Humanities Institute

PUI Symposium Discusses Humanistic Approaches to Health Equity and Justice

Mon, July 9, 2018
PUI Symposium Discusses Humanistic Approaches to Health Equity and Justice
Dr. Jonathan Metzl gives his keynote lecture at the Health Discovery Building, Dell Medical School.

By Sarah Schuster 

The University of Texas at Austin’s Health & Humanities Pop-Up Institute (PUI) hosted a Symposium on May 30th, featuring keynote speaker Jonathan Metzl. The PUI discussed a number of topics at the intersection of health and the humanities, including  Narrative Medicine/Narratives of Medicine, Humanistic Approaches to Health Equity and Justice, and Community Practice.

The Symposium featured leaders of community and health organizations from across the Austin metro area discussing “The Humanities in Practice.”

Several speakers focused on implementing humanities methodologies in health and social justice activism, including representatives from Mobile Loaves and Fishes, the Texas After Violence Project, and Texas Folklife. Speakers from the University of Texas discussed UT Voices Against Violence and the Value Institute of Dell Medical School.  

Charlie Lockwood, Executive Director of Texas Folklife and a former Humanities Institute Community Sabbatical grantee, discussed the organization's efforts to facilitate and encourage the continuation of folk and traditional arts practices from across the state. Texas Folklife began in 1984 to fulfill such a mission, and has produced traditional music programs, art projects, and apprenticeships across Texas.


Charlie Lockwood of Texas Folklife discusses the power of podcasting.


In his presentation, Lockwood focused on a recent endeavor: Stories From Deep in the Heart, a program designed to teach students and teachers ethnographic methods of recording and producing broadcast quality audio stories about folk artists and community traditions. He played clips from some recent podcasts made by students and teachers, interviewing folk healers Marika Alvarado, idea originator with Dell Med’s Center for Place-Based Initiatives, and her apprentice Maria Marenco. Alvarado and Marenco scout for herbs and healing plants growing wild on highway medians, sidewalks, and other common places.

In the clip, Alvarado shares wisdom on the nature of healing. “I don’t heal anyone,” Alvarado said. “I find how people heal themselves.” 

Lockwood concluded his presentation with an invitation to an upcoming podcast listening party, based on Stories From Deep in the Heart and their summer podcasting institute. He noted that Texas Folklife looked forward to creating future podcast series and youth internships.

Other speakers represented organizations that aim to use forms of narrative medicine, or who combine health services for at-risk individuals with creative endeavors.

Gabriel Solis, Executive Director of the Texas After Violence Project, for instance, noted how the death penalty not only has traumatic impacts on the families of the condemned but also on attorneys, jurors, judges, and murder victim survivors.

Solis started with the organization as an undergraduate intern while studying at UT, later transitioning to work as a capital defense mitigation specialist before returning to Texas After Violence. The organization typically works with custodial deaths, capital punishment and the health impacts of incarceration, especially in its latest project--recording oral histories of trauma and its aftermath.


Gabriel Solis discusses Texas After Violence.


The organization’s methods of interviewing subjects strives for equality between interviewee and interviewer, and thus, the staff often asks fellow inmates or peers to interview each other. Solis contrasted the organization’s approach with the ways that people with violent experiences are typically interviewed--the cross examination, the intake interview, the police interview, and other interrogative and potentially traumatic interviews.The organization tries to make space for people to tell their own stories from a variety of perspectives.

The criminal justice system, as Solis put it, “is a trauma-organized system; these policies perpetuate more violence and trauma.” With the goal of fundamentally reshaping this system, Texas After Violence is currently working with other organizations to ignite specific policy and documentary projects.


Amber Fogarty of Mobile Loaves and Fishes and Community First!


When it comes to reshaping systems, Amber Fogarty of Mobile Loaves and Fishes (MLF) and the associated Community First! Village encourages volunteers and individuals to give “their best first.”

As Fogarty put it, the organization looks to empower communities and support a lifestyle of service with the homeless. MLF believes that they are called to care for the men and women affected by homelessness--they look to “transform the way people view those who find themselves homeless.”  

For MLF, the top cause of homelessness is a “catastrophic loss of family.” Thus, Fogarty and MLF wanted to create Community First! as a place that helps chronically homeless people forge new community bonds and  rediscover and utilize talents to do purposeful work. They also seek to inspire people outside of the community to give “abundantly.”

Fogarty characterized the organization as a three legged stool, comprised of the Mobile Fishes and Loaves food trucks, the Community First! Village--a community of roughly 220 tiny homes and RVs--and lastly, various community works in the Village. These include the Genesis Gardens, community art house, community forge and woodshop, and community concessions and catering. The Village is breaking ground on new homes in phase two of Community First!, adding roughly three hundred new neighbors in the next three years.

Two panelists are conducting health justice work on campus. Amissa Miller, an Interactive Theatre Specialist, introduced UT Voices Against Violence (VAV), an organization housed in the student counseling center.

VAV focuses on dating and relationship violence, stalking, and sexual assault with a uniquely kinetic approach. There are, as Miller noted, risk reduction strategies, such as safe walk campaigns and self defense classes, but an important part of prevention is looking at root causes, such as a culture of violence.

Miller trains students to be actor coordinators by acting out skits and improv around issues of consent and issues of sexual violence. VAV frequently works with athletics, sorority and fraternity life, and other student organizations. All performances are offered free.

VAV uses a theory of applied theater known as image theater or “theater of the oppressed.” Audience members are invited to participate, using their bodies to create images and tableaus, for example.

One technique VAV frequently uses, known as form theater, directly involves the audience. Actors act out a short scenario and ask audience members to identify the problems in the scene. Audience members are encouraged to come to the stage and work out new solutions to the problem.

Miller noted that many students know what they want, but they “don’t have the words” to express it. Thus, in modeling potential situations of violence in skits and sketches, theater becomes a tool for these students to find the language needed to provide consent. 

Also working at UT is Dr.  Christopher Ulack, Experience Group Manager for Dell Medical School’s Value Institute. The Value Institute aims to return healthcare to its purpose--that is, achieving better health outcomes, defined as more meaningful to the patient.

Physicians have great knowledge and expertise, says Ulack, but they are only able to see their patients in a limited setting--the doctor’s office. In contrast, the Institute centers itself on the voices, insights, and goals of the patients who are directly experiencing their condition.

Part of the Institute’s project is listening to patient stories, and to the way the condition has affected their lives, using a qualitative research methodology referred to as Experience Groups. This method is a form of medical storytelling, a way for patients to be the experts.

The Institute gathers a small group of people for a group session spanning 60 to 90 minutes, in which Ulack and others offer general conversation starters. Participants in a given group all possess the same health condition and circumstances--a way of creating a context for participants to open up in a way they can’t to a doctor, or sometimes even to family members.


Dr. Christopher Ulack explains the role of experience groups at the Value Institute.


According to Ulack: “we’re able to learn what are the obstacles, the gaps, their hopes, their unmet or unarticulated needs,” the workarounds that people come up with to cope with their illness, and their desired health outcomes. In other words, experience groups help communicate patients’ day-to-day struggle and strategies.

Their experience groups have included women with breast cancer, where they discovered one of the major concerns was “chemo-brain”--something that was not being measured as a health outcome, and now, potentially, can be.

Health equity and justice was also addressed by keynote speaker Dr. Jonathan Metzl of Vanderbilt University. Metzl spoke on “Structural Competency Five Years On: Tracking a New Medical Approach to Stigma and Inequality,”

 He first discussed the work that led him to the concept of structural competency, as well as the future he sees for the concept in healthcare. He pinpointed the central idea of structural competency as a way to move beyond the focus on the individual.

“We have had an ongoing conversation about what health means,” he said. “Is it defined by the government, or individuals?”

Grappling with this question, and grappling with the tendency for the public to view health as a indicator of morality, Dr. Metzl began to conceive of structural competency.

Structural competency emphasizes the importance of understanding health and illness as they relate to social and historical structures. In particular, Dr. Metzl emphasized the utility of structural competency as a means of understanding health as a socially defined term produced by cultural and political discourses, and as a way to probe how diseases become socially coded. In this regard he cited his 2010 book The Protest Psychosis, which explores how schizophrenia became associated with black power protesters.


Dr. Jonathan Metzl discusses structural competency.


Dr. Metzl argued that cultural assumptions are recreated every day in a clinical setting, where doctors are at risk of encoding their biases in their diagnoses. Today, however, given recent developments in epigenetics and neuroscience, we are well-positioned to consider race and society as “pathogens” affecting patient health.

During the panel discussion following his presentation, Dr. Metzl stressed that he hopes to see structural competency take a more intersectional form than the better known “cultural competency” by acknowledging the overlaps between seemingly separate groups. He stressed that structural competency’s strength lies in understanding the systems surrounding the patient in order to provide effective treatment.

“It doesn’t matter how sensitive a doctor is if they can’t intervene,” he emphasized.

Ultimately, Dr. Metzl’s talk advocated for embedding the practices of structural competency into both the educational and professional medical spheres in order to improve patient outcomes and better understand the relationship among culture, history, politics, economics, and health.

The speakers and audience enjoyed lively discussion during and after each presentation, as panelists and audience members alike pondered the ways in which humanities research and medicine can significantly impact communities, both locally and nationally.

The discussion hasn’t ended, either. As Dr. Metzl joked after the panel discussion, “follow me on Twitter to continue the conversation!”


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