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The HIV/AIDS Epidemic: Revisiting the Early Days of a Global Health Crisis

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On June 5, 1981, the Centers for Disease Control and Prevention reported the first cases of a mysterious disease afflicting young, otherwise healthy men in a tiny suburb of Los Angeles, California. The disease, now known as AIDS, would go on to infect 85.6 million people around the world, sparking an epidemic that persists to this day.

On February 6, 2024, Duke’s Global Health Institute hosted a conversation with Dr. James Curran and Dr. Kevin M. De Cock, both former leaders at the CDC, about their experiences on the frontlines of the AIDS crisis in the earliest days of this epidemic. The conversation was moderated by Dr. Chris Beyrer and Dr. Nwora Lance Okeke, two Duke researchers in infectious disease.

Pictured from left to right: Dr. James Curran and Dr. Kevin M. De Cock

The Origin of the Epidemic

The first cases of AIDS were reported by Dr. Michael Gottlieb, a young immunologist from UCLA. His groundbreaking findings, published in the CDC’s Morbidity and Mortality Weekly Report, described “previously healthy gay men from Los Angeles, San Francisco, and New York, who presented with rare opportunistic infections,” said De Cock. These infections, known as PCP (Pneumocystis carinii pneumonia) and KS (Kaposi’s sarcoma), were extremely rare. Upon observation, Gottlieb identified a startling commonality among the cases: they were all sexually active gay men.

Michael Gottlieb: The Rutgers Alumnus Who First Identified the Deadly  Disease We Now Call AIDS | New Brunswick, NJ Patch

These findings “didn’t fit into any organizational unit at the CDC,” so a multispecialty task force was formed. Led by Curran, it recruited experts in STIs, parasitology, virology, cancer, and more.

Tracking the Epidemic

At the start of the epidemic, cases were phoned into the CDC by individual doctors. But this quickly became inadequate. The epidemic was growing fast, and CDC phone lines could not keep up. “The CDC, therefore, developed a surveillance case definition for the syndrome,” De Cock explained. “Cases meeting this definition were reported through health departments to the CDC.”

“I think we were able with the case definition for surveillance, to take advantage of the fact that all of these conditions were very serious and so unusual that the physician would say ‘I’ve never seen anything like it,’…,” Curran said. “The other conditions were far less specific and far less useful for tracking the disease.”

In October 1981, these tracking protocols helped identify AIDS as a sexually transmitted disease. A national case-control study found that sexual activity was a leading risk factor, and a cluster of cases in 10 US cities linked via sexual contact was discovered. “People just didn’t want to believe it,” Curran said. “They wanted to believe that it wasn’t something transmissible.” 

Expanding Epidemic

Over the next year, the epidemic expanded to include injection drug users, heterosexual partners of bisexual men, people of Haitian descent, and infants. But perhaps most surprising was the transmission occurring through blood transfusion. In December 1982, a case of AIDS-like illness was reported in a 20-month-old infant after receiving blood from a donor who later developed the virus.

“Until that December report of the infant, the mainstream media had actually paid very little attention to AIDS. But that suddenly changed,” said De Cock. “While AIDS was seen as a problem of marginalized groups… it was easy to ignore. But anyone might need a blood transfusion.”

In the following years, rumors surrounding transmission and contact sparked nationwide panic. Fear of contracting the disease caused AIDS patients to lose their jobs and housing. Although the CDC provided up-to-date information on the nature of the virus, quelling public fear was extremely difficult. “AIDS proved that you can’t separate prevention and treatment,” Curran explained.

Modern AIDS Era

As we get close… to 100 million HIV infections since the epidemic began- have we done as well as we should have?”

Dr. Kevin M. De Cock

In 1991, researchers successfully identified HIV (Human immunodeficiency virus) as the underlying cause of AIDS. Since then, scientific understanding of the disease has greatly improved. “Our success has made AIDS more normal, which has robbed the disease of some of its mystique,” De Cock expressed. However, there is still no known cure for AIDS. The disease is a lifelong battle that wreaks havoc on the people it infects.

HIV / AIDS - Our World in Data
Source: Our World in Data

De Cock and Curran’s contributions to the AIDS epidemic fundamentally shaped our understanding of the virus. Their work shines a light on the importance of frontline research and support. Their book, entitled ‘Dispatches from the AIDS Pandemic: A Public Health Story,’ is available to read here.

Written by Skylar Hughes, Class of 2025

The Controversial Birth of American Gynecology

As a woman, I am familiar with the gynecologist. In fact, thinking about it right now, I may need to create an appointment for one soon. However, I am not just a woman; I am a black woman, and in addition to being familiar with what the gynecologist is, I am also familiar with the dangers of the gynecologist. I know that if I were to become pregnant, I would be three times more likely to die by pregnancy-related causes compared with my white counterparts. This phenomenon is not new; in fact, it is a symptom of the racism within American Gynecology. The founding of this system is not pretty, or pure; it is ugly and distasteful, and during her lecture, historian Deirdre Cooper Owens explains it perfectly.

Dr. Deirdre Cooper Owens and I after her wonderful lecture

Cooper Owens is an associate professor of History and African studies at the University of Connecticut, and earlier this semester, she gave an insightful talk on how slavery and modern American gynecology are interconnected.

The controversial “father of gynecology” was J. Marion Sims, who experimented on enslaved women in Alabama. When talking about the racism in gynecology today and in the past, Sims mainly gets the blunt end of the stick. However, it was not just Sims; it was much bigger than him, Cooper Owens said.

Dr. Samual Cartwright was the first doctor for the Confederacy. Through his experiences with enslaved people, he believed that black people did not feel pain. Furthermore, he created a theory that if an enslaved person ran away or thought about running away, then they had a mental illness. Through the use of a spirometer (a medical tool still used today), he noted that black people have smaller lung capacity than white people. His findings were used to prove that there was a biological difference between races, which is not true.

This idea separated people and placed them in a hierarchy where white people were perceived as superior and black people inferior. The thought of this is damaging in itself, but back then, and sometimes now, they used this ideology as an excuse for the pain they caused African Americans.

Ephriam McDowell, for instance, removed a tumor from the ovaries of a white woman. From this, he then decided to “perfect” this surgery on five black women; four were enslaved, and one was freed. From this group, one person died, and other than that, there is no record of the women’s personal lives.

Dr. Francis M Prevost performed C-sections on enslaved people. These experiments did not take the pain of these women into account; due to the fact that he believed black people did not feel pain, but they did and still do. Now one would hope that a black woman’s relationship with C-sections has improved, but, from 1832 until two years ago, Louisiana was the state where a black woman’s body was used the most for a C-section. Today, that state is Mississippi.

John Peter Mettauer performed experiments on a white woman and a black woman. After the experiment, he claimed that the white woman was cured, but the black woman was not. As a result, he operated on the black woman eight times and claimed that if she did not have intercourse, she would have been cured. However, he failed to take into account that the woman was enslaved and had no control of her body autonomy. So how could she say no to both unwanted sexual encounters and to him?

Lastly, there is James Marion Sims, who is notorious for his contributions to American gynecology. However, such contributions were based on the bodies of enslaved women who had no choice. He used these experiments to advance his techniques and deepen his understanding of gynecology. In fact, it even went to the point where he built a hospital for the sole purpose of experimenting on enslaved women.

J. Marion Sims with his assistants and the victims of his experiments

While the acts and experiments that these men conducted were atrocious, they raised a question for me, why black women? At that time, black people were viewed as an inferior race; they were not equal in physical components and intelligence compared to white people. Therefore, if they are genetically different, why experiment with black women to find cures for white women? When asking that question, the answer is obvious; they knew there was no difference, so they chose to ignore it. They chose to continuously bring harm to these women, and until recently, they were rewarded for it.

Image provided by  Harvard T.H. Chan School of Public Health

I learned a lot from this lecture, but if I had to choose only one thing that stuck with me, it would be that the victims of these heinous acts were only referred to as enslaved persons with no name and no story. The only story that was told was the point of view of those committing the acts.

I hope one day, the mortality rate of black women giving birth will decrease to the point that it is simply unheard of. Still, for society and our health system to reach that point, we must understand American gynecology’s true history.

By Jakaiyah Franklin, Class of 2025

Historic Stagville: Stories of Resilience

I was overwhelmed with tranquility while driving along the everlasting gravel road, encased by looming, forest green trees. This healing reconnection with nature towards the entrance nearly allowed me to forget the purpose of my visit at Historic Stagville in Durham. However, as we arrived closer to the entrance of this state protected historic site, I recalled the haunting darkness of America’s past. Approximately 25 minutes away from Duke University lies what was once the largest plantation site in North Carolina, owned by the Bennehan and Cameron families. At its height, the families owned 30,000 acres and over 900 enslaved people. 

Richard Bennehan married Mary Amis in 1776 and acquired the original 66 acres of historic land in 1787. Their home, Stagville, was built by enslaved people on this land and further renovated with an additional story in 1799. They would raise two children, Rebecca and Thomas. Rebecca married Duncan Cameron in 1803 and had two sons and six daughters. Despite their plethora of children, most of the estate was given to their son, Paul, as the other children died and/or did not have heirs. Paul would eventually marry Anne Ruffin and have seven children. These generations of Camerons along with the original Bennehans furthered their infamous and appalling familial legacy of undeserved wealth through slavery.

Despite the Bennehan/Cameron family’s power, wealth, and dominance, the enslaved people of Stagville remained resilient against their injustices. For instance, Emma Turner Henderson decided to continue working for the Camerons as a cook after their emancipation; however, she and her family were evicted on a count of “imprudence” as Emma had claimed ownership of her newfound freedom, claimed ownership of the equality she shared with the white woman who had previously owned her, and claimed ownership of the violence she endured under their regime. According to Paul’s records, Emma had told Margaret Cameron that their disrespectful treatment is not justified as “[Emma’s] skin is nearly as white as [Margaret’s]– that her hair is just as straight– and that she was quite as free”. 

Mary Walker was the fifth generation of formerly enslaved people for the Camerons, born in 1820. She was given to four of Duncan Cameron’s daughters when she was nine years old. These young daughters would eventually pass away from tuberculosis, which is why she was given to their sister, Mildred. Mary Walker would act as Mildren’s caretaker as she had an unknown illness that required a wheelchair. She would frequently travel to Philadelphia during the summer, a free state, with the Camerons for Mildred’s medical appointments. By this point, Mary Walker had three children of her own and she constantly feared their safety. Therefore, Mary Walker evaded the Camerons on her last visit to Philadelphia in 1848 as her freedom was protected under the 1847 Personal Liberty Law. She was employed as a seamstress and spent the rest of her life attempting to reunite with her children. Walker attempted to purchase them from the Camerons or even kidnap them from the estate. Even with three known rescue attempts, Walker was unable to live with her children. That is, until seventeen years later, in which a Union soldier reunited Mary Walker with two of her children, Agnes and Bryant, after the Civil War. Historians do not believe that Mary reunited with her eldest son, Frank, as it is assumed that he escaped. His escape from the plantation was a miraculous feat as it would have taken Frank around two weeks to walk off the estate alone. While the Camerons did place ads for Frank, he could have passed as a white man as he had fair skin, blue eyes, straight black hair, and freckles. The greatest act of resilience from Mary Walker was her success as a seamstress after she settled in Cambridge as she created a strong reputation and a healthy life for herself and her family, despite the evil conditions of her past because of the Camerons. 

As I explored Stagville and Horton Grove, where the enslaved laborers built their homes and lived as they worked for the plantation, I felt the looming presence of their horrifying traumas throughout the estate. I spent time in each room of the luxurious (for its time period) Stagville home in which enslaved people were constantly beside those who committed the most injustice against them. I compared this to the unlivable conditions of the enslaved family homes in Horton Grove where eight people would stay in each room per building. Along the brick walls of these homes remain fingerprints from enslaved people from the creation of the bricks. One brick, in particular, encased the toe-prints of a small child from hundreds of years ago. 

Despite the unimaginable injustice generations of enslaved people endured from the Camerons, their resilient legacy continues with dignified honor. A number of formerly enslaved families continued to sharecrop at Stagville until the 1970s, when it became a state protected site, or settled in nearby locations as a testament to their familial heritage.

Bennehan/Cameron Stagville home

Average dwelling on Horton Grove

A child’s toe prints on the right-side of the third brick from the bottom of a brick on Horton Grove

By Samera Eusufzai, Class of 2026

One Man’s Death Is Not Another Man’s Science

Geer Cemetary in Durham is one of many burial grounds in America that hold the remains of thousands of Black Americans from the 19th century. There are no records of the people buried there. The process of researching grounds like these as a form of reparations to descendent communities was pioneered by Michael Blakey in the African Burial Ground Project in Lower Manhattan, New York. He is currently the Director of the Institute for Historical Biology at the College of William and Mary.

Dr. Michael Blakey. Image courtesy of Library of Virginia Education

On April 4, Blakey visited Duke as a guest of the Franklin Institute of Humanities, the Department of Classical Studies, the Department of International Comparative Studies, and Trinity College. In attendance to his lecture were students of Classical Studies 144: Principles of Archaeology with Alicia Jimenez, International Comparative Studies 283: Death, Burial, and Justice in the Americas with Adam Rosenblatt, and several graduate students by invitation (and me). His presence was clearly highly anticipated.

I initially approached Dr. Jimenez with my interest in bioarchaeology in January as I was planning my Program II application. She invited me to this seminar, and to lunch with Blakey and the graduate students beforehand. I came prepped with questions on osteopenia and hypertrophy, as well as a map of Brightleaf Square so I wouldn’t get lost (I still got lost) and a few dollars cash for parking (they only took card).

Geer Cemetery, Durham, NC. Image Courtesy of Durham in Plain Sight

For those of you who have ever loved the detective fiction heroine Temperance Brennan, Blakey’s work is for you. He is co-chair of the Commission for the Ethical Treatment of Human Remains through the American Anthropological Association. He was claiming the title of bioanthropologist before it was cool. He wrote a guide for the profession called Engaging Descendant Communities, or, more lovingly, The Rubric. Blakey encourages allowing those descendant communities to guide scientists’ research on human remains. He calls us Homo reminiscens, because what makes us “human” may be our affinity for memorializing our dead as much as it may be our large brains (á la Homo sapiens). “Burial is human dignity,” Blakey announced during the seminar, “Dignity is what we do.”

“Ethical code is not law. It is our greatest responsibility.”

Michael Blakey

After all, science has historically been used to justify the unjust. Bioarchaeology is a famous contributor to the field; the pseudoscience of phrenology was upheld until well into the 20th century, and was originally used as “scientific proof” that people of African descent were lesser than Europeans. It was also cited as a justification for displacing Native Americans from their lands.

During lunch, I was struck by Blakey’s cadence. He had a deep, slow voice and spoke with intention. He ordered the giant pretzel. I never asked my questions; instead, I was swept away by the group’s discussion on ethics–a topic I had no open Safari tabs on. I asked instead why a scientist would choose to guide themselves entirely by a non-expert opinion rather than scientific inquiry; would that not hinder discovery?

The scientific method, as you may recall, starts with asking a question. Rather than gracefully including descendent communities after the paper has been written, Blakey urges scientists to only pursue questions about remains that the descendants wish to answer. The science of death should never be self-serving, he noted. There is no purpose to publishing a paper if it is not in the service of the community that provided the subject. A critical reader may notice that The Rubric is not called The Gospel or The Constitution. Rather than a rule of law, it is a guideline. That’s because ethics is based on the respect of self, of craft, and of others. “Ethical code is not law,” Blakey reminds scientists. “It is our greatest responsibility.”

Geer Cemetary has been the subject of Duke research for years now, from a Story+ program to class field trips. Members of ICS, CLST, and FHHI have been in cooperation with Friends of Geer Cemetary to answer such questions about burial conditions–the attempt at dignity granted to Black residents of Durham by their descendants.


Edit: a previous version of this article had incorrectly stated that the Department of African and African American Studies sponsored Michael Blakey’s lecture.

Post by Olivia Ares, Class of 2025

“Humans Are Selectively Pro-science” and Other Ways to Think About Polarization

Photo from DonkeyHotey on flickr.com. Licensed under Creative Commons license.

We live in a country where 80% of both Democrats and Republicans believe that the other political party “poses a threat that if not stopped will destroy America as we know it.” Lovely.

A 2020 study found that only 3.5% of voters would avoid voting for their preferred candidate if that candidate engaged in undemocratic behavior. In 2022, 72% of surveyed Republicans said that Democrats are more immoral than other Americans, and 83% of Democrats said that Republicans are more close-minded than other Americans. Political polarization is apparently increasing faster in the U.S. than in other democracies, but Americans aren’t just divided along political lines. Other aspects of identity, like religious beliefs, can spawn discord as well. In the U.S., 70% of atheists think religious organizations “do more harm than good,” but 44% of Americans still think that you must believe in God “in order to be moral and have good values.”

Most Americans agree that polarization is a problem. But what can be done about it? The Trent Center for Bioethics, Humanities, and History of Medicine recently hosted a conversation between two people who have spent much of their careers engaging with many different beliefs and perspectives. A recording of the talk can be found here.

Molly Worthen, Ph.D., Associate Professor of History at UNC and a freelance journalist, grew up in a “secular, totally nonreligious home,” but courses she took in college made her realize that “for a huge swath of humanity, over the course of our history,” religion has helped people find meaning and community. She has explored religion extensively through her work as a historian, author, and journalist. Worthen says she has “way too risk-averse a temperament to be a full-time journalist,” but one advantage of journalism is that it provides “an excuse to ask people questions.”

Emma Green, a journalist at The New Yorker, has also covered religion in her writing and spent time engaging with people and communities who hold a wide variety of beliefs. Green believes that “the most interesting stories are often about the debates communities are having within themselves.” These debates aren’t just about religion. In communities of all kinds, people with different and often opposing beliefs navigate disagreements with their best friends, neighbors, and family members as they engage with polarizing issues and try to find ways to coexist.

The process of interviewing people with differing worldviews and beliefs can bring challenges, but both Worthen and Green have found that those challenges are not insurmountable. “If you do your homework and you really make a good-faith effort to learn where a person is coming from,” Worthen says, “they will tell you their story. They will not shut down.”

Worthen has spent time with a community of Russian Orthodox Old Believers in Alberta. It was an opportunity to make a “concerted effort to really get inside the worldview of someone very different from myself.”

Green has also spent time talking to and learning from religious communities. She published an article about Hyattsville Mennonite Church in Pennsylvania, which had been welcoming gay members for over a decade and had originally been “disciplined” by the Allegheny Mennonite Conference for its open acceptance of homosexuality. A decade later, the Conference gathered to determine whether the Hyattsville church should be allowed to rejoin the Conference or be removed from it altogether. (A third option, according to Green’s article, was to dissolve the Conference.) Green was struck by how the Mennonite community approached the dispute. They followed the formal “Robert’s Rules of Order,” but they also sang together in four-part harmony. The central dispute, Green says, was “about whether they could stay in community with one another.” Ultimately, the gay members were allowed to stay, though Green says that some people left the congregation in protest.

Polarization is a word we hear a lot, but why is it that we seem to have such a hard time finding common ground when it comes to important—or even seemingly unimportant—issues? Worthen points out that there seems to be a new survey every few years showing that “humans are generally impervious to evidence” that goes against our existing beliefs.

“Barraging a human with evidence doesn’t really work,” Worthen says. According to her, theologians and philosophers have long said that “we are depraved, irrational creatures, and the social science has finally caught up with that.”

This hesitancy to even consider evidence that conflicts with our existing beliefs has implications on public trust in science. Too often, “believing in science” takes on political implications. 

According to Pew Research Center, only 13% of Republicans have “a great deal” of confidence in scientists, compared to 43% of Democrats. “Many people on the left think of the universities as belonging to them,” says Worthen, leading to a greater sense of trust in science. “There is a desire on the left to want science to line up” with their political views, Green agrees, but good science isn’t inherently aligned with a particular political party. Science involves uncertainty and “iterative self-correction,” Worthen says, but even acknowledging uncertainty can spawn controversy. And when science doesn’t perfectly align with someone’s political or ideological beliefs, it can make people uncomfortable. For instance, Worthen believes that “the retreating date of viability” for fetuses and better fetal imaging technology is “provoking… discomfort on the left” in conversations about abortion.

Evolucionismo_Teísta.jpg by Felipe Ligeiro FL on Wikimedia Commons. Licensed under the Creative Commons Attribution-Share Alike 4.0 International license.

Similarly, evidence from evolutionary biology can be hard to reconcile with deeply held religious beliefs. Worthen describes an interview she did with Dr. Nathaniel Jeanson. He has a Ph.D. from Harvard in cell and developmental biology, but he is also a Young Earth creationist who believes the earth was created by God in six days. There are “plenty of conservative Christians who understand those days as metaphors,” Worthen says, but Jeanson takes the six-day timeframe described in the Bible literally. In Worthen’s article, she says that Jeanson “dutifully studied evolutionary biology during the day and read creationist literature at night.” One thing Worthen admired in Jeanson was his willingness to be “honest about who we are”: not very open to new evidence.

“I think very few humans are anti-science,” Worthen says. “It’s more that humans are selectively pro-science.”

It isn’t just politics that can cause people to distrust science. Green points out that people who have had frustrating experiences with traditional healthcare may look for “other pathways to achieving a sense of control.” When patients know that something is wrong, and mainstream medicine fails them in some way, they may turn to alternative treatments. “That feeling of not being understood by the people who are supposed to know better than you is actually pretty common,” Green says, and it can fuel “selective distrust.”

It can be helpful, Worthen says, for a clinician to present themselves as someone trustworthy within a larger system that some patients view as “suspect.”

Distrust in public health authorities has been a recurring theme during the Covid pandemic. Green recalls interviewing an orthodox Jewish man in New York about his community’s experiences during the pandemic. Many Orthodox Jewish communities were hit hard by Covid, and Green believes it’s important to recognize that there were many factors involved. Even well-meaning health officials often lacked the language skills to speak dialects of Yiddish and other languages, and the absence of strong, pre-existing relationships with Orthodox communities made it harder to build trust in the middle of a crisis.

Worthen spoke about vaccine hesitancy. “For most of the population who has gotten the [Covid] vaccine,” she says, “it’s not because they understand the science but because they’re willing to ‘outsource’” their health decisions to public health authorities. It is “important not to lose sight of… how much this is about trust rather than understanding empirical facts.”

Finally, both speakers discussed the impacts of social media on polarization. According to Green, “information ecosystems can develop in social media and become self-contained.” While “there are a lot of people out there who are quacks who purport to be experts,” social media has also created public health “stars” who offer advice and knowledge to a social media audience. Even that, however, can have downsides. “There isn’t a lot of space for uncertainty, which is a huge part of science,” Green says.

Worthen, meanwhile, believes that “social media is one of the main assets destroying our civilization…. I would encourage everyone to delete your accounts.”

Polarization is pervasive, dangerous, and difficult to change. “As a journalist, I basically never have answers,” Green says, but maybe learning from journalists and their efforts to understand many different perspectives can at least help us begin to ask the right questions. Learning to actually listen to each other could be a good place to start.

Post by Sophie Cox, Class of 2025

For Weary Scholars, a Moment to Regroup, Reconnect…and Write

DURHAM, N.C. — English professor Charlotte Sussman doesn’t get much time in her role as department chair to work on her latest book project, an edited collection of essays on migration in and out of Europe.

“At least not during daylight hours,” Sussman said.

But a recent workshop brought a welcome change to that. Sussman was one of 22 faculty who gathered Dec. 13 for an end-of-semester writing retreat hosted by the Duke Faculty Write Program.

Duke faculty and staff gather for an end-of-semester writing retreat.

Most of them know all too well the burnout faculty and students face at the end of the semester. But for a few precious hours, they hit pause on the constant onslaught of emails, meetings, grading and other duties to work alongside fellow writers.

The participants sat elbow-to-elbow around small tables in a sunlit room at the Duke Integrative Medicine Center. Some scribbled on pads of paper; others peered over their laptops.

Each person used the time to focus on a specific writing project. Sussman aimed to tackle an introduction for her 34-essay collection. Others spent the day working on a grant application, a book chapter, a course proposal, a conference presentation.

Jennifer Ahern-Dodson, Ph.D.
Jennifer Ahern-Dodson, Ph.D.

“We have so many negative associations with writing because there’s always something more to do,” said associate professor of the practice Jennifer Ahern-Dodson, who directs the program. “I want to change the way people experience writing.”

Ahern-Dodson encouraged the group to break their projects into small, specific tasks as they worked toward their goals. It might be reading a journal article, drafting an outline, organizing some notes, even just creating or finding a file.

After a brief workshop, she kicked off a 60-minute writing session. “Now we write!” she said.

The retreat is the latest installment in a series that Ahern-Dodson has been leading for over 10 years. In a typical week, most of these scholars wouldn’t find themselves in the same room. There were faculty and administrators from fields as diverse as history, African and African American Studies, law, psychology, classics, biostatistics. New hires sitting alongside senior scholars with decades at Duke.

Peggy Nicholson, J.D., Clinical Professor of Law, writing alongside colleagues from across campus

“I really like the diversity of the group,” said Carolyn Lee, Professor of the Practice of Asian and Middle Eastern Studies. “It’s a supportive environment without any judgement. They all have the same goal: they want to get some writing done.”

Sussman said such Faculty Write program get-togethers have been “indispensable” to bringing some of her writing projects over the finish line.

Participants say the program not only fosters productivity, but also a sense of connection and belonging. Take Cecilia Márquez, assistant professor in the Duke History Department. She joined the Duke faculty in 2019, but within months the world went into COVID-19 lockdown.

“This was my way to meet colleagues,” said Márquez, who has since started a writing group for Latinx scholars as an offshoot.

The writing retreats are free for participants, thanks to funding from the Office of the Dean of Trinity College of Arts and Sciences and the Thompson Writing Program. Participants enjoy lunch, coaching and community in what’s normally a solitary activity.

“I appreciate the culture of collaboration,” said David Landes, who came to Duke this year as Assistant Professor of the Practice in Duke’s Thompson Writing Program. “In the humanities our work is intensely individualized.”

Assistant Professor of Biostatistics & Bioinformatics Hwanhee Hong (left) and Adam Rosenblatt, Associate Professor of the Practice in International Comparative Studies (right)

Retreats are one of many forms of support offered by the Faculty Write program: there are also writing groups and workshops on topics such as balancing teaching and scholarship or managing large research projects.

“One of the distinguishing features of Faculty Write is the community that extends beyond one event,” Ahern-Dodson said. “Many retreats are reunions.”

After two hours of writing, Ahern-Dodson prompted the group to take a break. Some got up to stretch or grab a snack; others stepped outside to chat or stroll through the center’s labyrinth at the edge of Duke Forest.

It’s more than just dedicated writing time, Ahern-Dodson said. It’s also “learning how to work with the time they have.”

The retreats offer tips from behavioral psychology, writing studies, and other disciplines on time management, motivation, working with reader feedback, and other topics.

As they wrap up the last writing session of the day, Ahern-Dodson talks about how to keep momentum.

“Slow-downs and writing block are normal,” Ahern-Dodson said. Maybe how you wrote before isn’t working anymore, or you’re in a rut. Perhaps you’re not sure how to move forward, or maybe writing simply feels like a slog.

“There are some things you could try to get unstuck,” Ahern-Dodson said. Consider changing up your routine: when and where you write, or how long each writing session lasts.

“Protect your writing time as you would any other meeting,” Ahern-Dodson said.

Sharing weekly goals and accomplishments with other people can help too, she added.

“Celebrate each win.”

Ultimately, Ahern-Dodson says, the focus is not on productivity but on meaning, progress and satisfaction over time.

“It’s all about building a sustainable writing practice,” she said.

Ahern-Dodson leads an end-of-semester writing retreat for Duke scholars.

Coming soon: On Friday, Jan. 27 from 12-1 p.m., join Vice Provost for Faculty Advancement Abbas Benmamoun for a conversation about how writing works for him as a scholar and administrator. In person in Rubenstein Library 249 (Carpenter Fletcher Room)

Get Involved: Faculty and staff are invited to sign up for writing groups for spring 2023 here.

Learn more about sustainable writing practices: “The Productivity Trap: Why We Need a New Model of Faculty Writing Support,” Jennifer Ahern-Dodson and Monique Dufour. Change, January/February 2023.

Robin Smith
By Robin Smith

How Art Reflected Child Mortality in the 20th Century

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?

These guiding questions drove Dr. Perri Klass, Professor of Journalism and Pediatrics at NYU, to pen her recently published book, “The Best Medicine: How Science and Public Health Gave Children a Future.” A distinguished clinician, author, and medical historian, Klass explored prominent art and literary works from this era of high infant and child mortality at the recent Trent Humanities in Medicine Lecture at the Duke School of Medicine, titled “One Vacant Chair: Remembering Children”.

Dr. Perri Klass, MD

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.

“Uncle Tom’s Cabin.” Published in 1852 by Harriet Beecher Stowe.

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.

Post by Vibhav Nandagiri, Class of 2025

American Epidemics and the Viral Underclass

March 2020. The subsequent blur of months. Of spring into summer, fall into winter, a year into another and likely into the next. Like millions of humans around the world, 2020 itself feels infected, as if wrapped up with yellow caution tape. Virus dominates the current zeitgeist; pandemic won Merriam-Webster’s 2020 word of the year; vaccine in 2021.

We are all proto-virologists, sludging through the constant slew of “viral” media: novel variants, outbreaks, booster shots, mutations (a jargon in which we’re collectively fluent). 

In the somewhat-receding wake of COVID-19, like floodwater, viral fear recently surged again when the World Health Organization began reporting monkeypox (MPX) outbreaks in Europe and North America. The stigmatization of MPX patients as “disease-spreaders” (in the media, on the internet, in conversation, etc.) suggests these individuals have a kind of authority over the virulent strands of DNA in their bodies. This belief aligns with the etymology of “virus” from the Latin “poison,” a word that functions as both noun and verb. Passive and active. Culpable.

Alan Krumeweide in Contagion (Claudette Barius / Warner Bros.)

I’m reminded of Jude Law’s fear-mongering character in Contagion, Alan Krumewiede, the conspiracy theorist who conjectured MEV-1, the film’s fictional virus, was “Godzilla, King Kong, Frankenstein, all in one.” 

Of course, this sentiment did not bud from MPX or COVID-19 like a novel variant. No, it has existed in the United States for decades, if not longer, and it has not been dormant.

Dr. Stephen Thrasher, a scholar of the criminalization of HIV/AIDS at Northwestern University, stood in Duke’s anthropology lecture hall this month and drew parallels between the recent MPX/COVID-19 epidemics and that of HIV/AIDS in the 1980s-90s and stretching into the new millennium. He asked us to raise our hands if we personally knew someone with HIV/AIDS. A few did. If we knew someone who had died from HIV-related causes. A few less. What about COVID? The entire audience raised hands as if to signal the new era of viral infection.

Dr. Steven Thrasher is the inaugural Daniel H. Renberg Chair of social justice in reporting (with an emphasis on issues relevant to the LGBTQ community) and an assistant professor of journalism at Northwestern. His research focuses on HIV in America.

Since the start of the HIV/AIDS epidemic in 1981, more than 700,000 people have died from HIV-related illness in the United States, a disproportionate number of whom were men who had sex with men and injection drug users (with poverty exacerbating the likelihood of acquisition).

As Thrasher historicized, the stigma that encapsulated HIV/AIDS significantly delayed life-saving interventions on the local and national scale. Prejudice hindered research funding, drug distribution, and government health agency mobilization. The rising tide of the HIV/AIDS epidemic was concurrent with increased violence towards the LGBTQ community, and gay men in particular, analogous to a king tide flooding the coastline.

Thrasher exemplified this taboo through the “patient zero” misconception, which was propagated by the media during the epidemic and embedded like a splinter in pop culture’s thumb (i.e. the film Patient Zero with Matt Smith, Stanley Tucci, and Natalie Dormer). 

Gaëtan Dugas was miscredited as Patient Zero of the HIV/AIDS epidemic in America 
Credit: Fadoo Productions

Gaëtan Dugas, a Québécois Canadian flight attendant, was inappropriately labeled “patient zero” of the HIV/AIDS epidemic in America. As Thrasher and other researchers have debunked, Dugas was, in fact, not the first person to bring HIV to the United States. Further, Dugas was not even included in the early infection group. And Dugas was Patient O (like oh), not zero, for Out-of-State. Yet, this contextualization of the virus endures despite being disproved. Upon diagnosis, many infected individuals will experience shame.

In the 1980s and 90s, HIV/AIDS was characterized as the “gay plague,” setting ablaze a moral panic in America comparable to that of the Satanic Panic, rock ‘n’ roll, and fear of razor blades stuffed into gooey 3 Musketeers bars at Halloween (and there’s an interesting overlap in the timing of these hysterias in the collective American consciousness). And just two months ago even, many people were characterizing MPX in the same accusatory and morally dubious way. 

Like with the AIDS epidemic, Thrasher said the US government failed to mobilize public health initiatives early enough to proactively stifle MPX outbreaks in spite of the disease’s well-documented diffusion across Europe and into neighboring Canada.

“We could’ve tapped the Strategic National Stockpile,” he argued. Thrasher listed multiple public health interventions that could have and should have been implemented with the first faint smoke signals of MPX in the United States (as they were in the past for meningitis and polio outbreaks). 

For context, the Strategic National Stockpile (SNS) is a cache of medicines, antibiotics, and vaccines that the government started to accumulate just prior to 9/11 in 2001 and, seemingly, in an exponential manner after — almost like doomsday preppers hoarding freeze-dried beef stroganoff and cans of beans in their underground bunkers. Born from the smoking rubble and smoke of New York City following the terrorist attack, fear of biological warfare, especially the weaponization of smallpox, paralyzed the US (i.e. the Anthrax scare).

The SNS was tapped after 9/11, for 12 major hurricanes, COVID-19, and the swine flu (to name a few), but not for monkeypox.

As historically evidenced, mass vaccination and herd immunity effectively prevent the spread of viral infections, especially for slow-mutating viruses like MPX.

“We should have quickly vaccinated queer men and transmasc people,” Thrasher said, “building on a very historic anomaly which is that adults have been socialized to take vaccines en masse in a way that has not happened in many decades.” And because MPX and smallpox are closely related viruses, a rollout of the stockpile’s smallpox vaccine could have nipped the outbreak in the bud. 

But, the SNS was not tapped. 100 million doses remain stockpiled. There are nearly 28,000 total monkeypox cases documented in the United States.

A large focus of Thrasher’s research is on who is affected by viruses, and how, and why. Nearing 6.6 million COVID-19 deaths worldwide, many would argue that viruses — these ancient, non-life forms — are Earth’s “great equalizers,” as acknowledged by Thrasher in multiple publications. Evolution has pushed them to infect, replicate, and spread: machine-like and non-discriminatory.

But, he added, viruses are not great equalizers. Infection is inherently unequal. Again, we must ask the question who?

Thrasher’s book The Viral Underclass: The Human Toll When Inequality and Disease Collide was recently long-listed for the 2023 Andrew Carnegie Medal for Excellence in nonfiction

Viral infections disproportionately burden marginalized bodies and communities, a concept Thrasher framed as the viral underclass (coined by activist Sean Strub and reshaped by Thrasher to describe this phenomenon)Writing in his book of the same name, “… the viral underclass can help us think about how and why marginalized populations are subjected to increased harms of viral transmission, exposure, replication, and death.”  

Let’s return to the MPX vaccine. The Biden administration did not tap the SNS for mass vaccination. Instead, it rolled out meager health interventions at a snail’s pace (like Sisyphus pushing his stone up the hill). Still, many at-risk individuals, in particular men who have sex with men, opted to receive a two-shot regimen to protect themselves from the virus. Considering the viral underclass, Thrasher posed the following questions: 

Who is disproportionately burdened by MPX in the US? He answered, “Black and Latino men who have sex with men.” 

And, who is receiving the medical interventions to protect themselves from the painful infection? He answered again, “I got one MPX vaccine shot, almost everyone in line but me and a friend were white.” He describes the discrepancy between those receiving the vaccine and those most at-risk of acquiring MPX in his Scientific American article “Monkeypox Is a Sexually Transmitted Infection, and Knowing That Can Help Protect People.”

And his years of HIV research corroborate this trend.

From the New York Times, Michael Johnson has been working to overturn laws criminalizing HIV in the United States.

He spoke (and wrote in The Viral Underclass) about his time reporting the Michael Johnson court case in St. Louis, Missouri. Michael Johnson, a black, gay, former college wrestler, was sentenced to 30 years in prison after failing to disclose his HIV status to his sexual partners — a criminal offense. The prosecution had sought a maximum 60.5 years, practically a life sentence.

For context, in the state of North Carolina, the maximum sentence for voluntary manslaughter is a little under five and a half years. In the courtroom, Thrasher was privy to the prosecution’s smoking gun: Johnson had previously signed a legally-binding acknowledgment of his HIV diagnosis. With the flick of a pen, nondisclosure was a criminal offense.

In his interviews, however, Thrasher found that Michael Johnson was semi-illiterate and had not been properly informed of the legal implications of the document he had signed. Nor had he been informed of the consequences of breaking the legal contract. Nor had he been counseled or given any legal advice prior to being charged. 

Michael Johnson was released from prison 25 years early after his ruling was overturned. His is a body in the viral underclass. 

Excerpted from Thrasher’s book The Viral Underclass: The Human Toll When Inequality and Disease Collide
Vito Russo speaks at the 1988 ACT UP demonstration at the Department of Health and Human Services in Washington, D.C.
Credit: Rick Gerharter/HBO Documentary Films

Concluding his lecture, Thrasher quoted AIDS activist Vito Russo’s Why We Fight speech from the 1988 ACT UP Demonstration at the Department of Health and Human Services. In reading the entire transcript, I found that Russo was aware of the viral underclass, as Thrasher theorized, despite the term not yet existing in the academic ethos. He said in his address: 

“If I’m dying from anything — I’m dying from the fact that not enough rich, white, heterosexual men have gotten AIDS…. Living with AIDS in this country is like living in the twilight zone. Living with AIDS is like living through a war which is happening only for those people who happen to be in the trenches. Every time a shell explodes, you look around and you discover that you’ve lost more of your friends, but nobody else notices. It isn’t happening to them.” 

Is it possible to ever resolve the viral underclass in the US? As long as systemic inequities continue to exist, no. This may seem pessimistic or even cynical, but Thrasher concluded his lecture (and his book) with reserved optimism. “Let’s get to work,” he implored.

If we can identify and actively dismantle the systems that disproportionately burden certain populations with viruses and diseases, like a spool of yarn, we can begin to unravel the viral underclass in America.

Yes, infections should be treated with accessible and affordable medicine. Yes, healthcare should be expanded. Yes, we should continue to improve the efficacy of drugs and diagnostics. But, health interventions alone do not cure communities of disease.

Thrasher found that marginalized bodies will continue to be infected, in spite of medicinal intervention, if the inequities from which the viral underclass emerge are not concurrently cured. Let’s get to work.

If interested, here’s a link to Thrasher’s website and book: http://steventhrasher.com/

Post by Alex Clifford, Class of 2024

What is Biblical Research, Anyway? The Answer Might Surprise You

This is part one of a two-part series; next week we will dive into the nitty-gritty of biblical research, but for now, we’re focusing on what biblical research is and why it matters.

Image courtesy of Duke Divinity School

To the uninitiated, “biblical research” might not conjure up images of dancing, or analyzing films, or studying engineering. But meet Maximillion Whelan. A third-year M.Div. student at Duke, Whelan runs a website for film aficionados focusing on analyzing movie scenes and was recently published in Quarterly Review of Film and Video for an article on theology and film. He notes: “Biblical research sheds light on how everyday activities effectively shape history and are also shaped by history. By “zooming in,” delving into the details and contexts, biblical research enables us to simultaneously “zoom out” – to see what things we are taking for granted, where our readings have led us, and how we take our readings into other spheres of life.”

Image courtesy of Nicole Kallson (as part of her course Introduction to Theology and the Arts)

Or take Divinity School student Nicole Kallson. She is pursuing a Master’s of Theological Studies with a Certificate in Theology and the Arts.

“As a theologian and dancer, I use my background in dance to assist my understanding of the Bible.” Kallson explains. “I tend to focus on ideas of embodiment, beauty, and inter- and intra- personal relationships.”

Both students—along with countless other Blue Devils and other mascot identities—use their studies as a lens through which to examine themselves and their passions. And isn’t that what we emphasize so clearly at Duke—the interdisciplinary, interpersonal, interfaith, international, interwoven identities of people, places, and things? Is that not what research is all about in the end? Perhaps the purpose of biblical research is not as foreign to us as we may think at first.

Degree-seekers may come from expertise in literature, classical studies, practical faith, or other backgrounds that may easily come to mind. But they also come from natural sciences, physical sciences, political science, art and media studies, creative writing, engineering, medicine, sociology, public policy, economics, and so much more. And each of these students is applying their research and understanding of the Bible to their understanding of the world at large, seeking to become better, more intentional academics in the process.

The new Dean of Duke Divinity School was born and raised in Puerto Rico; he has prayed with Pope Francis and presented him with writings on interfaith dialogues. He also has Bachelor’s and Master’s degrees in mechanical engineering.

Dean Edgardo Colon-Emeric moderated a symposium on the Bible last Friday, October 11, 2022 through the Karsh Alumni Center Forever Learning Institute (part of the Policing Pages series, which Jakaiyah Franklin also wrote about for the Blog!).

“It might seem odd to have a series focused on the Bible as a banned book, given that it’s the most polished book in history,” he opened. He gave an example further; for a time in recent Guatemalan history, possession of the Bible was persecuted as a means of targeting perceived Communist empathizers. Even within Christain communities, he explains, there has been discourse among devotees of certain translations and versions—not all of them amenable.

The event also featured Brent Strawn of the Duke Divinity School and Jennifer Knust from Trinity College of Arts & Sciences Department of Religious Studies.

Jennifer Knust during the Forever Learning Institute’s Policing Pages presentation on the Bible

“The survival of the New Testament as a text and a collection is a theological and practical achievement,” noted Knust. “It is repeatedly refreshed in response to new circumstances, even as remains of past approaches continue to shape what can happen next.”

It is because of the differing opinions of so many people over such a long time that we have different faiths, and biblical research uses the lens of Christianity to evaluate that phenomenon.

Knust continues: “Today we know that there are over 5,000 manuscript copies of the New Testament, none of which are identical in every particular.”

She herself was a member of the board of the New Revised Standard Version Updated Edition—the most recent scholarly translation of the Bible, published in 2021. She elaborated on her feelings on the dynamics and fluidity of the text, describing a constant push and pull of desire and tradition. Perhaps researchers, in the present, past, or future, may desire to change words, meanings, or uses of the Bible, but they are contradicted by a tradition dictated by the populous.

Biblical research seeks to answer questions about the Bible— and by extension, the fruitfulness of humanity. The sustainability of religious texts of all kinds is a testament (pun intended) to the success of human minds compounded over thousands of years.

A 1611 copy of the Authorized Version Knust uses as an example of different Protestant translations.

On this PeopleMover-style tour of biblical research, I hope we’ve taken away some key points:

Firstly, the work of many biblical researchers is deeply personal. We’ve discovered through this that the work of any researcher in any field has the potential to be deeply personal.

Additionally, we learned that the interdisciplinary reach of biblical studies works inversely; students may turn to biblical research from other subjects to enhance their work, or they may even turn to other subjects to enhance their work in biblical research.

And finally, we arrive at our destination; next week we’ll talk more in-depth about what biblical research entails and meet some key players in those conversations.

Post by Olivia Ares, Class of 2025

Banned Books Then and Now

With the never-ending news of schools banning books, one has to ask about the history and effectiveness of banned books. Fortunately, the Duke Forever Learning Institute hosted a seminar on the history of banned books in late September and provided examples that showed the ineffectiveness of banned books throughout time.

There was one particular story, however, that caught my eye, and that was the retelling of the history behind a banned book written by a man named Gottschalk. Clare Woods, an associate professor of Classical Studies at Duke, delineated the narrative of Gottschalk’s life from birth to prisoner.

A map containing the monasteries Gottschalk visited. (provided by Dr. Clare Woods)

Gottschalk was born to an aristocratic family around 803 AD and started his academic career when he moved into Fulda, a monastery, to become a monk. However, in 829 AD, Gottschalk left Fulda for reasons based either on the loss of his older brother or the enlightenment he received from the monastery he attended while studying abroad.

Upon leaving Fulda, Gottschalk studied at the monasteries of Corbie and then moved to northern Italy after he received his orientation as a priest. Gottschalk was unusual because monks tended not to move around that much, and monks also tended not to speak about their studies on heretical doctrine. Unfortunately for Gottschalk, he ignored the criticisms from other monks and instead grew confident in his studies to the point where he wrote a book about them.

While receiving hate for his ideas from multiple people, one man from Gottschalk’s past was truly adamant about having Gottschalk punished. This man was named Rabanus (Hrabanus), and he was accused by Gottschalk of coercing Gottschalk’s earlier career as a monk. From that, and with Gottschalk leaving the Fulda, Rabanus developed a personal vendetta against Gottschalk.

This is an excerpt from Gottschalk’s confession, which was provided by Dr. Clare Woods.

Gottschalk, the confident man he was, decided to defend himself at a Synod in Mainz, but it proved unsuccessful because he was condemned by the Synod and banned from the Kingdom of Louis. From there on, things did not improve for Gottschalk because, in the following year, he was brought to a second Synod that was attended by King Charles, who was the brother of King Louis the German. By the end of this Synod, Gottschalk was stripped of his priesthood, sentenced to silence, and imprisoned.

However, even with the punishments Gottschalk personally received and his books being burned, his books were still preserved and influential on others.

This influence seen with Gottschalk’s books after being banned was not an anomaly because that was seen with all banned books throughout history.

Another example was given by Lauren Ginsberg, an associate professor of classical studies, who presented Permussius Cordis, an author who lived under the Roman emperor Tiberius in the 1st century AD.

His story ended in tragedy since his books were included in a mass book burning and he was sentenced to death. However, his book still was able to influence the Roman population due to his daughter Marsha’s vigilance in keeping her father’s book alive.

While I only provided two examples, this pattern of books withstanding their ban is throughout time, and it is being repeated in the present. Across this country, book banning is back in style. In 2018, there were only 347 books that schools formally challenged, but in 2021 it became 1,500.

An example of books that have been banned in multiple schools (Freedman)

While this does put light on our current education system in this country, this is simply a gesture. It does make us think about what children will be learning in schools, but because the books are banned in schools does not mean the information within those books will not reach their target demographic. As seen in history, knowledge always finds a way of spreading, but of course, that is dependent on those who want to expand that knowledge.

At the end of this article, I hope you are reassured that seeing a banned book does not mean it is forever silenced. Instead, I hope that by reading this, you understand that you have all the power to ensure that the words within a book can withstand anything, including time.

Post by Jakaiyah Franklin, Class of 2025

Citation: Freedman, Samuel G. “A Display of Banned or Censored Books at a Bookstore Last October. Over a Recent 9 Month Period More than 1,500 Books Have Been Banned in Schools, Most Featuring Nonwhite Protagonists, Dealing with Racism, or Addressing the LGBTQ Experience.” Los Angeles Times, Los Angeles Times, 27 June 2022, https://www.latimes.com/opinion/story/2022-06-27/book-bans-critical-race-theory-wisconsin. Accessed 10 Oct. 2022.

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