspective to helping and including indigenous knowledge and indigenous helping in that. 

You might be a researcher, for instance. You might be from a different locale or a cultural experience or group. Those are all kind of factoring in. And it’s also about convenience. , I’m doing this alongside my everyday work. If I happen to be in a part of the province where I know somebody lives, I’ll try to make that connection. One of the essential aspects of this is to have that face to face. And so it’s a blend. The ideal for me is to do an in-person recording if that’s possible. But I’ve also done them remotely, remote recordings through Riverside, by way of example, if I know it’s going to be Riverside, I make it essential that I meet with them in person beforehand. 

The more challenging part is to build that relationship because there needs to be some work invested into that. I’m not saying a whole lot, but there needs to be some kind of connection because as human beings, we interact face to face and communicate in those kinds of ways. So the initial first grouping was a bit of a balance between those who had somewhat known or had known of me. I had met them before and in some instances that might not have been the case, but it was mostly that scenario. They were comfortable with me.  

I also emphasized the spirit and intent, right? It’s about education and they …the guests on the podcast recognize the context in which things are, where indigenous peoples are not understood. There’s a lot of discrimination, a lot of conscious and unconscious bias in social interactions. There’s an exclusion of these ideas in the formal education. All Indigenous peoples are experts in these things. They know it. They know it from their inner essence and their being. They understand the potential that education can have in trying to address this. From my perspective, they see themselves as trying to change things, as am I. We both recognize that.  

I centralize education because with education, I’d like to humanize an understanding of traditional healers. I’ve been talking about indigenous issues for my entire teaching career. I’ve been mentoring. I’ve just passed 20 years of doing that now. And since the beginning, there’s this reaction towards anything indigenous. You could just say the word “indigenous,”–I’m going back 10, 15 years–and you can trigger a response by some people. You could trigger a physiological response just by mentioning “Native,” “First Nations,” “Inuit,” “Indigenous”, etc. I’ve always known that and I’ve experienced that in the classroom.  

When I speak about Indigenous healing, especially towards a group that has is trained in the sciences, for instance, there’s this instant reaction towards it with the assumption that it’s inherently unscientific, or it’s all made up. It has no place. It’s just this interesting cultural phenomenon or social phenomenon. If you look at it, if you use science to look at it, you could draw the conclusion that there is an essential inherent bias in understanding this because there’s assumptions based on that. Science is not supposed to be based on assumptions and bias.  

So, I thought that if people could hear the story of the person, hear their life experience, they could recognize that this is a human being that exists in this world, and they have experiences just like I do. And I have no right to assume that they’re inferior because of the socialization in which I come from in respect to indigenous knowledge and indigenous peoples. So that’s part of it. It’s about educating and even, I’ll just add, for indigenous peoples themselves. I see this as a new medium of communication. And it’s a consequence of the impact of a digital world in which we’re faced with. It’s really adapting to that. In times in the past, this knowledge would have been shared by way of storytelling that may have been on the land, it could have been around a table. I grew up at a time when there were very little TV channels. I like to say two-and-a-half channels because the third channel worked half the time. I spend most of the time outside in the community . In the community, I would just be around and in the process of just being around, I learned a lot. 

I learned a lot because I would be around stories, around people telling stories, around elders who would be telling stories, and I would just be part of the furniture in that sense. Those days are not here in the present. Maybe they’ll return in the future. So I see this as a new form of storytelling, a digital storytelling, right? And there’s some literature out there on it Jennifer Wemigwans has a book on it [A Digital Bundle: Protecting and Promoting Indigenous Culture Online, U Regina Press, 2018]. 

I see this as being part of that process, right? It serves a purpose for different audiences in a medium that is compatible with both of those sides, right? And I think that both sides are looking for something different. Those who are just curious about what this all means, for instance, from a non-Indigenous perspective. But from Indigenous perspective, there’s a built-in marketing because many of the people that I’ve spoken to are known. They’re known in the indigenous community, but they’re not known outside of it. That also relates back to your original question about inviting people. I know who these people are. We’re part of a community. 

We’re part of people who know somebody, right? We’re not so far removed in this area anyway. And I’m also focusing initially mostly on Northern Ontario, obviously because that’s where I work, but also because there’s a tendency to invest in creative works and knowledge production in places where capital is concentrated. And in the province of Ontario, it’s concentrated in southern Ontario. 

So you have this natural tendency, I suppose, within that framework to collect knowledge in those areas. In Northern Ontario, there’s little research in all aspects of research in itself . I think I have a responsibility to reflect and it also comes back to the social accountability mandate of the Northern Ontario School of Medicine University, which is to reflect the society in which it is located. And I tried to reflect the work that I do in the society in which I’m located. I’ve said quite a bit of things there. That’s kind of where things are at. 

I’m always recording and I don’t know how long this is going to go, but I’m going to take it as far as I can and continue this work because there’s a lot of important lives that are being lived out there that many of us have not learned about or heard about. 

JD: Right. Thank you for that wonderful answer. So I understand that, first of all, a lot of people in the community and second of all, all of your interviewees, as well as yourself, feel a responsibility to pass on knowledge. And this educational opportunity is a trigger for why they might accept to be recorded. I have two more questions. They’re “medicine” stories, in looking at some of them, I’m interested in hearing you tell us what you think “medicine” is or is about, because “medicine” is there to treat disease. We take medicine to get rid of disease. And “healing” is a very important word in your podcasts. What is the “medicine”? What is being healed? 

DM: I’m glad you asked that question. It brings to mind that I neglected to talk about something else. Traditional medicine or traditional healing is often stated as being holistic that’s maybe a common denominator in most of the definitions you come across or what people have to say. However, the stereotype is that it’s limited to plant medicines. It’s limited to this material consumption of something to relieve something, to have this particular outcome. And that’s a Western paradigm within healing in itself. 

 And I’ve heard this from healers that it’s more than that. Really that’s what I’m getting at. Really what they’re doing. This is also a form of indigenous pedagogy, which is a way of indigenous learning. And storytelling was that way of learning, of teaching and learning but there was also, obviously, observation that happened and you go about it and do what you need to do. But one element of it [medicine] is storytelling. 

I’ve read these historical accounts that indigenous peoples would tell stories all winter long. So this is the time of storytelling, a time of education. That’s the legacy. And often indigenous peoples will tell stories by way of an answer. This is what I try to teach in the classroom that when we have a placement at NOSM for students to go into an indigenous community for four weeks. I help them prepare for it, I tell them that you’re going to ask an elder a question. They’re going to tell you a story and in that story, they’re actually answering that question for you. And you may not know the answer to that question immediately, but it might come a time in the future when you recall that story and you make that connection. 

It’s a form of autonomous learning where the teacher or the elder or the storyteller tells the story and it’s up to the individual to the listener to “get it,” or not. And at some point in time they will. So, in essence, it’s a bit of an assessment like where are you at in terms of your knowledge and comprehension and understanding? I use that by way of an example because the stories that are being told are precisely about Indigenous healing and indigenous medicines in the sense that they’re a reflection upon the legacy of colonialism in Canada and the violence it is instilling on people of the past and the present and the impact that that has on people’s lives and how that translates into and manifests into these physiological outcomes that a biomedical lens can offer.  

But it also speaks to you from a biomedical standpoint; you could look at the impact of stress on health. You could look at childhood development. You could take all of these frameworks and apply them if you wish to do so. However, the way that it’s spoken about, it’s about It’s about trauma and healing and how that’s overcome. And often I will come across or and even know that that these seemingly abstract human experiences are actually medical or medicine for indigenous peoples. For instance, just learning more about teachings can offer healing for an individual who is yearning for that; maybe through the colonial process [it] was excluded. And it’s a void in their life. And they need it. They need that reason and purpose and identity and a sense of being and understanding. 

That relates to mental health and also physical health as well. They’re seeking an answer to their situation. And this is helpful for them. It’s also, I like to say, not the only solution, but it’s part of the answer, right? So obviously, meeting in person with someone is the best possible outcome. But it’s maybe a gateway towards that, ideally that it offers an opportunity for those to reach out to others. 

It’s also about them telling us about what they see it being. And again, it’s from different perspectives, right? You might have a researcher who’s chatting about what this means. It might be an indigenous-physician guest who talks about finding a way to include. It could be an elder. Knowledge is a form of wisdom, and some of that relates to a healing wisdom And it could be a practitioner or it could be a helper. It could even be about human relationships. You could translate some of this into a social determinants of health framework. 

So there’s various ways of interpreting, but it’s much like the story of the artwork that I shared that is the logo. It allows for the listener to draw the knowledge that they need or the teaching that they need, at that moment in time, at the level that they’re at, on their own terms. There’s nothing here is being imposed on anyone. When I’m asking the questions, I’m simultaneously processing what the listener may be thinking. And I deliberately do not reveal too much of the details, for instance, and I leave it up to the listener to figure that part out. There is in some part of responsibility but I’m not doing it for the person, and for instance, someone might be talking about the meaning of ceremony in their life. And I don’t go too deep. I just kind of touch upon the surface and it’s up to the listener to dig deeper if they need to. Right. This is what I’m talking about here in terms of this non-hierarchical way of learning this indigenous pedagogy, where there’s responsibility that is understood to exist with the person who seeks to learn. 

 And the teacher, or the one who’s telling the story, is not imposing things in part somewhat seemingly abstract, but is directly saying what needs to be said. And giving that option to the listener: this is what I’m telling you. If you don’t understand what I’m saying to you, it means you have more work to do. 

JD: Yes. 

DM: If you do understand what I’m saying to you, then you have a choice to take something from this if you would like. You don’t need to do so. And that is it. 

JD: That’s very intriguing because it is a different way of conceiving of medicine and also of healing. And I got the message early on in looking at the podcasts that the disease we’re healing is collective, held in our society, a historical legacy in a sense. The last question I want to ask you is about “stories” themselves as a form of knowledge. You’ve made it quite clear that it’s a way of answering and giving information among First Nations people. It’s a traditional way of understanding. But you’ve got me thinking, since I’ve been looking at your podcasts, that medicine does that too, in the sense that we take a history of every patient and we’re not supposed to impose too much, just as you suggest [in your work], but we curate those histories. And the other way that storytelling is a form of knowledge in medicine is the case of the “case histories,” which go back to antiquity. In the sense that we build a disease concept from multiple case histories of people who’ve had similar symptoms or similar experiences. And so for the last question, I want you to talk about storytelling as a form of knowledge. 

DM: Okay, … Let me situate that with Anishinaabe understanding of things. There are two forms of stories. They’re one form of storytelling is the tabatacamowin, which is stories of the past of events that have occurred. And there are sacred stories. And that is referred to as atiso’kanak. 

The difference between those two? Well, “sacred” speaks for itself, they’re mythic, sacred. One of those stories is alive and that’s atiso’kanak. And those are sacred stories. We don’t really engage upon sacred stories in Indigenous Medicine Stories, but we do focus on tabatacamowin, those stories of lives lived. I just wanted to kind of situate that. Those are two forms of storytelling.  

 I think to engage with your answer, at the start I see commonality in humanity, and even commonality in intellectual paradigms. It’s almost as though we’ve been conditioned to be in opposition. In many ways, we’re still tribal peoples at our core and we’re the scientists and you can interpret this as being a “story,” but we’re going to call this a “case history” and we’re going to call it this. And it’s not going to be that, but as you’ve described, you’re, you’re talking about something that’s very similar. And some of this may be indigestible to some and incompatible, but at some point in time, maybe that might not be the case, but that’s how I approach this. I see commonality.  

I often talk about narrative medicine, you’ll be familiar with that, on how that’s kind of framed as this academic understanding of what you described: this way of telling our stories to the physician or even maybe to the patient sometimes. And I bring in storywork. And this is when I talk about this academically, like I’m doing now. Jo-ann Archibald, a Canadian academic from BC, indigenous Canadian academic, writes about “storywork” and a way of teaching [Indigenous Storywork: Educating the Heart, Mind, Body, and Spirit, UBC Press, 2008]. But it really comes down to the inner essence of this history of indigenous learning in itself, right? And I just described that atiso’kanak.and tabatacamowin and how , stories have always been part of things, right? 

I like to tell this story about how I was doing this project with the First Nations Information Governance Center on Indigenous perspectives of poverty. And I was speaking to a Mi’kmaq and this is in the east of Canada, a Mi’kmaq, I’ll say, knowledge holder, academic. I asked him six questions and he told me six stories, and the stories were over two hours long! And it was after about maybe 90 minutes when he paused and he confessed. He goes, “You know, I don’t know if I’m answering your question and I don’t know if you’re understanding what I’m saying.” 

And I said, “I understand precisely what you’re saying. Keep on going.” When he came to the end in that research project, I just felt that at a loss because I could only capture maybe a minute or two of nearly two hours of very, very interesting stories that he was telling me that were just vibrant and alive. I could just feel and sense the detail of what he was talking about. Really, that’s what this is all about. It’s about demonstrating the utility of indigenous storytelling in educating because that’s what these are all about. And an elder or storyteller or, just an elder or, most will tell you a story anyway, right? They’ll just jump in the story and It’s just how it is, right? And it’s almost like this natural inclination of how to answer your question, because I think it makes it more interesting. When I hear stories about people’s lives and about experiences that they’ve had, it’s more interesting. I think you can remember it in much more detail.  

I’ll just give you another example. I was going down this body of water close to where I live, where I hadn’t gone to before when I was new to boating. And I was speaking to an experienced person in the community who knew the waters very well. And he was telling me by way of story about how to navigate those waters. And it was almost like generating a mental map in my mind through the anticipated experience that I would go through in order to really kind of paint a picture of a map of where to go. And he also did that with even hunting, where he would tell me, okay, you got to go here and then he would kind of generate this portrait of this place. And as I was going through those experiences I could hear the voice in my mind describing what I was seeing as I was doing it. It was kind of like an original kind of a GPS kind of experience.  

And I’ll just give you one more example of this. When I was early in my career, I was teaching indigenous studies at the University of Sudbury, which was formerly a federated University of Laurentian University in Sudbury Northeastern Ontario and I had invited an elder to come speak to the class and I thought they were learning all of these things. I was teaching a course on Indigenous tradition, culture, and spirituality. So I thought maybe I’ll invite an elder to the class. And the elder came in and I just gave a general idea, a general orientation to what the content was about. I didn’t impose what they should talk about, but I just offered that’s a useful direction to go. And over the course of an hour, the elder was telling stories about life and life stages and all of these things. And I found it fascinating. I was just captivated myself while sitting in the audience with the students. I just took a little pause and I looked around and I realized that some had no idea what was going on. 

They were expecting this structured lesson plan with learning outcomes and content that would correlate some way to those learning outcomes and then, if they were being evaluated, there would be some kind of assessment associated with that. And I just came to the realization that there is something different here and there’s something worthwhile to consider. After the next class, I had basically deconstructed things for students to explain that this is how things happen. I began to learn that this is something that I needed to explain because it’s just something that just happens in its natural form. 

Also, and as this relates to myself here, I didn’t immediately understand the meaning of all of what that elder had stated that day. I understood some or most of it. And it was probably about maybe five to seven years after the fact that I remembered that story and I still remember the story and this story, this is like 15 years ago, right? So this maybe speaks to the power of story in itself. It was five or seven years after that point in time that it was like a Eureka! moment that this is what that elder was telling me. I didn’t understand it at that time, but now I understand it. And I remember that story and I remember what they were trying to tell me and they were actually doing something that they thought was important for young people to know. 

At that time, I was young myself. Stories are very powerful. And I think it’s the ideal medium to transmit knowledge and to even translate knowledge in this essence and if the listener does not yet know what’s going on, then at some point in time, possibly they will. And they may return back to the story and find something new. 

And that’s the neat thing about learning. Sometimes you return back to a book you read 10 years ago and you find something new to learn and understand about it. So the same is the case with Indigenous medicine stories. 

JD: That’s wonderful. Darrel. Miigwech! Thank you so much. 

DM: Thank you for having me. And I look forward to sharing more Indigenous Medicine Stories with all of those who are interested in hearing them. 

Darrel Manitowabi is an associate professor in the Human Sciences Division at the Northern Ontario School of Medicine (NOSM), Sudbury, Ontario. He is a citizen of the Wiikwemkoong Unceded Territory, and he currently resides in the Whitefish River First Nation. He is an applied, medical and Indigenous anthropologist with research interests in Nishnaabe ethnohistory and Indigenous gambling, Indigenous social determinants of health, Indigenous healing, Indigenous-state relations and Indigenous self-determination. His research and publications examine how the historical legacy of, and contemporary expressions of colonialism impact the health and wellbeing of First Nations communities. Furthermore, his research examines how First Nations communities are active agents in decolonizing the Indigenous-state relationship through centring Indigenous perspectives in health, education, and governance.

Indigenous Medicine Stories Podcast