How does parenting change when infant and child mortality affects every family in society? Recent history may provide an answer. For the entirety of the 19th Century, child mortality was ubiquitous. In the year 1880, nearly 35% of children born in the United States passed away in their first five years. The medical literature that explores the common diseases and public health inadequacies, though expansive, often fails to address the central humanistic questions surrounding such widespread death. How were these children mourned? How did grieving families move on? And how has this mourning changed in the context of the past hundred years of medical advancement?
Throughout the lecture, Klass guided the audience through famous portraits, poems, and prose produced in the 18th Century that memorialized children who had died at a young age. Perhaps the most famous fictional account of childhood death in the 19th century emerged in Uncle Tom’s Cabin by Harriet Beecher Stowe. The emotionally wrenching death scene of young Eva, who succumbed to tuberculosis, struck a chord with virtually all those who read the novel. Published in 1852, Uncle Tom’s Cabin would go on to be reproduced in theaters across the country for several decades, the death scene becoming a ubiquitous anchor that often brought the audience to tears. Klass further described how Beecher Stowe drew from her personal experience, the death of her son Charlie from cholera only a few years prior to the writing of the book, to create this powerful literary scene.
Beecher Stowe was not the only author whose personal experience impacted their art. Charles Dickens, deeply impacted by the death of his children, had created a slew of sentimental yet mortal child characters in his stories. One of the most prominent examples, young Nell from “The Old Curiosity Shop,” was published in installments and developed a strong following. Dickens ended the series with the death of twelve-year old Nell, much to the outrage of international readers.
Perhaps it’s no surprise that parents chose to memorialize their deceased children through literature and art. Wealthy families would often contract famous portrait artists were often contracted to depict their dead children. Some, including the Rockefellers and the Stanfords, channeled the deaths of their children and grandchildren into resourced academic institutions.
For grief to drive philanthropy and art is not a new phenomenon, but the sources of grief that drive such artistic and financial overtures today have changed considerably. Klass sought to bridge this knowledge gap and pull closer the history to which society has the privilege of being oblivious. Maybe, even, it would even inform how we cope with the mortality of young people today.
“How do we situate ourselves in a world where infant and child mortality is so low?” Klass asked at the beginning of her presentation.
The past does not reveal one clear answer, but it does provide a tapestry of options, many lost in our modern collective memory, for mourning, for celebrating, and for memorializing.
The list of professions that have been pushed to the brink during the pandemic is ever-expanding. However, the sea change that swept over nursing in the past three years rivals that of almost any occupation, said panelists in a Sept. 28 event hosted by Duke University School of Nursing.
Already one of the most overworked professions, the pandemic only seemed to magnify nursing’s enduring problems, according to panelist and journalist Lauren Hilgers. A few months into the pandemic, nurses around the country began quitting in droves due to both burnout and undervaluation by their employers. As the front lines dwindled, hospitals working at full capacity needed to meet patient demand by any means necessary.
Enter travel nursing agencies, independent staffing organizations that matched nurses from across the country with hospitals dealing with acute labor shortages. Already increasing in popularity in the lead-up to the pandemic, demand for travel nurses in recent times has exploded. As this fundamental change in the make-up of the nursing labor pool occurred, people started to take notice.
In February of 2022, an article was published in the New York Times titled “Nurses Have Finally Learned What They’re Worth”. In the piece, Hilgers chronicles the major trends in the nursing workforce over the past three years. Hilgers describes the unique proposition facing the nurses who chose not to quit: remain as a staff nurse on their current salaries or sign up with a traveling agency and uproot their lives, albeit for higher pay. And the pay bump was substantial. Certain travel nurse jobs paid up to $10,000 a week, many times what staff nurses were earning. These nurses would often stay at a hospital anywhere from a couple of weeks to months, providing much-needed relief to healthcare systems. However, as the practice spread, questions soon began to emerge about the disparities in pay between staff and travel nurses, the sustainability of travel nurse programs, and, moreover, how the American healthcare system enabled travel nursing to rise to such prominence in the first place?
“Nursing is the largest segment of the healthcare workforce…yet what we contribute to the health and wellbeing of our country is invisible,” mentioned Dean Ramos at the discussion’s outset.
Smalheer agreed, adding that nurses today are contributing to patient care in ways that were vastly outside of their scope of practice just twenty years ago. A unique combination of technical proficiency, aptitude during crisis response, and ability to provide feelings of care and comfort, Hilgers describes nursing as one of, if not the only, profession in healthcare that considers the “entirety of a patient.”
A frequently cited statistic during the panel presentation referenced results from a Gallup poll indicating that nursing was rated as the most trusted profession for the 20th year in a row. While nurses were always aware of their influence and worth, getting healthcare systems to agree proved to be a much larger effort, one that only grew in importance as COVID-19 progressed.
“The pandemic has hardened us,” explains Smallheer. No longer were nurses willing to tolerate slights against their treatment as a profession. And they had tolerated plenty. Barraza, one of the protagonists of Hilgers’ piece, described the relentless search for purpose amidst constant burnout, especially during the pandemic’s heaviest waves. From finding efficient triage methods during a surge of cases to celebrating patient discharges, Barraza actively sought out ways to be “consistent when there was no consistency.” A charge nurse located in a region with severe labor shortages, Barraza had seen the influx of travel nurses firsthand every week. What ultimately kept him from traveling across the country in the pursuit of a more lucrative job, however, was the relationships he had forged within the hospital. Nurses, students, patients-they had all left an indelible mark on Barraza and enabled him to push through the long and grueling hours. Tennyson reinforced Barraza’s story by claiming that “you can be burnt out and still find value in a profession.” This seemingly contradictory duality may have proved sufficient to retain nurses during the pandemic, but as for long-term solutions, the panelists agree that significant change must occur at a systemic level.
One of the central tensions of Hilgers’ article is that between the hospital and the worker. The explosion of travel nursing during the pandemic was but a manifestation of decades of undervaluation by hospitals of nurses. In order to undo this narrative and enact concrete change, Tennyson argues that nurses must be represented in more interdisciplinary professional spaces, from healthcare administration to policy to business. Hilgers restates this idea more broadly, saying that nurses “need to have a seat at the table” in reshaping the healthcare system post-COVID-19.
Much of this work begins at the level of the educational institution. Smallheer and Tennyson spoke at length about how nurses can better be prepared to navigate the ever-changing healthcare workforce. They both highlighted a few of the Duke School of Nursing’s novel instructional methods, including early exposure to complicated patient cases, extensive practice with end-of-life scenarios, and recognition of overstimulation points in the field. Also important for nurses-in-training and existing nurses, according to all panelists, was collective action. Through supporting state and national nursing associations, writing to local politicians, and speaking to healthcare administrators, they argued that nurses will be better equipped to voice their demands.
As the panel reached its closing stages, one of the main talking points centered around changing the narrative of nursing as solely a burnout profession. Hilgers in particular remains critical of the portrayal of nurses, and more broadly those involved in care work, in popular media. She strongly advocates for authentic storytelling that including the voices of actual nurses, nurses such as Barraza. Ramos describes Barraza as someone who “represent[s] the best in nursing,” and the panelists maintained a strong desire to see such stories of resilience and passion spotlighted more frequently.
There is no simple formula to reform the nursing profession in the United States. However, through a combination of effective storytelling, more current educational standards, greater interdisciplinary involvement, and collective action, the panelists of the Dean’s Lecture Series firmly believe that lasting change is possible.
“If language shapes inequitable systems, then their disruption relies in part on our ability to effectively wield language in subversive ways”
Dr. Irène Mathieu, MD
Buried within a smattering of bullet points and data nuggets, these evocative words flashed across the slide deck of Dr. Irène Mathieu, MD. As Assistant Professor of Pediatrics at the University of Virginia School of Medicine and an award-winning poet, Mathieu thinks medical students could benefit from a stronger background in the humanities. Over the course of her guest lecture, “Playing Between the Lines: Poetry by a Pediatrician,” Mathieu dropped many such pieces of wisdom linking the study of language, and more broadly the humanities, with the practice of medicine. She shared this wisdom through a variety of methods, including original poetry, anecdotes from her life, and the latest research into the field of narrative medicine. The lecture was organized by the Trent Center for Bioethics, Humanities, and History of Medicine and hosted by Dr. Sneha Mantri, MD, MS, Assistant Professor of Neurology at Duke University School of Medicine.
The field of narrative medicine, hardly twenty years old, can trace its roots to Columbia University, when a group of physicians and scholars, spearheaded by Dr. Rita Charon, MD, PhD, sought to change the discourse surrounding traditional medical training. Emphasizing various humanities-based approaches, narrative medicine seeks to increase the propensity of physicians to perceive strife, uncertainty, and complexity in the pursuit of caring for complex illnesses. In her discussion, Mathieu cited multiple studies that detail the positive impact of an exposure to the humanities on the empathy, wisdom, tolerance for ambiguity, and resistance to burnout in medical students. More recent studies have shown that narrative medicine experimental training programs have similar impacts.
Like many of her contemporaries, Mathieu sees the utility in narrative medicine to impact not only the personal lives of physicians, but also the systems in which they interact. By approaching treatment through the lens of narrative medicine, she believes that physicians can better reimagine health systems into more equitable entities. In her pursuit of greater health equity, Mathieu identified two concepts that every physician should strive to possess: structural competency and critical consciousness. Structural competency, a term coined by her colleagues in an influential 2014 paper, proposes a model of patient engagement that goes beyond the realm of cultural awareness and further into understanding upstream, systemic issues such as zoning laws, food delivery systems, and health insurance. Critical consciousness, the ability to recognize the inherent contradictions and inequities within society, complements the structural competency framework. By consistently engaging in critical reading and reasoning, future physicians will be better able to reflect on the “power, privilege, and the inequities embedded within social relationships”.
While Mathieu recognized the power of narrative medicine, she also acknowledged how poetry has never had its proper place within the prose-heavy field. In her eyes, however, incorporating poetry into narrative medicine frameworks makes a lot of sense. For one, it allows a deeper level of vulnerability and dynamicity that literary fiction and theory cannot provide. More practically, however, poetry tends to err on the shorter side of literature (Mathieu calls them “multisensory micro-stories”), offering a less time-consuming alternative for busy medical students and residents.
For most of Mathieu’s life, her passion for poetry and medicine developed on parallel tracks. It wasn’t until her undergraduate years that she began to think of poetry more externally and started to seek out opportunities for publication. Around the same time, through her work in various global health initiatives, she witnessed the power words and policy can possess over the healthcare needs of entire populations. She identified a need for a humanities education, replete with poetry and theory and fiction, as critical to increasing equity within the healthcare system. When Mathieu assumed her latest role at UVA, on the eve of publishing her third poetry collection, the critically acclaimed Grand Marronage, she was given the opportunity to integrate her poetry within the university medical curriculum. Today, Mathieu has a secondary appointment as Assistant Director of the Program in Health Humanities at UVA’s Center for Health Humanities and Ethics. The parallel pathways of her life had converged.
As Mathieu revealed during her presentation, much of her poetry has little to do with her daily medical practice. Rather, she views poetry more along the lines of an escape. This escape takes the form of a critical reflection, by connecting the quotidian with themes of family and love, excess and presence. Mathieu’s poetry has the rare ability to walk readers through her complete narrative process, from the barest of sensory details to the ambiguities of emotion.
Perhaps there is no more fitting an ending to this article than an invitation to join Mathieu’s narrative world. After all, no amount of prose can substitute for a real poem. Below is a particularly striking excerpt of Mathieu’s artistry from the first stanza of her poem, “the forest fire of family trees”:
the problem is we don't know
that many ways of doing things
for instance, neither of us can
fry an egg without public radio
chattering in our ears, & there
are worse blueprints for a home,
like what my grandfather taught
my uncle. we think we know
people until we see the way
they eat a banana, totally unlike
how we peel and devour the fruit,
only instead of eating a banana
it's something way bigger,
like loving another person.
International students comprise an essential part of the fabric of US colleges.
Their contributions to ongoing campus dialogues, research initiatives, and cross-cultural exchange have improved not only the caliber, but also the relevance of American universities on a global scale. Yet, through a combination of legal challenges and the COVID-19 pandemic, enrollment of international students in the United States declined by 15% from 2020 to 2021.
This figure was a key motivating factor behind one of the panels at The Evolving Role of Universities in the American Innovation System conference, hosted by The Center for Innovation Policy at Duke Law School on March 3 and 4. The panel, titled “Immigration Policy and the Availability and Cultivation of Talent to Support U.S. Universities’ Missions,” explored the importance of effective immigration policy in fostering a culture of innovation in the United States. Featuring four thought leaders on the intersection of immigration policy and international students, the panel was moderated by Stuart Benjamin, JD, from Duke Law School.
Panelist Esther Brimmer, DPhil. stressed the importance of generating a coordinated national strategy for attracting international students, with the goal of creating an attractive environment for scientific leadership. Scientific fields are the focus because, while international students make up only 5% of total enrollment at US universities, over half of them are employed in STEM fields. Furthermore, in the 2016-2017 Academic Year, 54% of master’s degrees and 44% of doctorate degrees in STEM fields were issued to international students, two figures that have been on the rise in the past decades.
Richard Freeman, PhD, followed up Brummer’s points by analyzing the impact of international students on a recent scientific breakthrough: the development of COVID-19 vaccines. Working off of a thesis that the US university serves as a critical global hub for science, technology, and innovation, Freeman focused his analysis on the C-suites, inventors, and clinical trial authors as it pertained to major pharmaceutical firms Moderna, Novavax, Pfizer/BioNTech, Johnson & Johnson, and AstraZeneca/Oxford. Freeman found that US university education was a uniting factor in the backgrounds of most of the leaders and innovators within the vaccine development processes, irrespective of whether they were born in the United States. To propagate the vast US innovation system, Freeman alluded, it was imperative that policymakers develop the necessary frameworks to maintain a pool of international talent.
Caroline Wagner, PhD, proceeded to expound upon the critical policy frameworks necessary for enhancing international collaboration at US research universities. She discussed how liberal democracies such as the United States ought to shift their policies in terms of focus, funding, and approach towards research in order to keep pace with a more diffuse and fast-growing international STEM ecosystem. Therefore, research at the university level needed to be better aligned with US national interests on an economic and political level, claimed Wagner. Working off of this claim, the focus of Wagner’s current collaborative project with the Berkeley Research Group Institute is to develop and advise a more deliberate science and technology policy that would balance innovation with the needs of global security.
Dany Bahar, PhD, rounded out the panel with a discussion of the intersection between migration and innovation, with a specific focus on inventions. Through his research, Bahar identified a class of individuals whom he dubbed Global Mobile Inventors, scholars and inventors who patent multiple novel technologies in a multitude of different countries. As these individuals migrate across borders, they utilize their technical expertise to positively contribute to the economies of each country within which they reside. Upon mapping patent data against migration reform trends, Bahar found that negative migration reforms often stop innovative inventors from moving, leading to a loss of innovation and a lowering of economic output.
Bahar asserted, in no uncertain terms, that America needs migrants now more than ever before. This powerful statement was met with nods of approval from each panelist, an empowering example of consensus-building from leaders working within a decidedly imperfect university system. However, it was the panelists’ common recognition of institutional shortcomings that laid the groundwork for an especially fruitful discussion, one that will likely play out on the national and international political stage for years to come.
In an era of seemingly endless panaceas for age-based mental decline, navigating through the clutter can be a considerable challenge.
However, a team of Duke researchers, led by cognitive neuroscientist Edna Andrews, PhD, think they may have found a robust and long-term solution to countering this decline and preventing pathologies in an aging brain. Their approach does not require an invasive procedure or some pharmacological intervention, just a good ear, some sheet music, and maybe an instrument or two.
In early 2021, Andrews and her team published one of the first studies to look at musicianship’s impact in building cognitive brain reserve. Cognitive brain reserve, simply put, is a way to qualify the resilience of the brain in the face of various pathologies. High levels of cognitive reserve can help stave off dementia, Parkinson’s disease or multiple sclerosis for years on end. These levels are quantified through structural measurements of gray matter and white matter in the brain. The white matter may be thought of as the insulated wiring that helps different areas of the brain communicate.
In this particular study, Andrews’ team focused on measurements of white matter integrity through an advanced MRI technique known as diffusion tensor imaging, to see what shape it is in.
Previous neuroimaging studies have revealed that normal aging leads to a decrease in white matter integrity across the brain. Over the past fifteen years, however, researchers have found that complex sensory-motor activities may be able to slow down and even reverse the loss of white matter integrity. The two most robust examples of complex sensory-motor activities are multilingualism and musicianship.
Andrews has long been fascinated by the brain and languages. In 2014, she published one of the seminal texts in the field of cognitive neurolinguistics where she laid the groundwork for a new neuroscience model of language. Around the same time, she published the first and to-date only longitudinal fMRI study of second language acquisition. Her findings, built upon decades of research in cognitive neuroscience and linguistics, served as the foundation for her popular FOCUS course: Neuroscience/Human Language.
In more recent years, she has shifted her research focus to understanding the impact of musicianship on cognitive brain reserve. Invigorated by her lived experience as a professional musician and composer, she wanted to see whether lifelong musicianship could increase white matter integrity as one ages. She and her team hypothesized that musicianship would increase white matter integrity in certain fiber tracts related to the act of music-making
To accomplish this goal, she and her team scanned the brains of eight different musicians ranging in age from 20 years to 67 years old. These musicians dedicated an average of three hours per day to practice and had gained years’ worth of performance experience. After participants were placed into the MRI machine, the researchers used diffusion tensor imaging to calculate fractional antisotropy (FA) values for certain white matter fiber tracts. A higher FA value meant higher integrity and, consequently, higher cognitive brain reserve. Andrews and her team chose to observe FA values in two fiber tracts, the superior longitudinal fasciculus (SLF) and the uncinate fasciculus (UF), based on their relevance to musicianship in previous studies.
Previous studies of the two fiber tracts in non-musicians found that their integrity decreased with age. In other words, the older the participants, the lower their white matter integrity in these regions. After analyzing the anisotropy values via linear regression, they observed a clear positive correlation between age and fractional anisotropy in both fiber tracts. These trends were visible in both tracts of both the left and right hemispheres of the brain. Such an observation substantiated their hypothesis, suggesting that highly proficient musicianship can increase cognitive brain reserve as one ages.
These findings expand the existing literature of lifestyle changes that can improve brain health beyond diet and exercise. Though more demanding, neurological changes resulting from the acquisition and maintenance of language and music capabilities have the potential to endure longer into the life cycle.
Andrews is one of the strongest advocates of lifelong learning, not solely for the satisfaction it brings about, but also for the tangible impact it can have on cognitive brain reserve. Picking up a new language or a new instrument should not be pursuits confined to the young child.
It appears, then, that the kindest way to treat the brain is to throw something new at it. A little bit of practice couldn’t hurt either.
As any first-year will tell you, the scramble for joining new clubs can be a daunting one. As the dust settled from the Involvement Fair, I looked at the fistful of flyers overflowing from my desk. One of these flyers stood out to me in particular: Student Collaborative on Health Policy (SCOHP). The program, backed by the Duke Margolis Center for Health Policy, seeks to educate, serve, and research within the Duke and Durham community regarding the social, economic, and political determinants of health care.
Intrigued, I ventured to the Social Sciences building the following Sunday afternoon for their inaugural GBM. The event was lively, filled with a dizzying number of avenues for involvement. One such avenue that was the SCOHP-organized Health Policy Case Competition, advertised as a two-day team sprint to develop and pitch solutions to a pressing health care problem. The prizes were handsome: $1,000 for 1st place, $500 for 2nd place, and $250 for 3rd place, courtesy of the Margolis Center and RTI International. Furthermore, participants would be given access to mentors and industry leaders with vast experience in the area of public health.
Six teams, each consisting of three to five members, participated in the case-writing festivities. On Friday, September 10 at 5:00 PM, the case document was released. Our task: to develop a five-year plan aimed at increasing the screening for human papillomavirus (HPV) in either Malawi, South Africa, or Eswatini via a novel imaging technology known as microbeads. A considerably complex task given the vast number of social, institutional, and political barriers lying between the new technology and the women who needed it the most, not to mention the potential for HPV developing into cervical cancer if left undetected and untreated.
Our team, Team J, assumed the role of a local NGO partnering with the Eswatini government. The preliminary hours of the competition were spent sifting through a sea of research. We read reviews of tissue imaging technology, feasibility studies on drug distribution networks, and mathematical projections of healthcare costs. At once invigorating and ceaselessly frustrating, the process of developing a comprehensive solution required significant mental and physical rearrangement. The nine hours following the release of the case were spent in a variety of popular campus study spots, from Bostock to Rubenstein Library, The Coffeehouse to dorm common rooms. In the early morning hours, our plan had finally begun to take shape.
A meager five hours of rest separated Day One of the competition from Day Two. After a night of brainstorming and research, we were left with three hours to finalize our five-minute proposals before a hard 12:00 PM deadline. As the deadline approached, we changed into our best attire from the clavicle up (the marvels of Zoom) and sat down. For the next hour and change, ideas flowed thickly and quickly; eager and persuasive tones emanating from our screens, tense silence as the judges moved into breakout rooms for deliberation.
The top three teams, Team J included, were selected for a final presentation round. The guidelines for this round: strengthen the argument, lengthen the presentation. We were in the final stretch. What followed was two hours of remarkably focused work, the likes of which I had never experienced in a team setting. As we sat down for the deciding presentation of the competition, I felt an immense sense of pride, not only in our solution, but also in our twenty-six hour transformations from perplexed receivers to confident presenters. This confidence and breadth of knowledge was visible in all three teams over the course of their fifteen-minute presentations and subsequent five-minute Q&A’s.
As the clock struck 7:00 PM on Saturday, September 11, the judges had submitted their verdict, at which point the teams turned towards the screen with rapt attention. The SCOHP organizers began reading the final standings. In what was described as an extremely close decision for the judges, Team J ended up winning first place. Battling the equally powerful forces of disbelief and sleep deprivation, we let out a collective breath. It was all over.
At the time of the competition, I had yet to complete a month at Duke. I didn’t know it then, but those twenty-six hours would end up being some of the most impactful in my first semester. The competition offered an entirely different approach to learning, one that was grounded in interdisciplinary inquiry and effective collaboration. And to think–it all started with a flyer buried underneath many other flyers.
The focal point of this article will be the Energy Conference, which occurred on November 10. If you’re curious about the future of clean energy within North Carolina, my colleague at the Duke Research Blog, Nhu Bui (Class of 2024), wrote a fascinating piece on the Energy Innovation Showcase.
Over the course of eight hours, the Conference schedule alternated between a series of keynote addresses and fireside chats. The latter centered around a particular topical focus; each chat involved a faculty moderator and three industry experts whose organizations lie at the cutting edge of the climate transition within the private sector. In addition to the moderator’s questions, conference participants were invited to ask questions about the visions and innovations of their company.
The first fireside chat – Energy Transition Plans, Projects, and Pathways – broadly centered around the decarbonization of the energy industry. The speakers were Mallik Angalakudati, SVP of Strategy & Innovation at Washington Gas, Kirsten Knoepfle-Thorne, General Manager of Strategy at Chevron, and Jon Rodriguez, Energy Business Director of Engine Power Plants at Wartsila. All three acknowledged their companies’ traditional reliance on fossil fuels and stressed the need for emissions reduction moving into the future. The avenues each company was pursuing to reach this end varied considerably from green hydrogen to battery energy storage systems to carbon capture.
The second chat – Renewable Transportation – sought to highlight the latest innovations of firms within the burgeoning electric vehicle (EV) market. The panel consisted of Liz Finnegan (Fuqua ’17), Electric Vehicle Infrastructure and Energy at Rivian, Pei-Wen Hsu (Fuqua ’97), Global EV Marketing Director at Ford, and Kameale Terry, Co-Founder and CEO of ChargerHelp!. From launching new vehicles to servicing software breakdowns at charging stations across the nation, these speakers brought a wealth of perspectives to a high-growth market. They reinforced the certainty and necessity of mass consumer adoption of EV innovations, offering multiple roadmaps for the coming decades in transportation technologies.
The third chat – Investing in Climate Tech Solutions – addressed the financial side of climate tech solutions. The speakers were Nneka Kibuule, SVP at Aligned Climate Capital, Lisa Krueger, President of US Operations at AES, and Sophie Purdom, co-founder of Climate Tech VC and an early-stage investor. Each speaker targeted climate solutions at different developmental stages, from early-stage ventures to companies ready for their IPOs. Taken as a whole, their firms reflected the robust nature of the financial ecosystem available to aspiring climate entrepreneurs and firms.
The three fireside chats engaged a number of angles through which the private sector can collectively curb climate change. As lab-developed technologies reach sufficient scale, the efficacy of climate solutions depend not solely on the quality of the innovation, but rather the quality of their implementation.
The conference conveniently coincided with the final few days of the COP26 Climate Summit in Glasgow, Scotland. As policy leaders half a world away wrangled over the minutiae of coal usage and climate financing, it became clear that a different sort of conversation was taking place on our campus. By engaging with the Energy Conference, even the most ardent skeptics of climate change progress would find it hard to deny the tangible shift in priorities that have occurred over the past few years. The prioritization of environmental concerns by the energy industry is now a given. The bigger question to consider is whether their plans and promises are sufficient to avert climate disaster.
Six years after Nigeria gained its independence from Great Britain in 1960, a bloody military coup transferred power to the nation’s armed forces.
The ensuing forty-year period was marked by eight different military regimes and a Civil War, which were often demarcated by similarly violent coups that overthrew the initial Republic. Brief interludes of constitutional republics occasionally emerged, but these periods were short-lived and quickly replaced by another military government.
Daly says the writings and opinions of these autocrats often receives insufficient attention in the modern accounts of Nigerian history. The title of his lecture through the Franklin Humanities Institute, “How Soldiers Think,” attempted to address this lack of analysis by asking several important questions: What did these soldiers believe? Why did they enact the laws that they did? How did they envision Nigeria’s future?
The story of Nigerian militarism, according to Daly, has its roots in the decolonization process. The soldiers and lawmakers of the later 20th century found their inspiration in one of the most famous decolonial thinkers: Frantz Fanon. Fanon’s two seminal works – Black Skin, White Masks and The Wretched of The Earth– were rooted heavily in his experience as a trained psychiatrist and a soldier for the Front de Libération National, the Algerian nationalist movement that fought against French colonial rule during the French-Algerian War (1954-1962). His advocacy for violent decolonization inspired anticolonial fury within Nigerian intellectuals and soldiers alike, leading to the widely accepted notion that military violence could be both reparative and restorative.
Fanon, in many ways, gave these soldiers a language of revolution, but, as Daly points out, many of them found his socialist politics to be too radical for Nigerian society. To the military rulers, the ideal system of governance was ascetic, masculine, and heavily disciplined.
In many ways, these soldiers sought to craft Nigeria in their own image–an image of order and self-control, a society where civilians needed to be tamed.
To create this society, the soldiers relied heavily on criminal law and the law enforcement apparatus. To them, law served as a tool of social engineering, albeit one that didn’t always work in their favor. Despite setting up a plethora of friendly judges throughout the judicial system, occasional rulings would rub military officers the wrong way. Nonetheless, they were able to exercise their heavy influence over the legislative and judicial systems to set forth programs aimed to reduce the perceived disease of chaos that plagued the Nigerian population.
One of the major initiatives Daly highlighted was the infamous War Against Indiscipline (WAI). The WAI initiated a number of often draconian programs such as the mandate to queue in an orderly manner for buses. Those who refused to form a line would be promptly whipped or beaten by an officer. Other social reforms outside of WAI centered heavily around sacrifice and control, such as the requirements for women to dress modestly and for men to stay fit; in fact, exercise was routinely used as public punishment for unruly activity.
These behavioral and punitive measures were heavily inspired by the rigid and militaristic upbringing of these autocrats, which is precisely why they were so unpopular with civilians. Daly describes several misconceptions within these leaders’ political philosophy – their treatment of politics as binary, their desire for conformity, their misconstrued knowledge of what their people want – that ultimately led to the instability of their regimes.
Through a unique combination of warped decolonization rhetoric, militaristic attitudes, and malleable jurisprudence, Nigerian political practices of the late 20th century offer a glimpse at the shortcomings of discipline as a primary political ethos. The societies formed under the military heads of state were illiberal and, contrary to the title of this article, decidedly unfree.
*the images from this article were obtained from Dr. Daly’s 2021 presentation “How Soldiers Think” through the Franklin Humanities Institute.
In healthcare, developing a new treatment is often half of the battle. The other half lies in delivering these treatments to those communities who need them the most. Coordinating care delivery is the goal of NC Integrated Care for Kids (InCK), an integrated pediatric service delivery and payment platform looking to serve 100,000 kids within five counties — Alamance, Orange, Durham, Granville, and Vance — in central North Carolina. The project is a collaborative effort between Duke, UNC, and the NC Department of Health and Human Services (DHHS) funded by a federal grant from the Centers for Medicare and Medicaid Services (CMS). The program’s executive director is Dr. Charlene Wong (MD, MSPH), a Duke researcher, physician, and professor who leads an interdisciplinary team of researchers and policy experts as they explore ways to reduce costs via integrating care for North Carolina youth enrolled in Medicaid and Children’s Health Insurance Program (CHIP).
The five counties that are part of NC InCK
I recently had the opportunity to speak with two of InCK’s service partners: Dr. Gary Maslow (MD, MPH) and Chris Lea (Duke ’18). Both work within the Behavioral Health group of InCK, which seeks to use behavioral health expertise through collaborative care and training providers to help support pediatric care. Maslow, a professor at the Duke Medical School, has focused heavily on child and developmental psychiatry throughout his career. Having entered medical school with a desire to work in pediatric hematology, Maslow recalls how a conversation with a mentor steered him in the direction of behavioral health. At the time, Maslow was part of the Rural Health Scholars program at Dartmouth College; while discussing his aspirations, one of his professors asked him to consider conditions outside of cancer, leading Maslow to consider chronic illness and eventually child psychiatry. “Kids have other problems,” Maslow’s professor told him.
When looking at healthcare networks, especially those in rural areas in North Carolina, Maslow noticed a disaggregated service and payment network where primary care providers were not getting the necessary education to support the behavioral health needs of children. His work with Lea, a third-year medical student at Duke, has centered around looking at Medicaid data to understand provider distribution, medication prescription, and access to therapy based one’s area of residence. Lea’s path to NC InCK began as an undergraduate at Duke, where he obtained a B.S. in psychology in 2018. As he explains, mental health has been a vested interest of his for years, a passion reinforced by coursework, research at the Durham VA Medical Center, and NC InCK. He discussed the important of appropriate crisis response, specifically how to prepare families and providers in the event of pediatric behavioral health crises such as aggression or suicidality, as critical in improving behavioral health integration. These safety plans are critical both before a potential crisis and after an actual crisis occurs.
Two main goals of Maslow and Lea’s work are to increase the implementation of safety plans for at-risk youth and expand follow-up frequency in primary care settings. The focus on primary care physicians is especially critical considering the severe shortage of mental health professionals around North Carolina.
The behavioral health group is but one subset of the larger NC InCK framework. The team is led by Chelsea Swanson (MPH). Other collaborators include Dr. Richard Chung (MD), Dan Kimberg, and Ashley Saunders. NC InCK is currently in a two-year planning period, with the program’s launch date slated for 2022.
Hey everyone! My name is Vibhav Nandagiri, I use he/him/his pronouns, and I’m currently a first-year student at Duke. Amidst the sea of continuous transition brought upon by college, one area of my identity that has stayed fairly constant is my geography. I’ve lived in North Carolina for sixteen of my eighteen years, and my current home lies just twenty minutes from campus in sunny, suburban Cary, NC.
The two missing years are accounted for through my adventures in my parents’ hometown–Hyderabad, India–as a toddler. Spending some of my earliest years surrounded by a large and loving family impacted my life profoundly, forever cementing a strong connection to my emotional, cultural, and linguistic roots.
The latter had a secondary impact on me, one I wouldn’t discover until my parents enrolled me in preschool after returning to the States. With hubris, I marched into my first day of class, ready to seize the day, until I soon discovered an uncomfortable fact: I couldn’t speak English. I am told through some unfortunate stories that I struggled considerably during my first month in a new, Anglicized environment; however, I soon learned the quirks of this language, and two-year-old me, perhaps realizing that he had some catching up to do, fully immersed himself in the English language.
Nowadays, I read quite a bit. Fiction and journalism, academic and satire, I firmly believe that all styles of literature play a role in educating people on the ebbs and flows of our world. In recent years, I’ve developed a thematic fascination with the future. The genre of far-future science fiction, with its rich exploration of hypothetical advanced societies, has led me to ask pressing questions about the future of the human species. How will society organize itself politically? What are the ethical implications of future medical advancements? Will we achieve a healthy symbiosis with technology? As a Duke Research Blogger, I hope to find answers to these questions while getting a front-row, multidisciplinary seat to what the future has to offer. It’s an invigorating opportunity to grow as a writer and communicator, to have my curiosity piqued on a weekly basis, to understand the futuristic visions of innovators at the top of their field.
Prior to Duke, I had the opportunity to conduct research at the Appalachian State University Pediatric Exercise and Physiology Lab, where I co-authored a published paper about adolescent fat metabolism. Not only was I introduced to the academic research process, but I also learned the importance of communicating my findings clearly through writing and presentations. I intend to bring these valuable lessons and perspectives to the Duke Research Blog.
Beyond exercise science, I am intrigued by a diverse range of research areas, from Public Health to Climate Change to Business to Neuroscience, the latter of which I hope to explore further through the Cognitive Neuroscience and Law FOCUS. I was drawn to the program for the opportunity to build strong relationships with professors and investigators; I intend to approach my work at the Duke Research Blog with a similar keenness to listen and connect with researchers and readers alike. When I’m not reading or typing away furiously at my computer, you can find me hitting on the tennis courts, singing Choral or Indian Classical music, or convincing my friends that my music taste is better than theirs.