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Roots and Resilience: Students Document Climate Change in Durham

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On Thursday, April 17, students from Duke’s course Climate, Culture and Identity held a screening for their documentary shorts focusing on how climate change has been impacting Durham and nearby communities. Led by Duke professors Saskia Cornes and Lauren Henschel, the class produced intellectually stimulating and inspirational documentary shorts.

Students in Climate, Culture and Identity. Photo Credit: Shaun King, Duke

“These are people who have never made films before,” said Cornes, an assistant professor of the practice of the John Hope Franklin Humanities Institute and program director of the Duke Campus Farm. “They’ve spent a lot of time thinking with really complicated texts, with works of poetry, a lot of really heavy critical theory, films, and documentaries,” pointing to the rows of both butterfly-bellied and proud students waiting to share their work with us.

Henschel, Instructor in the Department of Gender, Sexuality & Feminist Studies, director of Doc+ at Duke Center for Documentary Studies and a Duke alumna, added that “These films are more than assignments. They are meaningful contributions to an ongoing conversation. They expand what it means to do climate work by bringing academic ideas into dialogue with real lives, real communities and real urgency.” She also said, “Just 14 weeks ago, the students didn’t even know they’d be making a film in this course” for which they used nothing but their own phones and the help of their professors.

From left to right: Lauren Henschel and Saskia Cornes. Photo Credit: Shaun King, Duke

The four films featured in the screening were “The Roots of Environmental Justice: Legacy & Origins in Warren County,” made by students Laura Cai, Durga Sreenivasan and Audie Waller; “Where Justice Grows: Food, Care, and Collective Sustainability,” made by students Alayna Binder, Annie Carey and Bella Vieser; “Sowing Seeds of Conversation: Navigating the History of the Duke Campus Farm,” made by students Hunter Habersaat, Ilakkiya Senthilkumar and Jennifer Yoon, and “From the Holler to the Sea, I’ve Got You and You’ve Got Me,” made by students Reesey du Pont, Lilah Gorfain and Beatrice Ghosn. Two films stood out to me.

Audience watching student film, “The Roots of Environmental Justice: Legacy & Origins in Warren County.” Photo Credit: Shaun King, Duke

Sowing Seeds of Conversation: Navigating the History of the Duke Campus Farm”

Shot at the Duke Campus Farm, this documentary short seeks to stitch together the joy of caring for the land at the Duke Campus Farm, and the muddied past of the area where the farm sits, in order to paint a complete picture of what the Duke Campus Farm means to its community. The students who created the film brought multiple perspectives forward, including conservationists, student volunteers, and Duke professors, intertwining these interviews with shots capturing the beauty of the farm.

The Duke Campus Farm is a place for many volunteers and workers to find peace and joy from nourishing. However, it is unclear if the farm sits upon land that once was plantation land where enslaved peoples were forced to work. As a result, the farm offers Duke students a chance to tend to soil marked by generations of violence, while also recognizing their place within a broader institution that has historically harmed marginalized communities. “That is what we want to highlight in our film, that you are doing something by being an active member of your community, and it matters,” said Yoon, who is studying biology at Duke. “You might just think this film is just a class project, but it’s really not because it’s making people’s voices heard and telling the story of the farm and how that affects people in Durham and whoever goes to volunteer.”

From left to right: Jennifer Yoon, Hunter Habersaat, and Ilakkiya Senthilkumar. Photo Credit: Shaun King, Duke

It is clear that these students were not afraid to tackle difficult topics, emphasizing the need to research the land’s unclear history so that Duke can acknowledge and implement it into the story of the Duke Campus Farm.

From the Holler to the Sea, I’ve Got You and You’ve Got Me

This documentary short focuses on Triangle Mutual Aid, a Research Triangle-based community-led initiative that supported Western North Carolina after the horrific destruction of Hurricane Helene.

Triangle Mutual Aid was quick to offer support, organizing the collection and delivery of supplies just days after the hurricane hit. However, none of this would have been possible without the caring people of Durham, who were promptly donating what they could to Triangle Mutual Aid’s drop-off locations.

The short emphasizes the difference between Mutual Aid and charity work. For one, Mutual Aid does not rely on a hierarchical power; anyone who wants to volunteer is appreciated, respected, and welcome to the community. Additionally, Triangle Mutual Aid prioritizes the relationships between those involved and the community, contributing to a better world, all while relying on the needs and desires of a community and the extent of help the volunteers can provide.

“I think a lot of times when you see pieces in the news after the devastation of hurricane Helene, or environmental disasters, you might see the words and maybe you start to absorb the words of folks, but to see them [the volunteers] on screen has a different effect for you as a viewer,” said Duke student Reesey du Pont, who is studying International Comparative Studies and Public Policy.

From left to right: Beatrice Ghosn, Lilah Gorfain, Reesey du Pont, and Lauren Henschel. Photo Credit: Shaun King, Duke

As someone from Asheville who saw the devastation of Helene affect my own community, family, and friends, getting to see the faces of those in the Durham community who were so responsive in the wake of the destruction made me feel grateful to be a part of this giving community.

Getting the opportunity to watch all four amazing documentary shorts was truly a pleasure. The students wove together the STEM world of environmental science and conservation and the humanities world of culture and documentary studies seamlessly, showing their true dedication to telling the stories of those involved in the Durham community. It is also clear how much the students look up to their professors, Saskia Cornes and Lauren Henschel, thanking them many times for all their help and guidance throughout the semester.

I hope that we all can learn from these documentary shorts and approach our lives as Durham residents differently, integrating ourselves into the generous community more while acknowledging the history of where we stand.

Sarah Pusser Class of 2028

How Churches and Communities Are Teaming Up for Climate Resilience

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As record-breaking heat waves spread across the nation, a new movement is rising. 

Houses of worship have long served as anchors during times of crisis. Now, they’re becoming hubs for climate resilience.

At a March 27 gathering in Duke’s Goodson Chapel, faith leaders, organizers, and energy advocates—Pastor Neil Bernard (New Wine Christian Fellowship), Angella Dunston (Warren County Environmental Action Team), and Reverend Leo Woodberry (Kingdom Living Temple and New Alpha Community Development)—came together to discuss powerful initiatives, from solar-powered sanctuaries in Louisiana to grassroots environmental justice campaigns in North Carolina.

The message was clear: no one can do this alone. But together, we can do everything.

Bernard, pastor of a congregation in Louisiana’s St. John the Baptist Parish—one of the most disaster-prone areas in the U.S., opened the evening with urgency and vision. He recalled when Hurricane Ida hit the Bayou State in 2021, and reflected on the death toll from extreme heat. But then he spoke of hope: Community Lighthouses—solar-powered hubs anchored in houses of worship, built to offer electricity and refuge in times of need

“Right now, we have 19. But the goal is one in every vulnerable community,” Bernard said, his voice rising. “When everyone has power—we have power.” His words weren’t just about electricity. They were about collective strength. Heads nodded. The room hummed in agreement.

These lighthouses didn’t materialize from one church alone—they were born from partnerships across city agencies, utilities, organizers, and faith groups. That’s the model. He said, “The power of teamwork is what makes the dream work.”

Duke’s Ashley Ward (L to R) hosts a panel with Pastor Neil Bernard (New Wine Christian Fellowship), Angella Dunston (Warren County Environmental Action Team), and Reverend Leo Woodberry (Kingdom Living Temple and New Alpha Community Development). Photo by Ashley Stephenson

Woodberry reminded the audience, his voice echoing through the chapel, “Jesus said, I give you power.” He added, “The most common way people give up their power is by believing they don’t have any.” These lighthouses are more than climate infrastructure—they are spiritual anchors grounded in the belief that resilience is holy work.

He argued that religious institutions are America’s greatest untapped asset. “They own land, buildings, communication tools—and they reach more people than any NGO,” he said. “If we fail to activate them, we leave the door open for exploitation.”

These institutions already know how to organize. They’ve been here before.

Dunston, an energy cooperative leader and longtime community advocate, brought the room back to the 1980s in Warren County, North Carolina. When state officials decided to dump toxic soil in her majority-Black neighborhood, the fight started not in courtrooms—but in her church.

“It was the women of our church who stood up,” she said, her voice ringing clear. “We don’t get the acknowledgment, but we do it anyway.”

Faith-based organizations have long played a vital role in responding to crises in our region, experts say. The conversation was part of Duke’s Cooling Communities project advancing community-driven solutions to extreme heat. Photo by Ashley Stephenson

The landfill closed permanently in 2003, but the damage—rising illness, distrust—remains. Still, Dunston has never stopped advocating. Today, she fights utility bills as high as $800 a month in the same communities. Her faith grounds her work, but she also knows that faith alone isn’t enough.

“If policy isn’t working for us, how do we organize our churches and communities?” she asked. “We must fight for those who cannot fight for themselves.”

Dunston stressed the need for partnerships—with government, scientists, and especially universities. Duke University students, for example, have supported advocacy efforts in Warren County. But she noted that faith communities won’t accept help from institutions they don’t trust. “Build relationships before the next crisis,” she urged. “We need data, yes—but we need trust more. Move at the speed of trust.”

The panel left me with an urge to offer this as a call to action: If you’re part of a faith institution, ask yourself—is your house of worship ready to become a community lighthouse? According to them, the climate crisis isn’t coming—it’s here. And the time to act, together, is now.

Post by Noor Nazir, class of 2027

How the Humanities Helped This Duke Grad Become the Doctor She Hoped to Be

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“I see you, you see me, I trust you to know me.”

This phrase was one of many that underscored the powerful testimony Dr. Jennifer Hong, Massachusetts General Hospital physician and Duke alumna, shared on March 23 in a talk on West Campus. Invited by Duke’s Humanities in Medicine club, Hong spoke eloquently about the importance of humanities in medicine, leaning on her undergraduate experience as an English/Neuroscience pre-med and her medical training. Her moving stories about patients and her perspective on the American medical system captivated the entire audience.

Dr. Jennifer Hong (‘14), MGM primary care physician and Duke alumna


Hong opened her discussion by underscoring the power of language—and the potential of wielding narrative writing as a “weapon of resistance.” She shared how, as an undergrad, her most memorable, impactful academic lessons were ones in the English realm, where she explored how historical narratives of female physicians revealed the pervasive patriarchy underlying medicine. Hong reflected that the skills required to be an adept doctor are much akin to those needed to write a good essay: one must be able to relate to people and experiences that are very different from one’s own.


To back up her claim, Hong shared a story from her early days of residency. One day, she and her team were overwhelmed by two Code Blues—the highest level of medical alerts—and a rapid response, which she was handling alone. As a slew of medical professionals rushed into the patient’s room, Hong noted that the patient and her partner had no idea what was happening, as they spoke no English. Connecting with the patient’s son over the phone, Hong tried to explain to the best of her ability the situation and her perspective—the patient’s metastatic cancer prognosis would be best approached with comfort care, not more ventilators.


“You’re hurting them. Stop hurting them,” was the son’s short reply.


This was a landmark moment in Hong’s training, one she described as “shell shocking” and “demonstrating to people who want control that they have no control”. In a rapidly evolving environment where so many elements demand physicians’ attention, Hong notes that it’s incredibly easy to act in a way not aligned with one’s personal values. This foreshadowed one of her responses to a later question regarding what exercises or habits prospective medical students should adopt before stepping into graduate education: she suggested that students should periodically check in on their values and how they plan on upholding them.


The captivating lecture continued to include many remarks on the current state of medicine in America. As an aspiring pre-med student, I find it enlightening and disturbing to hear about the unignorable forces at work every day in physician offices and the hospital setting. Hong carefully described how, despite medicine being “the last frontier” where societal wrongs could be remedied and addressed, capitalist institutions, like private equity investors, are forging ahead with standardizing care and prioritizing profit in medical spaces. Yet, she reminded the audience that hope is present and what drives her work are the physician-patient relationships she treasures. She emphasized the presence of humanities education in medical work, highlighting the skills of translating between “medical speak and patient speak”, seeing human dignity in every patient, and telling patients’ case histories as narratives.


I cannot conclude this blog without mentioning the powerful story Hong shared before she finished her remarks. Since her years as a resident, Hong has frequently met with a patient suffering from numerous chronic illnesses. Despite his many struggles, he maintained a lively sense of humor, evoking joy from every small moment. He was regularly hospitalized, sometimes up to months in duration, and he leaned on Hong to tell his story—his illnesses, his past medication history, and his resilience—to his different care teams. This was what drove the “I see you, you see me, I trust you to know me” quote: in his weakest moments, the patient wanted Hong to tell his story instead of telling his own experiences.

The patient passed away last year. Shortly before his passing, he still messaged Hong, sharing pictures of his youth. This patient was surely not the healthiest of Hong’s patients, but he was among the most memorable and impactful. Even as an audience member, I cannot help but root and feel fondness for this patient.


In my humble opinion, what made this lecture so motivational was not Hong’s advice and encouragement to a room full of pre-meds but her skilled recounting of firsthand experiences. Her testimony is proof that the humanities are still critically valuable, especially in medicine, providing food for thought for Duke students.

By Stone Yan, class of 2028

The Key to Transforming Minds

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Global wars. Ever-advancing artificial intelligence. Uncertain economic and job market prospects. Climate change. Amidst a world filled with change posing deep questions, could humanities provide counsel to our pressing issues and lead us towards more fulfilling, enriching daily experiences? 

Last week, I had the privilege to speak with Divinity School and history professor Polly Ha, director of the Transformative Ideas program and co-lecturer of “The Good Life,” an acclaimed course exploring the intersection of religion, philosophy, and other ethical issues. “The Good Life” encouraged Duke students, hailing from all disciplines and backgrounds, to slow down and incorporate more reflection and intention into their everyday lives.  

Duke professor Polly Ha, faculty in the Divinity School and director of the Transformative Ideas Program

Why is “slowing down” a key principle of “the Good Life”? As Ha pointed out, “it’s more stressful to try to slow down, to rest and reflect, than to take an exam for some students.” This powerful statement prompted me to reflect on my own experiences at Duke. Is it true that, amidst the hurries of daily academics and extracurriculars, merely pausing and thinking has become a difficult task? Perhaps so. If this is true for first-year students like me, how much more severe is this syndrome for upperclassmen undergraduate and graduate students? 

Ha approaches this topic fully empathizing with the busy lifestyle so many of us lead. “As the daughter of immigrant parents, the pace of my life has always been highly accelerated. The challenge of trying to slow down is something I can definitely relate to,” she commented. Ha identified this as a key reason why she required her Fall 2024 cohort to write down their reflections in physical journals so they could more clearly see their own growth throughout the semester. 

Encouraging Civility
A “Good Life” class is in session. Ha prepares to call on a student while Professor Abdullah Antepli of the Sanford School of Public Policy looks on.

The course professors also prepared students to engage in active civic discourse, a key pillar of the Transformative Ideas program. “Many students expressed that during our course, they felt understood and affirmed by their peers, sometimes for the first time,” Ha remarked. While she acknowledges that the class is not comprehensive in covering all thought-provoking, debatable issues of our day, Ha believes that her class prepares students to tackle all types of topics beyond the scope of the class. This is evident in the course’s continual evolvement to respond to our rapidly changing world: this year, she introduced lectures on transhumanism alongside ancient traditions. 

This appealing curriculum is far from the only major project Ha is undertaking. As an active author, scholar, lecturer, and administrator, she currently devotes much time to writing her newest book, “The Future of Freedom,” and researching history and its lessons on freedom and liberty. She is also involved in a multitude of interdisciplinary projects at Duke and beyond linking history and theology to fields as diverse as bioethics and public policy.  

Ha was gracious enough to provide me with a sneak peak of “The Future of Freedom.” In her words, this book is tailored not just to fellow academics but a broader audience, a read suitable for novices like me. Reading the first chapter, I was already transported into a world where grappling with heated topics is appreciated and celebrated. I especially enjoyed Ha’s continued use of rhetorical questions as she elucidated the modern threats against every liberty we cherish. Quotes like “Can we take freedom of conscience, thought, speech, consent, and action for granted?” challenged my perspective on my relationship to the ongoing battles surrounding surveillance capitalism and privacy protection—and whether I, an involved engineering student with aspirations in healthcare, have a role to play in this predicament. Given the captivating read, I am confident that Ha’s inquiry into 1600s England will enlighten many readers and portray the significance of history in our daily endeavors. 

As we chatted about history’s place within a larger interdisciplinary web of research active on Duke’s campus, Ha provided two incredible insights that could not be neglected in this blog. Firstly, she described history as “a spine that connects to many ideas,” contrary to the popular notion that it is solely a window into the past. If history is by nature interdisciplinary, why are renowned historical works still solely focused on primary sources, dates, and battlefield events? According to Ha, Duke’s interdisciplinary research scene is especially strong. “For me, as someone coming from some specialized cultures that did not have the same interdisciplinary superhighways, this has been something I deeply value,” she remarked.   

From teaching “The Good Life” to researching freedom’s past, present, and future, Ha has contributed much to our scholarly community. By bringing the humanities into conversation with twenty-first century challenges, and offering the immersive opportunities provided by Transformative Ideas, her work promises to sow the seeds in students that will sprout into exemplary lives. 

By Stone Yan, Class of 2028

Nathan Thrall’s “A Day in the Life of Abed Salama”

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Nathan Thrall, the 2024 Pulitzer Prize Winner for General Nonfiction, sat with Rebecca Stein, discussing his book, “A Day in the Life of Abed Salama: Anatomy of a Jerusalem Tragedy.” Published October 3, 2023 by Metropolitan Books, Thrall’s book tells the story of the people whose lives became intertwined by a tragic bus accident near Jerusalem 12 years ago, serving as a spotlight that identifies the corrupt powers that Israel has over Palestine. 

Author Nathan Thrall and his book “A Day in the Life of Abed Salama.” (Judy Heiblum)

Beginning with a synopsis of the book, Thrall shared the history of the West Bank enclave. Annexed and neglected, 130,000 people live between 26-foot tall concrete walls with only two exits. Within the enclave are no play areas, no sidewalks, and often trash burnings in the middle of the night; on the other side of the wall are rich images of middle-upper class housing and Hebrew University (the most prestigious university in Israel).

An Isreal wall separating Palestine and Jerusalem The Irish Times (Atef Safadi/EPA)

Students at a school within the enclave, in hopes of finding an area to play, walked with their teacher along the wall (along the apartheid road) and were devastatingly hit by a quarry semi-trailer. The truck proceeded to flip over and catch fire. The road where the accident took place, though used entirely by Palestinians, is under Israeli control, and therefore Palestinian authority is prohibited. Passerbys stopped and tried to help however they could, but the flames were too big. In the end, it took 30 minutes for Israeli fire trucks to show up to the burning semi-truck. Six children and one teacher died.

The book focuses on Abed Salama, the father of a boy who was involved in the accident, who after hearing about the accident, spent the next 24 hours trying to work his way through the restrictions placed on him as a Palestinian in order to find his son and make sure he was safe and alive. Abed went into the burning bus and rescued children, was rejected at many checkpoints in between hospitals where he thought his son may be–all of which are just a few of the many incommensurably heartwrenching tragedies he went through.

Abed Salama The New Yok Review (Ihab Jadallah)

After giving us the synopsis, Thrall then began to read a passage from his book, making it clear why he won a Pulitzer Prize. His writing, not only transformed a world of non-fiction into a very digestible piece of literature, but his ability to extract such emotion through his voice is truly inspiring. Looking around, I could see everyone leaning forward in their chairs–the room, was silent enough for the turning on and off of the air conditioning to turn my head. 

I knew walking into this talk, that this book’s meaning in the world and civil discourse would have more of an impact given the increasingly dire situations in Palestine over the past 12 months. While beginning her questions, Rebecca Stein did not shy away from this topic either.

“It’s a very ordinary event, it’s not like the kind of events that we see splashed across, you know, our television screens or our phones on social media, where we’re looking at tragedies at a much bigger scale…” “…why did you take this intimate incident as a way to try to tell this much bigger story?” she asked.

While I first was a bit taken aback at this question, I realized Rebecca was right. What makes the news is usually what will grab the most attention and the most emotion. And so rarely do we see the “smaller tragedies” (smaller as in fewer casualties). 

Thrall answered very calmly, and very methodically. 

“I wrote this book out of a sense of, uh, despair,” replied Thrall. “…what I was really aiming to do with this book was to draw, uh, our attention to the situation for Palestinians in their ordinary lives.”

And as Thrall continued to explain why he chose to write about the bus accident, he continued to show us his brilliance as both an author and speaker. For he was able to tell a story that shows readers how something so (unfortunately) common as a car accident, can lead to such heavy consequences when the systems in place are corrupt.

“…the best way to make a systemic critique, I think, is to show the everyday, um, because otherwise, if you choose something exceptional, something that a journalist might be drawn to, it’s easier to dismiss and say, this was the action of one, uh, bad commander.”

I was moved by how open the room was. Everyone was captured by the moment of Thrall spilling truths–some of which we were familiar with and some of which we had never heard before. I could see the weight of the subject, heavy in people’s faces and postures, and yet everyone remained, and many asked more questions. Some asked where Abed Salama is now. Thrall told us how the book was published on October 3rd, four days before the Hamas-led attack on Israel; Abed and Thrall had plans to travel together and tour the book, but after the war began, Abed had to miss many of their destinations. Thrall said that Abed, though he was able to attend some of the destinations for the book tour, is mostly at home mourning for and supporting his community.

There was a sort of ambiguity as the night came to a conclusion. Thrall’s book is living as a teacher and voice for those who don’t get the opportunity to tell their stories in Palestine. Thrall doesn’t know what is next, only that tragedies will continue to be treated as accidents, and systems, unjust as they are, are much easier continued, than broken.

By Sarah Pusser, Class of 2028

The Invisible Role of Women in Africa’s Liberation Movements

“Claims to knowledge are claims to power”

This phrase succinctly encapsulates Dr. Rama Salla Dieng’s talk on the intricate relationship between information and the patriarchy that exists, and has existed, in our society. 

As a Pan-Africanist Feminist scholar-activist, Dr. Dieng’s research mainly encompasses the Anti-Colonial Feminist Solidarity in West Africa. She delved into the Yewwu Yewwi, the first feminist movement in Senegal. She further highlighted the main aims of the women’s liberation movement; to cultivate and maintain solidarity between the members, to stand in solidarity with all Senegalese women, and to show support with all other victims of apartheid.

The focus of this talk was to shed light on movements in Africa that have supported women. She accentuated the importance of mid-wifes, and women who oversaw child-care, cooked, and worked on the fields. They were leading, not from the front but from the back. According to her, the purpose of the liberation movement is to not only celebrate the visible, but also acknowledge the invisible – the true backbone of those who lifted others during the apartheid. 

“Can rural African women be heard alongside Aimé and Senghor as also articulating prescient visions of liberation in the 20th century? Can M’ballia Camara’s death at the hands of a canton chief, her pregnant body slashed open by his saber in a dispute over local taxes for the colonial administration, speak across time and archival silences? Can it speak into a historical canon that is only now beginning to acknowledge black women as midwives who help to birth anticolonial movements and bear witness also to the leadership in these movements?” Dieng used Joseph-Gabriel’s poignant reflections to emphasize the pivotal yet overlooked contributions of rural African women in shaping liberation narratives, highlighting the necessity of integrating their voices into our historical understanding.

Dieng’s exploration into the Yewwu Yewwi movement and her invocation of historical accounts like M’ballia Camara’s tragic fate highlight a crucial message: the narratives of rural African women are integral to understanding the full spectrum of liberation efforts. By recognizing the gendered labor that has sustained communities through apartheid and beyond is not only existent but invaluable, we can begin to dismantle the structures of patriarchy that have long marginalized these vital contributions. 

M'ballia Camara

M’balia Camara: Guinean independence activist

As I reflect on the significance of these revelations, I am reminded that the path to true liberation is paved with the stories of those who have been overlooked.

Let us commit to making these voices heard, ensuring their rightful place in the annals of history and in the continuing struggle for equality and justice!

Post by Noor Nazir, class of 2027

It’s a Bird… It’s a Plane… It’s Comic Medicine!

Picture a comic book. Maybe you think of Superman or the Hulk, all cosmic green and razzmic berry, pressed into the glossy pages of your favorite childhood graphic novel. Or maybe you think of the Sunday paper. Calvin and Hobbes inked between the op-eds and the sports column. Maybe you think of punk rock zines, or political cartoons, or Mad magazine.

Now, put your first thought aside. Walk to the Duke Medical School library and descend to the first floor. Nestled in the quiet reading room, among the serious tomes on pancreatic enzymes and brain anatomy, is a collection of comic books. 

They don’t chronicle the kryptonite of superheroes or the adventures of Asterix. Instead, the curated Graphic Medicine Collection features soldiers with PTSD, mothers of children with Down Syndrome, and transgender patients’ gender-affirming care. They illustrate child loss, chronic illness, addiction, anxiety, autism, epilepsy, COVID, cancer, heart disease, reproductive health, and so on and so forth. 

photo credit: @dukemedlibrary (Instagram)

In 2007, physician and cartoonist Ian Williams coined the term “graphic medicine.” He writes that the “use of the word ‘medicine’ was not meant to connote the foregrounding of doctors over other healthcare professionals or over patients or comics artists, but, rather the suggestion that use of comics might have some sort of therapeutic potential – ‘medicine’ as in the bottled panacea, rather than the profession.” 

Dr. Ian Williams, GP and cartoonist

Duke’s Graphic Medicine Collection seeks to destigmatize, depicting everything from a patient’s experience with terminal cancer to STI prevention. Unsurprisingly, comics have long been used to educate and to challenge social taboos.

In 1954, they were controversial enough to trigger a congressional hearing. Despite grossing nearly $75 million in nickels and dimes (the cost of a comic in 1948), comic books fed the flames (often literally) of moral panics that came to dominate the Cold War era. 

In 1949, a small town Missouri girl scout troop burned a six foot tall stack of comics at the behest of their parents, teachers, and the local priest. This event followed the publication of an article written by New York City psychiatrist Dr. Fredric Wertham which drew a correlation between the occasional vulgar language and violent imagery in comic book and increased incidence of juvenile delinquency.   

Although Congress found no correlation between comics and criminal activity, ultimately disagreeing with Wertham, the comic industry created the “Comics Code Authority” out of fear of government censorship. Comics with everything from violence to werewolves, zombies, vampires and ghosts were banned. Though the comic code undeniably cowed their content, cartoonists continued to use the medium to criticize and confront stigmas. 

In the 60s and 70s, for example, “subversive women cartoonists, queer cartoonists, [and] cartoonists of color” disseminated their work in political circles. Later, in 1989, cartoonist Garry Trudeau depicted the first openly gay comic character Andy Lippincott’s diagnosis with HIV/AIDS. Though some gay activists criticized Trudeau’s portrayal, his comics nonetheless challenged the public’s stereotypes, fears, and ostracization of HIV/AIDS patients and Lippincott’s impact was wide-felt and humanizing.

Garry Trudeau’s Doonesbury comic character Andy Lippincott is depicted here in the fictional AIDS quilt. Lippincott was later given a real panel in the quilt.

In fact, in 1990, when Trudeau illustrated Lippincott’s death due to AIDS complications, an obituary was written for the fictional character in the San Francisco Chronicle: “… Lippincott, an affable man who had attempted to cope with the devastating disease with a continual patter of gallows humor, dies quietly in his bed, the window open to a sunny day and a coveted C.D. of the Beach Boys ‘Wouldn’t It be Nice’ playing.”

In the 2000s, like so many other middle school girls, when I turned 10 or 11, I was handed the American Girl’s “Care and Keeping of You.” The book includes comic strip-esque graphics and informational panels about everything from menstrual health to acne. It revolutionized the conversations that were and, more importantly, weren’t happening around girl’s health and puberty.

To put it simply: “Girls didn’t seem to have the courage to ask their own mothers these questions, but they were sending them to faceless magazine staffers in Middleton, Wisconsin.” Since its publication in 1998, “The Care & Keeping of You” has sold 7 million copies and counting. 

From cancer to STIs to AIDS to puberty, comics clearly do have a place in medicine. 

In recent decades, there has been a push in American healthcare for the medical humanities — a holistic movement that advocates for the intersection of science and art in medicine and medical education. Keith Wailoo, an American historian and professor at Princeton University, writes about the need for medical humanities:

“… [P]rofessional and human crisis has spawned the search for meaning and introspection about life, illness, recovery, human suffering, the care of the body and spirit, and death. Medicine’s social dilemmas, its professional controversies, human health crises, social tensions over topics from AIDS to abortion and genetics, as well as the profession’s very identity and its claim to authority have catalyzed and fed a growing demand for answers about meaning.”

Among the serious tomes included in Duke’s collection is the following spread from Tessa Brunton’s autobiographical “Notes from a Sickbed,” illustrating the onset and progression of her chronic illness. As Brunton writes, “catharsis” seems to best embody Duke’s Graphic Medicine collection. Like so many other comic strips, “Notes from a Sickbed” is a “bottled panacea.” Brunton confronts her illness and grapples with her own “search for meaning,” depicting her reality with humor, earnestness, and dialogue bubbles.

All of this to say: comics continue to have a place in medicine.

Here are a few texts in Duke’s Graphic Medicine Collection:

“Notes from a Sickbed” by Tessa Brunton
“Camouflage: the hidden lives of autistic women” by Dr. Sara Bargiela
“Kimiko Does Cancer” by Kimiko Tobimatsu
“First Year Out” by Sabrina Symington

You can check out the entire Comic Medicine Collection here: https://mclibrary.duke.edu/about/blog/new-graphic-medicine-collection

Post by Alex Clifford, Class of 2024

Leveraging Google’s Technology to Improve Mental Health

Last Tuesday, October 10 was World Mental Health Day. To mark the holiday, the Duke Institute for Brain Sciences, in partnership with other student wellness organizations, welcomed Dr. Megan Jones Bell, PsyD, the clinical director of consumer and mental health at Google, to discuss mental health. Bell was formerly chief strategy and science officer at Headspace and helped guide Headspace through its transformation from a meditation app into a comprehensive digital mental health platform, Headspace Health. Bell also founded one of the first digital mental health start-ups, Lantern, where she pioneered blended mental health interventions leveraging software and coaching. In her conversation with Dr. Murali Doraiswamy, Duke professor of psychiatry and behavioral sciences, and Thomas Szigethy, Associate Dean of Students and Director of Duke’s Student Wellness Center, Bell revealed the actions Google is taking to improve the health of the billions of people who use their platform. 

She began by defining mental health, paraphrasing the World Health Organization’s definition. She said, “Mental health, to me, is a state of wellbeing in which the individual realizes his or her or their own abilities, can cope with the normal stresses of life, work productively and fruitfully, and can contribute to their own community.” Rather than taking a medicalized approach to mental health, she argued, mental health should be recognized as something that we all have. Critically, she said that mental health is not just mental  disorders; the first step to improving mental health is recognition and upstream intervention.

Underlining the critical role Google plays in global mental health, Bell cited multiple statistics: three out of four people turn to the internet first for health information. On Google Search, there are 100 million searches on health everyday; Youtube boasts 25 billion views of mental health content. Given their billions of users, Bell intimated Google’s huge responsibility to provide people with accurate, authoritative, and empathetic information. The company has multiple goals in terms of mental health that are specific to different communities. There are three principal audiences that Bell described Google’s goals for: consumers, caregivers, and communities. 

Google’s consumer-facing focus is providing access to high quality information and tools to manage their users’ health. With regards to caregivers, Google strives to create strong partnerships to create solutions to transform care delivery. In terms of community health, the company works with public health organizations worldwide, focusing on social determinants of health and aiming to open up data and insights to the public health community. 

Szigethy followed by launching a discussion of Google’s efforts to protect adolescents. He referenced the growing and urgent mental health crisis amongst adolescents; what is Google doing to protect them? 

Bell mentioned multiple projects across different platforms in order to provide youth with safer online experiences. Key to these projects is the desire to promote their mental health by default. On Google Search, this takes the form of the SafeSearch feature. SafeSearch is on by default, filtering out explicit or inappropriate results. On Youtube, default policies include various prevention measures, one of which automatically removes content that is considered “immitable.” Bell used the example of disordered eating content in order to explain the policy– in accordance with their prevention approach, YouTube removes dangerous eating-related content containing anything that the viewer can copy. YouTube also has age-restricted videos, unavailable to users under 18, as well as certain product features that can be blocked. Google also created an eating disorder hotline with experts online 24/7. 

Jokingly, Bell assured the Zoom audience that Google wouldn’t be creating a therapist chatbot anytime soon — she asserted that digital tools are not “either or.” When the conversation veered towards generative AI, Bell admitted that AI has enormous potential for helping billions of people, but maintained that it needs to be developed in a responsible way. At Google, the greatest service AI provides is scalability. Google.org, Bell said, recently worked with The Trevor Project and ReflexAI on a crisis hotline for veterans called HomeTeam. Google used AI that stimulated crises to help scale up training for volunteers. Bell said, “The human is still on the other side of the phone, and AI helped achieve that”. 

Next, Bell tackled the question of health information and misinformation– what she called a significant area of focus for Google. Before diving in, however, Bell clarified, “It’s not up to Google to decide what is accurate and what is not accurate.” Rather, she said that anchoring to trusted organizations is critical to embedding mental health into the culture of a community. When it comes to health information and misinformation, Bell encapsulated Google’s philosophy in this phrase: “define, operationalize, and elevate high quality information.” In order to combat misinformation on their platform, Google asked the National Academy of Medicine to help define what accurate medical sources are. The Academy then put together a framework of authoritative health info, which WHO then nationalized. YouTube then launched its “health sources” feature, where videos from the framework are the first thing that you see. In effect, the highest quality information is raised to the top of your page when you make a search. Videos in this framework also have a visible badge on the watch panel that features a  phrase like “from a healthcare professional” or “from an organization with a healthcare professional.” Bell suggested that this also helps people to remember where their information is coming from, acting as a guardrail in itself. Additionally, Google continues to fight medical misinformation with an updated medical misinformation policy, which enables them to remove content that is contradictory to medical authorities or medical consensus. 

Near the end of the conversation, Szigethy asked Bell if she would recommend any behaviors for embracing wellbeing. A prevention researcher by background, Bell stressed the importance of early and regular action. Our biggest leverage point for changing mental health, she asserted, is upstream intervention and embracing routines that foster our mental health. She breaks these down into five dimensions of wellbeing: mindfulness, sleep, movement and exercise, nutrition, and social connection. Her advice is to ask the question: what daily/weekly routines do I have that foster each of these? Make a list, she suggests, and try to incorporate a daily routine that addresses each of the five dimensions. 

Before concluding, Bell advocated that the best thing that we can do is to approach mental health issues with humility and listen to a community first. She shared that, at Headspace, her team worked with the mayor’s office and community organizations in Hartford, Connecticut to co-define their mental health goals and map the strengths and assets of the community. Then, they could start to think about how to contextualize Headspace in that community. Bell graciously entered the Duke community with the same humility, and her conversation was a wonderful commemoration of World Mental Health Day. 

By Isa Helton, Class of 2026

Only Mostly Dead? The Evolving Ethics of Evaluating Death

I recently had the pleasure of attending Professor Janet Malek’s lecture: Only Mostly Dead? The Evolving Ethical Evaluation of Death by Neurologic Criteria, a lecture sponsored by the Trent Center for Bioethics, Humanities & History of Medicine.

Dr. Malek is an associate professor in the Duke Initiative for Science & Society, and at the Baylor College of Medicine Center for Medical Ethics and Health Policy.

Janet Malek Ph.D.

We don’t often talk about death. On the surface, it seems like it would be a straight-forward concept. You’re either dead, or you’re not dead. Right? It turns out that clinically defining death is not so simple.

Popular media has some grasp on the ambiguity of the definition of death. Remember this scene from the popular movie, The Princess Bride? Suspecting that the protagonist is dead, his friends bring him to a miracle-worker and have the following conversation. 

Miracle Max: “Whoo-hoo-hoo, look who knows so much. It just so happens that your friend here is only MOSTLY dead. There’s a big difference between mostly dead and all dead. Mostly dead is slightly alive. With all dead, well, with all dead there’s usually only one thing you can do.

Inigo Montoya: What’s that?

Miracle Max: Go through his clothes and look for loose change.

In real life, death used to be determined by cardiopulmonary criteria – when the heart and lungs stop working.  In recent decades the idea that death can be determined using neurologic criteria – when the brain stops working – has gained acceptance. As neuroscience and technology has evolved, so too have our definitions. Now that we know more about how the brain works, we know that there may be some brain activity even after a person has met the criteria for death by neurologic criteria (DNC). This leads to philosophically rich and practically relevant questions of ethics – for example, when do we stop providing life-sustaining care? In the field of bioethics and beyond, there is high demand for discussion on this topic.

There has been controversy over defining death since the 1650’s — when a woman named Anne Greene woke up after being hanged. It wasn’t until the 1980’s that a consensus definition of death was first identified. Here is a brief history:

1950s

  • Widespread availability of ventilators led to the identification of a state described as death of the neurological system.

1960s

  • Advances in organ transplantation foster discussion on the ethics of defining death.
  • A committee at Harvard Medical School examined the definition of Brain Death. They created a definition of “Irreversible Coma,” which focused on loss of neurological function.

1980s

  • The 1980 Uniform Determination of Death Act (UDDA) provided a legal basis for clinically determining death as: an individual who has sustained either 1) irreversible cessation of circulatory and respiratory functions OR 2) irreversible cessation of functions of the entire brain.
  • 1981: President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research report. Findings are centered on questions of functioning of the organism as a whole and the brain’s role in coordinating it.

1990s-2000s

  • Clinicians arrive at general agreement that a patient in a state of coma or unresponsiveness, without brainstem reflexes and who fails an apnea test is dead by neurologic criteria. Largely it is accepted that “brain death is death” but there is not complete consensus.

2010-late

  • 2013: Case of Jahi McMath. A 13-year old girl was declared “brain dead” in California, and a death certificate was issued. However, the family fought to have her maintained on life support. They moved to New Jersey, the only state which recognized objections to brain death, and the “brain dead” declaration was reversed. Jahi lived there for 4 years before passing away. This famous case caused people to reconsider the concept of brain death.

2020s:

  • Recent innovations in heart transplantation technology will likely challenge the acceptance of the Dead Donor Rule (DDR) which requires that an individual is clinically declared dead before vital organs are removed for transplantation.
  • 2021: Assembly of the Determination of Death Committee, tasked with updating the Uniform Determination of Death Act (UDDA). Duke faculty (and founding director of Science & Society) Nita Farahany, is involved with this process.

What ethical issues and practical questions challenging Death by Neurologic Criteria (DNC) today? Dr. Malek shared the following case.

Following a tragic car accident, Ms. Jones, a 20-year-old college student, was brought to the hospital, having suffered significant anoxic brain injury. The medical team determined that she met criteria for DNC. However, her family refused to allow for further testing. Several days passed. Ms. Jones was maintained on life support, during which she did not show signs of improvement. After several difficult conversations, the family consented for assessment and Ms. Jones was declared dead — using the criteria associated with DNC.

What is the proper amount of time to continue life-sustaining treatment if a physician suspects the patient will never recover?

Although this may sound like an uncommon occurrence, nearly half of neurologists have been asked to continue neurologic support for patients that may meet criteria for DNC.

Obligating life support for patients suspected of meeting DNC, either through the family’s refusal for testing or by direct request, would likely result in ethical harms such as violation of the dignity of decedent, unjustly using scarce resources, or causing moral distress in caregivers.

However, it may be permissible to maintain life support in these situations. Dr. Malek says that we do not yet have a good ethical framework for this. Reasonable accommodations that are in line with professional guidelines probably have minimal impact, and might provide some psychosocial benefits to families.

Is consent required to test for DNC? Should it be?

Legal and professional standards favor the idea that testing for DNC likely falls under the category of implied consent, which assumes that a person would want reasonable medical care in the event of unconsciousness. In fact, 80% of neurologists think that getting consent for these evaluations is unnecessary.

These are extremely difficult questions, and there is continuing controversy over what the correct answers should be. Dr. Malek advises medical experts to work with healthcare administrators to develop clear institutional policies.

Post by Victoria Wilson, 2023 MA student in Bioethics & Science Policy

“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

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