QScience Connect - Issue 3- Medical Humanities in the Middle East Conference

Life narratives are rare in the Gulf region due to many issues. Khaleeji women writing about their lives, bodies, illnesses, and disabilities is almost unheard of. By writing about their illness and disability, authors re-claim their voice and agency, writing their silenced bodies as Helene Cixous urges women to write through Écriture feminine. This presentation considers the genre of illness narrative through using my memoir on Multiple Sclerosis (MS), teaching, and academia. I will read excerpts from the memoir to contextualize the work in order to stimulate discussion. Head Above Water: Reflections on Illness was published on 30 May 2022, the World MS Day. I will share excerpts from the work with the audience and point out relevant issues of the medicalization of the body. Head Above Water considers the intersections of sexism, racism, and ableism. It calls for a destigmatization of disability and illness in our personal lives and in the academy. It is my hope that the presentation is accessible, creative, and inspires discussion.

This project has the primary aim of investigating the hypothesis that ‘voluntary euthanasia should be legalised due to the importance of respecting patient autonomy and dignity’. A secondary aim is to suggest possible reasons for the apparently lower levels of support for legalisation among physicians compared to the general population. The possible consequences of including dignity as part of the justification for legalising voluntary euthanasia are evaluated, with a focus on the link between dignity and incontinence and the resultant implications on the disabled population. Factors influencing the degree of autonomy a patient can experience when making end-of-life decisions are also explored and applied to the initial hypothesis presented. It is suggested that there are significant safeguarding concerns associated with legalising voluntary euthanasia, with specific considerations of the risks presented to the disabled and terminally ill communities. It is argued that this may provide an explanation for the discrepancies between levels of support for legalising euthanasia between the public, who largely do not have a duty to consider these safeguards, and medical professionals, who largely do. The project makes a universally generalisable conclusion that legalising euthanasia on the grounds of autonomy and dignity presents too significant a risk of harm to vulnerable communities within society, and therefore legalisation should be rejected. This presents a bridge connecting Islamic medical ethics, which strictly prohibits suicide and euthanasia, with values it holds in common with the ‘four principles approach’ outlined by Beauchamp and Childress and develops a rich space for the exploration of how autonomy and dignity can be related to Islamic values of community and public interest, and the paralleled principle of Justice.

Arithmetic in the Arabic world was introduced with the loanword Ariṯmāṭῑqῑ which is derived from the Greek root αριθμός meaning "number", and depending on the context, it is used in two quite distinct senses. In the first sense, arithmetic as a technical term refers to a branch of mathematics that deals with the theory of numbers, numerical computations, and calculations, which is known as ‘Ilm al-ḥisāb from the Islamic era onwards; in the second sense, arithmetic deals with magical matters, talismans, or even some mystical traditions based on numbers and ABJAD letters which could be generally supposed to be used for superstitious purposes. The period from the 9th to the 13th century is well-known as “The Islamic Golden Age” in which works in science and medicine flourished. During this time, knowledge was synthesized from works originating in ancient Mesopotamia, ancient Greece, ancient Rome, ancient Egypt, North Africa, Persia, India, China, and Byzantine civilizations, and the most remarkable treatises on the subject of medicine, specifically in pharmacology and in the profession of apothecary, were published by Arabs and non-Arabs in Muslim-ruled areas enriched by both preserving earlier traditions and enhancing extra experiences and findings of their own. On the other hand, the natural and cultural resources, as well as trade relations, had contributed greatly to the spread of these scientific works. Now, it may be asked, how these two completely distinct disciplines, arithmetic (in both senses) and medicine converge?! The purpose of this study is to investigate the relations between these two fields by examining the significant sources, treatises, ancient texts as well as by introducing notable scientists, physicians, mathematicians in the guise of a physician and polymaths who have written a treatise, monograph or even who collected an encyclopedia and were accomplished in numerous fields of endeavor and inquiry that had writings on both medicine and mathematics besides other fields of study like physics and philosophy. The present research intends to provide a short review on textbooks written by physicians in math but with a remarkable medical approach, on topics, for example, including weights and quantities required in posology (the study of dosages) observed as an example in al-Kindῑ’s pharmaceutical work by the title “Risālah fī ma˓rifat qūwah al-adwīyah al-murakkabah”, where the efficacy (qūwah) of compound medicine is based on geometric progression; or what Avicenna described and formulated in dispensing of medical material in his far-famed medical work al-Qānūn fῑ al-Ṭibb (The Canon of Medicine). Pharmaceutical works are typically about materia medica (a Latin term for medical substances from the work of Dioscorides: De materia medica), singular medicine, their specifications, and some others are mainly about compound medicines (Greek term: γραϕίδιον) which are produced by ingredients in certain proportions. Ariṯmāṭῑqῑ in terms of occult (Arabic term: Xafῑya) is considered a sort of supernatural belief recommended and used widely by especially non-academic practitioners in disease cures outside the scope of science, which leads us to spot the use of magic squares and their applications in medicine as a way of assumed treatment.

Objective: The study reports on medical student learning outcomes from a cancer survivorship narrative medicine service-learning project in Doha, State of Qatar.

Methodology: From 2014-2017 students at Weill Cornell Medical College in Qatar in collaboration with persons living with cancer wrote stories of the patients’ cancer journeys published in a dual language Arabic / English book entitled قصة الامل (Story of Hope). The stories examined the socioeconomic, psychosocial, and familial impact of acute and chronic disease from the patients’ perspective. The Story of Hope is used throughout Qatar in peer-peer patient education groups. The research was approved for human subjects research by the Internal Review Boards of Weill Cornell Medicine-Qatar and Hamad Medical Corporation in 2014 and 2016. A convenience sample of 9 medical and premedical students participated in semi-structured taped audio interviews and filled out a questionnaire with free response and 5-point Likert Scale items (mixed methods research). Grounded Theory methods (Glaser & Strauss) were used to establish nine themes in the transcribed interview data, and themes were correlated with the questionnaire data.

Results: On average, the student participants in the study only had previous encounters with cancer patients of less than 1 hour. The project represented the first one-on-one meeting with a cancer patient for 80.0% of the students. Most students agreed (20.0%=strongly agreed, with 60.0%=agreed) that their encounters with patients changed their perspective on all aspects of cancer. The students unanimously agreed (80.0%=strongly agreed, and 20.0% =agreed) that service learning should be formally integrated into medical education. Some of the key themes from the interviews included: 1. Cancer Stigma: “M9: “as long as there is a strong stereotype against cancer, there is a big fear from the society about cancer. So, I don’t see how people would be willing to actually volunteer to go out of their daily routine and do a checkup for cancer.”  2. Delivering Diagnosis: “M3: I will spend a lot of time, I mean maybe an equivalent amount of time thinking about how to find a way to break this news down to people, as opposed to spending a lot of time discovering what treatment plans, I mean obviously that is very important…. on how to actually introduce this new change.” 3. Family Dynamics in Cancer: “M8: ...and family support is important and even when we deal with a patient as a physician, we should not deal with the patient himself, we should deal with the whole group, like the patient, the sister, the mother, brother….I have to orchestrate how everyone can help.”

Conclusions: The study provides proof of concept for the teaching of narrative medicine in a service-learning format in medical education in a high-income but developing Middle Eastern country. Positive effects in student learning were observed, as well as improvements in the psychosocial functioning of persons living with cancer. The research additionally provides evidence for the value of incorporating the patient perspective on disease into health training to teach human factors in disease and social determinants of health.

Background: Humanistic approaches to healthcare are required to facilitate positive patient-healthcare provider relationships and health outcomes. Researching these humanistic approaches can be challenging as social interactions are complex by nature. Recognition of complexity in social interactions requires a move away from simple, linear methodologies towards methodologies that can embrace and harness complexity to answer research questions.

Video Reflexive Ethnography: Video Reflexive Ethnography (VRE) is a novel and proactive research approach which recognises the complexity of everyday social situations. VRE aims to not only generate understanding but also improves practice. It does this by engaging participants and researchers in a collaborative process of reviewing video footage to gain new insights and interpretations about everyday practices. This process can empower participants to improve and change their practices. VRE has not been widely used as a research approach in the Middle East and the acceptability of these techniques for participants in the Middle Eastern context is unknown. At The Hashemite University in Jordan, we used VRE to explore medical students’ practices of receiving feedback about their clinical communication. We will detail the principles of VRE using the research from Jordan as an illustrative example.

Principles of Video Reflexive Ethnography:

VRE does not have a prescriptive set of procedures but allows for flexible application of four VRE principles to guide the research process:

•  Exnovation (a combination of the words excavation and innovation) – watching video-footage turned medical students’ and our attention to habits - purposeful or unconscious - that inform behaviours during feedback interactions about clinical communication simulations.

• Collaboration – working collaboratively with medical students allowed for different perspectives to be fully explored in the research. This resulted in co-construction of the research and knowledge generating process. This approach was empowering and gave meaningful results to the medical students themselves.

• Reflexivity – video footage enabled a complex activity, such as feedback, to be re-played and viewed by medical students and ourselves. Familiar routine activities could be seen as unfamiliar activities of interest. Multiple meanings and interpretations were found as medical students viewed themselves as others might and discussed what was shown and what they saw. Reflexivity has the potential to improve feedback practices and to give medical students increased agency to change behaviours of which they were not previously aware.

• Care – maintaining respect and considering emotions and power dynamics for medical students and ourselves throughout the research process, to facilitate honest discussions about video footage.

Conclusion: We found VRE to be a useful, acceptable research approach for healthcare education research in the Middle East context. Medical students engaged with the research process, consented to be video recorded and eagerly contributed to discussions when reviewing video footage. Notably, certain feedback practices were highlighted by reviewing video footage, that students mentioned that they would use in future feedback encounters. Using VRE in the Jordanian context generated new understanding and also facilitated learning, as students engaged with the process, and moved towards change in feedback practices.

Medical Humanities is an interdisciplinary field that has slowly been integrated into medical education. Despite developments in medical technologies, patients still experience feelings of grief, anger, and anxiety about their health and rely on their doctor for moral and emotional support. Thus, patients are inevitably finding doctors' empathy and understanding equally as important as their medical knowledge and clinical experience. The development and incorporation of medical humanities courses are vital for enhancing the delivery of treatment to the patient and optimizing their physical, mental, social, and emotional well-being. Nonetheless, some healthcare professionals and educators still argue that the medical field has advanced far beyond the theoretical approaches of medical humanities, especially since limited data is available to support their effectiveness. Another objection that is raised against the humanities is that the medical curriculum is already extremely rigorous, which makes it challenging to incorporate any new material into the standard coursework. Seven medical students from WCM-Q aim to uncover the potential values and limitations of medical humanities in current education and its efficacy in clinical settings. The discussion sheds light on the core skills that can be promoted by humanities including observation, listening, sensitivity, sensibility, and communication. Furthermore, the panelists engaged in a fruitful conversation exploring the narrative and scientific thinking of doctors and examining the cost-benefit analysis of modern medical practices with traditional therapeutic approaches.

Home visits on patients require checks for the request, the illness, the date last seen, current medications, and who the carer is. Globally, especially in the Middle East, cultural awareness and sensitivity are paramount, particularly in palliative care. Family physicians care for terminally ill patients. Often in the last stages, fatigued, dyspneic, anemic, cachectic, relatively anorexic, a patient’s mind may still be needle-sharp. Sincere empathy should never be standardized. Questions should be answered truthfully. No two caring moments are the same, making each interaction unique. In palliative care, the quality of physician conversations can assume wide empathetic dimensions.

Training in family medicine, while thorough, usually provides lighter exposure to cancer patients. The first serious cancer death experience can be stressful for the carer. However, responsibility for palliative care is a reality. There is no respite. In family practice, deaths from cancer are common. Some bête-noirs include multiple myeloma, ovarian, lung, and breast cancer. Intrinsic patient conversations occur after each diagnosis, at the beginning, in between, and in palliation. What vital information needs relaying by the physician? How much is shared with spouses or family relatives, with consent? What impact does that make on both the patient and physician?

Patient self-awareness being near death in terminal illness is common. It is still unsettling. A physician of care considers the choice of a dying patient choosing to stay home. The gain is avoiding moving to a hospital or a hospice in unfamiliar settings. More poignantly, it enables loving care from one’s lifetime partner and family at home.

After death, an exchange of warm words with facial expressions evokes everyone’s emotions. Personal feelings resonate in care, empathy, hope, truth, trust, and professional respect for one another. The end feels more like losing a friend. Such patients are not forgotten; physicians learn from them.

The dead do not suffer pain, only those left behind. Is healing ever complete when looking after sick patients for the practicing physician grappling with professional and personal emotions? How long does that take? Do multiple deaths cumulate the impact? Recovery is part of being resilient, critical in the profession, and feeling vocational compassion satisfaction in work. What if one does not always cope adequately? Is compassion fatigue a danger? Who tends for the wounded carer? When is physician resilience needed most? What keeps physicians motivated? How do they care for themselves and stay well-balanced? Reflections on practice experiences keep life in perspective. Dying patients, subconsciously, are often our best teachers.

Technoscientific pharmacology involved in finding remedies for diseases has always been concerned with the activity of relevant medical support at the cellular level, working on the principles of the Cartesian treatment of the body as a machine to be tinkered upon and moulded by the power of the pharmakon. As such, the project of determining a cure for any disease ends in creating what Michael Montagne calls pharmacomythology, that is, a single story of the drug (inevitably a remedy or a poison) that concerns itself with dominant patterns only and eliminates the rest as anomalies (13). In doing so, scientific drug narratives overlook the agency of the body that has ingested the drug, something that goes beyond the dose-response relationships and places the diseased body at the crossroads of automation and autonomy. These contradictory aspects reveal themselves in their respective ways; the former allowing the artificial power of the pharmakon to ‘write’, or rather ‘rewrite/overwrite’ the body, and the latter augmenting the ability of the body to exert its own power over the institutionally organised, extraneous control of the pharmakon and ‘write back’. Rabih Alameddine’s Koolaids: The Art of War is a novel that contests the largely Western medical paradigm of AIDS care and cure with the anomalous states of the body under the regulation of technomedical knowledge and support. The diseased bodies of the various characters not only narrate against the clinical nature of should-be’s and should-not-be’s in the Western healthcare system with alternative, unscientific dimensions of healing, but also against the sensational and oversentimental rhetoric tailing the former. Bodies that are forced to heal reject the institutionalised care, and those that have lost hope from such care find solace and amelioration (if only temporary) from the non-traditional practices rooted in the non-Western cultural identity of the characters. Bodies also reject the idea that AIDS has a single, unidirectional narrative of dying and death, or that the scientific paradigm of treatment that merely depends on the transparency of a therapeutic cause-effect relationship is the only key to everyday normalcy that HIV-positive patients should aspire to. Ensconced within the recurring motifs of war against a virus and between communities, the silent war of the body against the traditions of healthcare has, according to this researcher, proven a worthy theme of study. This paper, therefore, aims to examine how Alameddine’s novel destabilises the constructed relationship between the diseased and accepted modes of treatment at the intersections of race, faith, gender, sexuality, ability and beyond to establish a dimension of healing that does not cater for the escapism of a cure but for the transformation of care itself.

Globally, one-third of the world’s population has difficulty searching, comprehending, and using information needed to maintain health and well-being (Van den Broucke, 2020). Empowering people to learn and practice healthy behaviors and engage in self-care is at the core of health promotion (Van den Broucke, 2020). Appropriate health communication has been vital during the COVID-19 pandemic. The pandemic impact can be alleviated by promoting healthy behaviors while using appropriate tools to publicize information in easily understood language by the public. Most health information is accessed online so digital health communication and promotion is important. Numerous digital tools are available. Electronic mail (email) is a powerful tool to engage with various audiences using electronic devices. Worldwide 3.9 billion people use email, spending up to five hours daily to check work and personal emails (SlideShare, 2019) (Statista, 2021). Emails are cost effective and directly connect the intended audience with personalized content. MailChimp is a digital tool that the Institute for Population Health (IPH), Weill Cornell Medicine-Qatar uses to disseminate credible information via email to create awareness about health-related topics. MailChimp is convenient to use with in-built templates to create visually appealing content along with the option to add unique links as required. Embedding useful links and eye-catching visuals attracts consumers to read and learn from the content. MailChimp also hosts the audience database, manages audience preferences, and facilitates scheduling/sending the newsletters. For example, the IPH ‘Stay Safe, Stay Healthy’ newsletter created on MailChimp, focuses on topics relevant to COVID-19, health, and well-being. The newsletters guide the public to navigate, and access trusted/reputable sources to adopt lifestyles appropriate for optimum health and well-being. They provide information in simple language using appealing and culturally appropriate visuals and communicate new or updated evidence as necessary. The newsletter email campaigns have garnered 111,789 opens (total times the campaign was opened by recipients) and 28,507 clicks (total times any tracked link was clicked) from March 2020-2022 (MailChimp, 2022). Reliable, evidence-based, and well-crafted health communication can facilitate behavior change, dispel fear and uncertainty, promote compliance with positive health behaviors, and disseminate reliable and succinct information (Finset, 2020). It can also help alleviate stress and feelings of ‘overwhelm’ when confronted with information overload online (Van den Broucke, 2020). Most digital tools such as MailChimp are accessible via a paid subscription. Subscription fees could be a deterrent to their use. Nevertheless, digital tools like MailChimp are an effective means to optimize emails and can contribute to health promotion by facilitating the dissemination of health-related information via email, in a timely, efficient, and effective manner.

In this personal narrative, adapted from my memoir of my years in Doha, I present a digest of the educational philosophy that informed four years of my teaching at the Weill Cornell Medical College in Qatar, as WCM-Q was known when first established. As an author, artist, educator and practitioner of complementary alternative medicine who has worked with international students over many years, and in my therapeutic practice treated many clients from diverse backgrounds, I had much to bring to my teaching and to my position as Coordinator of the Writing Program in the college's Premedical Studies department. The years 2005 – 2009 were crucial in Qatar's development as an “education economy” and cosmopolitan crossroads, and I was eager to work with first and second year premed students on their way to our Medical Studies program—the first to grant American medical degrees anywhere overseas. It's not really so difficult for motivated, well instructed students to learn to write college level essays, but I also wanted these science-minded future doctors to learn what sorts of questions are asked in fields of the humanities. I wanted them to have a taste of what Socrates meant when he said, “The unexamined life is not worth living.” Such inquiry goes with learning the skills of close reading, literary analysis, and research methodology, which were the bases of my writing seminars. As well, in my course on literature and psychology, I introduced future doctors to the archetype of the shaman as wounded healer. I related this concept to my own undergraduate crisis that resulted in my choosing to become a poet rather than a doctor of veterinary medicine, and eventually to becoming certified as a hypnotherapist and establishing my private practice. Things might have changed somewhat since I left Qatar, but in this presentation I hope to inform my audience of what we started with at WCM-Q and how I succeeded with my students. I invite colleagues to consider how they approach the subjects of Narrative Medicine and Medical Humanities today to teach students in the Middle East.

The Turkish National Artificial Intelligence Strategy (TNAIS) has been prepared in line with the 11th Development Plan and the Presidential Annual Programs of the Republic of Turkey. The purpose of this strategy report is to describe the methods of determining national strategic AI priorities and set these priorities. In this report, according to the patent applications between 1980 and 2016, it is stated that the fields in which AI technologies are applied the most are: communication (24%), transportation (24%), and health sciences (19%). Therefore, it is seen that almost 1/5 of all AI technologies are applied in the field of health science. It can be concluded that AI technologies used in the field of health have a special place in the scope of the TNAIS report. The report covers four ethical values including: respect for human rights, democracy and the rule of law, improving the environment and biological ecosystem, ensuring diversity and inclusion, and living in peaceful, just and cohesive societies; and eight ethical principles including (1) proportionality, (2) safety and security, (3) fairness, (4) privacy, (5) transparency and explainability, (6) responsibility and accountability, (7) data sovereignty, and (8) multi-stakeholder governance. Consequently, in this study, the TNAIS report will be analyzed based on the ethical values and principles it contains within the scope of patients' access to healthcare. Then the current or prospective ethical issues emerging from the existence of AI technology used in healthcare will be addressed. Finally, the suggestions about the perspectives for approaching ethical issues when these values and principles are in conflict will be shared.

Objective: To report novel developments in standard art therapy practices in the United Arab Emirates (UAE) and Qatar that arose during the COVID-19 pandemic circa 2020-22.

Background: Art therapy services are a new phenomenon in the Middle East, with current practitioners having received their training primarily in the UK, US, and Australia. Religious therapies, such as prayers, rituals, talismans (against the evil eye) and Quranic recitation continue to be common approaches to mental illness in the Arabian Gulf. The visual arts have experienced a renaissance in the Gulf Cooperation Council (GCC) region, with billions of U.S. dollars of government funds invested in art education, galleries, exhibitions, and museums (Louvre Abu Dhabi, Museum of Islamic Art, etc.). Qatar has a national strategy to become an art and cultural hub in the Middle East.

Methodology: Self-reflective exercises, process art, and specialist discussions among 5 experts in the field currently practicing in the Gulf were conducted in 2020 to document and analyze new methodologies and perspectives implemented during COVID-19 lockdowns, primarily in the area of telehealth and telemedicine. A related study by the authors in 2020, “Best Practices in Art Therapy Telehealth Communication: Perspectives from the Middle East,” provided additional analytical data. Qualitative data was organized into themes using standard Grounded Theory techniques. The practitioners framed their therapeutic work within the model of Relational Cultural Theory (RCT).

Results and Discussion: The thematic findings were grouped under the headings: “Stigma,” “Empowerment,” “Confidentiality,” “Therapeutic Relations,” and “Art/Nonverbal Communication.” The pandemic allowed practitioners to expand services geographically outside of the Gulf beyond traditional face-face meetings through the Zoom.com videoconferencing platform. Online sessions provided unexpected benefits in the areas of increased privacy and reduction of social stigma. Since telehealth laws in the Gulf are almost non-existent, practitioners collaborated with international partners to develop best practices and ethical guidelines adapted to the local cultural context. Results of the analysis revealed shifts in previously established boundaries and power dynamics (clients and therapists can turn video and microphone off, see each other’s house, pets and other family members). The presence of family members at home sometimes impacted the privacy of the client, but in some situations allowed opportunities to meet extended family members, providing additional diagnostic clues into family dynamics. A reduced ability to communicate and understand nonverbal cues and body language (eye contact was different, lack of seeing the body) was cited as a drawback to virtual clinical encounters. The expert / novice skill level disparity of the therapist / client was diminished when co-creating digital artwork (ex. use of the Zoom whiteboard). The limitations on art materials that could be obtained during shop closures for some clients increased creativity and innovation in artmaking, but for others it decreased artmaking opportunities.

Conclusion: All aspects of art therapy in the Arabian Gulf, and especially online services provision, are under-researched. Areas for further inquiry include: cultural adaptation of western models of care, local perceptions of the origins and treatment of mental health disorders, and awareness and acceptance of expressive arts psychotherapeutic interventions.

Due to COVID-19 safety protocols, the vulnerable within our community had limited access to resources. Children of determination have encountered disruption to therapeutic services especially from March 2020 to November 2020. The pilot attempted to address question(s) of feasibility in maintaining services, preventing mental health and deterioration of symptoms and behaviour, and in increasing access to resources for children with Autism Spectrum Disorder (ASD). The research looked to question, if online services could substitute in-person services with this population, and to determine plausibility of online group art therapy services for children and their caregivers. The impact of COVID-19 on mental health is still unclear; early published reports indicate the onset of moderate to severe depressive symptoms, anxiety, and stress, potentially having a prolonged psychological impact on some individuals (Qiu et al., 2020). Overall, there is a lack of literature on art therapy in the region, and more so for online intervention, specifically in support of ASD during the pandemic. ASD is a neurodevelopmental disorder that impairs a person’s ability to communicate, socialize, and respond to certain stimuli within environments. Parents, pediatricians, and nurseries typically identify concerns that prompt diagnosis, ideally by age 3; prevalence is higher in males than females (Elsabbagh et al., 2012). ASD is recognized by delayed language development, repetitive and stereotyped patterns of behavior, impacting imagination, and difficulty with social interaction (Rapin & Dunn, 1997). Overall, the Middle East has had relatively little published research on ASD etiology, although statistics indicate that ASD affects 1 in 146 births in the United Arab Emirates (UAE) (Virolainen, 2020). Genetic linkage such as kinship and multiparity is culturally and regionally common. Epidemiological research into autism in the UAE is relatively new. The prevalence of autism likely remains underdetermined as many cases of autism potentially go undiagnosed within the community due to stigma and lack of awareness; mild cases can be unnoticed, and delayed diagnoses might result from a lack of focus or training in the area of early intervention (Salhia et al., 2014). It is, therefore, crucial that there is a continuation of support without disruption. Art Therapy is an integrative mental health profession that engages participants with the creative process, active art-making, and integrated psychological theory within the context of a therapeutic relationship (American Art Therapy Association, 2020). Art psychotherapists have a minimum of a master’s degree in art psychotherapy with clinical practice and supervised experience before gaining professional registration, a rigorous process. Children with autism are generally referred to art therapy specifically in the West (Martin, 2009; Teeuw, 2011) to support coping with communication challenges, behaviour, and low self-esteem (Schweizer et al., 2014; Schweizer et al., 2017). Research demonstrates that children with autism are expected to benefit from a non-verbal treatment such as art therapy, through sensory exploration, looking at, and shaping art materials to facilitate expression (Malchiodi, 2003; Rubin, 2001; Schweizer et al., 2009). This pilot study explores if conducting art therapy online would be beneficial and fill the gap when in-person services are not possible.

“Sidekick,” an original short fiction work, explores the concept of belonging through its two main characters, Birch and Aggie, who struggle to find social acceptance. The challenge for Birch is that he has paranoid schizophrenia. While he exhibits symptoms of delusions and experiences auditory complex perceptions, as do many with paranoid schizophrenia, unlike most, he also sees visual hallucinations. The general population might confuse his disability with dissociative identity disorder, or existing in multiple personality states. Instead, Birch seems cut off from reality, and while highly intelligent and educated, has been unable, especially in recent years, to maintain a successful life. The narrator, Aggie, is a retiree whose career was spent as an expatriate working with farming communities for a non-governmental organization (NGO) in Cambodia. She has recently returned to her home in Virginia. Her perceptions and experience are partially based on research and my observations while visiting Cambodia and my conversations with NGO employees there. The greater portion, however, is informed by my observations and experiences over the last eighteen years as a member of the expatriate community in Doha, Qatar, one of the Gulf states. Usually, expatriates are motivated by imagining a better life abroad in status, salary, and/or in opportunities to make a meaningful contribution. Aggie’s desires fit within the third category, but as is common in the lives of expats, her dreams met with obstacles, which require adjustment if the expat is to remain abroad. Aggie was unable to find a way to adjust. However, upon her return, she has realized that her home is no longer familiar to her, and while she has never quite fit into the fashionable society of Richmond’s West End, her outsider status has become even more pronounced. Her first-person account relays her chance encounter at a café with the much younger Birch and the tentative attempts these two lonely people make in pursuing a possible platonic friendship.

Aim: To determine the relationship between effective communication and the Quality of Life (QoL) of cancer patients through conducting a Meta-analysis (MA) to quantify and summarize the evidence and present the results of our local findings in the National Center for Cancer Care & Research (NCCCR) of HMC in Qatar.

Methods: MA was conducted via searching four online databases including PubMed, Medline, EMBASE and Psych info electronic and grey literature database, ProQuest dissertations. The MA encompassed published cross-sectional, longitudinal studies and a postgraduate PhD dissertation, that investigated the communication among cancer patients on one hand, and health care professionals (HCPs) and health caregivers (HCGs), and their impact in the QoL, on the other hand. Out of 20,796 hits, 204 full-text articles were assessed for eligibility. The final eligible studies were 19 articles that satisfied the inclusion criteria (18 published papers and one PhD dissertation). The quality of encompassed studies was calculated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Comprehensive (CMA) software version 2 was used to perform the MA. The pooled effect size was calculated using the random effect and ANOVAs were performed for moderation analyses for categorical moderators and meta regression analysis for continuous moderators. In addition, publications bias analysis was also performed. The Cochrane software “Review Manager v5.3” was employed to examine the quality of the included studies. Patient perception of physician’s communication skills was compared with the perception of physicians using the American Board of Internal Medicine (ABIM) communication assessment tool and QoL of cancer patients was assessed via FACTG questionnaire. Correlation coefficients of perception of patients were carried out using positive correlation analysis via SPSS V.26.

Results: Communication had a significant positive impact on the QoL of cancer patients and a significant association and moderation was observed for the mental component summary (MCS). Furthermore, a significant positive impact of involving Health Caregivers (HCGs) in communication on the QoL of cancer patients was also found. Covariate analysis indicated a true variation in effect sizes between studies and confirmed the existence of inconsistencies among different studies due to the diverse definitions and assessment tools used to measure the outcomes. The heterogeneity assessment offered explanation where possible to the consistencies and diversities between studies. Clinical and design heterogeneities were observed and reported. Our local pilot study in Qatar suggested a significant positive correlation between QoL and patients perception of physicians’ communication skills, r = 0.222, P=0.3. Moreover, our pilot study suggests a significant discrepancy between the patients perceptions & HCP perceptions, of the different communication skills set (Interpersonal, Content, Total Communication Skills). The patients reporting a lower perception 57% vs 86% total communication skills p=0.0028, 58% vs 88% for IP communication skills p=0.0003, and 55% vs 84% for content communication skills p=0.0042.

Conclusion: This MA covered a gap that existed in the literature among published systematic reviews and meta-analyses. It confirmed a significant correlation between communication and QoL of cancer patients irrespective of cancer type, age group, culture, gender, prognosis, or year of study. These results were global, transcontinental, and transcultural. It clearly highlighted the significant need to communicate with cancer patients and how much its benefits improve their QoL, as well as medical services. The results can be used to inform policy makers and health practitioners. Future Interventions should take into account these results to improve the communication between health practitioners and cancer patients and the involvement of families in the communication process. The health care system should consider communication as a vital component of providing a holistic patient and family centered care. The umbrella of QoL, provides a clear picture about patients and their families’ conditions and dictates that their communication needs are addressed as part of a standard of care. Furthermore, communication with its wide list of components should undergo a crucial level of studying, researching, critiquing and standardization, so that patients’ right to access a high standard of care is guaranteed across all health care systems. Our local results in Qatar resonate with this MA and raise the attention needed to clinical communication practice.

FGM, Female Genital Mutilation, is one of the most prevalent types of violence against girls and women in Egypt. Despite its horrific short- and long-term physical and psychological complications, according to UNICEF data reports, FGM remains widely practised against girls and women aged 15-49 in around 30 countries in Africa and Asia (UNICEF Egypt Data Snapshot, 2019). Non-medical, primarily, social and cultural beliefs that are associated with girls’ and women’s chastity, marriageability, hygiene and honour continue to control the lives of millions of them and, in some cases, lead to their death. November 25, 2021 marked the 30^th anniversary of the global 16 days campaign of activism which was launched by the Centre for Women’s Leadership to raise awareness about violence against women worldwide. In Egypt, this year, among several events that commemorate the anniversary, Care Egypt Foundation in collaboration with the United Nations Population Fund (UNFPA) and the National Committee for the Eradication of Female Genital Mutilation (NCEFGM), launched a social media campaign against FGM entitled “My Story with Genital Mutilation” (Care Egypt, 2021). The campaign’s team gathered eight real-life stories of Egyptian women survivors and collaborated with artist Noran Fikri who drew the graphic artwork. In this research project, I argue that the aim of choosing graphic drawings for that campaign is twofold: 1) drawing real-life stories of Egyptian FGM survivors empowers thousands of girls/women to break their silence, and report about similar practices which may prevent potential victims from undergoing such abuse; 2) this campaign aims to reach large numbers of social platform users, to make FGM everyone’s problem in Egypt, in the hope of shifting the narrative from chiefly raising awareness about performing such violent practices into inspiring mainly not Non-Government Organizations, lawmakers or national officials but individuals—whether directly harmed or not—to take an action against FGM. I also suggest that this eight-graphic-stories collection is a representation of a graphic medicine movement in Egypt. Coined in 2010 by Ian Williams, Graphic Medicine is “the intersection of the medium of comics and the discourse of healthcare… a community where many people have found their voice” (Czerwiec et al, 2015, p. 1). The graphic form lends a fresh perspective on FGM survivors’ personal physical, psychological and mental suffering. It softly invites other women survivors to share their stories. Since it is a social media campaign, each of these eight very short stories is illustrated in a one-page graphic artwork, in a short, quick yet shocking and horrifying emotion-packed post. The graphic visual delineation of the memory of pain and hurt of such abuse which those women are forced to live with, subtly connect them to their fellow survivors in a manner that words cannot attain.

Medical teachings such as medicines, treatment methods, special prayers to cure diseases, etc. in hadiths have formed traditional narrative medicine. Since experience and the use of scientific methods have a special place in modern medicine, the question arises about the position of experience in narrative medicine. The present study tries to examine the position of experience in this medicine at two levels, relying on hadith sources and in a descriptive-analytical manner: 1. The position of experience in the medical knowledge of the Infallibles (i.e. the Prophet and Ahlul-Bayt) and, 2. The position of experience in evaluating medical narrations. In the first part, considering the existence of the teachings of other medical schools in the many narrations, it was concluded that the Infallibles, in addition to divine knowledge, had authorized and employed others' experiences in medicine. Regarding the position of experience in the evaluation of medical narrations, firstly it is beneficial to divide these narrations into two categories: those which have been taken from other medical schools and those which are seemingly original from Infallibles. The medical teachings in the second group could be separated into natural teachings and supernatural teachings as well. Using experience and scientific methods for evaluating medical narrations are just as applicable to narrations taken from other schools and those with natural teachings apparently originated from Infallibles.

The Emotion Sensing Recognition App (ESRA) is a mobile app that uses AI to assess children’s drawings with respect to potential mental health issues. This can be an important tool for parents, since children have difficulties articulating many aspects of their mental well-being. In this context, art therapy can help: an art therapist observes children while they are drawing, either guided (i.e., by requesting certain objects in the image) or unguided. Relative size of objects in the image, their placement, type, color scheme etc. then provide valuable clues about the child’s well-being. Still, parents need to make an initial observation before contacting an art therapist.

In this work, we explore how technology, in particular AI, can be used as a tool to assist parents in starting a dialogue with the child and, potentially, an art therapist. ESRA is one such technology: parents take a picture of their child’s drawing using their mobile phone, and ESRA provides a binary assessment (“good”, “bad”). However, in addition to only providing binary results, ESRA’s decision process is a black box that cannot be inspected.

In contrast, our extended version uses joint-localization and classification to find and identify objects in a child’s drawing. The goal is to provide parents with a verifiable assessment in plain English, summarizing their child’s drawing. To do so, we generated a data set of drawings by conducting a web scrape. We then cleaned and annotated the data set. Under the guidance of the second author of this work, an experienced art therapist, we selected objects in the image and assigned a numerical score ranging from “good” to “bad”. We then used this data to train a “You Only Look Once” (YOLO) artificial neural network (Redmon & Fahadi, 2018). The resulting model predicts the location and score of the objects in an image. We use this information to highlight the objects (i.e., with a bounding box and the label) and summarize the model’s findings in plain English. We pay particular attention to capability awareness by converting numerical scores to quantitative categories such as “We are quite certain that object #7 is a tree without leaves (90%), which could be mildly concerning”. Our tool considers YOLO’s confidence as well the relative size and type of the object. We believe that this approach addresses an important aspect in the ethical use of AI. Deep neural networks are black box oracles. Their decision-making process is not well understood, even by AI experts, let alone lay persons. Our approach therefore allows parents to make an informed decision by attempting to make the recommendation of the AI verifiable. While more studies are needed before using our tool at scale, we think that it can play an important role in initiating a dialogue between children, parents, and art therapists.

Several reports over the last two decades have indicated the importance and success of incorporating medical humanities courses and modules in medical schools. While this inclusion is well established in the Euro-American contexts, it is still underrepresented and understudied in Eastern contexts. In this presentation we aim to describe building an elective course titled “Medicine and the Arts” for second and third-year medical students of different nationalities at the College of Medicine in Qatar University. In offering this elective we aimed to establish an understanding of the linkages between humanities, medicine and art, and to strengthen concepts and practices of culture competence among the students.

Little has been written on designing medical humanities courses in non-Western contexts. In structuring and building the content of the course in a Middle Eastern context, we faced several challenges. The discipline privileges the Western scene and discourse in art and humanities, means that resources tend to be mainly Euro-American in their framing of medical concepts such as doctor-patient relationship, patient-centred approach, illness narratives. Whereas the students enrolled in the college come from non-Western contexts, which are largely ignored in the majority of the available current reports.

To equivocate these challenges, we used the Cultural Competence Model of Purnell; adopted an interdisciplinary approach and employed the concept of intersectionality to structure and deliver a culturally competent course that explores the nexus of medicine, humanities and art. Students were encouraged to link topics discussed in the course to their own experiences and cultures as a way to create relevance and meaning. Lastly, we made a concerted effort to curate art work reflecting the students’ rich cultural heritage.

The course comprises five themes, taught in two-week blocks:

– Medicine, history and painting

– Medicine, anthropology and photography/documentary

– Medicine, sociology and music

– Medicine, literature and philosophy

– Medicine, psychology and cinema

The remaining sessions include physician-artists guest speakers and visits to relevant art exhibitions to explore art in medical contexts.

Adopting a culturally competent approach to medical humanities helps to broaden the scope and make the course relevant to a culturally diverse student population. This approach harnesses the students’ own cultural backgrounds and works of art to explore the nexus between humanities, social sciences and medical care from around the world.

In her Memoirs of a Woman Doctor, Dr. Nawal El-Saadawi, an Egyptian physician, writer and feminist, describes the development of her existential questions as a human being and a doctor throughout her life changes and the interaction with her socio-cultural patriarchal context. Following a crisis in her professional identity, Dr. El-Saadawi questions the meaning of doctoring, the doctor-patient relationship, and life as well as the absurdity of death and alienation. A young woman died while giving birth to her first child, and Dr. El-Saadawi's failure to save the woman's life changed her self-positioning in relation to medicine and the sanctity of science. This experience caused her to sanctify human beings and the humanity of doctors, rather than sanctifying their knowledge only, and created an acute awareness of the link between her body, mind and soul. She writes “The focus of the struggle inside me widened out from masculinity and femininity to embrace humankind as a whole. Human beings appeared to be insignificant creatures in spite of their muscles, their brain cells and the complexity of their arterial and nervous systems. A small microbe, invisible to the naked eye, could be breathed in through the nose and eat away at the cells of the lungs. An unidentifiable virus could strike at random and make the cells of the liver or spleen or any other part of the body multiply at a crazy rate and devour everything around them […] I found my feet taking me in a completely new direction.” (p. 21). In the end, she finds relief for her soul in her love for a musician and attributes music to rescuing her from darkness. Drawing on content-thematic analysis of the memoirs, in this presentation I make an analogy between the crisis that Dr. El-Saadawi experienced, and the potential crises that health care providers (HCPs) faced during their work in the first stages of the COVID-19 pandemic. Through the existential and philosophical questions suggested by Dr. El-Saadawi, in this presentation, I suggest that we look behind the scenes of the ICU and think in-depth about healthcare providers' existential experiences during the COVID-19 outbreak - a global crisis that can be very personal for the HCPs. We will discuss how the crisis and facing death on daily basis could influence healthcare providers' existential and philosophical perceptions, when they are unable to control a virus and save lives.