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Somewhere on a secluded section of beach along the Minas Basin in Nova Scotia, you can probably find Dr Michael Cussen memorizing a poem. After he’s spent mindful time orating the poem out loud to himself and the waves, working on memory and sound, he’ll likely wander into the Hants Shore Community Health Centre, a multidisciplinary clinic begun back in 1985 that serves 13 “little rural hamlets” (as Michael calls them) on the southwest finger of the Bay of Fundy.
Poetry and doctoring are not so far apart in Michael’s world.
Last year Dr Cussen memorized Tintern Abbey by William Wordsworth. This year he’s tackling The Love Song of J. Alfred Prufrock, a long modernist poem by T.S. Eliot, which opens with a metaphor that transforms the evening sky into an etherized patient on a table, a poem with the somewhat obscure but singsong stanza and lyrical refrain of,
In the room the women come and go
Talking of Michelangelo.
While Michael Cussen’s vision of medicine and family practice is anything but “somewhat obscure,” his sense of well-being is firmly anchored in the lyrical, in passionate and inspired engagement with story and literature and education as fundamental to human health.
“Years ago I was sitting in a pub. In Dublin. I was sitting with a poet—he’s a publisher now—and we were having a pint. In comes this boy, you know, the boys selling the daily papers. We say to the boy, we say, we don’t want to buy the entire paper, but can he let us know who won the day’s match? The boy looks at us and says, ‘I don’t know. I can’t read.’ Well. That was an eye-opener.”
That eye-opener set Michael Cussen down a path, a path he’s still walking on today. A path on which literacy and a local medical clinic are woven together, a path that’s included a letter from Sarah McLachlan about her love of Leonard Cohen’s poem “For Anne,” a path with images of his daughter watching rural Nova Scotia morning mist rise as she waits for a bright yellow school bus, a path on which Michael has sat with circles of elementary school boys, reading stories about firefighters and police officers.
“Literacy is such a fundamental determinant of health,” observes Cussen. “I’ll give you an example. For years and years, in Alberta and in Newfoundland and in Nova Scotia, the places I lived after I came to Canada from Ireland, patients would ask me: ‘Doc, can you help me fill in this form?’ At first it was frustrating. I thought they might be wasting my time. Then I finally realized they couldn’t read the forms. Imagine!”
Michael offers concrete examples of the direct link between literacy and health, citing myriad times he’s worked with patients who can’t follow diabetes tests because they can’t read or write. Fundamentally, these patients are not able to advocate for their own health needs or potentially even understand what their health needs are. “If they can’t read it, or don’t understand what they’re seeing on a page, their mind closes down. That’s natural.”
So making people feel poorly about not being literate, or telling people they should read, are not productive strategies from Dr Cussen’s perspective. Instead, Michael gently and fulsomely refers to Paulo Freire’s canonical text Pedagogy of the Oppressed, offering thoughts on how marginalized peoples and communities hold the tools and knowledge for their own transformation, how working at the grass-roots level will always result in the greatest revolutions. “When I was in medical school in Dublin, we helped trade unions set up a literacy group. Here in rural Nova Scotia, it once used to be all blue-collar work. Even then they needed to read and write. But now. Now you really need to be able to read and write. It makes such a difference in people’s lives.”
The Hants Shore Community Health Centre, which by the way is the first thing that Google delivers when you search for “Hants Shore”—because the clinic is just that central to the region—embraces all the things that contribute to literacy. Food. Education. Community. Resources. If people are going to learn to read and write, they need more than a pencil, paper, or a book. They need support. They need care and they need leaders and advocates.
“Early on we had the help of a retired schoolteacher, tutoring one-on-one. It evolved to sophisticated group tutoring environments. That’s become the Hants Learning Network, a huge organization. We established a nursery centre, to get the kids involved in lifelong learning. We supported the first breakfast program in the schools. In the mid-90s, I started going to schools. Once a week. An hour a week. I wanted to work with the boys. I watched how I’d bring my daughter into a bookstore and she’d find book after book. That wasn’t so with my son. I wanted to see about a different approach for rural boys. So I’d sit with about 20 boys or so. And I’d interview a man. A pilot. A policeman. A fireman. And I’d ask them: ‘Do you need to read to do your job?’ Well of course all those men said yes! And then we’d all read a story together. I tried to get the boys into reading in a different kind of a way.”
Dr Michael Cussen’s work with tutoring programs and elementary school storytelling grew and grew. One word at a time, an entire novelesque world of good health began to story the towns in the Avon River Valley of rural Nova Scotia. “People let us into their kitchens. We asked them what they wanted to know. And we made sure everything they needed was written at a grade 7 level. People wanted to know how to read a thermometer when their child was sick.”
People also called out for knowledge about far more important things than thermometers—women along Hants Shore voiced the need to understand surviving childhood sexual violence. And they needed materials they could read and share and learn from. So the Hants Shore Community Health Centre stepped up and supported a group of 8 to 10 women, women who developed resources and facilitated discussion groups. People asked for information about heart health, so Dr Cussen and the centre partnered with a university in Halifax. But not without making darn sure any research committees that worked in the region were chaired by a local expert, and advised by community members—because Michael Cussen is serious, serious indeed, about Freire’s Pedagogy of the Oppressed.
Hants Shore Community Health Centre now has a bursary to support a student from the region. And Michael recently met a young woman from Hants Shore who has gone on to become a physician herself, against the odds, against teachers who said she shouldn’t “aim too high.”
“You get that a lot,” muses Cussen. “Prejudice against rural people. But that young physician’s mother was on the Board of Directors at the Hants Shore Community Health Centre.”
There’s something poetic in that kind of justice. It’s almost as if Dr Michael Cussen’s life and devotion to literacy and health in rural Nova Scotia stole a line right out of the poem he’s currently hard at work memorizing:
And indeed there will be time
To wonder, “Do I dare?” and, “Do I dare?”
The answer, of course, is yes. Dare. And be poetic.
Dr cussen is a family physician at the Hants Shore Community Health Centre in West Hants, NS.
The cover Project The Faces of Family Medicine project has evolved from individual faces of family medicine in Canada to portraits of physicians and communities across the country grappling with some of the inequities and challenges pervading society. It is our hope that over time this collection of covers and stories will help us to enhance our relationships with our patients in our own communities.