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DGHI Professor Takes Dramatic Approach to Teaching Global Health Ethics

November 28, 2017
Student with Special Object
As part of the performance preparation, Nisha Uppuluri (left) explains how her headphones represent one of the characters in the play while Mahnoor Nazeer looks on.

Global health professor Kearsley Stewart has been using a case study approach to teach her undergraduate “Ethics of Infectious Disease Control” course for several years, but this semester, she wanted to experiment with a more creative pedagogical method. As she’s done in the past, she turned to the humanities for inspiration.

Stewart knew that decades of research in the medical humanities has confirmed that theatre, particularly improvisation, can improve a physician’s communication with his or her patient through more effective problem solving, decision making and collaboration. She sought to challenge her students with a dynamic, interactive experience that would help them more deeply understand the emotional and motivational factors that play into ethical dilemmas. It occurred to her that having her students perform a play might meet those objectives—if she could find the right production.

“The use of theatre is especially innovative for a global health ethics course,” said Stewart. “The main goal is to use theatre’s active and experiential pedagogies to increase student capacity for affective learning and critical thinking in the context of medical research and clinical practices, specifically highlighting multiple, contradictory, and often irreconcilable points of view.”

The Perfect Play Was Just a Few Clicks Away

A brief internet search led Stewart to an award-winning play about research misconduct. Informed Consent, written by Deborah Zoe Laufer, is based on a true story about Arizona State University researchers working between 1989 and 2003 with the Havasupai, a Native American tribe who have lived in the bottom of the Grand Canyon for centuries. Coincidentally, Stewart has been incorporating this case study into her global health ethics classes for years, so it was a perfect match.

The Havasupai research project featured in Informed Consent included health education, collecting and testing of blood samples and genetic testing to search for links between genes and diabetes risk. The researchers didn’t find a genetic link to Type II Diabetes and subsequently used the blood samples for other unrelated studies, such as schizophrenia, migration and inbreeding—all taboo topics for the tribe. The case led to a lengthy legal battle, which ended with a settlement in favor of the Havasupai. Informed Consent explores the relationships and motivations of a few key people involved in the project. 

No Background in Theatre? No Problem! 

After identifying a new teaching approach and a relevant play, the next step for Stewart—who has no background in theater—was to find a faculty collaborator who could provide guidance on integrating drama into the course. She partnered with Jules Odendahl-James, director of academic engagement in the humanities, visiting lecturer in the Department of Theater Studies and a professional theater artist, to develop the Informed Consent module. 

“Incorporating theater into the learning module allows the students to take their disciplinary knowledge about the case the play dramatizes to a deeper level by building a representation of their understanding of how that study affected the lives of all involved,” said Odendahl-James. “The module enables students to consider on a limited but lived level what they might do to avoid unethical practices in the future.”

Later, Stewart enlisted the help of Nehanda Loiseau, a graduate student in the Romance Studies department whose research centers on global health and theatre, to direct the production.

Once Stewart obtained funding for the project through the Franklin Humanities Institute’s Health Humanities Lab, the project was a go.

Students Embrace Stewart’s Unique Teaching Approach

The course, “Ethics of Infectious Disease Control,” aims to help students understand the ethical issues typically encountered in delivering health care, conducting research and implementing interventions in low-resource settings, specifically in the context of infectious diseases. 

The Informed Consent module comprises about 25 percent of the course. In addition to reading, discussing and rehearsing the play, the students are researching and presenting a poster about their assigned character. The performance, a dramatic reading of the play, will take place on December 7 at 7pm at Duke’s Sheafer Theater in the Bryan Center.

Although they didn’t anticipate that their ethics course would involve a theatrical performance, most of the students have embraced the project. “I’ve enjoyed this module because it’s taken me out of my comfort zone,” said senior biology major Taji Phillips. “Performing this play allows us to become the integral figures in this case study, which provides us with a deeper and more engaging connection to our course material.” 

Adam Bullock, a junior majoring in public policy and global health, was particularly drawn to the case on which the play is based. “The Havasaupai case study has helped me realize that there are so many factors of truly ethical community-based research beyond simply getting consent,” he said. “Considering the cultural repercussions of your research and cooperating with the community with whom you’re engaging is essential, and effective evaluation of these considerations likely would have saved the researchers in this case study from the unethical work that they ended up doing.”

Watch the video to hear Stewart, Loiseau and Bullock reflect on the use of Informed Consent as a pedagogical tool:

 

Playwright Laufer Will Visit Duke as Artist-in-Residence

The playwright, Deborah Zoe Laufer, will visit Duke from December 5 to December 8 as a Health Humanities artist-in-residence, also funded through the Health Humanities Lab. 

As artist-in-residence, she’ll observe two of the rehearsals, attend the performance and host a question-and-answer session after the play. She will also join Charmaine Royal, associate professor in the department of African and African American Studies and in the Institute for Genome Sciences and Policy, for a conversation on genomics, consent and the public imaginary at 12pm on December 7 in 011 Old Chem. Odendahl-James will facilitate this discussion, which is hosted by Duke’s Forum for Scholars and Publics.

“Kearsley Stewart’s translations between global health research, teaching and theater exemplify global health humanities in action,” said Deborah Jenson, co-director of the Health Humanities Lab and professor of French, romance studies and global health. “Laufer’s residency, and her event with Charmaine Royal on genomics and the public imaginary, will bring real scholarly excitement to the Health Humanities Lab community.”

Stewart Seeks to Address Big Questions about Health Humanities

Stewart is also using the course as an opportunity to more broadly explore the role of theatre in training global health practitioners. She and her teaching assistant, Master of Science in Global Health student Crissi Rainer, are collecting data throughout the course with the hopes of publishing an article about the experience and the student learning outcomes in a peer-reviewed journal.

“One of the questions we’re ultimately seeking to answer is, ‘What is the role of the humanities in training global health practitioners, and is it a mirror image of how we deploy the humanities in medical education?’” Stewart said, acknowledging that her findings from this course will only begin to chip away at this expansive question. 

For now, though, she’s enjoying her pedagogical experiment and looking forward to the performance on December 7.

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Rehearsal of Dramatic Reading
Last week, the class began rehearsals for the Informed Consent performance on December 7.

Performing this play allows us to become the integral figures in this case study, which provides us with a deeper and more engaging connection to our course material.

Taji Phillips, senior biology major

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