Advocacy Toolkit

When I worked at the University of Arkansas for Medical Sciences (UAMS) Library, there was a limited budget, especially for untested ideas. This meant I faced a rather large challenge. I started with my direct supervisor, Susan Steelman. I introduced her to graphic medicine and started showing her examples from my personal collection and from the local library. Susan read one book herself, which became her favorite graphic medicine title. From then on, she was my ally. She helped me to draft a proposal for a collection and for programming. She went to my meetings with the administrators and advocated for me. We discussed the potential benefits of graphic medicine and how it could fit into our library and into the institution as a whole. Out of these meetings, came a graphic medicine collection consisting of 24 titles, which were tailored to our patrons. 

To extend the influence of graphic medicine, I partnered with Leah Eisenberg of the UAMS Medical Humanities and Bioethics Department. She had previously attended graphic medicine conferences, which meant she was a ready-made ally. At one conference, we discussed how to pay for MK Czerwiec to come talk and present a workshop at UAMS. Leah and I met many times. We obtained 8 copies of Taking Turns, MK’s book. Then Leah distributed these copies to the administrators who might fund the project. These decision makers previously had been wary, but were on board after reading the book. Using the ideas in this very Advocacy Toolkit, we were able to convince decision makers to support MK’s visit. 

Last week in Testing the Waters, I discussed the types of information you should gather for the decision makers in your institution. This week I continue the series by describing what you should do with this information. Now that you have pinpointed what matters to the decision makers, you will be armed with evidence and examples to present to them. Evidence includes articles, books, websites, podcasts, and blogs about graphic medicine. Examples are graphic medicine titles, which can be webcomics, books, and magazines/zines. 

There are many tools in the toolkit. You have to find which tool is right for you. Just as one situation may call for a screwdriver, and another may need a hammer, different jobs in graphic medicine advocacy will call for different tools. All the tools are in the Toolkit. It is up to you to select the right ones for the job at hand. Using what you’ve learned about your workplace, put together the Advocacy Toolkit that’s right for you. Include an example they would be excited about, something that is in their specialty, or something that they are passionate about. Webcomics are generally freely available. You may find quality graphic medicine books at your local library.


General Evidence

The most inclusive book for graphic medicine is the Graphic Medicine Manifesto by MK Czerwiec, Ian Williams, Susan Merrill Squier, Michael J. Green, Kimberly R. Myers, and Scott T. Smith. It has dozens of examples of graphic medicine interspersed with prose and comics explaining graphic medicine.

A great online source of evidence is the National Library of Medicine exhibit. This has information about the benefits of graphic medicine and additional resources. It even includes a lesson plan for high school students and an example university module.

Also be sure to check out the Graphic Medicine podcast!

The National Network of Libraries of Medicine (NNLM) New England Region has put together a book club and resource page. There are links to recordings of past webinars about graphic medicine.

General Examples

The Annals of Internal Medicine have a featured, open access, online section where they post graphic medicine. The comics cover a wide range of topics and health conditions. However, it is all centered around internal medicine. This is a great way to show powerful and serious comics, but some of them are humorous, too. The main advantage here is that it is freely available.

Another webcomic that is a great general example is Cancer Owl, which features shorter comics about his experiences with colon cancer depicted as an owl. 

Kid Gloves by Lucy Knisley is a graphic medicine memoir, which follows the creator getting pregnant through a dangerous birth. It touches on all the benefits listed below and serves as a good example of many aspects of graphic medicine. 


Benefits of Graphic Medicine

Listed below are some of the benefits of graphic medicine. I have grouped them together, because otherwise this would be much too long! I plan to post a series which goes more in-depth into each of these benefits. 

Note: There are scholarly articles listed as evidence in the sections below. When possible, I have selected examples that are open access. However, most are behind paywalls. If you are at an academic institution, you can see if your library has access to the journal. If not, they should be able to request the article via interlibrary loan (ILL). However public libraries often have limited funds for ILLs to scholarly locations. You should check to see if there is a system in place or a local university you can visit. If you have any questions, don’t hesitate to contact me.


Education, Understanding, and Communication

This section addresses knowledge retention, knowledge gain, understanding information, and communicating this knowledge and information. This includes the various types of literacies, especially reading literacy, visual literacy, and health literacy. The combination of words, pictures, and iconography in comics has shown to be a good educational and communication tool. For more information about graphic medicine and literacies, see this Graphic Medicine guest post

Exploring Graphic Pathographies in the Medical Humanities by Maria Vaccarella is a scholarly article, which discusses the educational benefits of graphic medicine.  

A book which is particularly good at illustrating the communication benefits of graphic medicine is Rock Steady by Ellen Forney, which provides examples of coping mechanisms for mental health issues.

The freely available webcomic, The Amazing Adventures of Captain Fit, which is directed at children, is a good example of an educational comic.  


Meaning-Making, Reflection and Therapy

Meaning-making is about finding the meaning and purpose in an event. With graphic medicine, this meaning comes out of understanding of an illness, awareness of the experience of taking care of someone, or becoming connected to another health related issue. Reflection is a structured and intentional form of meaning-making. Therapy can take the form of bibliotherapy or art therapy, depending on whether you are making or reading the comics. 

A good scholarly article on meaning-making, reflection and healing is Autography as Auto-Therapy: Psychic Pain and the Graphic Memoir by Ian Williams. 

As I said earlier, Leah and I used Taking Turns: Stories from HIV/AIDS Care Unit 371 by MK Czerwiec as an excellent example of graphic medicine, especially to demonstrate meaning-making in a graphic medicine memoir. She enlightens her readers through processing the illnesses and deaths of her patients as a nurse on an HIV/AIDS ward in the 1990s and 2000s.

A webcomic example is The Kidney Thing by Jana Christy. This follows Jana through her decision process of donating a kidney to her brother. She created the comic primarily  so future donors and recipients would know what to expect..


Empathy and Cultural Competency

Empathy and cultural competency are hot topics for many institutions. Due to graphic medicine’s particular aptitude for conveying emotional understanding, it is a powerful tool for encouraging empathy. Cultural competency in graphic medicine refers to acknowledging cultural differences around medicine and health and respecting other people’s beliefs.

Many scholarly articles about graphic medicine discuss the benefits of conscious cultivation of empathy and emotional understanding, including the Vaccarella and Williams articles listed above. Graphic Medicine: Comics Turn a Critical Eye on Health Care by Sarah Glazer considers comics’ ability to teach medical students about empathy.  Humanising Illness: Presenting Health Information in Educational Comics by Sarah McNicol explores the power of graphic medicine as a tool to increase empathy and emotional understanding and is open access.

Graphic medicine books in general increase empathy. My Degeneration: A Journey Through Parkinson’s by Peter Dunlap-Shohl provides distinctive insight on the patient side.  The author visually guides you through his diagnosis, symptoms, and adaptations to these symptoms.

Many healthcare providers have chronicled the adversities they face. A few examples are Michael Natter, Grace Farris, and Jack Maypole


Community 

Seeing a story about someone else who has similar circumstances or feelings as you can make you feel less alone. Graphic medicine creates a sense of community. There is also a robust community surrounding the reading, making, and using graphic medicine. You can follow #GraphicMedicine on Twitter, Instagram, and other social media. 

The Potential of Educational Comics as a Health Information Medium by Sarah McNicol discusses a study to determine patients’ and caregivers’ reactions to comics about a condition. It touches upon many benefits of graphic medicine, but especially on how the comics made them feel a “sense of companionship” with others with the same condition. This article is open access. 

People who suffer from mental health issues can feel isolated. This annotated bibliography by Tina Hefty and Jenifer Fisher highlights graphic medicine about mental health, where you can browse by title or diagnosis. The books included can make a reader feel less alone with their diagnosis. One particular title mentioned in this bibliography is The Courage to Be Me. It is a fantastic collection of stories from women who have been sexually abused. It is freely available online, but gives the option of purchasing a physical copy.

Cancer Made Me a Shallower Person by Miriam Engelberg pushes back against the warrior/fighting metaphor that is often used with cancer. She describes how feeling like she always had to be strong hurt her mental health.


Ethics

Graphic medicine is a way of engaging with the complex issues in medical ethics in an approachable way. 

There is an entire issue of the Journal of Ethics on graphic medicine, which is all open access! All the articles within are worth checking out and make excellent evidence supporting using graphic medicine with ethics.  

There is a great example describing bioethics and graphic medicine in Spanish. Con-Ciencia Médica by Mónica Lalanda explores the Spanish Medical Code of Ethics.


Using the Toolkit

Persistence is key. Keep bringing up graphic medicine. If one benefit didn’t impress, try another. There are many more examples and pieces of evidence out there. Make sure to use the communication method you picked up on from testing the waters. If they fail to respond to that, try other methods (email, face-to-face conversation, meeting item, phone call, etc). Find one that works. This is an iterative process. Use any and all examples and evidence, but make sure not to overwhelm them at first. Select the best pieces for them, then add on later. This is where the toolkit comes in. To beat this metaphor into the ground, if pliers didn’t work, try a wrench. 

Although I have left the UAMS Library, the graphic medicine collection is still there. My colleagues have plans to continue with graphic medicine efforts, because I made many allies and fans of graphic medicine there. Now I’m going after a wider audience…to take over the world! (Okay, not that.) However, I do want to convince the world of the beauty and impact of graphic medicine. 

Next week I will be discussing starting a graphic medicine collection or program at your workplace. Let me know what you think! Comment or get in touch with me on Twitter @AJaggers324 or Instagram @AJaggers324, like and subscribe. Also if you would like to support me financially, you can go to patreon.com/ajaggers324. Thank you!


Scholarly Articles Mentioned

  • Glazer, S. (2015). Graphic medicine: comics turn a critical eye on health care. The Hastings Center Report, 45(3), 15–19. https://doi.org/10.1002/hast.445 [doi]
  • McNicol, S. (2014). Humanising illness: presenting health information in educational comics. Medical Humanities, 40(1), 49–55. https://doi.org/10.1136/medhum-2013-010469 [doi]
  • McNicol, S. (2017). The potential of educational comics as a health information medium. Health Information & Libraries Journal, 34(1), 20–31. https://doi.org/10.1111/hir.12145
  • Vaccarella M. (2013). Exploring graphic pathographies in the medical humanities. Medical Humanities. 39(1):70–71. doi:10.1136/medhum-2012-010209
  • Williams, I. (2011). Autography as auto-therapy: psychic pain and the graphic memoir. Journal of Medical Humanities. 32(4), 353–366. doi:10.1007/s10912-011-9158-0

4 thoughts on “Advocacy Toolkit

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s