Difficult, dark and uncomfortable:  writing about terrible truths


Melissa Graboyes

Claire Wendland’s ethnography, A Heart for the Work: Journeys through an African Medical School, was a very tough book for me to read. I picked it up at a difficult moment in my own journey to producing a book. I was a few years past my dissertation, and there were still a few more years of hard labor left to do before my book would be complete. I felt burdened by my topic, by how much of what I was writing about was depressing or upsetting.

This wasn’t entirely surprising given that my research focused on the history of human experimentation in East Africa from 1940 through the present. Constantly being steeped in stories of people being treated unfairly and unethical can be hard to bear. I had stumbled into the topic while working in Tanzania for a global health NGO. As my knowledge of Swahili improved, I realized there was a gap between what many people understood when signing up for medical research trial, and the likely outcomes of participating. Whereas people talked about receiving dawa (medicine), there was little understanding that the medicines were experimental. When I picked up Wendland’s book, I was wavering on whether I should continue working on my project. I was having a hard time articulating why it was important to write about a set of encounters that were pretty bleak and sometimes veered into the grave. I daydreamed about abandoning the weight of my topic and finding something lighter to work on.


I read A Heart for the Work on a cross country flight, and spent the entire time frantically scribbling notes. Her academic text was imbued with so much humanity, I felt flashes of anger and then profound sadness as I was reading. The narrative interludes were particularly emotive, as Wendland focused on the young Malawians training to become doctors. These interludes channeled the volatile mixture of frustration, fear, joy, and aspiration that drove these Malawians to medicine. She was able to describe the many obstacles they faced in their quest to do good work, and conveyed both the desperation and hope of the situation. I found myself crying at the most powerful and tragic sections, which was surprising to me. I tried to decide if the book was wonderful even though it was filled with difficult stories, or if it was wonderful because it was filled with such difficult stories.

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Usoke African dressers assisting at lumbar punctures. Source: Tanganyika Terriroty Annual Medical and Sanitary Report 1929. Crown Copyright.

About half way through the book, Wendland engages with the work of the philosopher Martha Nussbaum, and presents at least one explanation for why it was important to write about the difficult, and dark, and uncomfortable topics of the world. The passage describes how when as reader is confronted with a “terrible truth,” that truth demands both “passionate attention and moral appraisal.” Wendland’s book was full of terrible truths: of overwhelming poverty, unjust deprivation, and preventable deaths. I imagine it was hard for Wendland to bear witness, to participate as an ethnographer and medical doctor, to recognize her limited ability to change the larger inequities she observed. Yet rather than losing hope in the project, or in the value of researching it or writing about, she reminds the reader that “Emotions…are forms of engagement and of moral judgment, ways of measuring the world and oneself” (147).

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Collecting blood in capillary tube for the CMR. Source: East African Institute for Medical Research Report. Crown Copyright.

Her belief, that eliciting an emotional reaction from a reader could be a valid form of engagement, was an elegant reminder of why I had to return to my own somber project. The stories I collected in East Africa had a weight to them that sometimes felt burdensome. Accounts of deceptive researchers, experimental drug trials and disease eradication attempts gone awry were not particularly uplifiting. For the most part, the materials I collected in unofficial archives and through oral interviews chronicled activities that were occasionally unethical, often unjust, and almost always regrettable. But when I got off the plane after reading Wendland’s book, I felt buoyed. I was reengaged to my project. I would allow readers to confront these terrible truths and I would do my best to elicit passionate attention.

I was thankful Wendland had stuck with her topic because it became an inspiring model for my own work, and a reminder that difficult and “depressing” topics also present amazing possibilities. By conveying the humanity of those who are involved and asking readers to confront painful realities, books such as Wendland’s can be uplifting in their own way.


Melissa Graboyes teaches at the University of Oregon. Her most recent book is The Experiment Must Continue: Medical Research and Ethics in East Africa 1940-2014 (Ohio University Press, 2015).


The image at the beginning of this post is copyright of Meg Riggs and should not be reused without permission.