Creative Collaborations: The Making of “Lissa (Still Time):  a graphic medical ethnography of friendship, loss, and revolution”

This article is part of the following series: Image + Text

Is there a widely accessible yet conceptually rigorous way to convey anthropological insights into the lived complexities and bioethical dilemmas that attend managing chronic illness in two vastly different contexts: the contemporary Arab world and the United States? As it turns out, there is: comics. At the time we began to explore this question, we had both been excited by the pedagogical potentials of this genre in our medical anthropological teaching (Hamdy 2014, Nye 2015). Like other scholars working in the growing field of what Ian Williams has termed “graphic medicine,” we found that the combination of text and image in graphic memoirs such as Hyperbole and a Half or Mom’s Cancer can powerfully convey the visceral, temporal, and social dimensions of illness, while the levity of the genre makes it easier to engage with difficult topics such as suicidal depression or cancer. We began to consider that the graphic form might also make it possible to succinctly and effectively visualize medical anthropological concepts such as “structural violence,” “biotechnical embrace,” or “political etiologies.”

Motivated by the conceptual and pedagogical potentials of comics, we began the process of crafting a collaborative narrative-based graphic adaptation of our original field research (process illustrated here by Hamdy’s daughter in figure 1). This has led to a richly collaborative multi-dimensional project developed with the guidance of award-winning cartoonist and editor Paul Karasik and illustrated by Rhode Island School of Design students Sarula Bao and Caroline Brewer. We are thrilled to announce that the resulting project, Lissa (Still Time): a graphic medical ethnography of friendship, loss, and revolution, is now forthcoming with University of Toronto Press’s ethnoGRAPHIC series edited by Anne Brackenbury. The print book will also be supplemented by an interactive digital platform that explores more deeply the conceptual themes of the book, as well as a documentary film by Francesco Dragone that captures the process of creating Lissa, including a research trip to Egypt (funded by the Henry Luce Foundation).

 

Set in Cairo, the project is informed by Sherine Hamdy’s work in the field of Islamic bioethics – specifically, her ethnographic research in Egypt on the vulnerabilities that expose people to kidney and liver disease, and the difficulties of accessing proper treatment. The work also draws on Coleman Nye’s research in the U.S. on the social and political calculus of managing genetic risk for breast and ovarian cancer within a commercial healthcare system. This graphic work of “ethnofiction” (Stoller 1992) tells the story of an unlikely friendship between Anna (depicted in figures 2 and 3), the daughter of American expats living in Cairo with a family history of breast cancer, and Layla (figure 4), the daughter of the doorman/servant of Anna’s apartment building, who grows to become a resolute physician struggling for better public health justice and rights in Egypt (based on work by Hamdy and Soha Bayoumi). Following the women as they grow up together and grapple with difficult medical decisions, our project explores how different people come to terms with illness and mortality against the backdrop of political, economic, and environmental crises. Ultimately this form of engaged scholarship transforms the ethnographic encounter into a more accessible, readable and visually effective medium that invites readers to draw their own conclusions about how the material relates to their lives.

 

 

But what exactly does this collaborative ethno-graphic endeavor look like in practice? How did this team of artists and ethnographers develop our characters, craft the story, and create the drawings? What representational choices did we make and why? This project has been an ongoing exercise in co-creation from building a story that bridges our research sites to translating it into the visual language of comics. While there is much to be said about this, we will briefly touch on a few of the decisions that arose in our work including the use of ethnofiction, the work of visual storytelling, and questions of knowledge production and authorship.

Hamdy’s project on kidney disease in Egypt and Nye’s on breast cancer genetics in the U.S. started out separately; neither was comparative nor collaborative. For the graphic novel, we created fictional characters to make these worlds intersect, crafting an absorbing character-driven narrative that allowed us to more fully examine the affinities and tensions between them. Layla and Anna, while fictional, are also in a sense composite characters, each based on scores of interviews and research that allowed us to make more explicit choices in conveying anthropological theory through dialogue and plot. Fictionalization also gave us the flexibility to constantly adapt the narrative in conversation with the artists and informants. As the artists began to draw, we would discuss how to make the narrative more visually compelling or concise based on their input and our own responses to the illustrations. For example, there was a moment when we chose to take out a violent scene because we found it too disturbing when faced with its visual representation. The narrative changed shape again as we spent time in Egypt meeting with doctors who provided care to wounded protestors in Tahrir Square. Their feedback and guidance helped us to adapt scenes in the story to more accurately portray their lived experiences.

One of the most generative aspects of the process has been realizing how much more we can convey through the combination of text and image. For example, the concept of political etiologies that took Hamdy roughly 30 pages to describe in an academic article (2008) can be graphically illustrated in a one page spread. We communicate this visually and associatively through an image of an Egyptian patient’s body linked to a dialysis machine, its tubes snaking outward spatially and temporally, connecting the patient’s sick body to the parasite-transmitting snails of the Nile, the Camp David Egypt-Israel Peace Agreement of 1979, the overproduction of U.S. Midwestern wheat upon which the Egyptian population now depends for food, chemical fertilizers, pesticides, failing infrastructure, and the black market in counterfeit medical drugs and equipment. Following connections across scales and times is more fluid in graphic form, facilitating our work between two contrasting global contexts to expose a range of interconnected issues in health, politics, and justice.

While the comics project has facilitated a range of collaborative, adaptive, and pedagogical functions, we also sacrificed some of the fine-grained ethnographic complexity of our sites and analyses. Not everything could make it into the final book project, and we do not ultimately portray the full range of perspectives of people facing medical decisions like those of our characters.

In an effort to recuperate some of the fuller complexity of our research and analysis, we are developing a digital platform. We envision the accompanying digital publication as a way to explode the standard linear reading of the narrative and to allow users to follow multiple paths of inquiry. We also seek to expose the very making of scholarship and the processes of knowledge production. This project has involved the translation of different forms of knowledge across genres, languages, contexts, and individual perspectives.

Of particular interest to us is the ethics of representation, due in part to the recent trend of academic tourism around the Arab Spring that has tended to overshadow the intellectual production emerging from the revolutionaries themselves and those most immediately affected by the political uprisings. It has been important to us to highlight the tremendous artistic, academic, and activist work that Egyptians themselves were doing in the very acts of fighting off riot police, improvisationally healing the wounded, navigating censorship, and presenting competing counter-narratives to state propaganda.

In recognition of our debt to these critical thinkers, their work appears on our digital site and in our documentary film. For example, we highlight the work of Egyptian graffiti artists who were already using illustrations in sophisticated and stunning ways to level trenchant political critiques. We also incorporate some revolutionaries as characters in the graphic narrative itself; for example Dr. Amr Shebaita, co-founder of Tahrir Doctors, Dr. Dina Shokry, and several women from the Women and Memory Forum archive are depicted in the graphic narrative interacting with our fictional characters.

The digital platform will enable us to highlight voices of the various contributors to this project, including the interlocutors upon which the narrative is based, the artists, technologists, researchers, animators, and filmmakers. At each point of intervention, we invite the reader to challenge the assumptions of authorship and scholarly authority.

 

 

Works Cited

Hamdy, Sherine. 2014. “Top of the Heap: ‘Graphic Medicine.’” Somatosphere, March 26.

Hamdy, Sherine. 2008. “When the State and Your Kidneys Fail: Political Etiologies in an Egyptian Dialysis Ward.” American Ethnologist 35(4): 553-569.

Nye, Coleman. 2015. “Teaching Comics in a Medical Anthropology and Humanities Classroom.” Teaching Culture, March 16.

Stoller, Paul. 1992. The Cinematic Griot: The Ethnography of Jean Rouch. Chicago: University of Chicago Press.