Commentary: The United States is not the only country contemplating significant political change. This week, the Nepalese are holding national elections that may eventually bring to an end the country’s 240 year old Hindu monarchy. Although on an infinitely smaller scale, it is nonetheless thrilling to think of the changes in medical education that Prof. Ravi Shankar and his colleagues are attempting to foster by introducing a medical humanities program to the system of physician training in this mountain kingdom. Despite the exotic location, what surprised me was how similar are the struggles in both countries to implement change and enlarged, more nuanced worldviews as part of our medical education enterprises.
I am sure many of us can relate as we read about the occasionally fumbling but irresistibly exciting initial phases of the Nepalese program. (The program in medical humanities at my own School of Medicine started with me and three pre-clinical students, two of whom never showed up for our inaugural literature and medicine seminar. It was tremendous fun!). I also resonated to the heart-warming and inspiring phenomenon of colleagues materializing out of the woodwork to lend their support and expertise in a humanities-based endeavor. I smiled ruefully when Prof. Shankar described the authoritarian, hierarchical nature of the student-teacher relationship at his medical school, fantasizing, I think, a contrasting degree of openness and familiarity on these democratic shores. Maybe there’s a difference of degree, but not of kind, at least not in my view, as medical education in the U.S. seems to be a surprisingly closed, top-down method of instruction overall, with its chain of command firmly entrenched.
In some respects, the content currently available to the Nepalese medical humanities program may be more “humane” than our own. Prof. Shankar references images of violence incorporated into his curriculum, likely resulting from decade long clashes of government forces with the rebel Maoist army. However, the Nepalese authorities signed a peace treaty with these guerilla forces in 2006. In this country, we have access to fresh images of war-related violence on a daily basis, should we choose to use them in our own teaching, and the end of our war is nowhere in sight.
Finally, although the family farm is rapidly disappearing in the U.S., I think many of us can still connect with the agricultural metaphor Prof Shankar employs. Cultivation of new seeds – and new ideas – is risky business, dependent on many factors from monsoons and weather conditions to funding, and institutional culture over which medical humanities educators often have little control. No matter whether we labor in the resource-rich environment of the United States or in the rapidly evolving kingdom of Nepal, those of us working in this field regularly hope to stave off aesthetic and spiritual hunger and routinely pray for a good humanities harvest.