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

On April 9 and 10, 2022, over 79 scholars and 230 attendees met online to share their research on the health and medical humanities in the Middle East and North Africa (MENA) region at the 2nd International Conference on the Medical Humanities in the Middle East (online). This meeting was the second convening of experts since the successful 2018 in-person conference in Doha, Qatar at the Sheraton Hotel. The 2022 conference was jointly sponsored by VCUArts Qatar and Weill Cornell Medicine – Qatar, and was convened by Drs. Alan Weber, Byrad Yyelland, and Mohamud Verjee. The diversity and increase in submissions from 2018 to 2022 testify to the growing importance of humanism in medicine in the region. The published abstracts in this special issue of QScience Connect provide a comprehensive overview of the medical and health humanities as they are currently practiced and researched in the Middle East region. For example, the first keynote speech, “Is the Beauty Industry a Virus Invading the Medical Profession?” by Iraqi surgeon and visual artist Dr. Ala Bashir, addressed a critical issue in the region, the growing popularity of cosmetic surgery and the unlicensed and unregulated nature of the industry.

The second keynote speech by health humanities professor Paul Crawford (University of Nottingham) entitled “Towards Creative Public Health: The Contribution of the Medical and Health Humanities,” provided an overview of recent international initiatives to harness the arts for health education, healing, and wellness. The other presentations from researchers in Kuwait, UK, Jordan, US, Turkey, Israel, Iran, Qatar, Iraq, UAE, India, and Egypt represented the full range of the medical and health humanities that are developing internationally, including the history of medicine, medical sociology and anthropology, narrative medicine, literature and medicine, graphic medicine, healthcare communications, art therapy, the visual arts, film and medicine, and medical ethics. In addition, a panel of premedical and medical students led by Maryam Arabi and Abdallah Tom provided their perspectives on the topic with respect to the educational needs of students. A group of gerontology experts composed of Mark Clarfield, Regina Roller-Wirnsberger, and Desmond O'Neill directed a workshop on publishing research on the health and medical humanities in scientific scholarly journals. Authors Shahd Alshammari and Robin Fetherston gave dramatic readings from their fiction and non-fiction works. Three posters published on the website added to the oral presentations (https://qatar-weill.cornell.edu/event/medical-humanities-in-the-middle-east/posters).

Three of the oral presentations spoke to ethics in medical humanities within the Middle East. Banu Buruk and Berna Arda shared the Turkish National Artificial Intelligence Strategy (TNAIS) report which describes methods for determining and initiating national priorities related to AI. This report identifies four ethical values and eight ethical principles worthy of examination since almost one in five AI strategies are applied in the health sciences. The authors discussed TNAIS and concomitant ethical issues, concluding with recommendations for dealing with conflicts as they arise. Alya Al Shakaki then presented on ethical questions related to use of the gene-editing tool, CRISPR-Cas9, which enables “designer babies”. CRISPR has been used in China to create babies that are immune to HIV and thereby able to create offspring with similar immunities; however, what happens to individual autonomy in such cases? Scholars of Islamic bioethics ask two questions: which cells will be edited and what is the aim of the editing? Editing confined to one individual without affecting the offspring is considered acceptable but human dignity must be protected. Fahad Ahmed, Yazgı Beriy Altun Güzelderen and Sefik Yurdakul shared their research on publications written by Turkish authors that have been retracted from scientific journals. In a study of PubMEd, Scopus and Web of Science databases, they identified 147 publications that had been removed due to duplication and irrelevant studies.

Six presentations were related to the history of medicine in the Middle East. Dmitry Balalykin tied the apodictic method (the method of rational and rigorous proof), typically accepted as the method of knowledge in the natural sciences, to the development of medicine as seen in anatomical dissections, clinical systematization and general pathology in Greek and medieval Islamic medicine. Balalykin cited Galen and Muhammad ibn Zakariya as pivotal influences. Katarzyna Gromek then discussed the history of perfumes as medical agents in early Islamic states; for example, scenting clothes, mostly undergarments, shirts, dresses, and bed linens, was also thought to increase therapeutic health effects, both in the sick and healthy. Fatima Saadatmand continued the historical discussion with a look at mystical applications of arithmetic, Ariṯmāṭῑqῑ in Arabic, in treating disease throughout the 9th to 13th centuries through an examination of ancient texts and modern writings.

Abdulnaser Kaadan’s historical research moves us into the writings of Avicenna (Ibn Sina) related to the diagnosis and treatment of breast lesions and the relevance of this historical work to current medicine. Amanda Caterina Leong then shared her work on the writings of Qajar Iranian Princess Taj al-Saltana in 19th century Iran, who discussed systemic challenges in reactions to Iran’s cholera epidemic and subsequent health care perils related to a corrupt patriarchy. Leong connected this work to current governmental handlings of COVID-19 issues. Finally, Forozan Falahatpishe examined the invisibility of autopsy within Islamic medicine. Of interest to mystics, theologians and philosophers as well as physicians, the autopsy has been historically avoided within the Avestan (ancient Iranian) approach to Islamic medicine because it has been perceived as a violation against the sanctity of the human body. Nevertheless, surgery has thrived within the Islamic world.

Art therapy in the Gulf was well represented by two full panels, one of which presented by Trish Bedford, Mowafa Househ, and Dr. Jens Schneider surveyed current art therapy practices including development of an art therapy app for making initial assessments powered by AI. In addition, Michelle Dixon, Natalia Gómez Carlier, Sara Powell, Mariam El-Halawani, and Alan Weber detailed in the paper, "Art Therapy Service Provision during the COVID-19 Pandemic in the Gulf Cooperation Council (GCC)" how services provision shifted abruptly to online telehealth. Natalia Gómez Carlier and Sara Powell additionally reported on their art therapy pilot dyadic (parent/caregiver and child) telemedicine program for children living with Autism Spectrum Disorder.

In a panel dedicated to healthcare communications, one paper described the best practices in communication skills with visually impaired patients (Dr. Nahla Khalaf Ali, Dr. Abdulsalam S. Sultan, Muna Hameed Faris, Muna Muneer Ahmed, Mohammed Modar Hameed, and Dr. Marab younis Abdullah Al-Fathy). A paper by Raji Anand and Dr. Sohaila Cheema included usage data that demonstrated that digital tools such as Mailchimp direct-mail campaigns can effectively promote positive public health behaviors. Another successful intervention for public health awareness was described in the panel "On Film and Medicine: Reflections on ‘Medfest Egypt’, an international ‘film for health’ forum," chaired by Khalid Ali, Mina El Naggar, and Robert Abrams.

Gatherings such as the 2nd International Conference on the Medical Humanities in the Middle East are designed to share the latest research findings among area experts, to help form new research collaborations, and to encourage translational medicine projects in which insights and pilot and full-scale studies of the medical and health humanities can be harnessed to revise medical education curricula, improve training for health sciences students, enhance clinical practice and ultimately improve patient outcomes to create more equitable, satisfying, and effective healthcare systems. Additionally, medical and health experiences can form the basis of artistic expression since health, disease, and illness represent key milestones in the universal life course.

The practice of medicine and the medical sciences have progressed tremendously in the past half century. This talk explores the background and causes of this transformation in medicine as seen through the lens of a surgeon who has practiced medicine for over 50 years.

If Medicine is the science and practice of diagnosis, treatment, prevention, alleviation, or cure of disease… If our role as Medical Professionals is to protect, promote, and restore good health… If our Hippocratic oath speaks to the notion of Primum Non Nocere. First, do no harm…

Then… Can the newly created branches of cosmetic and aesthetic surgery within the field of Reconstructive and Plastic Surgery be considered “Medicine”? Should Medicine be in the business of beauty services? Should beauty standards remain in the domain of art? Is the beauty industry a virus in the Medical Profession? How do we ensure our Profession stays true to its promise, its oath?

In this keynote address, Professor Paul Crawford introduces the distinctive fields of medical and health humanities, and the way that the arts and humanities can bring new capacities and possibilities for healthcare, health and wellbeing. He will discuss terminology and concepts of the medicalization of the illness experience and the rise of more critical, creative and democratising approaches. He will underline the substantial evidence for how the arts and humanities can improve medical outcomes and increase understanding of the public/patient experience of illness. In so doing, he addresses the potential for what he has called ‘creative public health’ that fully addresses the use of social and cultural assets to enhance the health of nations. In particular, he will provide insight into how this can be mobilised in practice through reference to major programs of research. First, he presents an overview of a major project to support and critically address the value of social and cultural assets for the public and a more medicalized initiative to provide patients with a social rather than pharmaceutical prescription. Second, he describes an innovative creative approach to ‘mutual recovery’ that seeks to enhance well-being within and between practitioners, family carers and patients as part of a whole community/ organisation approach to health. Third, he presents findings from his highly successful ‘What’s Up With Everyone’ research-embedded campaign to advance young people’s mental health literacy in association with Academy-award winning Aardman (Shaun the Sheep, Wallace & Gromit, etc). Finally, he discusses: a. the potential for creative industries to work more closely with governments and health organisations as part of a ‘shadow health service’, complementing centralised health services through the extensive resources of the creative arts; b. the importance of advancing creative clinical environments in a STEM-dominated healthcare culture.

The discovery of the genetic editing tool, CRISPR-Cas9, has enabled us to edit the human genome by removing or adding sections of the DNA. Scientists hope to eradicate some fatal diseases by using this technology. In short, CRISPR allows us to rewrite the code of life in contrast to discovery of the double helix where we can only read and understand our genome. Both somatic and germline editing can be done by this technology; however, they involve different ethical standpoints. The latter is controversial as it affects the reproductive cells, hence raising complex ethical dilemmas. Jennifer Doudna, a Noble prize winner in 2020, has contributed to the discovery of the CRISPR technology. She has never thought that this technology might be morally misused by others like the case of the Chinese scientist named He Jianki who produced the world's first CRISPR babies (Isaacson, 2021). Jianki's goal was to make the babies and their decedents immune to a deadly HIV virus; he knew that this announcement would be earth-shaking news that would ignite outrage among conservatives and religious scholars in the West and Islamic world alike.

Heated ethical deliberations have taken place following this incident by various groups, and each group believes that they have valid arguments for their reasoning. The opponents of the CRISPR germline editing argue that this technique violates one of the most important moral principles which is autonomy. Informed consent is an important element to ensure the subject's agreement to the treatment or procedure. The effect of germline editing will extend to future generations where autonomy would be neglected in this case (Hammerstein, 2019). This is concurrent with the moral view of Francis Collins, the former director of the National Institutes of Health (NIH). Collins argued that humans should not have the hubris to fiddle with nature (Skerrett, 2015). The CRISPR supporters, on the other side, argue that it would be immoral not to choose what are the best genes for you and your child (Savulescu, 2001), especially if germline editing can alleviate human suffering. The famous philosopher who advocated this approach is Julian Savulescu, a professor in practical ethics at Oxford University.

In Islamic bioethics, religious scholars make an ethical distinction between somatic and germline editing. They based their moral reasoning on two broad questions: what kind of cells will be edited, and what is the aim of editing? They legalized the use of somatic gene editing as it is confined to one person and does not affect the offspring; hence no ethical concerns arise. However, the majority of the scholars have condemned the use of germline editing and called for a temporary moratorium especially if mixing lineage is at stake (Ghaly, 2019). Following the news of the designer babies and its widespread media coverage, the International Islamic Fiqh Academy (IIFA), which represents Muslim countries and communities, convened a session in 2019 in the United Arab Emirates. They issued resolutions that corroborate the international calls to halt germline editing until further research proves its efficacy and safety. Moreover, they called to restrict the use of this technique for medical purposes and not for aesthetics or enhancement. Also, the committee stressed that human dignity should be preserved without exploitation. Therefore, more regulations are warranted (International Fiqh Academy, 2019).

Fragrances may appear to be a frivolous topic in the modern world, but well into the early modern period they were firmly located at the intersection of medicine and luxury products.

The fragrances created by physicians, pharmacists and perfumers in the early Islamic states influenced the olfactory traditions of Europe and Far East Asia. To study the fragrances of medieval China or the middle Byzantium, one needs first to understand how they were made at the source.

Many if not most of fragrance recipes are hidden in medical texts, cookbooks (as art of food preparation was considered a part of medicine), and independent treatises on perfumery. Besides being used for pleasure, as aphrodisiacs, or to satisfy the desire for luxury exotica, pleasant odours were associated with good health, and therefore were believed to have a therapeutic effect. In many cases, we have the direct statement of the author that a given incense or scented powder could cure body weakness, alleviate pain, or help with confusion after a stroke (Hamerneh, 1965). The beneficial effect may have been related more to the placebo effect though it is confirmed that odours can influence the human mind.

In my quest for accurate recreation of the beneficial fragrances, I study the processes used to prepare them by the original creators. This includes preparation of compound ingredients like ramik and sukk or distilled fragrant waters. I cross-reference different sources to identify ingredients although the ambiguity of identification cannot be fully eliminated. I attempt to source my ingredients, pending financial and legal limitations, from the same geographical locations referenced in the early medieval period. When the original ingredient is no longer available due to overharvesting or changes in plant biology, I look for a suitable replacement in contemporary sources, as many authors included chapters on substitutions (Levey, 1971).

As an independent scholar, my ability to study the effects of these recreated fragrances is limited to the assessment by olfactory approach (like in the experimental archaeology of food). I observe the stability and maturation of fragrances over time, as well as their longevity when applied to skin. A group of my volunteer testers helps with this task. They report if they liked the fragrance undergoing assessment, and how they felt about the odour. I am often surprised how the view of the same scent can range from ‘absolute stench’ to ‘good mood fragrance.’

I also organize presentations of the fragrances to introduce the public to the forgotten scents. I believe it is our duty to celebrate the traditions of all cultures, and this includes the amazing fragrances from the early caliphates, from Al-Andalus to the Near East and beyond.

Engaging in the arts has been demonstrated scientifically to enhance brain function. Creativity can modify a person’s perspective and experience of the world. Changes in cerebrum waves impact changes in the nervous system which can raise serotonin levels. This can affect emotions positively by regulating moods and improving brain function which influences both psychological and physiological wellbeing. Creativity is part of our natural development and should be a part of our healing as a community. Art Therapy (AT) is a mental health profession which carries out innovative adaptations as it is recognized as a stand-alone clinical intervention and through community engagement and social justice. Art Therapists are collaborating within diverse fields of clinical and non-clinical practice such as neuroscience and virtual reality. Three papers explore the development of Art Therapy as a profession in Qatar and how AT is an accessible and underutilised or often misjudged profession.

Paper one introduces ways that AT is practiced as a clinical, social action and community-based profession. AT might address the shame connected with psychological wellness by connecting with communities, sharing experiences of AT with the general public and by clinical professionals to support their careers, prompting less burnout. Dr. Hadi Mohamad Abu Rasheed shares the Qatar Cancer Society’s experience of using Art in psychosocial support for children living with cancer. The western trained Art Therapist's awareness of cultural competence when working in the context of non-western cultural approaches to mental health is imperative to complement the heritage, creativity and community values of the local culture. Intersectional frameworks will inform ethical professional values to be upheld.

Paper two develops how AT offers context to reduce the stigma of mental health in Qatar. The first Museum and Gallery AT visit in Qatar, with patients attending a substance misuse program, saw outcomes that included increased engagement in clinical sessions and an art exhibition that was held in the hospital and at conferences within Qatar and globally.

Paper three discusses the global alterations in the AT workplace following the Covid-19 epidemic; online AT; and how AT has adapted to employing technology before and after the pandemic. The technology employed in AT is not new. Art Therapists are now using Virtual Reality, where the client becomes part of the world they have created, interacting in it, with the art therapist present. The Emotion Sensing Recognition (ESRA) app is being developed by Dr. Mowafa and Dr. Jens with the consultation of an Art Therapist Trish, to ensure the ethics of working with images. This app can increase positive parent-child attachment and increase the ability to recognise and talk about feelings for parent and child.

AT is a cost-effective adaptive treatment and is being prescribed by General Practitioners in the UK and USA alongside visits to museums, choirs etc. How will Qatar embrace this adaptable, unique profession and will ensure it is ethically practiced by trained licensed Art Therapists? Collaborative research and training within different fields should be encouraged.

Based on five months of ethnographic fieldwork at an audiology department in Amman, Jordan, this paper anthropologically examines the provision of hearing technologies to deaf Jordanians as forms and practices of care (Livingston, 2012; McKay, 2018; Stevenson, 2014). Aside from hearing aids, the department also provides cochlear implants—medical devices implanted via surgery that aim to provide people with hearing loss with some electronic access to sound—to deaf Jordanians, in partnership with a state-affiliated initiative that has distributed more than 1,170 cochlear implants since its establishment in 2010. I ask: how do deaf Jordanians engage with the cochlear implant and other medical technologies, and the biomedical imaginaries in which they are embedded, within and outside the clinical encounter? The cochlear implant and, to a lesser degree, the hearing aid (Edwards, 2010), was controversial when it was first introduced in North America, where some deaf people saw cochlear implantation as a form of cultural “genocide” (Ladd, 2003; Lane et al., 1996; Padden & Humphries, 1988). The cochlear implant has not only become increasingly normalized in the U.S. (Mauldin, 2016) but has also spread transnationally as a medical technology for deaf people in Japan (Nakamura, 2006), India (Friedner, 2018), Mexico (Pfister, 2019), and elsewhere. As cochlear implants have become more prevalent in Jordan, they have become linked not only to debates about language—as I found during preliminary research in 2019 (Loh, 2022)—but also to broader questions about development (cf. Sargent, 2019b) and political economy in a materially under-resourced context where unemployment rates are high. Based on participant observation at the hospital and interviews with clinicians and patients, I argue that care is a useful analytic tool to understand the ambivalence with which many deaf Jordanians view these technologies, in its doublehanded recognition of how such technologies can be useful developmentally—in potentially providing access to speech and presumably better integration into society—but also problematic socio-politically—in diminishing their sense of belonging to broader deaf collectivities. I draw upon medical anthropology, science and technology studies, and “a disability-centered anthropology of the Middle East” (Sargent, 2019a) to ethnographically demonstrate the social life of these hearing technologies in Jordan.

Although the visual and expressive arts and music have been used in therapeutics and diagnosis for centuries, only in the past two decades has evidenced-based research on the role of arts in healing achieved a critical mass to warrant inclusion of the arts in health systems both inside and outside the clinic. Qualitative and quantitative studies have demonstrated that the arts can impact prevention, management, and treatment of disease in addition to health promotion. Specifically, the visual, performing and literary arts have been shown to positively affect the following dimensions of health: psychological (coping, emotional regulation); physiological (hormone response, immune function); social (isolation, social support); and behavioral (skills, lifestyle behaviors, exercise). This talk reviews the current medical evidence for the efficacy of Arts for Health programs based on recent reports from WHO, UK government white papers, and published scoping reviews, systematic reviews, and meta-analyses.

This presentation is a comparative study between two works of autobiographic fiction: Lauren Slater’s Lying (2000), which is about the author's epilepsy diagnosis, and Kuwaiti author Dr. Shahd Alshammari’s Notes on the Flesh (2017), about her diagnosis of, and how she lives with, multiple sclerosis. The two memoirs are studies of identity formation through disability and through the language surrounding disability: the languages both encompass disease as too medicalized and removed from personal experience to be able to describe disease. Both female authors choose to metaphorize their diagnoses in order to best understand (and explain) the pain they live in, the shock of receiving their diagnosis, and the confusion of living in a not-obviously disabled body. Their use of metaphor refers to hidden diseases: the title of Slater’s memoir is a reference to how her disease is hidden, unclear, and has made her feel like her diagnosis is false. Alshammari’s text is a reference to how the disease is written into the body, but not always outwardly shown on it. The authors use postmodern writing, weaving between ‘truth’ and, as Slater’s title blatantly puts it, ‘lying’, and what it means to vacillate between the two when talking about something as abstract as pain. Slater’s epilepsy makes her think that she is lying and that affects how she thinks of her disease. Slater invents a fictional medical procedure, relaying it in her memoir, which for a very long time, she believes happened. Alshammari writes about how her disease is etched onto, or right under, her flesh, and describes her medical procedures using similes and otherworldly language. Both authors show that even the language we use to describe medical procedures affect how we think of the medical practice. Using theorists who study memoir like Thomas Couser, I show that critics who place too much stock and importance in absolute truth in a disability memoir are limiting the disabled community’s chosen method of self-representation.

Paper 1: Introduction to Film and Medical Humanities

In recent years, medical humanities have become an important component of medical education. Student-selected modules, and special courses encourage medical students to reflect on the portrayal of illness and suffering as a means of nurturing empathy through watching film. Understanding the lived experience of sickness from a patient and family perspective is a requirement for all healthcare professionals. Role play and simulation focusing on doctor-patient encounters is commonly practised in undergraduate courses.

Academic institutions such as the Royal College of Psychiatry advocate the use of film as a platform for discussing mental health through their annual UK Medfest (https://www.medfest.co.uk/what-is-medfest). The WHO recently used film as an educational and cultural backdrop for exploring health (https://www.euro.who.int/en/media-centre/events/events/2019/10/the-health-for-all-film-festival-inviting-filmmakers-to-submit-health-for-all-short-videos). Hospitals, too, have embraced film as a learning and entertainment medium by building purpose-built cinemas within hospitals, as seen in Medicinema in the UK (https://www.medicinema.org.uk/).

Paper 2: Describing ‘Medfest Egypt’

Medfest-Egypt is an interactive program of films originally launched in Egypt in 2016 by Dr. Mina El-Naggar, and Dr. Khalid Ali. and intended for a diverse medical audience. The main objective of this forum was to assimilate wider social and artistic perspectives into clinical encounters, all via film. With the British Council as its principal funder, four editions have been delivered, “Under the Skin” (2017), exploring mental health; “About Her” (2018), reflecting on women’s health; “Tiny Marks” (2019), investigating children’s health, and ‘’Moments’’ (2022) portraying life-defining moments in family lives. In its 4 editions, Medfest-Egypt screened films from the MENA region, Europe, North and South America and Africa attracting around 7000 audience members involving 140 panellists in the Q and A sessions. Medfest screenings travelled within Egypt: Cairo, Alexandria, El Minya, Assiut, Sohag, and Luxor; and abroad in Tunisia, New York, and London.

Paper 3: Three Short films from ‘Medfest Egypt’

Over the course of ‘Medfest-Egypt’ editions, we have interspersed short films with full-length feature productions. Whether in conventional style or creative animations, short films can impact viewers in powerful, enduring ways. Furthermore, grouping evocative short films together affords an opportunity to explore the nuances of a subject within a single presentation providing a compelling, creative medium for clinical teaching. We will present three short films from different Medfest editions: Father and Daughter (Michaël Dudok de Wit, Netherlands, 2000), Mare Nostrum (Rana Kazkaz and Anas Khalaf, Syria, 2016), and Daughter (Daria Kashcheeva, Czech Republic, 2019). These films comprise three trenchant variations on father-daughter relationships, estrangement, and the dynamics of reconciliation and forgiveness at the end of life

Persianate cultures have been greatly influenced by the “mirror for princes” genre, which offers monarchs advice on how to treat their subjects justly and methods of being an ideal ruler. While scholars have chosen to study this genre from a male-centered perspective, how royal women shaped this genre has remained under-examined by current scholarship. This presentation argues that Crowning Anguish: Memoirs of a Persian Princess from the Harem to Modernity (1884-1936) by Iranian Qajar Princess Taj al-Saltana, offers new ways of seeing how women used memoir writing to challenge the dominance of their male counterparts during times of pandemics. As the daughter of Naser al-Din Shah, Princess Taj al-Saltana, was able to carefully document one of the many cholera epidemics that ravaged late 19^th century Iran from her unique perspective as a recognized intellectual and activist who advocated constitutionalism, freedom, and women’s rights in Iran. In addition to chronicling a cholera epidemic in Iran over one hundred years ago, Taj al-Saltana’s memoir holds interest for modern scholars interested in her handling of genre conventions, specifically how she indicts the ruling patriarchy of the Qajar government of Iran and its corruption which led to the failure to control cholera in the country, while simultaneously instructing female readers about the conduct of an ideal female ruler to build a healthier Iran. This presentation aims to show the way Crowning Anguish functions as a “mirror for princesses” and how we can come up with better strategies of resistance especially in the age of COVID-19 with the failures of patriarchal governments to stop pandemics.

The world is ageing, and this phenomenon is found in almost all countries: low-, middle-, and high-income. Scholarship providing perspectives on ageing deriving from the humanities, arts and cultural gerontology has augmented our understanding of ageing and the life course. Over the past decade one can observe an increased focus in relevant publications relating to ageing and its treatment in the disciplines within the Humanities. At this session we offer the perspective of two editors responsible for the humanities, arts and cultural gerontology columns in their respective journals (Journal of the American Geriatrics Society and European Geriatric Medicine). We outline the vision, philosophy, criteria and opportunities for publishing in these journals. The session will deal with how best to submit articles to such columns with practical advice offered. We hope that this session will interest members from various disciplines associated with gerontology and the humanities. We look forward to students, faculty and researchers interested in learning how to publish in the most appropriate journals in humanities and aging also to attend.

Introduction: Communication skills “CS” have no clear curriculum in most Iraqi medical colleges. This shortcoming of education is reflected in a doctor-centered approach in Iraq.

Aim: To identify challenges facing introduction of CS into medical education in Iraq.

Methods: Feedback form including the main challenges on introducing CS was distributed online to healthcare professionals who have participated in training of CS courses.

Results: Ninety-three healthcare professionals responded; 55 males and 38 females; 46 faculty members and 47 practitioners with part-time teaching. Doctors constituted 92 % of the respondents from different disciplines, and 75.2% had more than 15 years’ experience in practice. Frequency of educational and practical challenges were 40% and 44% respectively. Lack of appropriate curriculum constitutes 42% of educational challenges. Challenges include doctors' training in western models which are difficult to transform the interview into a dialogue that harmonizes Iraqi culture and social barriers (16% of respondents). A biomedical approach (22%) and lack of resources (22%) presented other challenges, while 14% of the participants mentioned high proportion of students to faculty members. Challenges related to practice includes a doctor-centered approach (47%) and neglect of patients' psychosocial needs (30%). Factors related to patients revealed that 46% of the challenges were related to health literacy and 26% to patients’ behavior for seeking medical advice. The presence of more than one person at interview was the most difficult factor for successful interview (14%), in addition to the passive role of the patient during interview (13%). There is no significance statistical difference in challenges in relation to specialty, workplace, sex and years of practice.

Conclusion: Multiple levels of challenges facing introduction of CS into medical education were revealed which need systematic review in the educational curricula and practice of medicine.

Avicenna (Ibn Sina) is Abu Ali al-Hussein, titled “Sheikh the President”. Avicenna was born in 370 Al-Hijra, (980 AD) in the village of Afshana, near Bukhara in Turkistan, or what is now the Republic of Uzbekistan. At the age of 21, he left Bukhara to spend the rest of his life travelling among various Persian cities. When he died in 1037 AD, he was considered one of the geniuses of philosophy in Islam, and in medicine he was placed in the rank of Galen, where he was called the Galen of Islam. Avicenna wrote 276 books, all written in Arabic, except for a few small books he wrote in his Persian native language. Unfortunately, most of these works have been lost, and have not reached us. There are currently 68 books scattered among east-west libraries. Avicenna’s most important book of medicine was al-Qanunn book, which is written in Arabic, and was described by William Osler, as the most famous medical textbook ever written.

Avicenna devoted a full article of the 12th art of the third book of al-Qanunn Book to talk about breast diseases; In this research, I followed a unified approach that included reviewing all the topics in which Avicenna talked about breast conditions and diseases, and then discussed these diseases according to the data of modern medicine.

Breast Injuries considered among celebrated illnesses that assault particularly females. For occasion, breast cancer assaults one among seven ladies. The point of this paper is to shed light on the accomplishments of Avicenna within the field of breast maladies which were known at that time, and to compare them with those known presently, to recognize the presence of a few components (dietary, natural, hormonal…) that take portion presently in actuating a few kinds of breast malady. Avicenna talked about Galactorrhoea, which could be a smooth emission from the breasts. The term presently ordinarily alludes to drain discharge not due to breast-feeding. It is reciprocal and from numerous conduits. Moreover, he depicted what is called presently fibrocystic breasts, which are characterized by unevenness, and as a rule distress in one or both breasts. The condition is exceptionally common presently, and kind, meaning that fibrocystic breasts are not dangerous (cancerous). Avicenna said what is called presently Incendiary Breast Cancer, which is considered nowadays as particularly forceful sort of breast cancer that can happen in ladies of any age (and, in spite of the fact that amazingly once in a while, in men). It gets its title from the ruddy, swollen, kindled appearance of the breast, as was portrayed by Avicenna.

Conclusion: Through this research we reviewed the various breast lesions, that Avicenna spoke of in his book al-Qanunn. Various chapters were reviewed, including all the breast lesions that were known at the time. These lesions have been interpreted according to our recent medical information. It is noteworthy that there is some convergence in Avicenna clinical description of some breast lesions with our current information, but Avicenna treatment methods for treating these conditions have largely differed from those currently in use.

With the aim of introducing medical humanities to medical colleges in Iraq, the researcher, who teaches English to medical students at Al-Nahrain University in Baghdad, initiated the idea of a performance of Shakespeare’s most popular play Romeo and Juliet. The main aim was to promote empathy and compassion for medical students after realizing that biomedical sciences have detached them from these feelings. Through activities in the English Language lectures, students, particularly 2nd and 3rd year, reflected on stories and passages in a way that lacked any connection or empathy. In one of the units of their English coursebook, there are two pages dedicated to Shakespeare’s play Romeo and Juliet. With the idea of the pair of star-crossed lovers, who suffer misfortunes brought upon them by causes quite independent of any flaw of character or immorality of conduct in both or either of them, the researcher found in the play a work of art that can create empathy and compassion in the readers as well as the audience, and hence came the idea of the performance. The researcher chose an abridged version of the play found on the Internet. To link the play with science to avoid objection from the scientific institution, the researcher added a scene taken from a speech by the scientist Fatima AlZahra’a Alatraktchi comparing the secret communication of bacteria with this Shakespearean play. The paper is about the reception of the idea of the play by the students at the medical college, who were overjoyed when they read the call for actors for the play and immediately a huge number of them showed interest in taking part in the performance. Though the performance was supposed to take place in mid-March, it was postponed because of the end-of-term exams. The paper deals with the manners of building empathy and compassion among the medical college community. Finally, the paper tries to show the importance of introducing literature and arts to medical students with the aim of giving more emphasis to the study of humanities disciplines in medical colleges in Iraq in the future.

Visual literacy is both an awareness of visual input and output, encoding and decoding, processing via the eyes and output through visual creation. When informed by the neuroscience of sight and memory, artists and educators can objectively understand their own visual work as well as nurture the visual language of their students (Kasdorf, 2020).

This arts-based and practice-based research was part of the author’s thesis during her master’s program in Museum and Gallery Practice at UCL Qatar (Kasdorf, 2020). The analysis further informs the author’s dialogue in creative workshops and classes in Qatar, with children and adults. In the case of workshops with illustration students, participants engage with the aesthetics of archival regional picture books to develop a personal voice. Their outcomes resist mainstream styles and embrace childlike exploration, a perspective that has been exercised in noteworthy Arab publishing history (Khan et al., 2009).

Observing Ephemeral Moments

An entry point into understanding visual neuroscience is pinpointing ephemeral moments; to acknowledge the “spark” of aesthetic preference. Masland (2017) describes that raw visual data is amalgamated for efficiency by the retina, thereby curated by the personal circuitry. Neurons are generally latent with consistent light and activated with changes in light and direction (Masland, 2017). More determinant of individuality is the heightened activity of neurons in the working memory in relation to a preferred visual; even when the visual is out of direct view, neuronic activity persists (Self & Roelfsema, 2017). By repeatedly recognizing these ephemeral moments, subconscious activity can be harnessed to build visual style and language.

Children and Visual Literacy

A child’s visual communication is noteworthy and telling of themselves (Khamis, 1962). With knowledge of the neuroscience of sight, an educator’s visual observation and objective language can nurture a child’s uninhibited and automated drawing and creating, as opposed to simply providing external validation. In turn, the child learns to value their own work objectively, without resorting to binary terms such as “good” or “bad”.

A Wider Spectrum of “Normal”

Visual literacy that incorporates knowledge of the neuroscience of sight supports more possibilities in drawing and creating, and thereby a broader sense of “normal”. Additionally, if drawing can allow for more diverse exploration, the same is enabled for people; visually literate people contribute to a broader normative knowledge system in society.

Drawing mirrors the relationships of people; if there is less of a “right” way to draw, there is less of a “right” way for people to be, and less of a “right” way for children (and adults) to understand themselves.

Philosophical interpretation of any scientific discipline is impossible without understanding the methods of cognition inherent in this discipline. The history of medicine is also formed by the understanding of the evolution of the methods of knowledge–clinical and experimental. Unfortunately, there is a tendency to describe the history of medicine as a set of individual events, but philosophy of medicine is understood as a system-forming phenomenon only from the moment of scientific revolutions (17th - 19th centuries). However, in relation to other natural science disciplines, for example, mathematics, the point of view regarding the apodictic method (i.e., the method of rigorous proof) is generally accepted as a method of knowledge that has determined the entire history of these disciplines. I argue that medicine was also strongly influenced by early Ionian physics (as well as astronomy or mathematics), and the apodictic method (methods of rigorous rational knowledge and proof) has existed in the history of medicine since antiquity. Even Sir Geoffrey Lloyd expressed this hypothesis, based on some treatises from the Hippocratic Corpus. In turn, I argue that the apodictic method in medicine had already been fully developed in the treatises of Galen. I propose to define the apodictic methodology in medicine as follows: the apodictic method of proof in medicine is anatomical dissections, clinical systematization and the rational doctrine of general pathology (the last one with certain limitations). The characteristics of the use of the method of rigorous proof in the work of ancient authors enables us to identify three stages in the development of the methodology of ancient medicine. The first stage ‒ the period of the inception of the apodictic method—defines the establishment of the foundations of Greek rational medicine, based on Hippocratic principles. The period of the establishment of the apodictic method is associated with the works of Aristotle devoted to the argumentation theory, the theory of motion and the practice of systematic dissection of animals based thereon. Most important was the establishment of comparative anatomy. The third stage—the period of the development of the apodictic method—is characterized by Galen’s work. Galen introduced the apodictic method in medical practice and substantiated its significance for further development of medicine as a science. The real keeper of Galenic-Hippocratic medicine during the 8th-11th centuries was the medicine of the Islamic world. In a certain sense, it was not only preserved, but also enriched. In this context the works of Muhammad ibn Zakariya al-Razi are of particular importance. He developed and critically rethought the teachings of Galen on the systematics of diseases. Most of al-Razi’s critical points were aimed at expanding and deepening clinical applications and general clinical logic reflected by this systematic approach. At the same time, we practically cannot speak about the development of anatomic dissections during the Islamic period of Galenic-Hippocratic medicine existence.

This paper will discuss the interdisciplinary approach of literature and medicine in light of the recent introduction of Narrative Medicine as a course at Fatima College of Health Sciences, Institute of Applied Technology, UAE. I proposed a Narrative Medicine course at Fatima College of Health Sciences (FCHS) which was accepted, and I currently teach and coordinate this course (which is also being taught at FCHS in Ajman and Al Ain). The course has been tailored to suit healthcare students in the field of nursing, psychology, radiography/imaging, paramedics, pharmacy and physiotherapy. This paper will examine the pedagogical approaches used to enhance the skills of creativity and close-reading and the application of these skills in medical contexts. More specifically, the paper will address the importance of using literature to teach the subjectivity of health-related experiences and the interconnectedness of literary frameworks to stories of illness—while taking into consideration the specific cultural context of the region. While the principles of Narrative Medicine of recognizing, absorbing, interpreting, and acting when hearing stories of illness may seem general and applicable to all contexts, it is essential to consider that the cultural context necessitates that these principles be applied with a sensitivity to both the cultural values of the region as well as its diversity and multiculturalism. The paper will focus on how these two sides are balanced while developing and teaching Narrative Medicine in the UAE. Drawing upon Susan Sontag’s Illness as Metaphor (1990), the paper will use the example of “military metaphors” in relation to a patient’s experience with cancer, to show how the linguistic underpinnings of these metaphors and their implications can vary depending upon the cultural and social context of a clinical setting. While Sontag’s attack on cancer’s military metaphors may seem applicable to some Western contexts, the application of Sontag’s work in an Arab context must take into consideration the difference in cultural perspective on the concepts of acceptance, surrender, and fight in relation to illness and death.

Background: Not all manuscripts that are accepted and published in scientific journals have retained their status as published articles, and some of them are retracted after publication. There are various reasons for retraction that are usually grouped into a scientific error, such as statistical flaws, and research misconduct such as plagiarism. Nowadays the number of scientific publications are a source of career advancement and respect in the scientific community. To attain these, the focus of researchers is towards increasing the number of publications per year which sometimes compromises the quality of publications.

Aim: The current study aimed to investigate the characteristics of retracted publications that were contributed by Turkish authors to scientific databases.

Methods: We searched PubMed, Scopus, and Web of Science databases. The search strategies were based on a combination of MeSH terms relevant to “retracted publication” and “Turkey.” The databases were searched on 23rd October 2021, without any restrictions on the search period. The inclusion criteria were: (i) retracted publication and, (ii) any authors of the study having affiliation with an institution in Turkey. The titles, authors' affiliations, and abstracts of the search results were screened and bibliographic information was extracted.

Results: After removing duplicates and irrelevant studies, our search retrieved a total of 147 publications. The oldest retracted article was published in 1996; thereafter an increasing trend of retracted publications was evident. Regarding access to full-text status, 106 (72.1%) of full-texts were available. Overall 127 scientific journals have published these articles. Biochemical Genetics was the most frequent publisher with five publications. From the institutional point of view, Hacettepe University was the main university, contributing seven papers. The most common reason for retractions was duplication = 50 (34%), and most retracted notices have been issued by the editor-in-chief = 63 (42.9% of papers). The majority of publications were from Medical Science = 93 (63.3% of papers). Among the Medical Science publications, the highest number, 44, were from surgery and allied fields. Turkish authors had international collaborations with 20 countries. Sixteen papers have international collaborations with researchers from Iran. Only 10 of the retracted publications have received funding. Five of the first authors have submitted more than one retracted publication. Citation analysis indicates that the median number of citations received by retracted publications was two (IQR 0-7). The minimum time lag between publication and retraction was less than one year and the maximum was 13 years.

Conclusion: The publish or perish pressure in academia sometimes leads to intentional and unintentional research misconduct. Although the number of retracted publications is fewer, their trend is increasing. To overcome the problem, it can be suggested that research methodology and research ethics training are essential in the under- and post-graduate curriculum.

Background: Disability is any restriction or lack of ability to perform an activity (WHO, 2022). The numbers of visually impaired persons globally was 285 million during 2020 and grows by up to 2 million yearly (Jabnoun et al., 2016). They receive the least benefits from health care services (Pratt et al, 2018). Realizing the principles of human rights regarding health care provision (Duffly, 2022), communication is an important human feature during the medical interview (Ben-noun, 2014) and it is very important to deliver a useful health service in any health system (Kaplonyi, 2017). It has been noted that unsighted persons suffer from communication problems with health care providers that affect their health care.

Aim: To identify needs of unsighted persons during the medical interview.

Materials and Methods: This study was done in Um Al-Rabean Development Foundation for Blinds and Purblinds in Mosul, Iraq, using a case series study design from January1 to February 1, 2022. Sixty-seven blind (unsighted) persons. Data were collected by using an electronic data collection Google form consisting of two axes, the 1st one included the demographic information of the study sample, and the 2nd one included the doctor- communication skills followed during the medical interview with the unsighted patients.

Results: This study revealed that the participants’ response rate was equal among both sexes. Most of them were aged 18 years and above and about one third were married. The percentage of celibacy was high, about 58.2%. Only (44.8%) of respondents had access to education, and the percentage of government employees was very low at 26.9%. The doctors’ communication skills followed during the medical interview with the participants were weak; more than half of doctors did not introduce their names, lower their voice, or give enough time for the patient to present their problem; adding to that, 74.6% did not shake hands with patients (before the COVID-19 pandemic). 20% of doctors did not assist during seating, only one third asked permission before giving help, and only 25.4% of doctors treat unsighted patients as normal persons. Roughly one fifth of doctors called the participants by their names more than once.

Conclusion: Training of doctors in communication skills techniques concerning this group is seriously needed. We recommend broader research work on a larger sample to study this topic from the point of view of doctors and patients.