Listening to Skid Road

IMG_4007Listening to Skid Road: Join us for a lunchtime panel discussion on the intersections of health, homelessness, and racism in King County, as well as explorations of the moral responsibilities of the University of Washington in addressing these issues. Hear from panelists who participated in the oral history collection for the Skid Road project, currently on display in the University of Washington Odegaard Library. Panelists include Krystal Koop, MSW; Nancy Amidei, MSW; Sinan Demirel, PhD; Rebekah Demirel (author of the memoir Nothing’s for Nothing: Transformation through Trauma) and Eric Seitz, RN; with Josephine Ensign (PI of the Skid Road project) as moderator.

Date: Tuesday February 6, 2018
Time: 11:30am-1:30pm
Place: University of Washington Odegaard Library, Room 220
Light lunch and beverages provided
Open to the Public

4culture_colorSpecial thanks to public historian Lorraine McConaghy, PhD for her support and mentorship throughout this project.

This project was supported, in part, by an award from 4Culture. Additional support for the audio portion of the DS videos comes from Jack Straw Cultural Center. My Skid Road project was also funded, in part, by the University of Washington Simpson Center for the Humanities, the University of Washington College of Arts and Sciences, the National Endowment for the Humanities, and Humanities Washington.

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Solastalgia: Homesickness and Climate Change

BC642845-1D42-466F-870C-CC1456A62A08Population health effects from climate change are established scientific facts. Like anti-vaxxers (anti-vaccinators), climate change deniers are not only wrong-headed, they are dangerous to everyone’s health (and to planetary health). Case in point: beware of the pets of anti-vaxxers since many seem to be refusing rabies vaccinations for their cats and dogs/ see “Anti-vaxxers now refuse to vaccinate pets” by Nick Thieme, Slate, August 3, 2017; at the same time, global warming is increasing the spread of rabies among animal hosts such as foxes in Alaska/ see “Ecological niche modeling of rabies in the changing Arctic of Alaska” by Huettman, Magnuson, and Hueffer, Acta Veterinaria Scandinavica, March 20, 2017. And as a reminder, rabies in humans is almost 100% fatal (source: CDC).

The Centers for Disease Control has developed an excellent graphic depiction of the impact of climate change on human health, shown here:

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Of special note in this graphic is the fact that mental health impacts are shown twice, associated with both severe weather and with environmental degradation.

A recent (November 25, 2017) NYT article illustrates the mental health effects from climate change for people who live in Rigolet, Labrador. As Livia Albeck-Ripka states in the article “Why Lost Ice Means Lost Hope for an Inuit Village” there are increases in depression, substance abuse, domestic violence, and suicide related to the disorienting environmental changes and increased isolation for villagers. “An unpredictable environment means disempowerment,” she writes and links this with the stirring up of the intergenerational trauma of colonization for indigenous people. But she also points out that mental health effects from climate change and environmental degradation affect us all. She quotes Australian philosopher Glenn Albrecht as stating, “We weren’t around when the asteroid wiped out dinosaurs, but now we have humans in the 21st century who are trying to deal with a change to the world which is unprecedented.” Albrecht coined the term Solastalgia: “a form of homesickness one experiences when one is still at home.”

But what can we individually and collectively do about climate change and about the health effects of climate change? Perhaps the most important action is to become better informed and more civically engaged in respect to these topics. The Lancet has a good website: Tracking the Connections Between Public Health and Climate Change which includes a synthesis of scientific evidence in The 2017 Report of The Lancet Countdown. In the US reliable sources of information include the CDC (resources linked above) and the American Public Health Association (APHA). The APHA graphic “How Climate Change Affects Your Health” (included below) is a bit overly-busy and heavy on the gloom and doom (and curiously does not include mental health), yet could spur helpful discussion in certain settings:

Climate_Change_Overview

Another great resource that is geared towards a young adult audience is the Seattle-based environmental news site Grist, with the vision of working for “a planet that doesn’t burn and a future that doesn’t suck.” Their funny and informative (a good combination) “Ask Umbra” eco-advice column is worth following. Take a look at Umbra’s “21-day Apathy Detox” for great ideas on brushing up on civic engagement related to environmental justice and climate change. My two favorites are “Day 5: Read More Than Dead White Men” and Day 20: Art Brings Life to Social Movements.” 

Get involved. Do what you can to beautify and “green” the places where you work, live, and play. Work upstream for social and environmental justice. Bloom where you are planted. Those are some of the thoughts I’ve had this fall as I’ve been involved with this year’s University of Washington Health Sciences Common Book Changing Climate, Changing Health: How the Climate Crisis Threatens Our Health and What We Can Do about It by Paul R. Epstein and Dan Ferber (University of California Press, 2011).

In order to emphasize the what we can do about it, I’ve been part of a team attempting to green the ugly weed-filled concrete planters in the main courtyard at the University of Washington Health Sciences—a courtyard with entrances to the Schools of Nursing, Medicine, Dentistry, the UW Health Sciences Library, as well as the UW Medical Center. The photos at the beginning of this post show the planters in their current (dismal, depressing) state, along with my tiny (art project!) protest sign next to a fake flower “blooming” in a pot. Our team wanted to plant spring bulbs and a healing garden full of water-wise herbs like rosemary and lavender, as well as indigenous healing herbs and native wildflowers. We have had a seemingly endless series of meetings with people from the medical center, the health sciences schools, the building and grounds folks, and the UW Sustainability group. Something that would appear to be easy to do is not. As I understand it, the (ugly concrete/example of Brutalist “raw concrete” architecture) Health Sciences building where this courtyard is located, is crumbling and leaking inside, including in the rare books collection of the library. We have been told that we can’t plant anything until the courtyard infrastructure and water membranes are replaced, which would cost millions of dollars ($7.5 million to quote one reliable estimate).

This is a somewhat trivial problem when compared with other environmental issues affecting our most vulnerable populations, but it is a daily reminder of the negative mental health effects of environmental degradation—including from poor choices for our built environment and health institutions.

Fight Hate

img_1244I grew up in rural Virginia surrounded by White supremacists and the KKK. I went to school with—and received direct threats from—the son of the Grand Dragon of the KKK. Hate groups are, unfortunately, alive and all too ‘well’ today as they were then, and according to the wise folks at the Southern Poverty Law Center, they are proliferating in number. Hate groups are not confined to the South but they do seem particularly prevalent there, especially White supremacist hate groups, for obvious historical reasons. It is both disingenuous and dangerous for Virginia politicians, including Governor Terry McAuliffe and Mayor of Charlottesville Michael Signer to claim that the White supremacists at this past weekend’s hate rally were “not from here.” Of course, they likely represented almost every state and dark, dismal corner of our country. But of course, they were born and bred Virginians as well. It is dangerous for us to deny that hate starts at home, that hate is present where we all live, in each and every community. Fight hate. Here are ten ways to fight hate in your community, brought to you by the Southern Poverty Law Center.

Hate crimes are a public health issue, recognized as such by the American College of Physicians in a recent statement, by the American Public Health Association, the American Psychological Association, the American Nurses Association, and by a growing number of other professional associations.

And, because the memory of the following experience was brought back for me over the past few days, here is my story of my first run-in with the KKK. I was ten years old. Oh yes, and when I was back in Virginia this past fall right before the November election, on the exact farm where this KKK rally occurred, there were huge signs for both Trump and a White supremacist/nationalist group.

One late summer day I was riding in our VW bug, my mother driving on back roads from the airport, within view of downtown Richmond, not far from Oakwood Cemetery. We had just dropped off a camp counselor who was flying back to college. I was ten, sitting in the backseat, slumped against the right side window, reading a book, vaguely registering the countryside and farms we were passing, when my mother slammed on the brakes.

“Damn!” I never heard my mother curse, so I looked up quickly.

“What?” I asked.

“Keep your head down and stay quiet,” she said, adding more softly as she turned off the engine, “It’ll be OK.”  I could see her leaning forwards, both hands tightly clutching the top of the steering wheel. I slumped down in the seat while quickly peering out the side window to see what had stopped us, to see what would be OK, to see what she didn’t want me to see. I figured it was a bad car accident and she didn’t want me to see the dead or injured people.

It was approaching dusk, the witching magic hour for the waning sun. The field next to us glowed golden, with large rectangular hay bales strewn about the field of wheat stalk stubble. Hovering over the field, suspended in the thick damp evening air were shining motes of hay bits, effervescent like Fourth-of-July sparklers. With our car engine turned off, the sound of cicadas and crickets created a curtain of white noise, as mesmerizing as the floating hay.

“ Evening, ma’am. Don’t mean no trouble. I gotta’ stop you here awhile. There’s a meeting that’s passing through, that’s all. You can get going in a minute or so,” a man’s voice, polite, official-sounding, with crisp words stuck in a slow Southern drawl, came in my mother’s open window. I looked between the seats and saw a spotless white-gloved hand cupped over the doorsill. Behind that was blazing white with a thin, trickling, blood-red cross, above the cross was no face within a white mask, pale thin lips moving within an elliptical cutout area. From the words spoken and the weight of the voice, I expected to see the uniform of a policeman. When I first saw the white mask, I felt disoriented and had to remind myself it wasn’t Halloween. I stayed quiet, huddled down behind the seats. As the man walked away, I looked out the front windshield to see where he was going. Up ahead, perhaps fifty feet away, was a swarm of ghostly pointed-hat masked figures swirling around a huge bonfire. It took a moment for me to see that inside the bonfire was a ten-foot dark wooden cross.

“What’s that and why are they wearing those weird costumes?” I asked.

“Shhhhh—I’ll tell you later. Stay down and stay quiet,” my mother said.

Absorbing the fear in my mother’s voice, I sank deeper in the seat, but moved over in the middle so I could see out the front windshield at the fire and the figures. Several of the white-clad men reached into the fire with long wooden sticks and withdrew flaming torches. Then en masse, with fluid amoeboid movement, the group came toward us, sucking in lone figures as it streamed forward. I heard deep-voiced chanting, words indecipherable as a foreign language. They grew louder, surrounding our car, lighting the inside with their glowing whiteness and lit torches, gently rocking the car as they brushed past it, moving across the road, then thinning to double file down a dirt path that cut through the next field. The comforting, familiar smell of wood smoke followed them.

I didn’t hear my mother start the car. We were speeding away, screeching around bends in the road. Reflected in the rearview mirror, I saw my mother’s face set hard as stone, etched with the fierce anger I seldom saw. I was more afraid of her anger than I had been of the men we had seen. I stayed quiet, huddled down in the back seat, bracing myself for the rough ride. When we got home she disappeared into her bedroom, talking quietly with my father—so quietly that I couldn’t make out what they were saying, even with my ear pressed against the rough stucco wall between our bedrooms.

At the dinner table that night, my father told me we had been in the middle of a Klu Klux Klan meeting. “They’re racist white men who wear those costumes to look like ghosts of Confederate soldiers to scare black people, and to scare white people who don’t agree with them, like it scared your mother.” As I slowly chewed a mouthful of food, I considered this information. The ghostly man who had stopped us seemed polite, a Southern gentleman. Being in the midst of the KKK meeting had been exotic, dreamlike, seductive—almost beautiful. I knew that what I had seen, the way I had seen it, was not something to discuss. I swallowed the dissonance between my mother’s reaction and my own experience of the encounter.

The dissonance remains. It took living out of and looking back at the South to understand that ghosts becoming part of the landscape are something not to relax into. The landscape of my childhood is a landscape of half-buried violence, covered with violets, punctuated by deep, abandoned wells. The roads leading back to it are as twisted as the country roads I grew up on. Within the accretive layers of nostalgia lies the sludge of orange dust tasting of blood. I both fear and yearn for the complexity, the offbeat rhythm of the South that has formed me.

From the chapter “First Families” included in my medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net.

Stealing Stories

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Kris W. “Wall of Distraction” Photograph on canvas. 2011—Youth in Focus/ On display at the UW School of Social Work, Seattle

The commodification and co-optation of stories—of individuals and communities—is something I have been thinking about lately at both a personal and professional level. Personal, as I reflect on the various critiques of my medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net (Berkeley: She Writes Press, 2016). And professional, as I walk through the medical center where I work and notice the larger-than-life patient testimonials (read: advertisements) for the medical care they have received—and read the various gut-wrenching personal stories of people who will be adversely affected by the current Republican-led efforts to “reform” our healthcare system.

In addition, I am thinking about this issue as I finish final writing and editing of my next book manuscript, Soul Stories: Voices from the Margins. The following is an excerpt from the chapter/essay “The Body Remembers”:

“Telling the story of trauma—of survival—may have the capacity for at least aiding in healing at the individual level, but then there is the added danger, once shared, of it being appropriated and misused by more powerful political or fundraising causes. Stories can be stolen. Arthur Frank calls these hijacked narratives. “Telling one’s own story is good, but it is never inherently good, and the story is never entirely one’s own.”

An intriguing example of a stolen story is the one included in Rebecca Skloot’s narrative nonfiction book The Immortal Life of Henrietta Lacks, which tells the story of the “stolen” cervical cancer cells from an impoverished and poorly educated black woman in Baltimore in the 1950s—cells that scientists at Johns Hopkins University Hospital subsequently profited from through the culturing and selling of HeLa cells—cells which killed Henrietta Lacks and cells which neither she nor her family members consented to being used and profited from. Skloot, a highly educated white woman, has profited from the use of the Lacks’ family story, although she has set up a scholarship fund for the Lacks’ family members. I am reminded of the proverb that Vanessa Northington Gamble shares in her moving essay, “Subcutaneous Scars,” about her experience of racism as a black physician. Dr. Gamble’s grandmother, a poor black woman in Philadelphia, used to admonish her, “The three most important things that you own in this world are your name, your word, and your story. Be careful who you tell your story to.”  (From “Subcutaneous Scars” Narrative Matters, Health Affairs, 2000, 19(1):164-169.)

  • See also my previous blog post “The Commodification and Co-optation of Patient Narratives” from February 11, 2011. Re-reading this blog post, I remembered that it was deemed too controversial and critical by a university librarian to include on our narrative medicine university-sponsored blog site (now inactive—the library blog, not the librarian).

Health Care as Political Weapon

Version 2Access to affordable, quality, basic health care is a basic human right. Basic, as in fundamental and essential. In a civil society, in a democracy, health care should not be used as a political weapon—as it is being used by the current U.S. government administration. Using health care as a political weapon is sick. That it is being used as a weapon by powerful, affluent (mostly men) with the best health care and most comprehensive health insurance in the country—against those of our society who have the least power and resources, is despicable.

Repealing the ACA, which all health policy experts agree has had far-reaching positive effects on our health care system and on millions of people’s access to care, is senseless and mean-spirited.

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For a brilliant critique of the current heartless rhetoric of the leaders of the ACA dismantling, please read Nicholas Kristof’s NYT op-ed piece, “And Jesus Said Unto Paul of Ryan…” (3-16-17).

Ally is a Verb

IMG_1807.jpg“I’m tired of ally being used as just a noun—we need to remember that ally is a verb.” This was one of the more powerful statements made this past week by Roxane Gay, author of Bad Feminist, at her Seattle Arts and Lectures talk at Town Hall Seattle. To me, this is an important reminder to speak up and act up to address and redress the despicable hate speech and violence currently bubbling up from the sewers and cesspools of our country—and directed toward anyone who is not white/straight/male/American citizen/so-called conservative Christian.

We are living in dangerous times. Documented hate crimes are occurring daily, hourly, across our country and so much so that hate crime watch groups like the Southern Poverty Law Center and the ACLU are working hard to keep up with all of them. The Southern Poverty Law Center has an interactive Hate Map where you can look up the location of a currently active hate group (of the over 1,600)  in the U.S. that they are currently tracking. Having been born and raised in rural Virginia near the former capital of the Confederacy, Richmond—and on the South’s first racially-integrated children’s summer camp—and, oh yes, being a classmate of  (and receiving death threats from) the Grand Dragon of the Loyal White Knights of the KKK—I am not at all surprised to see the number of KKK and White Supremacist groups currently alive (and unwell and festering) in my home state of Virginia. I am, however, dismayed and discouraged to see that in my adopted state of Washington we currently have six white nationalist/skinhead/neo-Nazi groups, as well as three anti-islamic groups. Although I am not surprised even by that, given the fact that starting on Trump’s inauguration day last month, flyers (including razor blades affixed to the backs of them) from white supremacist groups, began appearing on the walls of classrooms—and even the hospital—of the University of Washington in Seattle where I teach.

Despicable. Cowardly. Violent and hate-filled vitriol that has absolutely no place in our society. This is not free speech; this is hate speech. There are no Constitutional or moral or religious or anything else protections for such actions, such words.

Roxane Gay ended her talk with this statement: “I have to believe there is grace beyond the disgrace.” Ally is a verb. Act now and weigh in on the side of grace.

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An additional and new resource for reporting of hate and bias crimes is Propublica’s site Documenting Hate. Use it.

Love and Sex in the Time of Misogyny

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“Woman in Love” stainless steel, 1983, Bob Haozous at the Heard Museum, Phoenix, Arizona. Photo credit: Josephine Ensign/2016

Prostitution is commercial sexual exploitation and no, I’m not throwing women under the bus by stating this, and yes, I am a feminist. Prostitution is not a victimless crime. Prostitution is a public health issue. Prostitution is a significant part of continued and even accelerated violence against women and children. Amnesty International‘s prostitution policy, which was enacted on May 26, 2016, frames prostitution as sex work, pimps as legitimate sex business operators, and johns as deserving customers. Did Amnesty International sell its human rights soul to the highly lucrative and heavily male-dominated sex industry?

Consider this: “The commercial sex industry is sustained through violence and exploitation. Prostituted people live with the daily threat of violence. Traffickers and pimps are not the only abusers—buyers cause tremendous harm through the repeated sexual use of women and children and other physical and psychological violence. Sex buying exploits vulnerable people and hurts our communities.” (source citations at Ending Exploitation.)  The vast majority of women and children who are prostituted come from poor and marginalized communities and have histories of childhood sexual abuse. The typical age of entry into prostitution is 12-15 years of age and upwards of 90% of all prostituted women and children want to leave “the life.” And in countries that legalize/decriminalize/regulate prostitution, the demand increases as does the number of women and children (typically, again, from impoverished and marginalized communities) trafficked into prostitution.

And consider this innovative Seattle-based program on men’s accountability (and misogyny and perpetuation of the patriarchy): The Buyer Beware partnership to end commercial sexual exploitation, coordinated by the King County Prosecuting Attorney’s Office and the Organization for Prostitution Survivors (OPS).  The Buyer Beware model emphasizes prosecuting (and educating) sex buyers and connecting prostituted women and children to services. The goal of the program is to reduce demand for commercial sex, thereby decreasing harm to prostituted persons, reducing self-destructive (toxic masculinity) behaviors of buyers, and curbing sex trafficking in our region. This is a highly enlightened approach and one that our health system—including public health—should support. For instance, standard screening questions on sexual health for health care providers to use with patients can include ones pertinent to sexual exploitation and the buying of sex, along with appropriate referrals for assistance.

In the Seattle area we have YouthCare’s Bridge Program for prostituted teens, the OPS programs for adult women seeking to exit commercial sex exploitation, and the OPS men’s accountability program “Stopping Sexual Exploitation: A Program for Men.” There is a recent and fascinating GQ article “Can we ‘cure’ the men who pay for sex?” about this program by Brooke Jarvis (February 2, 2017). In the article, Jarvis avoids straying into the current political climate as it relates to the fueling of toxic masculinity and violence against women, but she does write this tagline: “Inside a two-month program that aims to end prostitution—and help dismantle the patriarchy—by rehabilitating the men who perpetuate it.” It should be abundantly clear that this is a lofty—and essential—goal for all of us to be working towards.