Lissa: A Story About Medical Promise, Friendship, and Revolution

Written by Sherine Hamdy and Coleman Nye

Illustrated by Sarula Bao and Caroline Brewer

Lettering by Marc Parenteau

University of Toronto Press, 2017. 304 pages.

 

For several years many anthropologists have engaged in questions about the possibilities of a graphic anthropology. “Graphic,” here specifically references comics and graphic narratives and novels for communicating ethnography. Lissa: A Story about Medical Promise, Friendship, and Revolution is an innovative demonstration of the possibilities a graphic anthropology. Creating a graphic narrative is not a one-to-one translation of ethnographic fieldnotes into a drawing and dialogue on a page, but an intensely collaborative process that demands a different method for seeing and communicating relationships in the field. Lissa is a graphic narrative, a fictional story based in years of ethnographic fieldwork, a book about how to read and make comics, how to collaborate on such endeavors, and how to teach graphic narrative. It hits all of our imaginaries such that any reader can use the book to answer or guide them through disciplinary, methodological, and ethnographic questions.

Lissa is told in three parts, and is centered on the relationship of two young women, Anna and Layla. The story follows them from adolescence into early adulthood. Set primarily in Cairo, Egypt with moments in the United States, the first two parts of the book focus on major medical decisions with which they and their families are confronted. Part three of the story is set during the 2011 Egyptian revolution, and emphasizes how seemingly individual medical decisions and procedures are embedded in forms of social suffering and struggle. This time of revolution is critical in contextualizing how the state creates and exacerbates pain, what change can mean for our hopes for a better life, and access to technologies whose affordances make choices possible. The Appendices are a valuable resource that include a timeline of the revolution, interviews with the Hamdy, Nye, Parenteau, and Brackenbury, a teaching guide, and a further reading/resource guide. Paul Karasik’s chapter at the end of the narrative provides instructions for novice comics readers. Because Lissa is told in comic form we learn to read the non-verbal cues—such as which direction the characters are looking when are faces partially shown or not shown at all. These issues are important for readers new to comics, who often only read the words and not the images in relationship to the words.

In medical narratives, readers are often situated into the moment when the illness has been diagnosed and complicated decisions are in process. In contrast, Anna’s and Layla’s lives are visually situated across time and in ethnographic context. Dealing with choices about breast cancer genetic risk and organ transplantation we are narratively and visually immersed in intimate moments as Anna and Layla negotiate personal histories, family demands, cultural expectations, and economic access. Communicating the tensions between agency, ethics, and political economies of health often take pages in traditional ethnographies. In Lissa, we are provided with insights into complicated social worlds in panels that connect people, processes, and things. Most striking are two, two-page panels that move from the internal conflicts and potential for change to structural barriers and indifference to human life. Anna’s two page panel has sweeping lines of DNA strands connecting to chemical toxins that are embodied in the treatment of a patient living with cancer, carcinogens in the environment and household carcinogens that transform our bodies are connected with dollar signs and DNA strands, that draw the reader’s eyes down the page to be met with a family history—Anna’s cancer genealogy. Two pages later we similarly see Layla’s two-page panel with her father on dialysis, parasites and schistosomiasis in water, power grids and industrial pollution, the politics and greed associated with wheat production, all drawing the readers’ eyes to Layla holding a flyer for the revolution. The conflicts that Anna and Layla experience and potential theoretical concepts such as structural vulnerability, bioethics, and history and memory, are further examined in the teaching guides provided in Appendix III. From discussion guides to toxic mapping exercises, symbolism and authorship, Hamdy and Nye create a space for the classroom to collaboratively engage this work.

Many of strengths in Lissa’s story emphasize relationships and the connections between individuals and structural processes. From the beginning of the book the focus is on the relationships between the two young women. As a graphic narrative, the reader becomes a part of their intimate conversations, their hopes for their lives and their family. We follow them across several years of their lives, how they stay in contact across distances, the details of their lives that they share with each other, or not, and how they decide when the other’s advice makes sense in their own context. The second are the connections between individual and structural processes. As mentioned in the previous paragraph, the two-page panels contextualize cancer and kidney failure in political economies that produce increases in life threatening illnesses. Earlier in the story there is a panel on Anna’s search to obtain testing for the BRCA gene. This panel emphasizes familial, legal, and economic relationships that first prohibit, and then make way for Anna to obtain the test (p85). These relationships are also creatively drawn as Layla struggles with her father’s kidney failure, Anna’s desire for knowledge of her cancer history, and her brother being shot in the eye – part of the Egyptian military’s intentional targeting of protestors’ eyes. In anthropology, this form of storytelling is an innovative way to compare people’s lives without broad stroke generalizations. People and political impacts in the story are always in relation to each other, even when they are pondering a decision that they alone must make. A final note on the effective use of visuals in this graphic narrative are the role of texting and its importance in the Egyptian revolution. It was well reported that cyberactivism, social media and texting, were instrumental in communicating during the revolution. Instead of panels with word balloons between people, we see drawings of a Facebook page or a series of texts. In this way the reader interprets the calls for help and organization in a familiar technological medium. The relationships that are being drawn are not just between the characters in the book, but are visualized such that the reader is included in that intimate political relationship.

Having read numerous graphic medicine narratives and followed the work of colleagues who are creating graphic narratives from their own ethnographic fieldwork, I have for too long grappled with the question of how to create the graphic narrative. As ethnographers, how do we tell the story? Do we recreate the stories from people we interviewed in the field as we obtained them in the field? If we do this, do we have sufficient ethnographic data to write the story? It is not a simple translation between our fieldnotes and the image + text on the page. As Nye explains in her interview with Marc Parenteau in Appendix II, Layla, Anna, and their story are fictionalized. They are, however, based in years of ethnographic work on organ transplantation in Egypt and genetic risk for breast cancer in the United States. The visualized moments and conversations with doctors and family members emerge from ethnographic data from Hamdy’s and Nye’s research in Egypt and the United States, respectively. The work that Hamdy and Nye have done here help us to ask important methodological questions about how we see in the field and what kind of data we collect. Hamdy and Nye are in a productive dialogue with Galman (2009), Ramos (2015), and Causey (2017) who show us how drawing teaches us to see more and see differently in our ethnographic methods and ethnographies.

In Lissa, Hamdy, Nye, their artists Bao, Brewer, and Parenteau show us how we can collaboratively transform anthropology’s ways of seeing and communicating depth and nuance in our ethnographies. Importantly, the authors have not only shared the finished product with us, but they have shared their path to Lissa through online contributions to Somatosphere (Creative Collaborations) and Teaching as Culture (The Making of Lissa). As the first publication in the new ethnoGRAPHIC series from University of Toronto Press, Lissa sets a high bar and positive tone for what we can expect from this series. Like most great books, Lissa allows the reader to bring different meanings and needs to the book, engaging them in multiple conversations that explore the ways in which we are connected.

 

Juliet McMullin is a Professor in the School of Medicine at the University of California, Riverside. Her work examines the intersections of knowledge production, political economy of health and community building. Her two ongoing projects include; an ethnography of the field of graphic medicine, the second is based on her earlier research and explores how to represent health inequalities in graphic narrative form. She can be reached via email at julietm@ucr.edu

 

References

Causey, A. 2017. Drawn to See: Drawing as an ethnographic method. Toronto: University of Toronto Press.

Galman, S. 2009. The truthful messenger: visual methods and representation in qualitative research in education. Qualitative Research 9(2): 197-217

Ramos, J. 2015. Stop the Academic World, I Wanna Get Off in the Quai de Branly. Of Sketchbooks, museums and anthroplogy. Artivismo: poéticas e performances políticas na rua e na rede. 4(2)