The Trauma of Medical Training in Two Webcomics: A Call for Multimodal Citation

This essay is an attempt to rethink how medical anthropologists can engage more with visual media. I take as an example two comic memoirs created by physicians about their medical training. For a field interested in holistic ways of understanding the body/self, medical anthropology as a whole has been surprisingly reticent to engage with visual media forms and creative expression, whether film, comics, or animation, even as these media have been shown to augment the bodily and emotional impact on the viewers as compared to solely text-based media. The expanding interdisciplinary realm known as “graphic medicine” (Czerwiec et al 2015), which focuses on comics at the intersection of health care and illness experiences, has capitalized on how comics can aptly communicate patient experiences and even form a powerful counterbalance to the mystifying medical discourse that can otherwise leave patients feeling overwhelmed, unempowered, and detached from their own bodily experiences (Green and Myers 2010; Hamdy and Nye 2017; McMullin 2016; Squier 2015; Williams 2012). Graphic medicine promises not only greater accessibility of messages, but also an ability to depict pain and emotion in ways that text alone cannot. Further, with the juxtaposition of text and image in the comic form, creators can offer new theoretical insights by manipulating time, perspective, and space on the page.

The case of these two physician-created comic memoirs brings two immediate problems to the mainstream field of medical anthropology: the first is a relative unfamiliarity with how to engage theoretically and analytically with visual media; the second is how to think anthropologically about personal narratives of patients or health care providers, who are often the objects of medical anthropological research. In addressing each of these problems below, I hope to make a case for including, engaging with, and citing this work as forms of medical anthropological knowledge, rather than as mere “supplemental” or “auxiliary” material that illuminates what we already know from the textual canon (Cartwright and Crowder 2017). I aim to model how to think capaciously with different types of media in non-hierarchical ways to fully appreciate the synergies through which the two different pieces shed light on one another.

I draw on the work of Faye Ginsburg to advance my claims, as she has compellingly made the case for how anthropologists more broadly can both support and benefit from visual media. Further, Ginsburg has particularly addressed visual anthropologists on how they can support and benefit from indigenous media-making—i.e., people who have likely been the primary objects of ethnographic film who have increasingly taken up their own self representation. Like documentary filmmaking, comic memoirs constitute an increasingly salient visual medium, and those produced on the web allow for ever-more creators to share and circulate their work and ideas across the globe—notwithstanding persistent digital divides and inequalities.

The two webcomics—“Healing Alone” (2019) and “Dailies of a Junior Doc” (2021) —were each produced with different goals and readerships in mind, and both effectively convey strong emotional and bodily experiences tied to medical education and practice. In reading “Healing Alone” alongside Byron and MaryJo Good’s study of Harvard medical students, I show how the various juxtapositions of image and text in the comic amplify, exemplify, and refocus the Goods’ contributions. I then turn to “Dailies,” which I analyze alongside Claire Wendland’s ethnography of the first cohort of medical doctors to be trained in Malawi. I show how the comics creator brings attention to the vast discrepancy in resources between the Global North and South that forms the through-line of Wendland’s analysis. In both cases, like Goods’ and Wendland’s medical anthropological contributions that have richly described the ritualistic aspects of becoming a physician, the two comic-memoirs provide insight into the harrowing training endured by medical students and residents, and the potential loss of humanity along the way.

Healing Alone

The first webcomic I will analyze here, “Healing Alone,” was published online by The Guardian in 2019, and was produced as a collaborative project between the Sydney-based Australian physician health-advocate Dr. Isabel Hanson and the comic artist Safdar Ahmed. Hanson received a fellowship from the Harold and Gwenneth Harris Endowment for Medical Humanities for this work and wrote that she intended for this public-facing project to “start a conversation about how we can lead with compassion and make healthcare system better for everyone together” (Hanson 2019). The comic addresses some of the harmful practices that continue to undergird medical training, causing physician burnout and other deleterious effects.

The webcomic follows the story of Grace, the first person in her family to attend a university. As both a female and first-generation college student, Grace is doubly an “outsider” to the elite circles of medical practice and education. In the panel captions, Grace is introduced as a “passionate idealist” who “dreams of one day working with Médecins Sans Frontières.” Her college graduation day marked the proudest accomplishment of her life. Yet while her passionate idealism is what fuels Grace’s ambition and endurance, we soon discover that her medical training will erode her pride and sense of accomplishment. Crushing this idealism not only serves to narrow the entry of people from diverse backgrounds to the field, it also reinstates the general disregard toward work aimed at serving the world’s most vulnerable people.

Byron and MaryJo Good’s classic study of Harvard Medical School’s graduating cohort of 1990 demonstrated with great nuance the phenomenological aspects through which doctors come to see patients’ bodies as objects to construct diseases and how doctors learn to edit out patients’ stories to present cases succinctly and persuasively to their superiors (Good and Good 1993). The Goods conducted their research at a time when Harvard had developed a “New” curriculum (for classes that entered in 1985 and 1986) that was meant to be more student centered and humane. They did not delve into any of the extreme abuses exposed, for example, in the novel The House of God (Shem 1988 [1978] but more subtly demonstrate how the many rituals involved with medical training reinforce particular hierarchies that produce doctors who, over the course of their training, empathize less with their patients, listen less to them, and see them less holistically while learning to observe and discern their bodies and physiological mechanisms as objects for their manipulation. This pattern held true for both the medical students in the “old” and the “new” curricula.

Compared to Goods’ analysis, Hanson and Ahmed’s piece is far more pointed in its critiques of hierarchies, the whittling down of interns’ self-esteem, and the ubiquity of humiliation, particularly during general rounds. They note that it is a standard in medical education for attending doctors to interrogate students, interns, and residents and for the attending doctors to purposely humiliate and undermine their underlings.

Panels illustrating general rounds in the comic are surrounded by red splatterings of blood, as we see Grace’s utter panic and vulnerability. But whose blood is it? The most immediate interpretation is that it symbolizes Grace’s psychic injury. The splattering also references the amount of blood the attending physician has seen and managed throughout his career, desensitizing him to the pain he is now causing. The blood also references that of the silenced and passive patient, whose pain is out of frame and out of focus as his own body is being discussed in terms that are likely unintelligible to him. The polysemity of the blood splattering in these images breaks the taboo around admitting the shared bloodiness and bodiliness between patients and physicians. As Dasgupta and Charon put it, “[T]he relationship between physicians and their own physicality is vexed.” They continue:

Although the field of medicine is dedicated to the examination, diagnosis, and treatment of bodies, the relationship of physicians to their own physicality is poorly understood, if not willfully ignored. In part, their disassociation stems globally from the Cartesian dualism and the ensuing traditions of Western science, psychology, and civilization that privilege mind over body. The distancing of physicians from their bodies, however, exceeds a Western predisposition to dualism. The separation is undoubtedly widened by the fundamental differentiation of physicianhood from patienthood (2004: 352).

Treating doctors-in-training to endure pain and humiliation, thus, is meant to create a disconnect between doctors and their own bodies and to heighten the distinction between them and the patients they treat. The doctors are trained to regard themselves as the unfeeling but thinking actors who intervene onto feeling and passive bodies. Hanson and Ahmed’s intervention explicitly rejects this logic and presents Grace as a fully feeling, bleeding, and hurting human. The illustrations draw attention to the physicality of the arduous emotional experiences she is facing by making visible people’s body postures, gestures, blushing, sweating, or grimacing. The splattering of blood effectively signals the links between the patient’s passivity and disempowerment on the one hand, and the dehumanizing tactics of medical training on the other. The blood also connects bodies longitudinally across time, its splattering haunting reminders of what doctors have seen through their years of practice. Physicians who become desensitized to the sight of blood and to the suffering of their patients are also desensitized to the psychic pain they may be inflicting on the next generation of medical trainees.

Comics creators utilize captions to convey a third-person omniscient voice presenting facts. One caption reads: “Med students are routinely interrogated in front of their peers as a part of their education,” and another continues, “The practice is known as ‘pimping,’” with a footnote referencing a 1989 Journal of American Medical Association article by Brancati (1989). At the same time, speech balloons within the panels convey embodied snippets of conversation that hone in on the very place and time of the interaction. The conventions of the medium thus enable an effective use of shifting temporal and spatial scales, so that readers/viewers can appreciate how the micro-specifics of Grace’s case (with her direct words in speech balloons) are contextualized within larger structures of medical education (explained in the captions). We can connect with Grace emotionally on an individual level through the intimate access we are given to her day-to-day journey and psychic interiority. The captions tell us that Grace’s experiences are not specific to her alone, and that dehumanization has been historically and structurally maintained on a global scale within the field of medical training.

The caption of the next panel succinctly states, “Such hierarchies create spaces for bullying and sexual harassment” and within the panel we see Grace shrinking in discomfort after a male peer comments about her figure. Doctors’ bodies are unacknowledged as part of medical training, yet calling attention to the bodies of women is normalized with the persistence of sexism. Aside from constituting harassment, this body-marking effectively tells women that they do not belong in the profession. A senior female attending doctor informs Grace that there is no point in lodging a complaint, as this will only hurt her career. Silence and normalization are coping mechanisms to avoid the retaliation that trainees may face if they speak out.

In the next section, we are introduced to Sameer, an immigrant from Iran, who is admitted as a patient to the Emergency Room for a flare-up of his painful Crohn’s disease, one of the many chronic conditions that is not well understood or alleviated by biomedicine (Kleinman 1988). The grimaces on Sameer’s face, set against flashes of bright red, convey the intensity of his pain. Grace sees Sameer as a whole person embedded in a family, while the caption tells us: “Sameer struggles with his illness but gets by on the usual masculine quota of stoicism and restraint.” Marking Sameer’s stoicism as “masculine” brings home the larger point that the dehumanization of medical training is particularly gendered in its disregard for physicians’ discomfort. Because medical training assumes male trainees as the default, the stoicism that is encouraged in the socialization of men is the expected behavior of all medical trainees. Those who have not been socialized as male have less recourse to “getting by” on the “usual masculine quota,” thus their negative responses to the dehumanization process is unexpected in its palpability.

Through Grace’s eyes, we can appreciate the pain and isolation that Sameer endures, and the ways in which she is not supposed to see what she does. Further, Grace apprehends how the hospital is not well equipped to address Sameer’s full concerns. Through Grace’s thwarted attempts to connect with Sameer, we come to experience the process that Byron Good describes about how doctors are trained to view patients as passive objects of intervention (1993). In the comic, we can see the ways in which multiple vectors of Sameer’s painful inflammatory attacks, marked in red, are followed by images of the impassive faces of his white male physicians and their detached medical pronouncements.

Grace, alongside them, is trained to observe and make note of his oxygen levels, respiratory and heart rates, blood pressure, and temperature. She learns to suppress the questions that she wants to ask: whether he understands what is happening to him, whether he has his belongings with him, whether he needs emotional support or knows anyone there. The caption reads “Their [the patients’] wholeness is obscured from view.” This obfuscation mirrors the ways in which Grace is obscured from the patient’s view when the senior doctors introduce themselves to Sameer. The tenuousness of Grace’s position in the medical hierarchy characterizes the tenuousness with which she attempts to forge a connection with her patients.

Grace is able to connect with Sameer for a brief moment when she notes that he is reading her favorite poet, Rumi, in the original Persian. This brief connection is the only time we see Sameer looking alert and not pained, at peace in the hospital setting. Yet Grace is promptly called away, leaving a distraught Sameer on his own yet again.

A panel caption explains the historical origins of the word “patient” and the implication that patients are meant to endure their illness and suffering patiently and passively. Patients abdicate their agency to experts with the skill, expertise, and knowledge to help treat them. Yet the doctor-in-training is put in the impossible position of carrying out this responsibility without the necessary support, information, training, and authority to do so. This is expertly illustrated in the following panel when Grace is shouted at by a fellow hospital worker for trying to carry out orders to schedule a CT scan; the caption describes this encounter as just one example of how “doctors negotiate a busy and often adversarial work environment.” Grace is berated for not knowing what to do, even though she is tasked with doing things that she has not had the chance to learn (like inserting a naso-gastral tube), or even the ultimate authority to carry out (like ordering a CT scan). This erodes her confidence and simultaneously diminishes the care that Sameer receives.

While Sameer is left alone in anguish and apprehension, the captions tell us that:

Doctors develop a condensed language to communicate effectively with one another. But this can lock others out of the conversation. Patients often withhold their questions for fear of looking stupid, or not wanting to “bother” the doctor.

When Sameer attempts to open up to Grace about his fear of yet another surgery, Grace finds herself lost for words on how best to comfort him. After all, she is acutely aware that biomedicine does not have all the answers about how to alleviate his pain. As Grace searches for words in vain, the captions narrate:

In medical school, sessions are run on breaking bad news to patients. … But it is all about saying the right things to an actor, not about how to really listen to people or to hold space for their suffering.

Grace, like most doctors, joined the profession to help people. But research shows doctor empathy declines throughout medical school and residency.

Around half of junior doctors show signs of burnout. This stems from mistreatment of supervisors. Chronic sleep deprivation and shift work. Social isolation. And helplessness in the face of human suffering.

Medicine is a profession founded on principles of service. Dignity. And compassion.

Yet the modern health care system alienates patients and doctors from these values. And from each other.

These problems are structural—they are not inevitable. The health system was made by people. It can be changed by people.

The comic effectively pulls us into Grace’s journey from hope, ambition, and pride to demoralization and isolation. “Healing Alone” was published just before the major global pandemic that hit the world in 2020 made the public more aware of the dangers of physician burnout. It remains now more than ever an urgent call to recognize, name, and change harmful practices of medical training that have downstream effects on the very possibilities of care and compassion.

“Dailies of a Junior Doc,” Khartoum, Sudan, posted on webtoons 2019

Dr. Alaa Saeed, a young pediatrician who completed her medical school training in Khartoum, Sudan, is the comic creator—both writer and illustrator—of the serialized “Dailies of a Junior Doc,” which has been featured on Webtoons since 2019. Aside from being a medical clinician, Saeed is also a self-taught comic artist and fan of manga, who learned techniques through various web fora. The utter shock that Saeed endured during her medical training that included a rotation at a public children’s hospital in Khartoum inspired her to create the serialized comic about Junior’s experiences. In an interview with her, she explained that she created the comic to both process the experience for herself and to let others know of the experiences of young Sudanese doctors in training.

Whereas Grace’s experience in “Healing Alone” was mainly characterized by demoralization, Saeed’s “Dailies” primarily conveys being overwhelmed. Saeed approaches the enormity, and perhaps even impossibility, of her training at a public pediatric hospital with humor. She establishes the beginning panels as a mise-en-scène, so that readers feel they are with Junior on her first day on the job. Through the panels, readers accompany Junior from the anxious thoughts in her head on the car ride over to the cautious steps she takes through the hospital’s intimidating gates. In her first encounter at the hospital, Junior meets a gruff, sleep-deprived, and disheveled, flip-flop-shod young man who insists on grabbing her phone. She soon learns that this “psychotic, homeless jerk” attempting to steal her phone is in fact her Senior resident. The Junior doctor was never properly introduced to her supervisor, and thus had no way of knowing who he was. Still, he has no interest or incentive to make her feel at ease. Instead, he gruffly grabs her phone and uses it, and then sardonically welcomes her to the unit, quickly followed by the command, “Now get your a** moving, brat.” The panel shifts from the outward action—where we see Junior dwarfed and shrinking by the towering gruff Senior resident—to Junior’s psychic interiority where she is stricken with terror.

After rudely ordering the Junior doctor to move, Senior then tells her to brace herself before thrusting open the door to the Short-Stay clinic of the hospital. The next panel is amazingly effective in displaying the sheer chaos, overwhelmingness, and noise of a unit overflowing with desperate mothers and sick children. We see that, indeed, Junior and Senior are sole warriors facing an uphill battle as Senior caustically comments to her, “Welcome to the Jungle.”

When a confused and astonished Junior asks how there can be 52 admissions in a unit with only 10 hospital beds, Senior explains what he calls the “magic of the ward.” Like the Biblical fishes and loaves that fed all the hungry mouths, three patients share a single bed, and the others are dispersed between the waiting area, the nurses’ desks, the “asthma corner,” and, of course, there are always a number of “escapees.” The term escapees, too, disturbs Junior who wonders aloud if the unit is in fact a prison. “Well yeah,” Senior retorts, “This unit intimidates mothers as well as Junior Doctors. Let’s see how long you’ll last.”

In Senior’s casual cruelty toward Junior, it is clear that the system of hierarchical abuse in medical training is alive and well in Khartoum as much as it is in the Global North. Breaking the taboo of silence protecting this abuse was the main intention of Hanson in embarking on producing “Healing Alone.” In contrast, Saeed’s intent is simply to “show things as they are.” And for Saeed, the hierarchical structure between the attending physicians, senior residents, and junior doctors is just one of the many inconveniences of the work. Junior in Sudan, like Grace in Australia, also experiences unwelcome sexual harassment from a senior attending surgeon. But unlike Grace who feels dehumanized by the encounter, Junior is much more ambivalent, as all her discomfort is dwarfed by the sheer enormity of the demands and needs of the patients. Saeed effectively and subtly shows, by changing her stylization of characters, how the doctors’ view of patients can shift from aggregate masses—depicted in almost abstract ways—to individual subjects—whose individual expressions and details are given attention. She also uses techniques of blurring and focusing images so readers can sense how her ability to focus on the patients’ overwhelming demands wanes and waxes throughout the long day.

Both the Senior resident’s humiliation of Junior and the attending surgeon’s unwanted advances are quickly diffused with humor. In fact, alongside Junior doctor herself, we as readers soften toward these male superiors when we see how hard they work to navigate the impossible conditions, and how little reward there is, whether in terms of social recognition or monetary compensation, for their Herculean efforts. For doctors working in public hospitals in the region, salaries do not increase by admitting more patients. Indeed, Senior’s enacting “magic” in the ward only increases his own workload, stress, and potential for getting into trouble. Senior’s actions, not his gruff words, show us that he still is an idealist at heart, sacrificing his own wellness and comfort to help patients get better. As brusque as he is with Junior, we cannot help but admire Senior’s commitment toward his patients, as well as his skill and resourcefulness. In her work alongside Malawian doctors-in-training, anthropologist Claire Wendland memorably referred to this as having a “heart for the work” (2010). Junior doctor’s path very much echoes the themes Wendland identifies in her work in Malawi, in how the physicians in the Global South see themselves in solidarity with patients, rather than in opposition to them, given that their basic needs have been neglected in a largely resource-poor setting and how utterly dependent they are on the physician’s care.

To highlight the contrast, I juxtapose the depictions of the experiences of Grace (in Australia) and Junior (in Sudan) when they are each left alone to carry out a medical procedure that they have never formally learned. I will compare how “Healing Alone” depicts Grace when she is ordered to place a nasal-gastral tube in her patient Sameer, with how “Dailies of a Junior Doc” depicts Junior’s attempt to collect blood and urine from an infant.

In Grace’s case, we learn that the philosophy of medical education is: “See one, do one, teach one.” Having seen it once, the clinician-in-training is supposed to learn how to reproduce it on her own.

As the panel captions tell us, “This archaic principle leaves no room for struggle, human learning, or failure.” It produces in Grace unnecessary anxiety as well as a major blow to her confidence. Grace’s patient, Sameer, in turn, can feel and sense Grace’s anxiety and trepidation, and the outcome is a botched attempt, which induces Sameer to vomit, unsettlingly illustrated in the graphic.

In “Dailies of a Junior Doc,” we see Junior in a hospital in Khartoum, Sudan, similarly left alone, feeling like the world’s “most clueless doctor.”

But the assumed foil for Saeed is an imagined well-functioning medical system in the Global North. For her, the resource-poor conditions are what explain the difficulty of her job. By Episode #7, Senior has humiliated Junior for having lost consciousness when feeling overwhelmed and crowded by the demands of all the patients’ mothers (although he is kind enough to take her to the courtyard for tea). He has berated her for being spoiled and taken her to general rounds with the attending physician, with no explanation of what she is supposed to do while there, thereby setting her up for failure. He then takes a long-overdue rest after a seemingly endless shift, and Junior doctor is left on her own and tasked with collecting blood and urine from a small baby. She has learned to do this in adults, but never in babies. An overworked nurse who has been there far past the end of her shift is there to explain to Junior that she will need a catheter to collect the urine, as Junior didn’t even realize the mom could not “collect it” in the specimen container, since the diapered infant is so small.

Feeling utterly alone and dismayed, Junior convinces herself to rally and to try her best. In episode 8, we see Junior attempting to learn via a YouTube video how to insert a urine catheter, but she does not have the cellular data to load the video, an oblique reminder about the divide of digital access and, more generally, of medical resources.

She ascertains, through reading online instead of video-watching, that in addition to the catheter she needs alcohol, gauze, a saline-filled syringe, and xylocaine gel, a local anesthetic. Many of the basic items such as alcohol, gauze, and saline can be provided by patients’ families if hospitals are low in stock. However, xylocaine gel, the nurse quickly informs Junior, is simply not available and too expensive for patient families to provide. In place of the local anesthetic, the nurse shows Junior how to use petroleum jelly for lubrication, because it’s “better than nothing.”

When the nurse notes again that it is long past her time to return home, Junior describes herself as on the verge of a mental breakdown at the prospect of abandonment and gets on her knees and begs the nurse not to leave her. The caption explains how understaffed hospitals are, and how there is a stark shortage in nurses, leaving doctors to carry out what in other places would be left to their charge.

The nurse shows mercy to Junior and agrees to help her, even though she has already worked (unpaid) far past her shift. She continues to teach Junior tricks of how to “make do” with available resources. Like Senior’s earlier explanation of the “magic of the ward” to accommodate more patients than beds available, the nurse teaches Junior how to work with what they have. Because they do not have special pediatric equipment for drawing blood, she shows Junior how to adjust adult medical supplies to suit their needs. The syringes are too big for children, and so the nurse breaks off a needle from an IV set instead. If there is no more alcohol, she uses saline to prepare the puncture site. For a baby-sized tourniquet, the nurse rips the bottom end of her latex glove to wrap around the child’s arm. The needle that was broken off the IV set is quickly used to drip the blood collected into the specimen tube. In the end, the nurse wisely tells Junior, “There is definitely a better way to do this, but that’s the best you can do with the available resources.”

Wendland’s ethnography details how the major struggle for doctors-in-training in Malawi is in learning to reconcile their education with the reality of daily work in poverty-stricken regions where “overwhelming need meets inadequate resources” (Wendland 2010: 24). Junior’s “shock”—what Saeed effectively conveys in this webcomic—is the great discrepancy between what is “supposed to be”—based on English language medical instruction, or even YouTube tutorials—and the reality of the clinical spaces in which she must train. Like Wendland’s work makes clear, the reliance on medical curricula produced in the Global North creates a disjuncture for doctors in clinical training in the Global South. English-language curricula describe clinical procedures and guidelines that depend on the availability of resources that are either absent or in short supply in overcrowded and understaffed hospitals.

When Junior is left in a ward to complete a task unsupervised and undertrained, she never once imagines or narrates that this is, in fact, an integral and ubiquitous aspect of medical training. Whereas Hanson and Ahmed identified this practice of abandonment as part of the “archaic tradition” of “see one, do one, teach one,” for Saeed, Junior’s abandonment is simply part of the landscape of hardships that her job entails. Later in “Dailies,” Junior faces challenges that her colleagues in the Global North would most likely not endure, such as: lack of medical transport vehicles, lack of blood supplies and transportation, broken-down life-saving equipment, lines of patients that extend for blocks to enter the Emergency Room, or the lack of security in hospitals, leaving doctors vulnerable to violence. In fact, Saeed’s target audience (she writes, after all, in English) is readers who may not be aware of these realities of practicing medicine in the Global South.

Hanson and Ahmed’s intervention is to show that cultivating “tough” doctors through harsh training is deleterious to the profession and to the patients. Yet Wendland argues that the dehumanization and desensitization of medical training that has been so well described for the Global North, is not necessarily the case everywhere. In Malawi’s Queens Hospital where medical students are trained, much like what we see with Senior and Junior doctors in Khartoum, Sudan, Wendland demonstrates that physicians generally remain committed to their patients; they do not learn to see them as mere objects; they do not blame them for their own sickness or noncompliance. Wendland argues that biomedical training is not simply adopted wholesale everywhere, and that it can be re-signified and re-adapted in different situations.

Reading the comic “Dailies,” I am amazed by the sharpness of Wendland’s analysis and how well it extends beyond her specific site of Malawi. She demonstrates that because medical students are made so acutely aware of “the gaping inadequacies of the health sector,” they focus their anger and frustration at the socio–political systems that have rendered their patients so vulnerable, rather than at the patients themselves. One of my favorite panels perfectly illustrates this: even in the middle of her panic, self-doubt, and uncertainty, Junior is overcome by affection for the cute infant that she is tasked with treating.

As a doctor-in-training in the Global South, Junior is concerned primarily with making do with the available resources in the face of the overwhelming demand on the systems and on the people who work in it. The interpersonal tensions among clinicians are soon dwarfed by the magnitude of this context. Indeed, a mutual respect quickly develops between Senior and Junior, despite the hierarchy, psychological abuse, and gruffness, because they are “in it together” against the odds. Wendland writes that “the antagonistic hostility toward patients consistently found in Northern settings seemed simply to be absent” (2010: 172). Further, she argues that because the medical “socialization” process in the Global South can lead to different outcomes, we should rethink our tendency to regard “biomedical training” as a universalizing or globalizing experience.

But Hanson and Ahmed want us to do just that: to recognize a problem at the very core of biomedical training that are global phenomena—abusive training, trauma, and burnout among physicians.

How to reconcile these two views?

On my first reading of “Dailies,” I immediately thought of Wendland’s takeaway from A Heart for the Work, that the adoption of the biomedical curriculum does not necessitate the adoption of its concomitant values such as individualism, radical reductionism, and fetishization of technological solutions. Yet reading “Dailies” alongside “Healing Alone” made the intergenerational dynamics and cruelty of medical training difficult to move on from. It became clear that the ubiquitous “archaic practices” of medical training that include hazing, humiliation, and tests of the young doctors’ physical endurance exacerbated Junior’s feelings of desperation, panic, anxiety, and self-doubt. These cruelties are not irrelevant or insignificant to doctors in the Global South. It may be that Wendland does not expound on them because her field research was among the very first cohort of Malawian-trained physicians, where there were no inter-generational dynamics to observe.

At what cost do medical students endure the traumatic hierarchical abuse of their training? What are the effects of neglecting their own bodily needs and comfort as part of this training? The fact that these concerns are ultimately dwarfed in the Global South by the enormity of their patients’ needs is no reason to ignore or diminish them. It may be that the interpersonal harm of the training does not translate into physicians’ antagonistic attitudes toward their patients, but that does not mean that there is no harm done at all.

In “Dailies,” Senior and Junior form a unified front the moment that Senior thrusts open the door to the overflowing waiting room and welcomes her “to the jungle.” But how much less stressful would it have been to Junior if Senior had treated her with respect, reassurance, and solidarity from the very first instance? How much more confidence would Junior have had, facing the patients’ demands, if she had not had to suffer sexual objectification by the attending surgeon? We know that one outcome of crisis situations is that tensions between people can dissipate and new solidarities can be forged (Fassin and Vasquez 2005). But the fact that many health systems in the Global South are in crisis does not mean we should look the other way when it comes to interpersonal tensions and cruelty during medical training. These tensions can persist and erupt at other (less crisis-laden, less chaotic) times when they continue unaddressed (Fassin and Vasquez 2005).

Hanson and Ahmed’s “Healing Alone” so successfully highlighted the problems of interpersonal abuse in biomedical training that I could not lose sight of its occurrence in the Global South, even if it was not the primary problem that medical trainees voice. In reading the two webcomics side by side, I came to see Wendland’s argument for global biomedicine’s plurality as working against the type of bold rethinking that Hanson and Ahmed are calling for. “Healing Alone” raises objections to core features of biomedical training—the mind/body dualism, the radical individualization, the disregard of emotional wellbeing—partly because their privileged location in the Global North enables them to do so. In contrast, doctors in the Global South tend to interpret hardships in terms of the general landscape of their practice, which prevents them from questioning core tenets of biomedicine per se. Wendland’s ethnography and “Dailies” both make clear that doctors in Malawi and Sudan continuously imagine Euro-American contexts as the foil for how clinics are “supposed to” function. Though they may feel that a particular biomedical procedure or practice is not best suited to their own context, they rarely take on the core tenets of biomedicine writ large. This is all the more reason for projects like Hanson and Ahmed’s “Healing Alone” to address a global audience about archaic, outdated, and harmful notions that remain intrinsic to biomedical training. Biomedical training systems established in Euro-America have been globalized, even if their outcomes or the specificities of how these look will necessarily differ depending on context. Core notions about passive patients and tough physicians continue to impede the quality of training and care and exacerbate the hardships that doctors face in under-resourced settings in the Global South.

Expanding Medical Anthropological Knowledge-making

My appreciation for “Healing Alone” and “Dailies of a Junior Doc” is deepened by my having read medical anthropological works that help me situate each panel. At the same time, reading comics is a more immersive experience for me than reading text-based works alone. Comics can also cover more ground in a single page, thus making it easier to contrast similar experiences across cultural settings. As “Healing Alone” and “Dailies of a Junior Doc” show, visual techniques of storytelling can resonate profoundly with the work of medical anthropologists who have long worked to challenge the mind/body dualism. These two webcomics, in different ways, purposely call attention to the emotive, embodied subjectivities of doctors-in-training precisely to challenge the ways their bodily emotive subjectivities are expressly ignored and denied.

When I have given talks to make the case for incorporating visual media as part of medical anthropological knowledge-making, I am often asked: “What information do the comics convey that textual ethnographies do not?” This question seems to imply that for their value to be acknowledged, comics must include more or different information than that found already in texts. This question overlooks what the medium of comics itself is doing in engaging readers on a deeper, more sensorial level which explains their wide popularity. Marshall McLuhan’s now famous phrase, written in the 1960s, that “the medium is the message” was an important critique of how people tended to focus on the contents of mass mediated messages without full apprehension of the impact of the form itself (1964). The comics medium, with its juxtaposition of space and time, word and image, already orients readers in different ways than does text alone.

Many have noted that college students in North American universities today are engaged with visual media, and thus visual anthropological works become especially important teaching tools in the classroom. Like with other visual media, the form and aesthetic conventions of comics and the relatively open web-based platforms through which people can share their workallow for enriching opportunities for anthropologists to expand their archives and for their students to engage with thoughtful and careful creators—like a young female Sudanese doctor—from whom they might not otherwise hear directly.

But while university professors have increasingly adopted visual materials in the classroom, they tend to serve as “supplement” to the “real” scholarship in printed academic venues. Within the academy, scholars of various disciplines have yet to come to a consensus on how to evaluate the value of multi-modal works that illuminate research results, including creative writing, poetry, films, plays, photography, photo-essays, sound projects, comics, and longer-form graphic novels. Although university administrators pay lip service to the importance of public engagement, the fetishization of peer review and print publications as the “golden standard” of academic production reproduces the logocentrism and gatekeeping of the academy that has long excluded nonwhite, non-male, and non-elite voices and perspectives from both producing and accessing the work. Even within the confines of academic, peer-reviewed print publications, gendered dynamics and citational politics continue to amplify the voices of white men (Mott and Cockayne 2017; Smith and Garrett-Scott 2021).

One factor among many that has impeded the North American academy from fully embracing multi-modal production is the persistence of the binary opposition between “rational thought” and “emotion.” Academic scholarship, particularly in the sciences, shies away from genres that are especially emotive, such as visual media or storytelling. In the interest of producing scholarship that is “disinterested,” “rigorous,” or “unbiased,” scholars are often encouraged to strip away traces of the emotional work that produced it. This is especially uncomfortable for disciplines in the humanities and social sciences, like anthropology, that are necessarily engaged with the messiness of human life that consistently demonstrates how quickly the rational/emotional binary logic falls apart (Behar and Gordon 1995). Medical anthropologists have been quick to critique this disembodied notion of the human subject, and yet through our professionalization we are compelled to make such arguments via the disembodied channels and media forms of text-based publications and word-heavy lectures. Numerous scholars have pointed out how the assumed opposition between thought/emotion, or relatedly, mind/body underlies the heteropatriarchal and racist logics in which the putative “objective scholar” is an able-bodied white male, less tainted by the bodiliness that marks women, disabled people, and sexual and racialized minorities as unreliable Others (Behar 1997; Behar and Gordon 1995; Haraway 1989; Schiebinger 2004). Even as the academy expands to include other voices, we have not yet changed our main forms of communication.

Conclusions

Thirty years ago, anthropologist Faye Ginsburg alerted anthropologists to the ways that visual media were increasingly shaping cultural forces, placing “the capacities of image-making, once monopolized by media industries, in the hands of people almost everywhere on the planet” (1994: 5). Ginsburg urged anthropologists to take these changes as an opportunity to examine their practices, and to place anthropology within a broader range of media representing culture. Comic memoirs use the personal first-person voice to delve deeply into psychic interiority, and to re-create worlds and experiences for the readers to share. Anthropological work—with its focus on historical context, social discourse, resonance, and cross-cultural analysis—illuminates how the social and structural conditions have shaped and made possible these personal narrated experiences. We learn from Grace and Junior Doctor how they have felt overwhelmed, debased, and humiliated as they embark on their medical careers—which they entered with the noblest of intentions: to help others. The anthropological work helps us understand that these experiences are not unique, but socially pervasive, and what specific social conditions and political economic resource distribution are in place that make these experiences both commonplace and persistent across time. The powerful emotional messages of comics have the potential to re-frame textual based scholarship and see our analytical contributions from new perspectives. There are certain affordances and conventions of this particular medium, especially the depiction of emotional pain and psychic interiority, that powerfully crystallize medical anthropological critiques about the desensitization of medical training and the Cartesianism that permeates biomedicine, marking particular bodies (of women, racialized others, or disabled people) as more bodily (and therefore more susceptible to intervention) than others.

Isabel Hanson set out to create a work that consciously disrupts the persistent refusal to address the physical and emotional vulnerabilities of physicians and demonstrates how this refusal leads to physician burnout and isolation, as well as suboptimal patient care. In contrast, Saeed did not consciously or intentionally set out to disrupt biomedical tenets or assumptions. Rather, her comic was meant to process her own emotional trauma of having gone through a difficult rotation, as well as to introduce her target audience (including those in the Global North) to the conditions of medical training and practice in resource-poor and politically mismanaged settings. Hanson and Ahmed deliver their point powerfully: that the full humanity of physicians is threatened when ignored and denied. Saeed less consciously makes this point as well, but it is a secondary effect of the specificity of the medium. Drawn to the conventions of manga that visualize and amplify internal emotions, Saeed powerfully depicts Junior’s vulnerabilities, anxieties, panic, fear, astonishment, cluelessness, blackout, baby-love, fatigue, pain, and exhaustion. Her tiny feminine frame beside the physically large and looming Senior doctor already makes the point that there are a range of bodies and types who can become doctors and her beautiful artwork displays the ranges of skin tones, dress, shapes and sizes of her patients and their families. In rooting for Junior, I find myself also yearning for the world that Hanson and Ahmed call forth, in which Junior could have been trained with more gentleness, consideration, and compassion.

The authors of the Graphic Medicine Manifesto define “graphic medicine” as an emerging area of interdisciplinary academic study that “combines the principles of narrative medicine with an exploration of the visual systems of comic art, interrogating the representation of physical and emotional signs and symptoms within the medium” (Czerwiec et al. 2015: 1). They note that it is also a call for change by “giving voice to those who are often not heard” and “offering a more inclusive perspective of medicine, illness, disability, caregiving, and being cared for” (2015: 1). This is in keeping with anthropologists’ call for greater multimodality as a way to better engage, collaborate, and democratically shift power in anthropology (Collins et al. 2017). Although I am excited about the possibilities of this medium, I am also more cautious about overstating its liberatory potentials. As Takaragawa et al. make clear, “there is nothing inherently liberatory about multimodal approaches in anthropology” (2019). Visual media can be leveraged to consolidate power as much as to diffuse it, and the political weight of the work must be thoroughly evaluated rather than assumed.

Works like “Healing Alone” and “Dailies of a Junior Doc” are powerful examples of how the simple medium of comics can be leveraged to break taboos and have us reexamine our assumptions about what medical training needs to look like, who can be doctors, how doctors are molded, and what sustains care. By visualizing emotional and bodily processes that exceed words alone, these two webcomics powerfully convey the daily realities and specificities of doctors-in-training, allowing us to juxtapose the two settings and ask new questions. The chosen medium forces us to expand our archives to reexamine what constitutes anthropological observation, analysis, and scholarly interventions. The emotive delivery of the message through visualization breaks through the opposition between the vulnerable body on the one hand, and the authoritative knower on the other. As anthropologists, our engagement and even production of work in various formats can afford us the potential of greater impact in both relaying bodily and emotional processes and evoking bodily and emotional responses in our viewers/readers. Quickly proliferating and circulating forms of visual media can be so much more than “cultural objects” or “visualization aides.” Fully embracing other modalities as intellectual contributions in their own right can deepen our own understanding of changing cultural phenomena while helping us forge solidarities across sharply distinct settings.

Acknowledgments

Special thanks to Dr. Alaa Saeed for her generous engagement and to Deena Mohamed for first introducing me to “Dailes.” I have included images of Dr. Saeed’s work with her permission, and of Hanson and Safdar’s “Healing Alone” under The Guardian’s Open License Agreement, Courtesy of Guardian News and Media Limited. I would also like to thank my colleagues Dr. Eleana Kim, Dr. Alex Nading, Dr. Coleman Nye, Dr. Claire Wendland, and Dr. Emily Yates-Doerr for their helpful feedback.

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