15th October 2020, MAASTRICHT - Touch is becoming an increasingly discussed sensory experience in pandemic times, of interest to the public, doctors, artists and many others. In a rare moment in which to have an in-person conversation, Anna took part in a discussion on this topic with the talented artist Eva Spierenburg as part of the Open Courses: Art & Medicine, organised by Pieternel Fleskens, Rosanne van Wijk and Floor Krooi at the Jan van Eyck Academie. The discussion ranged from the moving works that Eva has done in response to her mother's recent passing, to ways in which artistic and ethnographic methods and vocabularies intersect and diverge. You can read more about the event, called Dissecting Touch below.
Dutch call, English is below ….
Kunst & Geneeskunde #4: Dissecting Touch
In de vierde bijeenkomst van de serie Openbare Lessen: Kunst & Geneeskunde verwelkomt de Jan van Eyck Academie beeldend kunstenaar Eva Spierenburg. In haar beelden, tekeningen en video’s onderzoekt zij het lichaam, aanraking en materialiteit. Ter gelegenheid van deze bijeenkomst gaat zij het gesprek aan met Anna Harris, assistent-professor en medisch antropoloog aan de Universiteit Maastricht, wiens onderzoek zich richt op de zintuigelijke training van artsen in het digitale tijdperk.
In deze tijden van de wereldwijde coronacrisis krijgt het idee van aanraking een extra lading en betekenis. Welke verschillende vormen van aanraking kunnen we onderscheiden in een artistieke en medisch praktijk en op welke manier verschillen deze vormen van elkaar? Kunnen deze bevindingen zelfs nieuwe perspectieven bieden op de huidige situatie van sociale terughoudendheid? Samen met u als publiek willen we onderzoeken wat lichamelijk en zintuiglijk leren kan betekenen binnen artistieke en medische beroepspraktijken. Tegelijkertijd zullen we de rol van aanraking in het werk van Spierenburg en Harris verder ontleden.
Openbare Lessen: Kunst & Geneeskunde
Vanuit de gemeenschappelijke nieuwsgierigheid en verwondering naar de mens en het menselijk lichaam hadden geneeskunde en kunst ooit een sterke band met elkaar. Door de vele maatschappelijke en technologische ontwikkelingen, zijn deze twee werelden jarenlang tegenover elkaar komen te staan. De medische wereld stond voor objectiviteit, de kunstwereld symboliseerde de subjectiviteit. Sinds enkele jaren zien we echter dat de vakgebieden een nieuwe interesse in elkaar krijgen. In een reeks Openbare Lessen bekijkt de Jan van Eyck Academie wat er gebeurt als deze twee domeinen samenkomen. Door de dialoog tussen de kunsten en de geneeskunde te stimuleren, onderzoeken we samen met het publiek wat de meerwaarde kan zijn. Dit is het vierde event in deze serie.
Openbare Lessen: Kunst & Geneeskunde is een initiatief van Onderzoek & Educatie, een deelinstituut van de Jan van Eyck Academie.
Ondersteund door: BankGiro Loterij Fonds
Art & Medicine #4: Dissecting Touch
For Part 4 of the Open Courses: Art & Medicine, Jan van Eyck Academie welcomes visual artist Eva Spierenburg whose sculptures, drawings and video works investigate the body, touch, and materiality. For this occasion, she will delve into a conversation with Anna Harris, an assistant professor and medical anthropologist of Maastricht University whose research falls on doctors’ sensory training in the digital age.
The notion of touch becomes extra complex in these times of the COVID-19 pandemic. What are the different types of touch within artistic and medical practices, and how do these distinguish from one another? Moreover, can the findings lead to a new understanding of the current situation of social distancing? Together with you, we would like to explore sensorial and embodied learning within artistic and medical professions, and shape the conversation by dissecting the role of touch in Spierenburg and Harris’ practices.
Project Art & Medicine
Based on their mutual curiosity and interest in the human and human body, both art and medicine once held a very strong bond. With many societal and technological changes and developments, these two worlds began opposing each other, with the discipline of medicine representing objectivity, and the art world symbolizing subjectivity. Recently, however, we have been able to see these two domains moving towards each other with a new fascination for one another. In a series of Open Courses, the Jan van Eyck Academie zooms in on what happens when these two domains meet. Together with the public and by stimulating a dialogue between the arts and medicine, we wish to discover what the added value of this connection could be.
This is the fourth event in this series.
Open Courses: Art & Medicine is an initiative of the institute for Research & Education of the Jan van Eyck Academie.
Supported by: BankGiro Loterij Fonds
1. Instead of keynotes, we asked inspiring scholars in our field to make 10 minute audio postcards, which we compiled in a folder for participants to listen at leisure in the week leading up to the event. They did so while running, cooking, sitting at computers, and it gave many a welcome relief from their laptops.
2. We made kids activities.
3. Rather then then dive into online discussion, we arranged walk-talks as the first activity for the day, with pairs of participants who lived near each other meeting up and discussing their thoughts during a one-hour stroll in their neighbourhood. Many not only had a chance to meet a new/old colleague they hadn’t seen for months, but also to see their area anew.
4. Next was slightly larger group brainstorming. Utilising the breakout room function on Zoom, we added to this a dedicated Google Doc, for making rapid notes. We all joined the main room and heard 3 min recaps of the discussion.
5. After this intense online part of the event, we took a break for stretching, coffee, cat patting, but also brainwriting, every participant having access to all the Google Docs for individual writing.
6. Finally we all came together for a short group discussion, followed by an optional movie night that evening.
You can read more about the event on the MUSTS website here: https://www.maastrichtsts.nl/musts-thematic-event-embodied-expertise-in-art-science-and-medicine/
The stethoscope goes digital: Learning through attention, distraction and distortion
For centuries, those training doctors have been faced with the challenges of standardising subjective experiences and constructing “the universal body” in learning situations. Various technologies have been introduced to address these challenges, with varying degrees of success. In this article we focus on the stethoscope, specifically the electrical and digital stethoscope models. Historical and social studies of medicine have already underlined the sociomateriality of learning in medicine. In this article we underscore the performative nature of teaching and learning in the sociomaterial context. We do so by juxtaposing ethnographic and historical events that stage electrical and digital stethoscopes. These are not documentations of everyday practices but rather reconstructions of choreographed performances for learning about the body. In these stagings, the novice is taught to focus attention and avoid distraction, when learning the sounds of “the body”. Through engaging with, and comparing, different ethnographic and historic materials and artefacts, and through methodological reflection, we examine the importance not only of attention and distraction in learning a bodily skill, but also of dealing with distortion. We argue that these ethnographic and historic insights into distortion illuminate a neglected aspect of medical training, and more generally, in shaping sensory perceptions.
Read more here.
This article draws on research funded by a Dutch NWO Vici Grant entitled Sonic Skills: Sound and Listening in the Development of Science, Technology, Medicine (1920–now) awarded to Karin Bijsterveld (grant agreement No: 277-45-003). Melissa Van Drie further developed the article’s historiographical approaches to sensory experiences of sound devices and did archival research on hearing disabilities during a postdoctoral position in the European Research Council (ERC) funded project Sound and Materialism in the 19th Century awarded to David Trippett at the University of Cambridge (Horizon 2020 scheme, grant agreement No. 638241). Final corrections were completed during Melissa’s current ERC funded Marie Skłodowska-Curie Individual Fellowship project called Sounds Delicious at the University of Copenhagen (grant agreement No. 753565). The article also draws on Anna Harris’ current research on digital doctors funded by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (grant agreement No. 678390). Anna would like to thank the participants in her studies for their time and for sharing their experiences, skills and stethoscopes with her, and Ruth Benschop for introducing Hirschauer’s work. Melissa and Anna would like to thank the Sonic Skills team for their constructive feedback on our collaborative project along the way, as well as Whitney Laemmli, Kate Smith, Josh Grace, Caitlin Wylie, Johanna Gonçalves Martin, Stewart Allen, Nina Lerman and Dagmar Schäfer for their comments on earlier drafts during our time together at the Max Planck Institute for the History of Science in Berlin. Finally, Melissa and Anna are grateful to the anonymous reviewers, and to Thibault Walter and Vincent Barras for encouraging them to develop a conference presentation into this piece, and for their support along the way.
Travelling histories: An ancient jar of starter?
Sensory memory fragment, written April 2016, unpublished, archived in Dropbox
One Sunday I was handed, somewhat ceremoniously, a warped little take-away container of bubbly brown goop. My husband and I were taking a free sourdough bread making workshop, part of a skills sharing scheme in our very ecologically friendly new home town of Totnes, in the heart of the Devon countryside. Our cheerful instructor Holly had given us both (and the other six bread-making novices in the class), what is called “a starter”. She was learning how to make bread herself and thought she would learn alongside us. With post-it-noted library books spread out on her kitchen table, we poured over the advice from the best bakers in the UK. It looked easy enough: flour, water, salt. Some kneading. A warm place to rise. A hot oven. The tricky part seemed to be the yeasty and bacterial starter. We had known this from our previous attempts at making bread. Kilner jar after kilner jar of tepid brown muds that we had created from flour, water and raisins, were emptied into the kitchen sink, not a bubble of microbiological activity in sight. But now we had something special, so Holly told us. A starter that was not created last week in her kitchen, but rather one that was over a hundred years old. Handed down from hessian wearing monks keeping themselves warm during a Devon winter with woodfires baking their sourdough loaves. My husband and I looked down at our goop, which had now transformed into something ancient and mythical. [unfinished]
Sourdough starters: The sticky archives of quarantine 2020
Written July 2020, for Sensate Memories
Nearing the end of this historic-ethnographic project on learning sensing in medicine, I am wading into the dropboxed digital-sensate memories of past ideas, those like travelling bacteria. Rereading the sensory artifact above, I can smell those starters we made in Devon, our starter travelling with us around the world – wrapped carefully in suitcases, snaplocked into friends’ freezers during our holidays, through customs dried onto parchment paper, into many loaves of bread – only now to lay dormant in our fridge, not a bubble in sight. I recently read many newspaper articles and saw lots of Instagram photos of the sourdough craze sweeping those crazed by lockdown during the current pandemic. With no daycare for months, my husband and I struggled to keep it together, let alone keep our starter alive. But so many seemed to be finding security, creativity, distraction and visual delight in the simple act of making of a sourdough starter.
When lockdowns spread around the world, something stopped spreading besides a virus: our own bacteria. Sequestered in our homes, our travelling germs had nowhere to go, could not be shared in our contact with others, plants, animals in the outside world. Instead, our own homes and their large inhabitants became isolated microcosms of tiny creatures, breeding and diverging. And where was one of the places they found a home? Those multiplying sourdough starters. Microbiologists have found that some of the bacteria and yeasts in starters come from the bodies of bakers, and moreover, that the bodies of bakers start to grow the lactic acid bacteria of their starters. So these starters born into the world in quarantine kitchens in fact become like sensory archives of the bodies of its inhabitants, and their new habits and routines and ingredients in lockdown life. At the same time, the inhabitants also become sensory archives of their new engagements with the microscopic world.
These are literally sticky threads of history, which cling, reproduce and diverge with our bodies. Our research team thinks a lot about the sticky threads of history in our medical education project, particularly the historian on the project, John Nott, as there are so many ideas and ways of sensing that stick to the materials with which medical students learn sensory skills. Our object of focus has been tools and technologies, and we explore the materiality of sensing through these artifacts in medical schools. The great starter project of quarantine makes me think of other ways to trace sticky threads of micro-histories in bodies, jars, the food we eat. I wonder how we might trace these archives, in ways beyond text, something which the Centre for Imaginative Ethnography, and the creative sensory ethnographers affiliated, have been exploring with inspiring results. Overleaf is the germ of an idea that explores a more textile based experiment with sensate memories and bodily archives in embroidery. These are embroidered microbes I made previously, but I also imagine what it might be like to share and look microscopically at quarantine starters, and perhaps even to trace, with fabric and thread, what has grown in these sour, gloopy, bubbling and stagnate jars, how this might speak to another kind of historical record of our times.
In an essay for Cultural Praxis, I wrote about playing with my toddler in lockdown, and with my father too, and how our Making Clinical Sense project is also imbued with, and inspired, by playful research methods and forms of gathering. I consider at the end how, “in the future, I would like to try and engage in more open-ended methodological experiments that have an “underwater” or “extra-terrestrial” feel, of further escape and open-ended possibility, for it seems to be this is where we can learn not only about the not-yet, but about ordinary life too, and question the status quo”.
Medicine has long been criticised by STS for its measuring practices. The racist use of tools such as measuring tapes, even in today’s public health programs, has shown to problematically shape the worlds measured and overshadow alternative narratives (García-Meza and Yates-Doerr 2020/Yates-Doerr and García-Meza 2020). To date, focus has been on the clinician/healthcare worker/medical researcher at work, with their tools of measurement to hand. In this paper I step back into the training of clinicians. I draw on ethnographic fieldwork in medical schools (part of a larger project, Making Clinical Sense) where bodies as standards of measurement are continually formed and calibrated. I look at how, through the very same instrument that interests critical scholars of metrics – measuring tapes – numbers get implicated into doctors’ embodied knowledge. With this soft and flexible tape, medical students learn to calibrate their own sensory knowledge as they measure lung expansion, gestation on plastic models and the length of their fingers. In doing so they create their own bodies as the standard or measure of things (Hoel and Carusi 2018). I suggest that unpacking this inexpensive teaching device, part of medical knowledge creation that wraps itself around and into bodies, offers new insights into the study of metrics in medicine (Adams 2016). Tracing the making of measuring bodies, as well as measured bodies opens up questions about the implications of the sociomateriality of learning, the politics of using one’s own body as standard, and the never-ending quest for the numerical objectification of sensory knowing.
Dr. Auzoux’s developed his papier-mâché anatomical models after finding it difficult to source and preserve cadavers. They were soon being made for medical schools around the world, to teach anatomy. His workshop later went on to make animal and botanical models too. It is a fascinating history worth delving into, when more time becomes available.
For now though, in my own quarantine workshop, one thing I have realised about the papier-mâché things we are making is how easy it is to mold the paper into whatever form you want to make. There comes a point of firmness however, when the object is fixed, and unlike more dynamic models made from other materials, knitting for example, there is no way to make it move, other than with your hands (flying the rocket through the air on blast-off for example).
In such flight, I also realise how fragile these paper models are. Below I have included some other fragile models, these made of glass and photographed during a visit to the Natural History Museum in Vienna after last year’s AMEE (European medical education association) conference. These paper and glass models, digital on our screens, are material objects with their own properties, lessons and fragility, something that is almost tangible if we look in tactile ways.
Image of models are all used under a Creative Commons Lisence, the pregnancy model downloaded from Wikimedia, originally uploaded from the Boerhaave Museum; the flower model also downloaded from Wikimedia originally uploaded by MuseeEducation, and the eye model from Wikimedia originally uploaded by Gmogicato (CC BY-SA (https://creativecommons.org/licenses/by-sa/4.0))
Face Masks and Respirators
The N95 respirator mask has become one of the most important medical devices of this time. Fast Company has written an excellent history of the object which filters particles, telling about its origins during another disease outbreak. Today we are seeing fast developments in improvised respirator design, such as the use of snorkelling masks in northern Italy and worldwide. Many others are making their own masks, one of my favourite designs the Olson Mask (I made a few below), an initiative “powered by” Maker Health who has been driving great making activities in hospitals for some years now.
Shipping container hospital rooms
Also in Italy, architects have designed shipping containers that connect to each other to form an intensive care unit. With extractors to create negative air pressure, these units are designed to be transported anywhere and usable within a few hours, meaning that they can travel to where they are most needed. The architects have made their design open-source.
Such open-source on-the-ground innovations will also be met with resistance and competition from commercial industries. As Vincanne Adams writes in her astute and critical commentary on disaster capitalism surrounding the pandemic in Somatosphere: “grassroots efforts to make hospital masks with 3D printers are threatened with patent infringement lawsuits, and Amazon entrepreneurs who hoarded toilet paper and hand sanitizer are allowed to gouge prices without being hauled off to jail.” This pandemic, like others before it, is having unequal effects reiterating global and other inequalities. There is hope in these open-source and shared innovations attempting to address healthcare resource shortages, often using local materials, but also threats to their possibilities too.
Image from Banej CC BY-SA (https://creativecommons.org/licenses/by-sa/3.0).
As telemedicine and robotic care come to the fore in clinical situations and smartphones aid contract-tracing, medical educators are trying to think of creative ways to educate future doctors online. Medical organisations are frantically arranging video conferences to work out how to respond to these “accelerated changes” in medical education.
While some final year medical students are being called to the frontline of healthcare with early graduations, and others volunteer their services where they can, many more sit at home, in front of computers and books, trying to learn about anatomy and pathology, about the sensory signs and symptoms of clinical conditions in their future patients. They are taking online courses on how to break bad news, watching videos on how to examine someone’s lungs and lectures on reading pathology results.
Medical councils are investigating whether there can be an increase in the amount of experience gained through simulations, with “meaningful alternatives” to in-person clinical learning encouraged. Virtual Reality providers in medical education are seeing a boom in sales and advertising their products widely since the global spread of the virus (judging from the number of emails from them in my inbox). For the first time final year medical students are being examined online. Last week at Imperial College: “students in their sixth year of medical studies logged in at 1pm on Wednesday and Friday to demonstrate their ability to diagnose a patient’s condition. They were presented with a patient and given their history, findings from clinical examination and data from investigations such as blood tests. They then had to answer 150 questions in three hours, meaning they had 72 seconds to answer each one”.
The implications of this kind of testing, of the increased reliance on simulation and on learning how to listen, touch and be with patients online are challenging and uncertain. There is much to think about and contribute to this situation, in regards to how material conditions shape the ways doctors train doctors who will increasingly be facing such situations. In the coming weeks we will offer some further reflections on this topic based on our work, as we, like the rest of the world, try to grapple with what is happening.
The image above was originally posted to Flickr by IntelFreePress at https://www.flickr.com/photos/54450095@N05/6948764580. It was reviewed on by FlickreviewR and was confirmed to be licensed under the terms of the cc-by-sa-2.0.
For our next Basement Talk, we are happy to welcome Anna Harris from Maastricht University who will talk about how instructions offer different ways of re-orientating sensory knowledge. This talk will take place on Thursday 20 February at 1pm.
WHERE: Designroom Mintlab (Parkstraat 45, 3000 Leuven)
WHEN: Thursday, February 20 from 1PM to 2PM
It’s a free and public event, but please confirm your attendance via email to marije.nouwen[at]kuleuven.be on Wednesday 19 February the latest.
Speaker: Anna Harris
Title: Sensory instructions: examples and experiments
Abstract: In this basement talk Anna Harris will focus on the use and reconfiguration of instructions, as both an object of enquiry and a methodological approach in teaching and research. In particular, she looks at instructions which offer different ways of re-orientating sensory knowledge. She will look at this topic from four different and intersecting points:
- A look at the sensory lessons entailed in cooking recipes
- Through an ethnographic examination of how protocols used to teach doctors sensory skills are made, used and remade
- By playing with how instructions can inform collaboration in a team sensory ethnography project about training medical skills of diagnosis
- Considering instructions as probes for creative research and teaching more broadly
When exploring these points she will look at how multisensorality is used in instructions to expand imaginative spaces and reorientate the senses. In doing so she tries to develop upon our knowledge of the “arts of noticing” (Tsing 2015), and consider how, as researchers, we can also bring such observations more creatively into our own methodological and academic practices. The talk will draw upon research and experiments she has been doing with her research team, Making Clinical Sense, a European Research Council funded project, as well as her forthcoming book, A Sensory Education (Bloomsbury 2020).
Bio: Anna Harris first worked as a doctor in Australia and the UK before learning anthropology and turning her ethnographic gaze back to the medical profession. Missing the hands-on element of clinical practice in academia, her work endeavors to find creative and practically engaging methods for studying questions of embodiment, learning, materiality and infrastructures of medical practice. She currently works with a great team of anthropologists and historians at Maastricht University on the European Research Council funded project Making Clinical Sense. In her spare time she experiments with cooking, embroidery and knitting.