The I Congreso Medicina Gráfica (First Graphic Medicine Congress) was a one-day conference held at the University of Zaragoza on 30 November 2018. It explored the diverse intersections between the healthcare sector, the comic, the graphic novel and other innovative illustrative tools such as infographics and animations. With over 200 delegates, and 30 speakers, the conference showcased the impressive range of graphic materials and research being produced across Spain by healthcare professionals, undergraduate and postgraduate students, artists, patients and their families. Fittingly, the venue for the event was the grand former faculty of Medicine and Sciences, which, as one of the speakers noted, was the alma mater of Nobel prize winner, Santiago Ramón y Cajal, who was both a ground-breaking neuroscientist and an exceptional illustrator. This mention reflected a message that was reinforced throughout the conference; namely, the need to rectify the arbitrary separation that society has made between the arts and medicine. The conference highlighted a fundamental need for a more humanistic and altruistic conception of medicine and the healthcare sector, in which comics and other graphic materials play a key role in mediating patient-doctor relationships, and in facilitating public and professional understandings of the subjective, lived experience of both physical and mental illness.
The day started with an introduction from Sandra García Armesto, Director of The Aragonese Institute of Health Sciences (Instituto Aragonés de Ciencias de la Salud) and Mónica Lalanda, President of the Graphic Medicine Scientific Committee and Cartoonist-Physician. They began by presenting the graphic medicine team (and conference organisers) who represent a wide variety of healthcare professions and disciplines (medicine, nursing, pharmacy, teaching, investigation) in both Spain and Latin America. The team, who connected via social media, are bound by a shared passion for comics and a mutual belief in their power and value to the world of medicine, and as an engaging antidote to dense, and often dry, written medical materials. In March 2017, they launched the website Medicina Gráfica – the Spanish-language sister site of the Anglo-Saxon Graphic Medicine website created by Dr Ian Williams in 2007, who also attended the conference.
The need for more humanistic forms of medical education
The morning was divided into five sessions. The first examined the importance of Graphic Medicine within the current medical panorama in Spain. Dr Milagros García, President of the Spanish Society of Medical Education, emphasised the need to develop more humanistic, interpersonal tools and skillsets in Spanish undergraduate medical education, to complement existing technical, biomedical and clinical resources, and to respond to demographic and epidemiological changes, and new ethical dimensions. She stressed the need for short, immediate, and graphic, rather than textual messages (of the type that are now being employed by the BMJ) which are in step with new, rapidly-changing forms of technology and communication. In this same session, Dr Fernando Carballo, President of the Federation of Spanish Scientific Associations (FACME), called for comics, as well as literature, cinema and music, to be included in medical training. He suggested that a focus on sub-specialisms has dehumanised medicine, making it abstract and disconnected from the patient’s subjective experiences of pain, suffering, death or psychological distress. Carballo proposed that as the arts have long delved into these feelings, it follows that doctors should use such texts to access the experiences of their patients and to inform their professional practice.
The birth of graphic medicine
The second session provided a brief history of the graphic medicine manifesto, and of the comic and comic language. It also explored representations of illness in the contemporary comic. Dr Ian Williams, who first coined the term ‘graphic medicine’, started the session by charting the origins and development of the graphic medicine scene, which emerged from his Medical Humanities MA thesis on comics as a resource for healthcare professionals, and the creation of his graphic medicine website in 2007. He discussed how the website connected him to other comic artists and medics like Professor Michael Green (Penn State Medical School) and MK Czerwiec, who had a shared interest in the intersection between comics and medicine. This led to the inaugural Comics and Medicine conference in London in 2010, and the subsequent formation of the Anglo-Saxon graphic medicine collective, who now hold yearly conferences. For two years, Williams also produced a weekly comic strip called Sick Notes on the state of the NHS for The Guardian newspaper. He then explained how the English and Spanish-language graphic medicine movements became interconnected in 2014, following an invitation from Mónica Lalanda to talk to medical professionals in Zaragoza about the concept of graphic medicine, which prompted the linking up of the two websites last year.
Making the invisible visible
Following on from Williams, comic specialist, Juan Royo highlighted the value of using daily life to tell stories about illness (referencing poignant Spanish graphic works depicting quotidian experiences of illness such as Cristina Durán’s Una posibilidad entre mil or Ana Penyas’s Estamos todas bien). He indicated that daily life provides a particularly accessible lens for generating knowledge of and sensitizing less understood illnesses such as mental health conditions. Comic expert Álvaro Pons then ran through the history of comics, from cave drawings to the comics of the modern era; reminding the audience that illustrations, though often dismissed as ‘childish’, are an innate part of human storytelling. The last speaker of the session, Inés Gonzalez Cabeza, a PhD student at the University of León, and author of the book Imágenes de la enfermedad en el comic actual, discussed graphic pathographies – telling how the description of illness using printed images exposes us to alternative realities; to subjective experiences of illness which are difficult to articulate in words, and which are only usually felt by the person actually living them. Graphic pathographies allow us to see illness from the point of view of the sufferer and to witness instances which are often invisible, using techniques such as visual metaphors. Indeed, in one of the most memorable statements of the day, Inés pointed out that: ‘el comic es un lenguaje eficaz para representar la parte invisible de la enfermedad’ (‘the comic is an effective language to represent the invisible part of illness’).
Graphic medicine as a means of disseminating information to the public and professionals
The final three sessions of the morning looked at the comic and graphic medicine as tools for teaching ethics and communication to students, for transmitting information from professional to professional, and as a means of diffusing information to society. Here, A&E doctor and writer JM Salas presented his project Jacinto y sus amigos, which uses fun animations and comics to teach first aid to children, while nurse Tolo Villalonga discussed the project Rincones de salud, which involves reimagining inhospitable surgeries to include comics, cartoons and illustrations. Next, nurse Silvia Sanchez exhibited her Enfermeria creativa (creative nursing) project, a series of infographics providing visual support to other nursing professionals. The session rounded off with biologists Miriam Rivero and Jesús Sanchez presenting the infographics and comics they have produced (BIOMIICS, A lymph’s life) as a means of translating complex biological concepts into a more comprehensible visual language. As a Medical Humanities PhD student from a non-medical background exploring mental health through the graphic novel, literature and cinema, and hypothesising about the influence of such narratives on the wider public, it was fascinating to hear concrete rather than theoretical examples of how graphic images can influence the public perception of medicine, and to see how graphics are being actively employed in medical training. I was extremely impressed by the creativity and artistic talent of the medical professionals who exhibited the graphic tools that they are incorporating into their practice.
Round table: Graphic pathographies
The afternoon kicked off with a lively round table discussion on graphic pathographies. The discussion was facilitated by Mónica Lalanda and Alejandro Martínez, who invited authors of Spanish graphic novels depicting illness to discuss the themes and messages transmitted in their own frames. The panel comprised: Miguel Gallardo, author of María y yo, which portrays Gallardo’s own experiences as a single father raising his young daughter who has autism; Cristina Durán, whose work Una posibilidad entre mil, tells the story of how she and her husband coped when their baby daughter Laia suffered a thrombosis just forty-eight hours after her birth; María Hernández and Isabel Franc, authors of Que no, que no me muero, and Alicia en el mundo real, which evoke their respective experiences of breast cancer with poignancy and humour; and Zarva Barroso, who described his graphic novel Don Barroso as a type of ‘duelo artístico’ (artistic mourning) for his father who had colon cancer. Interestingly, when asked whether crafting their graphic novels became a form of therapy, the authors agreed that they did not perceive the process as personally therapeutic, but they recognised the potential of their narratives to help others in similar situations to not feel so alone or to be better informed. Gallardo noted how his graphic novel has helped other parents to identify autism in their children, meaning that they have avoided the long delay in diagnosis that he experienced with his daughter María.
The comparison of the different frames also drew out an interesting discussion on the formal techniques (visual metaphors, colours) used by the authors to represent and communicate pain and hope. Durán, for example, used a black stain to symbolise moments of risk, fear or poor prognosis and green colouring to convey hope. Perhaps, the most salient and sobering theme which cut across all the graphic novels, was the disconnect between the patient and medical professionals. Each of the novels contained frames in which the patient is either ill-informed about their diagnosis or treatment by medics or bombarded with complex medical terminology. There were also examples of professionals treating patients dismissively or with disinterest. The graphic novel thus provides an opportunity for medics to see their practice from the patient’s point of view and to reflect on their interpersonal skills; a need which was articulated by most of the speakers throughout the course of the day. However, the frames also encourage reflection on why professionals’ interpersonal skills may be compromised. They indicate a need to evaluate demands on the public health sector such as financial pressures or increasing patient numbers, which impact on doctors’ ability to provide personalised and compassionate care.
Graphic medicine created by patients
The final session of the day provided further examples of graphic medicine created by patients. It started with a conversation between Fernando Abadía and Jorge Arranz, who have taken the Urban Sketchers movement (a global artistic community who draw on location in places they either live or travel to) into hospitals and surgeries. Jorge displayed the sketches he produced while hospitalised for heart surgery in Madrid which ranged from an image of himself lying in bed covered in tubes and hooked up to machines, to the view from his hospital bed of the street outside, and his journey home. Once more, these images allowed medical staff access to perspectives that are normally unseen. In the last presentation of the conference, María Escudero and Teresa Bordons discussed the project Contigo en el hospital – a guide illustrated with drawings and photos, designed to prepare adolescents for heart surgery. The guide is produced by other young people who have undergone heart surgery and it is edited by the Menudos corazones foundation. The aim of the project is to give a voice and a sense of empowerment to young people with congenital heart disease and to reduce uncertainty before, during and after surgery, and it has proven to be a source of emotional support when young people feel unable to talk to adults about their feelings. For the umpteenth time that day, I was touched by the demonstrable emotive and restorative power of the visual image, and struck by the breadth of projects that are being developed throughout Spain to tap into the comic’s affective power.
In the concluding remarks, Rafael Marrón (member of the medicina gráfica team and A&E doctor) reiterated the need to integrate the worlds of the arts and medicine; the value of which was more than demonstrable in the day’s presentations. He echoed the speakers in lamenting that medicine is often separated from people, yet ended with the positive message that comics and other graphic materials provide a means of bridging this gap. On a personal note, the conference gave a useful insight into the formal illustrative, often metaphorical techniques used to convey illness and pain which I will build into my research, as well as providing a wealth of real-life examples of comics’ medical, social and subjective uses. Finally, I have also been inspired to become an urban sketcher!
Katie Salmon is a PhD researcher at Newcastle University. Her thesis explores representations of crisis and mental health in contemporary Chilean and Spanish film, literature and graphic novels.