Our Snapshot article series features Q&As with key pioneers, innovators and emerging practitioners across the multidisciplinary and multi-dimensional arts and health field in Canada, who are part of the Arts Health Network Canada community.
Interview by: Zara Contractor
Hartley Jafine is currently an instructor at McMaster University where he faciltates theatre and arts-based courses/workshops within the Bachelor of Health Sciences (Honours) and Arts & Science programs and Interprofessional Education program. Additionally he is a communications coach at the University of Toronto - Postgraduate Medical Education and an Interprofessional Arts-Based Leaning Specialist at Baycrest Hospital. He holds a BA in Theatre Studies from Acadia University, a MA in Applied Drama from Goldsmiths, University of London (UK) and is currently a PhD candidate at York University. His teaching and research interests are focused on Applied Drama; research-based theatre/verbatim theatre; and the use of drama in professional health sciences training and environments to enhance wellness and develop communication and empathy. He has facilitated workshops and productions in Canada, USA, England, Bulgaria and Kosovo.
1. Tell us a bit about yourself and how you are involved in arts and health?
When I was a child I spent a lot of the time in the hospital. Before the age of nine I lost three grandparents and my mother. My own experiences led me to question ‘how can we take a space that nobody elects to be in, and make it more of a positive space using theatre and the arts’? It was really when I was in my Masters program that I started thinking about how theatre can be used as a tool for development.
My background is in Theatre and Applied Theatre. I completed my undergraduate degree in theatre, during which I was introduced to the work of Augusto Boal’s Theatre of the Oppressed and the concept of Applied Theatre. That really inspired me, so I shifted gears from wanting to be an Actor and I began to work in Applied Theatre instead.
During my Masters I started thinking about some conversations that I had as an undergraduate student, around how ‘theatre skills are life skills’, that is, how skills you develop as an actor can be transferred to other spaces. I have always been interested in the intersections of theatre and health. I began thinking about medicine as performance and how theatre can be used to improve that performance.
I also started to do more research in to health work and just seeing the enormous pressures on health care workers made me realize that Theatre can help alleviate some of that. With this in mind, one of my professors told me about an initiative in London called the Clod Ensemble, which collaborates with the Queen Mary Medical School to train doctors using Theatre through a program called Performing Medicine. I met with the director of the program and she said that she was interested in exploring the idea ‘if medicine is a performance, then how is it performed’. Those concepts married nicely with my thinking that ‘theatre skills are life skills’.
When I moved back to Canada after living in England for a year I connected with the Dean of Undergraduate Health Sciences at McMaster University, who was very open to innovative ideas. I pitched a course to the program and ended up co-developing one course and developing another one on my own, which uses theatre and the arts within undergraduate health science education.
From there I have been able to grow my work at McMaster within the Bachelor of Health Sciences program and now I teach handful of theatre and arts-based courses for the undergrad program, and it has also allowed me to work with the faculty of Nursing as well as the Med school there.
I’ve also conducted workshops at other universities in Canada, for example at the University of Western Ontario and University of Toronto’s Med schools. I have worked with the Annual Canadian Conference on Medical Education and have also connected with Baycrest Hospital in Toronto where I work as an inter-professional arts based educator. In my role there, I work with clinics and health-care teams by using theatre as a way to develop professional competencies, particularly communication, empathy, perspective making, and concepts of power and status.
2. What have been some of the major benefits in your experience, of using drama within the professional health sciences?
The pressures on health care professionals, doctors in particular, are enormous and there is an expectation of constant perfection, especially in Med schools.
There is a feeling that Med students can't show weakness, anxiety or fear. I think theatre offers the space to have conversations around those issues and to build their resiliency against the enormous pressures they face on a day-to-day basis.
I just closed a show I've been doing for 3 years running. It’s a show looking at inter-professionalism within health care training, which is held at McMaster for all the students in professional health care training. It is a big day where we invite 750 students and we do a show for them around inter-professionalism.
We draw on the principles of the Theatre of the Oppressed, in terms of trying to get the student’s involvement and to prompt them to think of other ways of being, and how they can change a situation. I think theatre offers the space to have conversations around anxiety or fear. We explore these themes either by projecting on to another character or using storytelling to develop plays and/or devising scenarios about struggles they might be experiencing. Often the devised pieces are reflective of their own lives. Its helpful as a tool to develop strategies to change the outcome of something, or sometimes its beneficial to know that you are not alone and that someone else is also experiencing the same fear and anxiety that you are feeling.
It is a very embodied and engaging way of learning, as opposed to traditional lecture-style based education. I've seen how these workshops have added value in skill development, communication, and empathy. I have also seen improvements in how they use the space, as well as their bodies and their tone of voice when they present.
The benefit of this kind of work is that it’s a lived experience; once the students are able to make these discoveries for themselves, it sticks a little bit better and has more impact. It is also beneficial to introduce these concepts early on, at a pre-professional level. I have spoken to graduates of the program at McMasters who are now Residents and many of them say the training has stuck with them throughout.
On the other hand, when I use theatre in clinical settings with health care professionals I see other benefits; it allows colleagues to work together in different ways. A lot of the feedback I’ve received is that it allows professionals to break down some of the barriers and work together in innovative and unique ways.
When I first started I was looking at how I could train health care professionals to work with undergrad health science students to develop relevant skills that they can use in the future. Eventually I started to look at the benefits to the healer. That links in with the idea of providing a really nice creative space which can improve the psychological resiliency of health care professionals. I always say what we do in this space is serious play. It is work, it involves training and it is tiring, but it is playful, and because of that it allows for joy and for fun, and it can really have a positive impact on health.
3. What are some of the challenges you’ve faced and continue dealing with in your work and how have you responded to those?
With the Bachelor of Health Sciences program, the administration and students have been very receptive towards the idea of using theatre. Even though the tide is changing and there is more of an acceptance of this kind of work, in medical school and other health care professional training programs I think the challenge is convincing the administration to include this work in their curriculum. Generally speaking, the more training students receive, the less creative they become. As a professional there are certain roles that need to be performed and there is less room for serious play.
The challenge that I face personally is having other people see the value of this type of work. This ties into funding. I get a lot of programs that want me to do the work for free, because they don't recognise the expertise that comes with the work and/or they aren't willing to carve out the time or finances to help support it.
Another issue is that a lot of medical schools have distribution sites to get doctors trained in underserved areas-for example, the University of Western Ontario in London has a satellite campus in Windsor, McMasters has a site in Waterloo. I think one of the challenges is that anything that is done in one campus needs to be replicated in another campus, but this is not the type of work that can be done over a video conference or over the internet, so it diminishes the potential for this type of work particularly in satellite campuses.
The third issue is sustainability - a lot of this work is "one and done". I am really lucky that the Health Sciences program has allowed me to develop courses for them, but a lot of the work I've done in medical schools and other settings is limited to a workshop or two with no continuity unless you are lucky enough to get a grant.
The work that I do in Baycrest is part of a 2-year grant in collaboration with a colleague who is a social worker. One of the things that we are discovering is that there is a need for continuity and sustainability. We do a full-day workshop for health care teams and then we go back and do a 1 hr workshop a few months later to provide that sustainability. If you are in a situation where you don't have that sustainability it can be a challenge since there is no way continue to develop those core skills.
4. Looking to the next five years, what do you envision for the field of arts and health in Canada?
This is a really exciting time to be involved with Arts and Health. Right now there is a fair amount of arts-based work being done in medical training or health science based professional training; however, a lot of it is elective based, which is great as a start, but it needs to be embedded within the curriculum. If you offer it as an elective you attract students that already see the value in it, so there is no “conversion”. One way that the field will hopefully grow in the next 5 years is for it to be compulsory or built in to the curriculum.
I think a lot of the arts based work I'm exposed to exists in an academic setting and during health care training but a lot less so in clinical environments. The work that I'm doing with my colleague at Baycrest is particularly exciting because it allows us to work with health care professionals in their professional roles. There is a lot of space for theatre and the arts to be applied not only within educational training, but also within professional spaces and hopefully we will see that idea expand in the next five years.
Once these processes are in place, there is a need to build sustainability in to the field, so that teams of doctors can regularly come together within hospital spaces to do drama together. That way there is some sustainability and consistency and they can continue to build on what they have learned.
5. What advice would you give to someone interested in pursing a career path similar to yours?
Look for the opportunities and be persistent. Find ways to show the value of what you do to others. One of the major things that I learned early on is that I was speaking the language of theatre, and what I needed to be doing was showing the value of theatre in a way that those in a health-based setting can understand and recognize. In this case it is using the modality of theatre, but using the language of health. One way in which I do this is to interview participants and then created verbatim theatre productions, as a way to disseminate the research findings at conferences etc.
I think as we increase the number of initiatives, publish more research and expand on the existing body of evidence, it will lead to the sustainability that all Arts and Health workers dream of.