Helen: Welcome to Health Literacy Out Loud. I’m Helen Osborne, president of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.

In these podcasts, you get to listen in on my conversations with some really remarkable people—hearing what health literacy is, why it matters, and ways every one of us can improve health understanding.

Today I’m talking with MK Czerwiec, a nurse who makes comics. MK has a master’s degree in medical humanities from Northwestern University, where she developed and teaches a seminar to medical students called Drawing Medicine.

Along with Ian Williams, a doctor in the UK who also makes comics, MK co-runs www.GraphicMedicine.org, a website that looks at the intersection between comics and the discourse of medicine. Welcome, MK.

MK: Thank you. It’s a pleasure to be on your show.

Helen: As Health Literacy Out Loud listeners may know, I am a huge fan of communicating health information in whatever ways work. I am super intrigued about how you use comics. Let’s take it from the beginning. When you call yourself a comic nurse, what do you mean by that term?

MK: I am a nurse who makes comics, as you said. I started making comics while I was working as a nurse during the AIDS crisis as a young person just trying to make sense of what I was seeing. My background was in literature, so I was trying to use story in telling my stories of the patient encounters I was having.

The AIDS crisis was such a terrible time. There was a point at which words were failing me, so I started using images. Then there was one day where they just came together for me.

Helen: Are you an artist by training? You said you were a literature major, but are you also an artist?

MK: No, not at all. That’s one of the things I love about comics. It’s a very democratic medium. We all have a visual language. I’ve reflected a lot on this since, but what I really did in those days was just reclaim my visual language.

Helen: What do you mean by visual language?

MK: When we’re kids, we all draw as a way of thinking. We all process the world through our drawings with our crayons. There’s actually research about when and why this happens, but at some point we get language. Then we’re often supposed to use words, and only kids who have talent or show aptitude toward realism in their drawings are allowed to keep drawing.

For the rest of us, we have to keep trying to reclaim that visual literacy as adults.

Helen: I’ve been to your website, www.ComicNurse.com. I hope others go there too. When you say comics, do you mean those strip comics that have four boxes in a row? Is this more like an editorial cartoon that’s just one picture? Describe this for our audience, please.

MK: Any of those fall into the realm. Basically, comics are sequential art that convey a narrative. That often incorporates text, but it doesn’t have to. The way that I’d like people to think about comics is analogous to how you think about film. It’s a medium, and within that medium there are many genres.

You just named two genres of comics, the strips we read in the paper or single-panel gag comics like in The New Yorker. Those are different genres. There are many different genres of comics. Unfortunately, when a lot of people think about comics, they think about super heroes. That’s just one genre. That would be like thinking of film as just Disney animated films.

Helen: There’s a wide variety out there. Are these good for everybody or are they more for kids?

MK: They definitely have applications for adults. There are a lot of graphic novels that are specifically aimed at adults. I think a lot of people are aware that there’s been a real surge of graphic novels for adults. The bookstores have graphic novel sections now. It’s both.

In graphic medicine, we certainly are looking at the uses of comics in medicine for kids, but we’re focusing on adults. I teach medical students using comics. There are several people in the world doing that. It’s definitely something for adults.

Helen: I want to hear more about this. You said you teach medical students about it, and I know you use comics in medicine. Make this vivid for us. I know we’re challenged because it’s just words, but can you help us picture what this is like?

MK: There is a great body of graphic novels that are on medical themes.

What’s really wonderful about them, why I use them in teaching medical students and why I think all healthcare professionals can benefit from them, is that they are for the most part actually non-fiction memoir made by people who are living with illness or caregiving people living with illness. In one way or another, they’re living with illness.

One of the most popular, widely read ones is called Cancer Vixen. It’s by a woman in New York who was diagnosed with breast cancer who happened to also be a cartoonist.

There are many examples. One of the purposes of our website, www.GraphicMedicine.org, is to catalog the hundreds of graphic novels on medical themes by diagnosis area.

If people have a specific clinical interest area and they’re considering using comics in their teaching or are looking at living with the disease, they can find them very specifically.

The other thing I want to stress that’s amazing to me is the range of diagnosis areas that are covered by graphic novels by people living with it or going through it.

Helen: What surprised you? Give us an example of that range.

MK: Someone made a comic about what it’s like to donate a kidney. There are many comics about living with diabetes. There are a great number of comics about living with cancer or caregiving someone with cancer, or even Asperger’s.

There’s just about anything. I speak with healthcare providers in specialty areas and I’m always rattling off titles to them. It’s amazing how many there are out there.

Helen: I’m really impressed by that. I know you teach medical students. You talked about them using comics. Maybe we’re not all quite as bold as you to be able to draw, but how can professionals use comics in their practice?

MK: There are two ways. One is what you just referred to in terms of drawing. There’s this aspect of reflective drawing. I think both healthcare providers and people living with illness and caregiving can use drawing in the same way that they might write in a journal or write about the experiences they’re having in healthcare.

Helen: Do you mean if somebody’s going through donating a kidney or something, as a professional you might suggest, “Why don’t you draw out this experience?” Is that what you mean?

MK: Yes, absolutely. Draw about it. Make a comic. Make a couple of boxes, put a few words in there, put a few images to accompany those words and then make another box. There’s something about the sequential nature of the boxes that helps draw out the narrative and tell a story.

People often report that they fact they’re using drawings in addition to writing small amounts draws out different aspects of the story that they might not have accessed before.

Helen: You might encourage a patient or even a provider to draw out the experience?

MK: Absolutely. That’s the first aspect of how we’re using comics in medicine. It’s this thing that we’re calling reflective drawing.

The other aspect of it is reading these graphic novels by people who are living with illness gives an insight into the experience that we’re not going to get from a clinic visit.

I can think of an example called Tangles, which is by a Canadian woman named Sarah Leavitt. She writes about what it was like for her mom to have early onset Alzheimer’s and to eventually lose her mom to this. She made this beautiful, dark, black and white graphic novel about that experience.

There are aspects of what it’s like to lose someone in that way that we would never hear from a patient or a family member in a hospital or clinic. We have this insight into the home life and the day-to-day living with it.

That’s what a lot of these graphic novels really provide for us as providers who are looking for insight into what our patients are going through. When we better understand that, we can better provide care that’s relevant to them.

Helen: That gets back to the beginning of your story when you were working with patients who had AIDS. What about drawing? Is that something that you’d recommend professionals do? Should we try some of our own drawing?

MK: Absolutely. As I said, one of the things that is amazing about comics is that it’s a very democratic medium. We all have a visual language. We either left it behind in fourth or fifth grade when we stopped drawing or we’ve maintained it through something we don’t think about, like doodling. We all use a visual language.

Embracing that, even if it starts with just making stick figures, can have the same kinds of outcome that I was saying in terms of accessing parts of the story that we hadn’t really considered or looking at a story in a way we hadn’t thought about.

Helen: People should just give it a try and not be too worried about whether they’re magnificent at what they’re doing. I talk to professionals who say, “I can’t draw.”

MK: That’s right. You hear that from adults. The truth is that we all can draw.

Helen: Muster up your courage. Do comics work in medicine?

MK: Absolutely. There’s no question that the answer to that is yes. Medicine is evidence based, right? We’d have to look at specific aspects when we talk about using comics in medicine.

What’s fascinating is that there are so many aspects to this, such as teaching medical students. That would be a different question. Do medical students have a different understanding of the lived experience of illness as a result of reading a graphic novel? That would be one research study.

We recently had a panel at the American Society for Bioethics and Humanities conference about looking at research outcomes. This was a bit of a cheeky title on my part. It was “Research outcomes when the medical intervention is a comic.”

We looked at studies across the lifespan. A stereotype that comics deal with is only being for children. We looked at using comics for children specifically for asthma inhaler education. There was a study of the efficacy of that. Then we had another study from Mayo Clinic using comics with adolescents, “Assent to Biobanking.”

I had a study at the University of Chicago Medical Clinic about using comics to help adults come back to the clinic after their student doctor graduates. These were three very discrete studies with early data, but they all seem to indicate that there’s an impact, even if it’s just that comics can be so visually interesting that they get people’s attention.

Helen: That’s great. Certainly the places you’re talking about and the studies you’re looking at are not just a whim. You’re looking at serious medicine here.

My interest, as listeners know, is health literacy and communicating health information in ways that patients and families can understand. I’ll give you a health literacy hat to put on. How can comics help us do just that?

MK: One of the many great benefits that comics carry is the ability to convey visual metaphors. We can use visual metaphors like characters to convey information.

I mentioned the example of asthma inhalers. It’s hard for adults to figure out or remember which inhaler is for long acting versus short acting in their asthma management. What these guys have done is created characters whose stories, both visually and just in concept, tie to the action of the inhaler.

Helen: You have almost a visual memory when you hear whatever drug name it is. You can almost associate it with the picture.

MK: That’s an excellent point. They can associate a visual, which brings in another way of processing information that can really benefit health education.

Helen: We already talked about ages. You said it goes throughout the lifespan and that you can use pictures and words. What about across cultures?

MK: Absolutely. There are a lot of comics that are used where cross-cultural issues and language barriers are one of the things that providers are dealing with.

Often you’ll hear this cited by people who talk about comics. When you sit down on a plane and look at the information card in front of you, basically what you’re being handed tells you how to survive should something happen to your plane. That is a comic.

Helen: That one with the person crouched down or opening the emergency door.

MK: Yes, or how to put your emergency vest on. That’s basically done in comic form because it’s so efficient at transcending language and education level. It’s just visually sequential art, and that’s what a comic is.

Helen: That’s wonderful. You’ve got a captive audience of listeners who care a lot about health communication. What would you like us to know or do?

MK: If you’re interested in comics and using them in medicine in any form, we would definitely encourage you to come to our website, www.GraphicMedicine.org.

On top right, there’s a search bar. We try to label every post and every lecture that we put on the site with diagnosis areas and with information that will help you find it in a targeted way. Feel free to use the site in that way.

The second thing is that we do have annual international conferences. It turns out that there are people doing this work all over the world.

Helen: It’s not just you and one other doctor in the UK?

MK: That’s what’s so exciting about this. It’s turned out to also be a community. We now have a graphic medicine community of people using comics in many different ways all over the world. We have annual conferences, so you can look on the website about that.

Also, if you’re interested in my twist on this and how I use it for effective writing in medicine, you can go to my website at www.ComicNurse.com. Feel free to email me through either of those sites.

Helen: MK, you’re great. I actually found you because somebody sent me an email about that international conference on graphic medicine. I thought it was so great that I went hunting and searching around and found you. It’s great.

I also love your picture on the Health Literacy Out Loud website. Usually I have photos of everyone I’m interviewing. Yours is a comic. MK, you’re terrific. Thank you so much for all that you are doing and for sharing it with listeners of Health Literacy Out Loud.

MK: Thank you.

Helen: I learned so much from MK Czerwiec about comics and medicine. I’m actually more enthused than ever about the role of visual literacy, drawing and communicating health information in whatever ways work.

Health literacy, as we all know, isn’t always so easy to do. For help clearly communicating your health message, please visit my health literacy consulting website at www.HealthLiteracy.com. While you are there, sign up for the free enewsletter, What’s New in Health Literacy Consulting.

NewHealth Literacy Out Loud podcasts come out every few weeks. Subscribe for free to hear them all. You can find us on iTunes, Stitcher Radio, and on the Health Literacy Out Loud website at www.HealthLiteracyOutLoud.org.

Did you like this podcast? Did you learn something new? If so, tell your colleagues and friends. Together, let’s let the whole world know why health literacy matters. Until next time, I’m Helen Osborne.