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Postdigital Health Communication and World Health Organization (WHO) Inforgraphics about COVID-19: A Study in Graphic Medicine

Prologue

 Digitalization has revolutionized the way we interact with one another. It has also changed the mode of information through which we are advised to take safety measures during public emergencies such as COVID-19. World Health Organization (WHO) employed online digital media such as their website, Twitter handle, Facebook page and television channels for the awareness of the public during pandemic period of COVID-19. Comics in the form of infographics have been extensively used by WHO to advise the public as well as doctors on how they can protect themselves and others, and break the spread of the pandemic.

         Although there was much fuss about borders, quarantines and social distancing; the pandemic knew no boundaries. Blumczynski and Wilson remark that the etymology of the word pandemic has a tension in it in that pan means all (humans) and this implies that the virus does not know any national borders and localities and demos means people or peoples whom pandemic “affects … in all their cultural, ethnic, religious, linguistic and political diversity” (3) and it must be tackled globally and “centrally by the World Health Organization” (3). Hence, it was the duty of a global organization of the scope of WHO to issue guidelines and measures to be followed by all the people(s) around the globe.

            It was further noted that during the pandemic, not only common languages but also visual languages were also used in online health communications. The purpose was that such language may be understood across cultures, communities, ethnic and racial groups, and countries through the international medium which is the internet. Infographics used by WHO are also a form of visual language encoded to disseminate its message to all across the globe. The idea of graphic medicine comes in handy in connection with infographics and it carries central position in the discussion of graphical representation of messages in Medical Humanities. Czerwiec et al. define graphic medicine in Graphic Medicine Manifesto as “the intersection of the medium of comics and the discourse of health care” (1). Written in the form of comics, the book asserts that comics are a form of potential energy (7). They assert that there is a great range of comics to choose from in the talks of medical humanities and disability studies, hence the selection of infographics used by WHO in promoting awareness of the public regarding protection and prevention in COVID-19 period.

The term ‘Medical Humanities’ like Yeats’ famous phrase “terrible beauty” is an oxymoron and baffles those who encounter it for the first time. It was George Sarton, a historian, who used term ‘medical humanities’ for the first time in 1948 (Errington). In the US, Pennsylvania State College of Medicine opened the first Department of Humanities in a medical university in 1967. In the UK, there was a drive to reintroduce medical ethics to education of medicine through such forums as the London Medical Group. Whitehead and Wood note that “medical humanities … names a series of intersections, exchanges and entanglements between the biomedical sciences, the arts and humanities, and the social sciences” (1). It was observed that medicine and humanities had a great potential for bridging the divide between science and technology and could solve the issues of the culture on the other (Engelhardt 238). Medical Humanities has enhanced the scope of humanities in that humanities are expected “to leave their isolation and speak again to the broad concerns of our cultures” (239). COVID-19 was a common concern of all cultures for which much was contributed by the Medical Humanities scholarship.

         However, Medical Humanities scholars may take advantage from the scholarship and findings of digital humanities. It has been observed that “in the postpandemic programmatic reflections is a call for a systematic attention to digital environments” (Pietrzak-Franger 1). In fact, little has been said about the use of a particular digital mechanism in the processes of knowledge production and dissemination in postdigital times. There is a need to augment and move beyond the communication carried through only narratives in the field of medicine and focus alternative ways of conveying health information. In this connection, Digital Humanities may be mobilized for the assistance of Medical Humanities.

COVID-19 and Comics

       Comics were also used in online learning during COVID-19 pandemic period. Thus Saputra and Pasha carried out a development research project of the development and use of comics in learning in online learning during COVID-19 period (330). They find that comics not only provide stimulus to teachers but also are a means of learning for students in the classroom as well as at home. In comparison, children find it difficult to learn from apps and their parents are unable to help them in this regard. Moreover, comics developed in the jpg and pdf formats may be efficiently used in online and offline modes.

       This use of comics was also studied in other angles. Damopolii et al. studied the impact of the use of comics in learning on the cognitive learning outcomes of students (33). The students were given comic assisted and non-comic assisted data to learn and they came out with more learning with comic assisted input. Hence, comics can enhance students’ cognitive learning outcomes. They recommend “that d-comics can be an alternative source of learning for students during the COVID-19 pandemic” (43). Hence, improved results may be achieved by using comics in online learning. The connection between public health and visual arts such as graphic novels in connection with COVID-19 may also be explored. Ma et al. conducted an online survey to collect data from the children in New Zealand about what is their favorite place in the neighborhood (1). On the basis of it they developed recommendations to write a graphic novel and actually developed a graphic novel as well. They aimed to “explore what aspects of children’s neighbourhood environment supported their wellbeing” in the COVID-19 lockdown period (7). The output of the project was a graphic novel and its audio version which were made freely available online, and undoubtedly the article that reported the findings and the products of the endeavour. The study enabled the perspectives of participants shared with others through various media.

       Likewise, Hamaguchi et al. study the dissemination of validated information through infographics in the fast-evolving ecology of false news during COVID-19 period. Their focus was on how fast the validated infographics and other tools of visual communication transmit the correct public health measures information in COVID-19 lockdown. They created and transmitted this information through social media in twenty languages of the world. They found that visual language such as infographics may be a valuable currency in the economy of public health communication (Hamaguchi et al. 485). Further, it has the potential to fill the gaps in public health education and make the citizens more responsible as regards sharing of information about a crisis such as COVID-19.

        Visual language and comics have also been used to communicate social skills and coping strategies in COVID-19 period. Rais et al. studied the effect of digital comics especially selfregulation and self-awareness comics on the social skills of students of elementary level (180). For them, self-awareness means “the positive response to being aware of obeying the covid-19 prevention protocol” (181) for example being conscious of wearing masks, frequently washing hands and using your own utensils. On the other hand, self-regulation, in the context of COVID19, “is related to students’ awareness to obey the rule to wear a mask, wash their hands, and other healthy acts to stop the spread of the virus, especially at school” (181). Using quantitative methods, they find that both self-awareness digital comics and self-regulation digital comics increase the life and social skills of students regarding COVID-19.

       Comics were used effectively for public awareness during COVID-19 period. Kearns and Kearns remark that for a mass scale shift of behaviour during the COVID-19 crisis, there was a great need for the large scale awareness of public (1). Governments and other health bodies including media companies found an effective medium of communication in the form of comics. They argue that, due to their dual coding, comics increase the comprehension and memory of the readers due to visual and verbal elements. Furthermore, comics also have a symbolic element along with direct realistic reflection that they perform. The use of comics in symbolic sense “allows abstract concepts to be made tangible such as showing coughs spread clouds of infective material which is invisible in life, and representing the presence of infection” (Kearns and Kearns 2).

       Another way of concrete representation is metaphor which makes the ideas clear and memorable such as ‘isolation bubble’ and ‘tsunami of COVID’ convey the ideas of social isolation and arrival of a catastrophe clear. The researchers argue that scientific concepts may be communicated in an engaging and memorable manner through the use of comics which combine the powers of text, visuals and narrative. In the same coin, Saji et al. remark that comics respond to and document the ways we deal with pandemics and crises (136).

       They focus the COVID comics in the form of cartoons and comics as used by Graphic Medicine website and analyse them using Medical Humanities theories. They remark that comics make a collective response to the pandemic by constructing metonyms, metaphors and symbols. They contend that “anthropomorphic metaphors used in the COVID-19 comics capture the existential experiences of the self and the bestial nature of the virus, the superhero metaphors endorse health-care professionals who are engaged in minimizing the spread and impact of the virus” (152). Further, the graphic story of COVID-19 is replete with the metaphors of conflict and war; however, they convey the sense of shared understanding and common target.

       However, it may be observed that no study explored the WHO infographics as a tool of graphic medicine to communicate public health messages fully and maximally. Therefore, this study aims to analyse WHO infographics using the theory of graphic medicine and the method of visual grammar as given by Kress and van Leeuwen.

The term ‘Medical Humanities’ like Yeats’ famous phrase “terrible beauty” is an oxymoron and baffles those who encounter it for the first time. It was George Sarton, a historian, who used term ‘medical humanities’ for the first time in 1948 (Errington). In the US, Pennsylvania State College of Medicine opened the first Department of Humanities in a medical university in 1967. In the UK, there was a drive to reintroduce medical ethics to education of medicine through such forums as the London Medical Group. Whitehead and Wood note that “medical humanities … names a series of intersections, exchanges and entanglements between the biomedical sciences, the arts and humanities, and the social sciences” (1). It was observed that medicine and humanities had a great potential for bridging the divide between science and technology and could solve the issues of the culture on the other (Engelhardt 238). Medical Humanities has enhanced the scope of humanities in that humanities are expected “to leave their isolation and speak again to the broad concerns of our cultures” (239). COVID-19 was a common concern of all cultures for which much was contributed by the Medical Humanities scholarship.

         However, Medical Humanities scholars may take advantage from the scholarship and findings of digital humanities. It has been observed that “in the postpandemic programmatic reflections is a call for a systematic attention to digital environments” (Pietrzak-Franger 1). In fact, little has been said about the use of a particular digital mechanism in the processes of knowledge production and dissemination in postdigital times. There is a need to augment and move beyond the communication carried through only narratives in the field of medicine and focus alternative ways of conveying health information. In this connection, Digital Humanities may be mobilized for the assistance of Medical Humanities.

 Text-image relations

Bateman has also given four ways of text-image relations in connection with comics (107). These may be inherent where the text is the part and parcel of the image representation. They are emergent if they use thought bubbles and speech balloons. They are adjoined if image and text are connected indirectly through spatial proximity and captions. They are independent when image and text are totally separate and relations can be “only signalled by in-text references of the form” (Bateman 107).

Barthesian Anchorage

Do captions also matter? Yes, they do. In this regard, Barthes’ idea of anchorage is very relevant. He is of the view that images are poysemous and represent a range of signifiers floating freely under the surface (Barthes 39). Due to this, problem of meaning arises. Text performs the denotative description of the image and is called anchorage by Barthes because it binds the meaning. It creates the correct level of perception. Captions exactly do that.

 Text-image relations

Bateman has also given four ways of text-image relations in connection with comics (107). These may be inherent where the text is the part and parcel of the image representation. They are emergent if they use thought bubbles and speech balloons. They are adjoined if image and text are connected indirectly through spatial proximity and captions. They are independent when image and text are totally separate and relations can be “only signalled by in-text references of the form” (Bateman 107).

Barthesian Anchorage

Do captions also matter? Yes, they do. In this regard, Barthes’ idea of anchorage is very relevant. He is of the view that images are poysemous and represent a range of signifiers floating freely under the surface (Barthes 39). Due to this, problem of meaning arises. Text performs the denotative description of the image and is called anchorage by Barthes because it binds the meaning. It creates the correct level of perception. Captions exactly do that.

Data

Visual data related to COVID-19 has been collected from WHO advice for the public website, the pages dealing with advice for the public and it has been analyzed through Kress and van Leeuwen’s visual grammar and other related ideas of visual analysis in the framework of graphic medicine.

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Fig. 1. Be a Champion in the Fight against COVID-19

Watch your favourite game at home

To cope with stress and maintain mental and physical well-being, WHO advised the public to keep engaged in sports and games. The language of sportsmanship is used to encourage people in the times of distress. The WHO inforgraphic represents a multimodal discourse comprising text and images (see fig. 1). The infographic represents five human participants; and two objects, that is, a TV and a sofa to sit in. The background of the visual is blurred, however, the objects and the comfy environment suggest that it is a home and the family is observing social isolation. The interactive participants are a public health organization of international scope, WHO and public at large.

   Their narrative action has been represented through the vectors of their raised arms which show their sense of enjoyment achieved by watching games on TV. The accompanied text requires from the worldwide audience of the infographic to watch games on TV to become a champion against COVID-19. Therefore, the anchorage of the text suggests that the represented participants are using a strategy to fight against COVID-19. The participants are also giving reaction to the phenomenon of games shown through TV.

    As far as conceptual representation is concerned, the represented participants are of various skin colours and ages. The two on the left hand of the viewer are white, other two who are sitting are black and the girl standing behind them is brown. Symbolically, these stereotypes refer to specific types of human beings and finally to the whole humanity. It is quite in keeping with the requirements of graphic medicine which aims at the equality of all. One of the girls, who is standing behind the sofa, uses her gaze to see towards viewers to demand the action represented in figure 1.

   The interaction between the represented people and the viewers is a long shot which represents the public nature of relations between the interactive participants and the people in the image. Therefore, the message is for all regardless of colour, age, region or ethnicity. As far as the attitude of the participants is concerned, they are showing their detachment through the oblique angle of their representation on the horizontal scale. It is, perhaps, due to the official nature of the message in which there is no direct involvement of participants. Vertical level of interaction shows equality between the represented persons and public at large. Figure 1 also represents language-centered way of human thinking in which text precedes all the other modes of communication. Text is on the left and image is one the right suggesting that it is something new or added to existing text. The text size and contrast of color highlights the main message of becoming a champion against COVID-19 (fig. 1). Colours of participants’ shirts also achieve salience and grab the focus of audience.

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Fig. 2. What to do if someone is Sick in your Household

How to protect yourself from COVID-19

Moreover, WHO issued guidelines about the spread and prevention of COVID-19 via their infographics. They conveyed the message of social distancing, hands washing, and that of using sanitizers and masks to the public through infographics (see fig. 3). So far as composition is concerned, the information has been arranged in the left to right fashion where the left side lists causes of spread of COVID-19 and right side suggests ways to protect oneself and others. Circular shapes of white color against the blue background achieve salience and at times do the task of segregation and separation as frames. Diagrammatical resources of arrows have been used as logical vectors to represent the causes of the spread of COVID-19 and towards the arrowhead are the ways of protection. These arrows (see fig.3) also give logical symmetry to the whole infographic in that the information given below has also been arranged on the same pattern.

    The representation includes close shot of girls and distanced features blurring shot of boys and close shots of hands being washed. On the left side, the girls are present in a shared social space and the narrative action is that the left girls is sneezing, as shown by the vector of her hand, and other is the target of the droplets of her sneezing as shown by two drops on her face. Hence, it is only through infographics that the invisible has been made visible. The right side interaction between these represented girls shows two things: the girls, hence the viewers as well, should maintain a distance of one metre and also use facemasks. The separate frames shown by white color also represent social distancing through separation of frames.

    The second line also gives the guidelines of observing social distancing in social settings. However, the social distance in the second line shows the long distance frame hence, the public space. The message amounts to that one should maintain social distancing in public spaces. In the same coin, handshakes also spread pandemic and two ways should be used to protect yourself and others. Do not touch your face with hands and keep washing your hands with soap (fig. 3). The things which are used by multiple people should be sanitized for protection.

Parenting advice

Besides, WHO dealt not only with physical aspects of the disease but also with the social and mental aspects. During COVID-19, people were socially isolated, even quarantined, in their homes. There were no special physical or mental activities available for elders and children. News of death and spread of coronavirus were making people depressed. Kids were not allowed to go out into parks or playgrounds. There was a need to give them our time.

   

   

   

 

 

 

 

 

 

 

 

 

 

 

       

     

  

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Fig. 4. COVID-19 Parenting: One-on-One Time

Mask: DOs and DONTs

Masks were a spectacular reality of the COVID-19 period. Everybody was required to wear masks wherever they were. WHO issued clear instructions in the form of do’s and don’ts in side-by-side infographics on their website. Therefore, I have also set these infographics in sideby-side manner for maximum effect. Such juxtaposition of visual elements has its own impact and effectiveness.

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 The represented participants in these infographics are the actors ‘frozen’ in performing some action or the objects such as masks (fig. 5 and fig. 6). It may again be noted that in both infographics skin colours of participants are symbolic of the whole humanity. Discursively, the message is intended for everybody from the American film star to the Pakistani farmer; from the Chinese manufacturer to the Somali student.

    Furthermore, the instructions are also for those engaged in public healthcare profession along with general public. The infographic dealing with do’s (see fig. 5) fulfils the criteria of the definition of comics as a sequential art. The compositional arrangement of visual resources along with their captions is in the form of logical steps to be followed is given from left to right arrangement. It is the order of the English language in which we read an English sentence. The setting of white frames of don’ts in figure 6 is also in the form of rows that may be read from left to right but there is no sense of seriality on the logical level. They may be read in any other fashion as well. The instructions written in the imperative mood make anchorage in the Barthesian terms for the image which fixes the meaning at a specific level. Otherwise, a mask hanging in the air may have infinity meanings. Have a look on the second frame of figure 5. It is the instruction “[i]nspect the mask for tears and holes” (fig. 5) which makes the things clear. Participants in each frame are involved in one action or the other using the vectors of their hands or arms. Although a salient “Don’ts” has been written in figure 6, the diagrammatical representation of don’ts using ×’s (cross signs) superimposed on each frame makes the message more effective and clearer.

Fig 5. Medical Masks- Do's

Fig 6. Medical Masks- Don;ts

Works Cited
      Al-Jawad, Muna, and MK Czerwiec. “Comics.” Research Methods in Health Humanities. Edited by Craig M. Klugman and Erin Gentry Lamb, Oxford UP, 2019, pp. 78–99.
      Barthes, Roland. Image, Music, Text. Translated by Stephen Heath, Fontana Press, 1977.
       Bateman, John A. Text and Image: A Critical Introduction to the Visual/Verbal Divide. Routledge, 2014.
     Blumczynski, Piotr, and Steven Wilson. The Languages of COVID-19. Routledge, 2022.
     Charon, Rita. Narrative Medicine: Honoring the Stories of Illness. Oxford UP, 2006.
      Cole, Thomas R., et al. Medical Humanities : An Introduction. Cambridge UP, 2015.
       Crawford, Paul, et al. “Health Humanities: The Future of Medical Humanities?” Mental Health Review Journal, vol. 15, no. 3, Nov. 2010, pp. 4–10. https://doi.org/10.5042/mhrj.2010.0654.
      Cummings, John Rosswell. Comics and Medical Narrative: A Visual Semiotic Dissection of Graphic Medicine, Journal of Graphic Novels and Comics, 2018, pp. 27. https://doi.org/10.1080/21504857.2018.1530271
      Czerwiec, MaryKay, et al. Graphic Medicine Manifesto. Penn State P, 2020.
       Damopolii, Insar, et al. “Digital Comics in Online Learning During COVID-19: Its Effect on Student Cognitive Learning Outcomes.” International Journal of Interactive Mobile Technologies (IJIM), vol. 15, no. 19, Oct. 2021, pp. 33-47. https://doi.org/10.3991/ijim.v15i19.23395.
       Engelhardt, H. Tristram. “The Birth of the Medical Humanities and the Rebirth of the Philosophy of Medicine: The Vision of Edmund D. Pellegrino.” Journal of Medicine and Philosophy, vol. 15, no. 3, June 1990, pp. 237–41. https://doi.org/10.1093/jmp/15.3.237.
       Errington, Kate. “The Long History of the Medical Humanities.” The Polyphony, 3 Oct. 2023, thepolyphony.org/2022/07/07/the-long-history-of-the-medical-humanities.
      Gilman, Sander L. Illness and Image. Routledge, 2018.
      Hamaguchi, Ryoko, et al. “Picture of a Pandemic: Visual Aids in the COVID-19 Crisis.” Journal of Public Health, vol. 42, no. 3, June 2020, pp. 483–85. https://doi.org/10.1093/pubmed/fdaa080.
        Kearns, Ciléin, and Nethmi Kearns. “The Role of Comics in Public Health Communication during the COVID-19 Pandemic.” Journal of Visual Communication in Medicine, vol. 43, no. 3, July 2020, pp. 139–49. https://doi.org/10.1080/17453054.2020.1761248.
        Kirmayer, Laurence J., et al. “Narrative Medicine.” Person Centered Medicine. Edited by Juan E. Mezzich, Springer Nature, 2023, pp. 235–55. https://doi.org/10.1007/978-3-031- 17650-0_14.
        Kress, Gunther, and Theo van Leeuwen. Reading Images: The  Grammar of Visual Design. 3rd ed., Routledge, 2021.
       Kress, Gunther. Multimodality. Routledge, 2010.
        Langum, Virginia, and Terry Walker. “The Medical Humanities, Literature and Language.” Nordic Journal of English Studies, vol. 21, no. 2, 2022, pp. 1-7. https://doi.org/10.35360/njes.772.
        Ma, Catherine, et al. “Creative and Visual Communication of Health Research: Development of a Graphic Novel to Share Children’s Neighbourhood Perspectives of COVID-19 Lockdowns in Aotearoa New Zealand.” Visual Communication, Mar. 2023, p.
147035722311570. https://doi.org/10.1177/14703572231157042.
        McNicol, Sarah. “Humanising Illness: Presenting Health Information in Educational Comics.” Medical Humanities, vol. 40, no. 1, Jan. 2014, pp. 49–55. https://doi.org/10.1136/medhum-2013-010469.
       Ostherr, Kirsten. “The Future of Translational Medical Humanities: Bridging the Data/Narrative Divide.” Medical Humanities, vol. 49, no. 4, Dec. 2023, pp. 529–36. https://doi.org/10.1136/medhum-2023-012627.
       Pietrzak-Franger, Monika. “Postdigital Health Practices: New Directions in Medical Humanities.” Medical Humanities, vol. 49, no. 4, Nov. 2023, pp. 503–10.https://doi.org/10.1136/medhum-2023-012611.
      Rais, Muhammad, et al. “The Influence of Android-Based Digital Comics on the Social Skills to Prevent the Covid-19 Through Student Social Interaction.” Journal of Educational Science and Technology (EST), vol. 8, no. 3, Dec. 2022, pp. 180-87. https://doi.org/10.26858/est.v8i3.37318.
      Saji, Sweetha, et al. “Comics in the Time of a Pan(Dem)Ic: COVID-19, Graphic Medicine, and Metaphors.” Perspectives in Biology and Medicine, vol. 64, no. 1, 2021, pp. 136–54. https://doi.org/10.1353/pbm.2021.0010.
      Saputra, Very Hendra, and Donaya Pasha. “Comics as Learning Medium during the COVID-19 Pandemic.” Proceeding International Conference on Science and Engineering. Vol. 4. 2021.
     Whitehead, Anne, and Angela Woods. “Introduction.” The Edinburgh Companion to the Critical Medical Humanities, June 2016, pp. 1–32.
      Williams, Ian C. M. “Graphic Medicine: Comics as Medical Narrative.” Medical Humanities, vol. 38, no. 1, Jan. 2012, pp. 21–27. https://doi.org/10.1136/medhum-2011-010093.
      World Health Organization. “Be a Champion in the Fight against COVID-19.” World Health Organization, 2021, www.who.int/images/default-source/health topics/coronavirus/riskcommunications/olympic_games_tile_30_7_1.jpg?sfvrsn=a1672b82_9. Accessed 1 Feb. 2024.
     ---. “COVID-19 Parenting: One-on-One Time.” World Health Organization, www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/healthyparenting. Accessed 6 Feb. 2024.
     ---. “How to Protect Yourself from COVID-19.” World Health Organization, 2020, cdn.who.int/media/images/default source/health-topics/coronavirus/mythbusters/infographic-covid-19-transmission-and-protectionsfinal2.jpg?sfvrsn=7fc5264a_2. Accessed 5 Feb. 2024.
     ---. “Medical Masks-Do’s.” World Health Organization,
www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-andhow-to-use-masks. Accessed 7 Feb. 2024.
     ---. “Medical Masks-Don’ts.” World Health Organization,
www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-andhow-to-use-masks. Accessed 8 Feb. 2024.
     ---. “Shopping for Groceries: COVID-19.” World Health Organization, cdn.who.int/media/images/default-source/health-topics/coronavirus/groceryshopping.jpg?sfvrsn=57603db5_15. Accessed 9 Feb. 2024.
     ---. “What to Do if Someone is Sick in your Household .” World Health Organization, cdn.who.int/media/images/default source/health-topics/coronavirus/person-sick-in-yourhousehold-what-to-do.jpg?sfvrsn=39d1287_18. Accessed 2 Feb. 2024.

Pandemic, Literature and Translation

Much has been written on the use of narratives and comics in the health and medicine related communications especially about COVID-19 pandemic. Langum and walker report that the Facebook posts shared by people showed that they were involved in reading The Decameron by Boccaccio and other pandemic novels in COVID-19 period (2). The reality is that under such surreal times, literature has something to do with the crisis. The researchers remark that the literature about bibliotherapy, the use of literature to treat illness, is increasing at a high rate. Furthermore, the pandemic drew attention to the nuances of language and the metaphors of war have been developed to convey the sense of emergency and crisis and words such as ‘war zone’ and ‘frontline soldiers’ were used for hospitals and doctors respectively. However, language was also involved in COVID-19 related communication in another way, that is, through translation. 

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Another study focused on Translational Medical Humanities and its role in bridging the gap between medical academic scholars and general public (Ostherr 529). Ostherr argues that by responding to the communication needs in the COVID-19 crisis, translation is already responding to the ever-increasing needs of the field. It has also broadened the definition of translation. Hence, he remarks that “the concept of ‘translational humanities’ should be understood as a method for improving health, both by expanding the definition of ‘health’, and by balancing out the technological and biomedical responses to the crisis” (Ostherr 530). Furthermore, the projects of translational medical humanities are able to cross the data/ narrative gap by combining artistic shapes of data visualization with historical or personal stories that provide background specificity and affective or aesthetic signs. However, verbal mode was not the only mode of COVID-19 related communication, visual language especially comics were used at a large scale to convey the health information.

  Comics and Health Care

Another prominent researcher, Sarah McNicol, focuses on the role of comic books in the health communication and comments that the comics do something more than transmitting health information, they help the readers empathize with the mental and social conditions of patients (50). The researcher argues that not only the results of testing but also the reactions of friends and family may be represented through comics. Further, she argues that erroneous beliefs may also be eradicated through the interplay of characters in which one character puts forth such belief and others contradict him. The visual component and the element of humour make the facts memorable in comics. A question arises: can medical narratives be put in comic book form?

        Using the principles of narrative medicine, Williams sought answer to the question whether comics and graphic fiction may be utilized as a resource for patients, caregivers and health professionals (Williams 21). Various comic narratives are analyzed taking them as examples of graphic medicine. The researcher argues that graphic narratives pose some complicated issues of the nature of fictiveness and truth in them (Williams 26). The writer develops the persona different from his own personality so that his peer cannot find exact equals in the narrative. Self-reflexivity is also used in graphic narratives in which the creation of comics within comics is shown. These autobiographies and the problems related to them enlighten the healthcare professionals and “may lead to a more considerate and enlightened attitude when dealing with the patient’s history” (Williams 26) which is considered a poor and contradictory history on the part of the patient. It has also been found that the medium of comics is fit for the depiction of subjective experiences of the writer concerning suffering and illness and it can enhance the education of healthcare professionals as well as general public.

        Comics and the medium of graphics may also increase the empathy in doctor-patient relation. Cummings analyses graphic medicine in the forms of medical narratives and comics and uses the semiotic model of Kress and van Leeuwen to discover to what extent they create empathy in the doctor-patient relationship (Cummings 1). He notes that the detached concern is a big flaw of medical profession and there is a need for the cultivation of the empathetic approach. By analyzing the key themes in four different comics, the researcher finds that empathy has been emphasized in all of these comics. The vitality of human experience and the significance of bearing witness have also been recognized (Cummings 25). Furthermore, detached concern of the medical professionals has been decried.

Medical and Health Humanities

\Medical Humanities as a field of study lays stress on the value and role of traditional humanities and social sciences in responding to the broad range of problems and questions concerning human health and what we call illness (Gilman xi). It has much to do with the education and training of health professionals without spreading any negativity about the learning and research undertaken at schools of public health, medicine, dentistry and nursing. Cole et al. define Medical Humanities as “an inter- and multidisciplinary field that explores contexts, experiences, and critical and conceptual issues in medicine and health care, while supporting professional identity formation” (7 stress in original). Other disciplines that help medicine and healthcare are traditional humanities and social sciences. Due to such fields as Medical humanities and Bioethics, there has been a great shift from medical reductionism to medical holism. The patient is not seen as an illness or disease only but as a whole person who has all facets of his personality active. Medical Humanities bridge the gap between sciences and human experience and add the social and psychological dimension to the medicine and healthcare.

        Moreover, it may be observed that arts have also been wedded to sciences through Medical Humanities. Literature, music and visual arts make health and medicine their subject matter and provide means of clear comprehension to the health sciences. Health Humanities is a later term that accepts interdisciplinarity in a more democratic way and also focuses on the contributions and role of those who are marginalized in Medical Humanities such as allied health professionals, patients, nurses and caretakers. Humanities have not only focused on doctors’ education but also have a place in the education of nurses. Mental healthcare has been related to humanities in additive and integrative manner (Crawford et al. 5). Mental healthcare basically provided the site of inclusivity of the marginalized because many methods of treatment here are not medicinal.

Narrative Medicine

Narrative Medicine is the latest advance in the research, clinical training, and practice which gives recognition to human ability to narrate stories as something pivotal to healthcare. Everybody has tales to tell and “patients’ stories are key to understanding their health care problems, predicaments and concerns and to negotiating effective treatment” (Kirmayer et al. 235). As self-interpreters, we narrate the stories of our lives in ways that are the essential determiners of our experience of illness and behaviors, and others’ responses. Physicians also use the medium of narrative to systematize their thinking, involve in clinical dialogues with colleagues and patients, and give explanations.

      Rita Charon has defined Narrative Medicine to “mean medicine practiced with these narrative skills of recognizing, absorbing, interpreting, and being moved by the stories of illness” (4). Patients, literature teachers, novelists and storytellers have collaborated to teach doctors, nurses and healthcare professionals the skills to attentively listen to tales of illness, to get their meanings and interpretations, and to understand the patients’ plight in full complexity. 

Graphic Medicine

Graphic Medicine is the meeting point of comics and healthcare. The framework of Graphic Medicine has been laid down in Graphic Medicine Manifesto (Czerwiec et al). It is an interdisciplinary area of study and an approach to healthcare education in which principles of narrative medicine are combined with an exploration of the visual medium of comics. The authors assert that “[c]omics give voice to those who are often not heard” (2). It gives more inclusive perspective to healthcare.

Page 2 of Graphic Medicine Manifesto (Czerwiec)

Graphic Medicine gives equality to multiple subjects and differing points of view and experiences. It explores the myriad ways in which health and disease may be represented using graphic form. In medical classrooms, stress is laid on the use of comics to communicate ideas. Graphic Medicine is a collaborative effort in which healthcare teachers, professionals, professors of literature, cartoonists and many others take part. Their work is concerned with text as well as space. It is all about creativity and the use value of comics in communication.

      Comics are like potential energy which does not need any external force to move them. Different people having different interests join together to talk about comics in new ways. They assert that in Medical Humanities “there is a wonderful array of comics to choose from that address illness, disability, caregiving” (Czerwiec et al. 8). It has also been found that in healthcare many ethical issues are caused by poor communication.

     The authors also observe that the comics artists play with the medium of communication and the medium of comics plays with our perceptions creating an enthralling and fluid experience. Whatever the subject matter, we do have enjoyment while reading comics. Furthermore, Al-Jawad and Czerwiec remark that comics are necessarily and quite obviously “constructed narratives” (82). Text, visual, speech, and elements of narration can all be consciously created and studied. Comics do have visual elements to be analyzed, too. They content that “gutters, symbols, color, thoughts, and sound effects are all part of the visual language that is unique to comics” (82). Hence, we may infer from this discussion that comics are a multimodal discourse to be analyzed using multimodal discourse analysis techniques. However, comics are fundamentally a visual medium of representation. The researcher should study what is represented, use of color, technique, space, metaphor and meaning.

Multimodality and the grammar of visual designs 

Gunther Kress and Theo Van Leeuwen have introduced the multimodal method to study the form of data that uses text, image and color. Kress argues that multimodality is the normal condition of human communication (1). We use images to show what will take much time in reading process. Text is used to name what cannot be shown by images and color is used to highlight which aspects we need to focus. He further remarks that we use one of the many ways of doing discourse analysis which is based on social semiotics.​​

     Their theory is the social semiotic theory of multimodality. We can notice semiotic effects everywhere from media to the communication of messages, especially “at the level of semiotic production in the shift from the older technologies of print to digital, electronic means” (Kress 6). Their focus is not on the iconographical effects of separate elements of images as lexical items, rather on the cumulative effect in combined form as meaningful wholes. Kress and Leeuwen remark that their grammar of visual design is a general purpose tool having “principles that can apply to an oil painting as well as a magazine layout, to a comic strip as much as to a scientific diagram” (4).

     Kress and Leeuwen derive their model from Michael Halliday’s metafunctions of language. They believe that the theory of systemic functional linguistics may be adapted for visual analysis (Kress and van Leeuwen16). Ideational, interpersonal and textual functions correspond with the patterns of representation, interaction and composition respectively. The patterns of representation refer to the people, places and things represented in the image. The patterns of interaction refer to the resources which create a link among the viewer of the image, maker of the image and those represented in it. The patterns of composition are related to the ways through which two above-mentioned patterns integrate into a meaningful whole.

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 Representation is realized through relating the participants in narrative or conceptual forms. We have participants of two kinds: interactive participants those who interact with the visual as viewers or producers and represented participants those who are depicted in the image (Kress and van Leeuwen 113). There are two kinds of representation: narrative and conceptual. Narrative representation uses action verbs in the form of directed actions that are called vectors. A vector may be conceived as an oblique line made by arms and objects etc. which makes a connection between participants. To convey the sense of semantic roles, visual grammar uses these vectors.

     In the actional processes, if the vector starts from the participant, he is the actor. If it leads to the participant, he is the goal. If there is only one participant in the image, it is nontransactional. If there are more than one participants in it, it is transactional. On the other hand, in reactional processes, participants give reaction through gaze to some object. The reactor is a human or anthropomorphic entity. The receiving participant of the gaze is called phenomenon. Reactional processes also have transactional as well as non-transactional sub-processes.

    Secondly, conceptual representation refers to the constructs that represent participants in “more generalized and more or less stable and timeless essence, in terms of class, or structure or meaning” (Kress and van Leeuwen 76). Such representation is composed of classificational, analytical and symbolic processes. In classificational processes, subordinates are related with one or more overt or covert supordinates. Analytical processes join the participants in the part-whole bond. Two types of participants are involved in it. Carriers are those which represent whole and possessive attributes are the parts. Symbolic processes refer to the meaning or nature of participants.

    Interaction is the social relation developed between interactive participants and represented participants. An image builds relationship between the producer of images and the audience. Interaction comprises three basic categories: contact or gaze, social distance and attitude. Gaze has two types: offer gaze and demand gaze. Offer is made when represented participants look at one another or look outside the image or frame. When the participant looks outwards to the viewer, he creates demand. Social distance refers to the size of frame which represents closeness of viewers to the participants. Attitude or point of view towards the participants is shown through some visual resources which may be objective or subjective. Horizontal and vertical angles also perform their function in this regard. Composition is related to how images are composed and how they communicate the ideas. Composition refers to the manner in which interactive and representational resources “are integrated into a meaningful whole” (Kress and van Leeuwen 179). Three principles are associated with composition, which are information value, framing and salience. Information value is related with the positioning of elements in specific image zones which have meaningful information. Left to right means given information to new information. Secondly, top means ideal and bottom means real structures. Thirdly, centre mediates overall structure and margin is just ancillary.

    On the other hand, salience considers hierarchies of significance among elements of represented on the page wanting immediate concentration to some elements instead of others. Salience may be recognized by such factors as relative size, foregrounding, tonal contrast and sharpness of focus. Framing refers to the dividing lines and shapes which connect or separate the elements of the image. It represents which elements belong to one another and which ones do not. The elements belonging to each other make one unit.

Measures to be taken when someones gets sick in your household

WHO focused on all the aspects and issues related to COVID-19 and relayed guidance about them through their online channels such as website, Facebook page, Twitter handle and purpose-built WhatsApp Channel. It may be observed in the light of Graphic Medicine that infographics play with the perceptions of men to impress upon them the message contained in them. The inforgraphic given in figure 2 is the representative of human participants, medicines, kitchen accessories and home fixtures. Discourse of all the three verbal, visual and diagrammatical kinds has been used in the infographic. Frames are used to segregate and separate various sets of instructions from one another using different colours such as blue and white, and lined quadrangles (fig. 2). Emergency sign has been used thrice in the infographic representing the sensitive and dangerous nature of the issue of one member of family contracting COVID-19.

   The human participants used in the first frame (see fig. 2) are of symbolic nature and they symbolize how one imagined patient is socially isolated in a separate room by other members of the family. The accompanying text also gives instructions for isolating the sick one. In Bateman’s terms, the text-image relation in this infographic is inherent because both convey the same message. In the second frame, a young man is carrying a tray using his arms as vectors in which he has set food supposedly for the patient. The text on the left side performs the function of anchorage and clarifies that the most resistant member has been appointed as the caretaker of the patient.

   The boy in second frame exercises gaze on the viewers demanding from them to follow these steps and roles (fig. 2). Top information is substantive and ideal in the form of general heading and subheading while bottom information is real and procedural. The steps have been given in the sequential array from left to right. A horizontal line and red frame give information about ‘danger signs’. Semiotically, red is color of danger and emergency. The human participants are once again representative of the whole humanity because it is duty of WHO to deal with all men of the world. It is noticeable that empty speech bubble signifies the loss of speech as a symptom of COVID-19. Hence, WHO infographics successfully spread public awareness by using multimodal discourse which can be understood by even those who cannot understand the language properly.

Fig. 7. Shopping for Groceries: COVID-19

Shopping advice

The apocalypse was there but life was to go on in the times of COVID-19. WHO developed the infographic about precautions for shopping of groceries. The represented participants are buyers busy in the act of buying groceries and the represented objects are related with the field of public healthcare as it is applicable to the conditions of COVID-19. The composition of the infographic is such that it comprises frames associated with particular steps and occasions such as for “reduce your risk” and “when inside stores” (fig. 7). Further, the gutter between two frames has been used creatively to insert text associate with the upper or lower frame.

    The narrative function of shopping has been represented by human actors whose arms and hands are vectors which represent them holding products of daily use. One frame has only objects in it such as a list of local instructions, masks and sanitizers. These are the things to be taken care of ‘before you go out’ (fig. 7). Conceptual representation shows participants as a group of carriers who possess daily-use products in their hands. One possessive attribute of theirs is the presence of masks on their faces which asks the viewers to use masks when going to the market. A covert superordinate of the instruction of using face masks joins together the subordinate frames in one whole.

    The nature of interaction between the viewers and the represented participants is such that they are using offer gaze by not looking into the eyes of imagined viewers (fig.7). By their example, they are offering the visual model for others to follow in a simple manner. The social distance represents a long shot which means that the buyers are in a public space that is a market. The horizontal angle of representation is oblique which means that there is an air of detachment about the buyers vis-à-vis viewers of the infographic. Such detachment is quite a characteristic of shopping for groceries. It may also be observed that centre-margin arrangement of multimodal information has been effectively used. Main message has been allotted the central space and ancillary or subsidiary information has been given in the marginal space, for example, in figure 7 things to remember have been represented in the footer of the infographic.

 

Coda

   We may conclude that WHO performed their duty to inform the public about precautions to be taken during COVID-19 pandemic, among other things, in an effective and efficient manner. As a part of their public advice function, they used WHO infographics to disseminate public advice through multimodal discourse of infographics. Through the use of stereotypes such as skin color or symbolic figures, WHO infographics address the whole human race. Such equality and inclusivity are the hallmark of Graphic Medicine. The human participants represented in the infographics demand action from the viewers in a proactive manner. The artistic design of infographics affects the perceptions of viewers to move them into action.

     Similarly, the visual resources of the infographics directly involve viewers into the represented situation. Frames and sequential array have been judiciously used in infographics to segregate the steps or parts of the whole. The public healthcare messages regarding the use of masks and sanitizers, social distancing, social isolation, and time management have been effectively conveyed through WHO infographics. Furthermore, captions have effectively kept the polysemous nature of visual elements at a specific intended level of interpretation. Even those who cannot understand English are able to understand the visual part of the infographic. According to the tenets of Graphic Medicine, WHO infographics have effectively conveyed the public healthcare information in the times of global crisis.

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