Medical Humanities

We are a vibrant interdisciplinary research cluster that focuses on the literary, linguistic, social, cultural, historical, and philosophical dimensions of health and sickness. We promote the contributions of the humanities to healthcare, medical practice, and the wider community and foster international collaboration among medical humanities scholars to address healthcare issues of urgent concern in South East Asia and beyond. We seek to expand our network across a wide range of disciplines and welcome applications for PhD research on topics related to health, culture, and society.

Graham MATTHEWS
Cluster Coordinator
gmatthews@ntu.edu.sg

Melvin CHEN
melvinchen@ntu.edu.sg

Michelle CHIANG Hui Ling
michellechiang@ntu.edu.sg

Katherine HINDLEY

khindley@ntu.edu.sg

HO Hau Yan Andy

andyhyho@ntu.edu.sg

LIM Ni Eng

nelim@ntu.edu.sg

KK LUKE

kkluke@ntu.edu.sg

PARK Hyung Wook

hwpark@ntu.edu.sg

Francesco PERONO CACCIAFOCO

fcacciafoco@ntu.edu.sg

Michael STANLEY-BAKER
msb@ntu.edu.sg

Hallam STEVENS
hstevens@ntu.edu.sg

Ivy Hui-Yuan YEH

hyyeh@ntu.edu.sg

Ian DIXON

ian.dixon@ntu.edu.sg

FANG Xiaoping

XPFang@ntu.edu.sg

Medical Humanities is an interdisciplinary research cluster with active researchers from Literature, Linguistics, Philosophy, History, and China Studies. The cluster creates impactful research that is attentive to the traditional concerns of the humanities but also seeks ways to generate and sustain civic engagement. We have three key areas of focus:

Health Communication

Enhancing the capacity of individuals to obtain, process, and understand the basic health information and services needed to make appropriate health decisions. Our projects focus on the communication skills of lay persons and medical professionals as well as community engagement and public health.

Narrative Medicine
Pathographies or stories of sickness are personal narratives that describe experiences of illness, treatment, and sometimes death. They offer the opportunity to understand and analyse the impact of socio-cultural factors (age, ethnicity, gender, sexuality, religion, etc) on conceptions of health and sickness.

History of Medicine
Shows how societies have changed in their approach to health, sickness and disease from ancient times to the present. Our cluster specialises in the Asian contexts of medicine with research projects on the Silk Road, the spread of medicine in China, and hospitals in South Korea.

Barefoot Doctors and Western Medicine in China

Fang Xiaoping

In 1968, at the height of the Cultural Revolution, the Chinese Communist Party endorsed a radical new system of health-care delivery for the rural masses. Soon every village had at least one barefoot doctor to provide basic medical care, creating a national network of health-care services for the very first time. The barefoot doctors were portrayed nationally and internationally as revolutionary heroes, wading undaunted through rice paddies to bring effective, low-cost care to poor peasants. This book is the first comprehensive study to look beyond the nostalgia dominating present scholarship on public health in China and offer a powerful and carefully contextualized critique of the prevailing views on the role of barefoot doctors, their legacy, and their impact. Drawing on primary documents from the Cultural Revolution and personal interviews with patients and doctors, Xiaoping Fang examines the evidence within the broader history of medicine in revolutionary and postreform China. He finds that rather than consolidating traditional Chinese medicine, as purported by government propaganda, the barefoot doctor program introduced modern Western medicine to rural China, effectively modernizing established methods and forms of care. As a result, this volume retrieves from potential oblivion a critical part of the history of Western medicine in China.

Care, Narrativity, and the Nature of Disponibilité

Melvin Chen

This paper attempts to make more explicit the relationship between narrativity and feminist care eth-ics. The central concern is the way in which narrativity carries the semantic load that some accounts of feminist care ethics imply but leave hanging. In so doing, some feminist theorists of care-based ethics then undervalue the major contribution that narrativity provides to care ethics: it carries the semantic load that is essential to the best care. In this article, I defend the narrative as the central medium though which we make sense of and communicate our lives and their attendant hopes and cares. More than just working with the narrative of the cared-for, caring is about investing in the nar-rative of the cared-for in order to meet the needs of this cared-for and how this narrative might turn out. I will further demonstrate how the attitude of caring or investing in a narrative would amount to what Gabriel Marcel has described as the attitude of disponibilité.

Crafting Seoul National University Hospital: Healthcare, Medical Modernity, and their Techno-Cultural Construction

Park Hyung Wook

This project aims at studying the evolution of South Korean hospitals from 1945 to 2015. This is a significant academic subject in three aspects. First, hospitals are the key places of biomedicine, a new form of healthcare in modern society. By analyzing the changing roles and structures of South Korean hospitals, we can understand how health has been technologically constructed and culturally negotiated in South Korea. Second, Korean hospitals have played important historical roles at key moments. Above all, they were the crucial agencies of national reconstruction after the Korean War, when the United States federal government retrained Korean physicians and medical professors, who contributed to transforming the practice of healthcare in the country. Third, Korean hospitals have often been castigated for their manifold problems, while, paradoxically, advertising their "advanced" system to medical tourists from China, Vietnam, and Malaysia. As we can see in the recent MERS (Middle Eastern Respiratory Syndrome) outbreak in Korea, their Confucianism-inspired reliance on patients' family members for patient care and feeding have incurred substantial casualties and bitter criticism. Obviously, South Korea's hospitals are a reflection of the country's troubled past as well as an ongoing project toward medical modernity in the global era. Thus my hypothesis is that the current problems and strength of Korean hospitals were simultaneously formed as a techno-cultural response to the questions and conditions of modernity that people had to negotiate with during the shifting social conditions. I want to examine this hypothesis using a historical and sociological methodology and approach, namely, archival research and interviewing. This project is relevant to Singapore, because Korea’s growth pattern was similar to Singapore’s during the twentieth century. In my study of a Korean case, Singaporeans will find a useful resource for improving their healthcare system.

Death Memoirs: Chronophobia, the Terminal Body, and the Search for Temporal Control

Michelle Chiang

“Would I be surprised if this patient died in the next 12 months?” This is the Surprise Question which is used in the UK and US to identify terminally ill patients who might benefit from palliative care services. Studies on its accuracy often reported modest to poor performance, and the search for better assessment tools is ongoing. The difficulty to accurately predict or obtain an accurate predic-tion from medical experts about when one’s end would arrive as the body fails, contributes to the titular term of this project ‘Chronophobia’ or the fear of passing time and the future. By exploring end-of-life memoirs written in the perspectives of patients and their caregivers, the research (a) shines a spotlight on the centrality of time perception in the experience of terminal illnesses, and (b) proposes that a key therapeutic benefit of writing is the sense of temporal control, which patients and their loved ones could derive from the process of re-ordering and re-living a life narrative in the face of an unpredictable and impending end.

Doctoring the Elderly

Lim Ni Eng and KK Luke

The project is an interdisciplinary study on authentic medical interaction with elderly patients within the diverse context of multilingual-multicultural Singapore. The proposed methodology uses video recordings of the actual doctor-patient consultations to examine the efficacy of regular interactional practices that doctors use in their consultation with elderly patients, via the qualitative methodology of Conversation Analysis (CA). How these interactional practices impact patients’ satisfaction and their understanding of the medical consultation are examined to identify best practices and common short-comings in communicating healthcare to elderly patients in Singapore. The eventual goal of this project is to improve medical outcomes for the elderly (i.e. better healthcare knowledge, higher patient satisfaction and stronger treatment adherence) through more effective medical communication. To operationalize the study, we collated a corpus of video-recordings on first-visit consultations in the Urology clinics of Tan Tock Seng Hospital. Initial findings from the pilot data reveal specific areas of concerns, such as how different formulations of talk and their sequential positioning in the doctors’ recommendation may affect patients’ agreement to undergo crucial diagnostic tests for treatment of hematuria (blood in urine). The interdisciplinary collaboration between linguists, frontline clinicians and medical educators in this research promises findings of significance not only to medical studies, but to language and cultural studies in the social sciences as well.

Doctors, Daoists and Demons: Situating Medicine and Religion in Early Imperial China

Michael Stanley-Baker

The emergence of classical Chinese medicine took place within a dynamic and vibrant marketplace populated by a host of other practitioners—trance mediums, transcendents, Daoists and Buddhists of different stripes. This book examines how these local communities and individuals defined themselves through diverse repertoires of rituals, drugs, exercises and other treatments, and introduces novel arguments within the history of Chinese medicine and religions. It argues that the relationship between medicine and religion was not cleaved by the emergence of classical medicine, but that an emerging distance between developed as healers responded to changing conditions of their time. Through close reading of primary sources, paying attention to the language of practice and how healers situated their practices in relation to others, we see the emergence of complex, shifting relations over time. The story moves through complex solutions produced in response to the collapse of the Han Dynasty and its widespread epidemics; a period of consolidation, structuring and competition in the third and fourth century; a radical shift to post-mortem forms of salvation in the fifth century, with the introduction of large volumes of Buddhist translations and increasing institutional presence; and the development of state medicine by the Sui/Tang court.

Switching focus away from the history of ideas and social history, Stanley-Baker argues that early healers’ reflections on what they did and how it differed from others was expressed in the language of practice—be it linguistic, technical, embodied, or bibliographic. Arguing that knowledge is al-ways situated and performative, Stanley-Baker shifts our view from one from above to a view from within, teasing out the means by which early healers situated themselves, negotiating the value and meaning of what they did within their contemporary environment. Examining the processes by which real-world actors engaged with material problems in complex ways, rather than mapping out abstract structures of an abstract marketplace, this book portrays “religion” and “medicine” as emergent, dynamic positional claims, rather than defined and fixed fields of activity or knowledge.

Early Evidence for Travel with Infectious Diseases along the Silk Road

Ivy Yeh Hui-Yan

The aim of this project is to investigate the kinds of intestinal parasites present in those people who were using a latrine from the northwest frontline of ancient China. This project is to understand their hygiene level, diet practices and what kind of diseases they might have contracted. The Silk Road has often been blamed for the spread of infectious diseases in the past between East Asia, the Middle East and Europe. While such a hypothesis seems plausible, there is actually very little concrete evidence to prove that diseases were transmitted by early travellers moving along its various branches. The aim of this study is to look for ancient parasite eggs on personal hygiene sticks in a latrine at a large relay station on the Silk Road at Xuanquanzhi (111 BCE–CE 109), at the eastern margin of the Tarim Basin in north-western China. We isolated eggs of four species of parasitic intestinal worms: Chinese liver fluke (Clonorchis sinensis), Taenia sp. tapeworm (likely Taenia asiatica, Taenia solium or Taenia saginata), roundworm (Ascaris lumbricoides) and whipworm (Trichuris trichiura). The Chinese liver fluke requires wet marshy areas to sustain its life cycle and could not have been endemic to this arid region. The presence of this species suggests that people from well-watered areas of eastern or southern China travelled with their parasites to this relay station along the Silk Road, either for trade or on government business. This appears to be the earliest archaeological evidence for travel with infectious diseases along the Silk Road.

Endemic Diseases and Their Perception- Cultural Anthropology of Illnesses in Alor Island

Francesco Perono Cacciafoco

This paper reconstructs the etymology of the names of endemic diseases and their perception and interpretation by local people in the context of Abui language and culture. Abui (ISO 639-3: abz; Glottolog: abui1241) is a Papuan language (Trans-New Guinea family, Alor-Pantar sub-family) spoken approximately by 17,000 speakers in the central part of Alor Island, South-East Indonesia, Alor-Pantar archipelago, Timor area. The native name of the language is Abui tangà, literally meaning ‘mountain language’. The Alor-Pantar languages are a family of clearly related Papuan languages spoken on islands of the Alor-Pantar archipelago. Besides eminently linguistic aspects of the naming strategies used by Abui speakers in ‘making’ and (sometimes par-etymologically) explaining the names of local diseases, the paper investigates anthropological elements of the relations between Abui people and local illnesses common in Timor’s area, like resistant malaria, yellow fever, cutaneous Leishmaniasis, Japanese encephalitis, and typhoid fever. In particular, the paper analyzes local beliefs about the origins of these diseases, often connected with the breaking of a taboo or with a ‘curse’ triggered by a ‘criminal act’ (e.g. fruit theft from a private property, specifically from a tree to which a spell has been ‘applied’ by the owner of the land). The paper investigates, therefore, the perception of the illnesses by local people, from the appearance of the first symptoms to their course, and the cause-effect relationship of the onset of the diseases according to local beliefs and traditional Abui medicine. The analysis is developed through a comparative approach focused, mainly, on Papuan and Austronesian aboriginal contexts. This study associates Etymology and Language Documentation with Cultural Anthropology, History of Medicine, and History of Culture.

Healing Plants and Their Cultural Meaning: An Intangible Heritage between Linguistics and History of Medicine

Francesco Perono Cacciafoco

This paper provides a comparative etymological reconstruction of the names of 22 medicinal plants among Indo-European, Papuan, Austronesian, and Semitic languages, focusing both on their popular denominations in different languages and cultural contexts and on their scientific designations (binomial nomenclature). Starting from the linguistic analysis of the origins and original meanings of these medicinal plant names, the paper highlights analogies and differences in the naming processes of phytonyms in unrelated linguistic and cultural contexts (Indo-European, Papuan, Austronesian, and Semitic), looking for common patterns in the related onomatopoesis. Besides linguistic and historical perspectives, the paper investigates the use made, over time, of medicinal plants by different people, in different chronological and geographical contexts, both at the level of disease treatments and at the level of nutritional supports (in the daily diet and in diet-therapy). Starting from the analysis of ancient written records and ancestral oral traditions, the paper documents stories and legends connected with specific medicinal plants, unearthing an almost lost intangible heritage reconstructed on the basis of historical sources, when available (especially in Indo-European and Semitic contexts), and of fieldwork reports and recordings of still unpublished aboriginal oral traditions and myths (especially in Austronesian and Papuan contexts). The paper aims at highlighting possible common patterns in the naming processes of medicinal plants in different and unrelated linguistic contexts and at safeguarding a traditional heritage of myths and legends linked to medicinal phytonyms that still needs to be explored in depth and that, in the case of aboriginal contexts, urgently needs to be preserved and documented. This interdisciplinary work associates Historical Linguistics and Anthropological Linguistics with History of Medicine, Language Documentation, and History of Culture.

We are intensively cooperating with the University of Hawaii at Manoa (A.L. Blake) and with the Palacky University at Olomuc, Czech Republic (Frantisek Kratochvil), sharing data, double-checking them, including fieldwork reports, expanding considerably the database, and aiming at including new Papuan languages of the Alor-Pantar language family and archipelago, like Sawila.

Publications:

Lim, Tyan Gin Shaun, and Perono Cacciafoco, Francesco. [December 2020]. Plants and Place Names: A Case Study of Abui Toponymy. Review of Historical Geography and Toponomastics, 15, 29-30.

Further details: https://blogs.ntu.edu.sg/abui/

Machine Learning for Diabetes Management

Ivy Yeh Hui-Yuan

Diabetes refers to a group of metabolic diseases described by hyperglycemia resulting from irregularities in insulin function. The chronic hyperglycemia of diabetes is related to long-term damage, dysfunction, and failure of multiple organs. Diabetes affects more than 200 million people, and it will continue to increase in the future. To prevent, cure and ameliorate conditions of diabetics, creating a precise model to predict diabetes is essential. Given the development of big data sets, studies have been conducted to apply AI/data mining in diabetes prediction. However, in these approaches, researchers attempted to improve prediction by using datasets or advanced algorithms predicated upon a high niche group of people or clinician information without lifestyle information. Lifestyle information plays important roles in the prediction of diabetes. Therefore, in our research, we wish to incorporate lifestyle information in our dataset. We aim to build a powerful model with complete information for diabetes prediction.

Medical Artificial Intelligence

Melvin Chen

The secret of the care of a patient, as Peabody (1927) well knew with respect to the humanistic ideal of his medical profession, is in caring for the patient. Current medical practice, however, suggests an industry misaligned with this ideal and in disarray. The shift from private practice to hospital practice has given rise to a progressive dehumanization in the practice of medicine. Burnout is on the rise, with more physicians and nurses feeling emotionally exhausted, depersonalized, and ineffective. Can the introduction of medical AI close the quality gap or quality chasm in the medical domain by promoting better disease surveillance, facilitating early detection, allowing for improved diagnoses, and discovering novel treatments (Fogel & Kvedar, 2018)? Might the introduction of medical AI usher in an era of truly personalized medicine, in which healthcare systems are able to match individual patient characteristics with detailed evidence available in real time at the point of care (Abernethy et al, 2010)? At least two fundamental deficits in the design of medical AI systems – the causality deficit and the care deficit – remain to be addressed if this quality gap is to be closed (Chen, 2019).

This Medical AI project, helmed by a philosopher (Dr. Melvin Chen, PI) and a physicist (Assoc. Prof. Chew Lock Yue, Co-I), is generously funded by the NTU Accelerating Creativity & Excellence grant and counts two other physicists and an NUH gastroenterologist among its collaborators. The research team has already worked on the theoretical foundations of causal reasoning and various computational approaches to causal reasoning and is currently modelling the differential diagnosis procedure with respect to patients who have a clinical presentation of jaundice. This project aims to address the causality deficit by designing an algorithm that can approximate causal reasoning and assist medical doctors in primary care settings with the differential diagnosis of jaundice.

Old Age, New Science: Gerontologists and their Biosocial Visions, 1900-1960

Park Hyung Wook

This book focuses on the “biosocial visions” shared by early gerontologists in American and British science and culture from the early to mid-twentieth century who believed the phenomenon of aging was not just biological, but social in nature. Advancements in the life sciences, together with shifting perspectives on the state and future of the elderly in society, informed how gerontologists interacted with seniors, and how they defined successful aging. Park shows how these visions shaped popular discourses on aging, directly influenced the institutionalization of gerontology, and also reflected the class, gender, and race biases of their founders.

On Parchment or on Bread: Textual Magic in Medieval England

Katherine Hindley

This project explores the medieval belief that spoken and written words, in the form of charms and textual amulets, could physically change the world. The project draws on extensive manuscript re-search, resulting in a database of over a thousand charms copied in medieval England between the eighth and fifteenth centuries. This corpus-based approach overturns earlier assumptions about the use of charms in medieval England: for example, where previous scholars have found a hiatus in the copying of charms during the twelfth and thirteenth centuries, I have found a rich and flourishing tradition. This project highlights compelling relationships between medicine, materiality, and language to demonstrate that charm texts were seen as relics, as medical ingredients, and as divine messages. Through examples drawn from literary texts, I also demonstrate that charms were deeply-rooted in medieval English culture. By examining the power of the written word from a range of disciplinary perspectives, the project contributes to knowledge in the fields of literature, religious cultures, and the history of magic and medicine.

Pandemics in Mao’s China: Disease and Mobility between the Great Famine and the Cultural Revolution

Fang Xiaoping

This project explores the mobility of four disparate Chinese social groups— returning diaspora, urban residents, rural populations, and Red Guards—and how they related to the spread and control of the two pandemics between the Great Famine and the Cultural Revolution: El Tor cholera—the first global pandemic to affect China—and epidemic meningitis—the country’s most deadly pandemic after 1949. The project investigates how social control and pandemic control schemes strengthened each other in Mao’s China. It applies medical and political history to create a delicate social study of a previously unexplored aspect of socialist China in the early 1960s.

Research Team:

Michael Stanley-Baker (Principal Investigator)
Faizah binte Zakaria (Co-investigator)
Francesco Perono Cacciafoco

Medicines circulate across languages, regions and communities, forming cultural bridges and revealing how materials and knowledge circulate. What can the study of medicine teach us about cultural exchange, identity-formation and the transmission of knowledge?

This project, funded by the National Heritage Board of Singapore, will build foundational digital tools to enable the cross-cultural study of the history of medicine in maritime Southeast Asia. These consist of a searchable digital text repository and digital drug term synonymy which will help identify and track medicinal products across different languages. Using these tools, we will compare the use of medical materials across three languages: Malay, Chinese and Abui. We will develop a repository of digitized and searchable Malay medical manuscripts, Chinese late imperial medical works and local Peranakan family manuscripts. We will also bring the past into dialogue with the traditions of the present, by hosting oral interviews about the use of medicinal products among Malay, Chinese and Abui speaking communities. This project will also allow scholars to publish further ethnobotanical data, and incorporate it into a comparative framework.

The digital synonymy will enable us to correlate terms across the three languages, and bring historical and contemporary texts into correlation, allowing us to study the degree to which traditional medicines – long considered to be culturally and linguistically enclosed– were built from a history of contact, borrowings and adaptation. We refer to these fluid modalities of healing as “polyglot medicine” and tentatively argue that being polyglot is a hallmark of medical traditions among the diverse communities living in maritime Southeast Asia.

Image Credit: Lin Henghan –Huayü tonghua 华夷通, 1883

Routledge Handbook of Chinese Medicine

Edited by Michael Stanley-Baker (NTU), Vivienne Lo (University College, London)

This handbook aims to showcase the latest research on medicine in China as it has developed over 3,000 years. It will identify themes concerned with both history and culture and the significance of Chinese medicine in the modern world, and invite established experts together with some of the most exciting and innovative younger researchers to respond. China will be understood as an open empire,receptive to all the in-coming influences of religion, materia medica and dietetica , and techniques that have shaped its healing traditions; and also exerting influence through the land, maritime, air and cyber networks that have connected it with other places. To avoid the pitfalls of representing Chinese medicine as a monolithic tradition, detailed attention will be paid to the social and cultural contexts within which a classical medicine emerged, as well as to the realities of everyday practice, to the extent that they can be known. The themes of the book will be traced historically through the healing traditions of Early China, medieval religious institutions, the transmission of knowledge and practice through ritual, writing and authority and the impact of the printing technologies of early modern China. The Ming period, in particular, provides a wealth of exquisitely illustrated medical works which demonstrate the eclectic healing environment. The Handbook will end with two sections on the significance of Chinese medicine in the modern world addressing issues of evidence and, most significantly, an analysis of the global impact of everyday Chinese attitudes to health. It will draw out the complex and paradoxical role of Chinese medicine in the construction of modern Chinese nation as well as its adoption as a strategy of resistance to the perception of an all powerful biomedicine in the Euro-American sphere.

Spaces of Biomedicine in East Asia

Hallam Stevens

Laboratory studies has been a critical aspect of science & technology studies and anthropology of science since the publication of Latour and Woolgar’s Laboratory Life (1979). This project is a multi-sited ethnography of labs and other biomedical spaces in Southeast and East Asia, but attempts to push laboratory studies in some new (methodological) directions.

First, it draws on the field of performance studies as a resource for understanding scientific life and its various enactments. This project is based on a collaboration with performance studies scholar Eddie Paterson (University of Melbourne). Using concepts such as “dramaturgy” as well as paying attention to “theatrical” elements in science, such as costume and movement, we hope to add new dimensions to the understanding of lives in (and around) laboratories.

Second, and as part of this attention to the broader context in which science takes place, this project is especially interested in the urban settings within which laboratories exist. What is the relationship between labs and geographic spaces around them? How do they influence cities socially and culturally? How does this affect the science that goes on inside them? Here we hope to bring laboratory studies into dialogue with urban studies.

We conducted fieldwork in Singapore and at BGI in Shenzhen and Hong Kong. A short piece we wrote about BGI was published in the Life Sciences Foundation Magazine Winter 2015 issue. A longer piece about BGI was published here.

This project was sponsored by a Tier 1 grant from the Ministry of Education, Singapore.