No Time to Be Silent: On Radical Nursing

P1020860There is a time and place for silence, but only when it is freely chosen, not imposed. But now is not the time for silence. Now is the time to step us, speak out, and, at least in the United States, to vote. It is time to remember that progress on human rights and social justice issues in our world is not a given. That basic respect for girls and women is not a given. That universal abhorrence of gender-based violence is not a given. We all have to work for it—even when (and especially when)—our lives are turned upside down.

Nurses are the most trusted professionals in both the U.S. and the U.K. (although tellingly, nursing was only added as a legitimate profession to these polls in the U.K. two years ago). As nurses, we have always prided ourselves on being truthful, for speaking out and advocating for our individual patients or communities. But for various reasons (including a lack of contemporary role models or inclusion in nursing curricula), nurses have not be so good at political advocacy and activism.

Historically, nursing does have some amazing examples of nurses who bucked the status quo, spoke truth to power—who were radical nurses. Florence Nightingale in the U.K.—and especially her work after the Crimean War in bringing nurses to work in poor/workhouses in England.  And in the U.S., my favorite historical role model is Lillian Wald in New York City. Lillian Wald founded the Henry Street Settlement in the poorest section of New York City, and she founded public health nursing. Public, community, population health nursing is what drew me to nursing in the first place and it continues to be my passion. Public health nursing work is always political work.

In the U.K. in the 1980s there was the short-lived but influential Radical Nurses Group (RNG). Some of their archived material was the subject of a (again, short-lived) blog, “The Radical Nurses Archive” written by a former NHS nurse using the lovely pseudonym, The Grumbling Appendix (with another blog on nursing and politics in the U.K. that ended in 2015).  Where have the radical nurses in the U.K. gone? I am currently on a quest to find them.

Back in the U.S. we have the NurseManifest website and resources on nursing and activism co-founded by Sue Hagedorn, Peggy Chinn, and Richard Cowling. Beginning in the summer of 2018, they have added the Nursing Activism Project with a growing list of historical and contemporary nurse activists “Inspirations for Activism.”  In addition, they have a dynamic list of resources for nurse activism.

No excuses. All you nurses out there in the world: Get informed. Get inspired. Get active.

I include a recent interview I had with my colleague here at Edinburgh Napier University School of Nursing and Social Care, Dr. Peter Hillen, on nursing and activism.

 

Reflections on the Poor Laws

P1020893.JPGWater of Leith, Edinburgh, bench beside Saint Bernard’s well with a statue of Hygieia, goddess of health

The largely impenetrable layers of history and how we humans are so prone to repeat past mistakes.

That is what occurs to me today as I walk these ancient paths and sit beside an ancient, pagan well of healing—mineral waters—overlaid, of course, by Christian (Saint Bernard) and ancient Greek (Hygieia) symbols. After a morning of reading ancient British Poor Laws—weeks of researching them and tracing their repercussions today, not only in the U.K. but also in the U.S. and in Seattle/Washington State. The worthy and unworthy poor. The deserving and underserving poor. The impotent poor. Paupers. Vagrants. Ruffians. Charity and its attendant ills. Solidarity and its limitations.

Beige mud puddles surround me here as I sit on this bench, barely staying dry underneath my umbrella. What sort of stone is all this beige-ness? (note: ancient sandstone, over 300 million years old.) The entire city of Edinburgh is composed of beige stone. And what minerals are in this water? (note: Sulphur, magnesium, and iron it seems.)

A soft purple Scottish thistle—late blooming ones in the midst of a large patch of blackened, dried up plants with thistle heads. There seems to be a prickly and a not so prickly version of thistles here. Why is the thistle the national flower of Scotland? (note: no one seems to know although there is a story about it that involves Norwegian invaders by sea who stepped on the thistles and alerted the Scots to their presence.)

Why aren’t nurses taught more about the history of social welfare and of the legacies of ancient pauper laws? Are they taught that at all here in Scotland or elsewhere in the U.K.? How much of it are even social workers taught either here in the U.K. or back home in the U.S.? It seems so important and puts many things in perspective, especially in terms of addressing the current thorny question, “What to do about the homeless?” And my own ongoing work in the vicinity of that question. I almost feel cheated in not having known about it much earlier in my life and my career as a nurse.

The deep layers of the histories of places and peoples are important to acknowledge, to know, at least at some more than superficial level. Is this something that can only be appreciated as one ages and takes on a proper sense of time?

A beechnut exploded, scattered on the ground along the river walk path wending its way beneath an old tree. They look like flowers but are hard. I try to press one between these pages and it breaks through the paper. Only the seeds remain.

 

Students Rock

IMG_4490This is why I continue to love my academic work: smart, creative, compassionate students who see what is needed in our world and find ways to ‘just do it.’ They ask the hard questions, like “well, why not?” and they help keep us honest about what we are supposed to be focused on within higher education—and especially at public institutions in our country. As the University of Washington Vision and Values statement puts it, we educate a diverse student body “to become responsible global citizens and future leaders,” and “we discover timely solutions to the world’s most complex problems and enrich the lives of people throughout our community, the state of Washington, the nation and the world.”

This past academic year I’ve had the pleasure (most days) of directing the Doorway Project, with the aim of creating an innovative community cafe/navigation hub for young people (including, unfortunately, many of our own students) who are homeless and/or experiencing food insecurity in the University District of Seattle. It has not been without its many challenges, but also satisfactions and delightful surprises. It is swamp work, as in real work on real-world problems. (see my previous blog post “Life in the Swamp: Float, Don’t Flail” from April 28, 2018 for an explanation of the swamp work reference.)

What gives me hope in terms of the real-world wicked problems like homelessness? I was asked a version of that question recently in a Seattle Growth Podcast with UW professor of business Jeff Schulman. “Our students and young people,” was part of my response.

Here is a hot-off-the-press news article “Student volunteers help expand UW’s outreach to homeless youth” by Kim Eckart (UW News, August 20, 2018). Enjoy a ray of (smoky here) sunshine and hope for the future. And here is the latest new and improved design for the Doorway Cafe (design credits: Hope Freije and Delphine Zhu).

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Trauma Mastery

IMG_0253Note: This is an excerpt from my essay “The Body Remembers” in my book Soul Stories: Voices from the Margins (San Francisco: University of California Medical Humanities Press, 2018).

Early in my career as a nurse, I worked for a year in a “safe house” emergency shelter for women who were escaping intimate partner violence. Before my work there, I did not understand the concept of trauma mastery and how this plays out in the lives of women caught up in the cycle of abuse. I sided with the common misperception that the reason so many women return to their abusive partners is because the women are psychologically damaged and weak.

I learned that there is the not-insignificant role of addiction to the thrill of trauma and danger—to the effects of the very activating yet numbing fight-or-flight neurochemicals—which can bring at least temporary relief to the bouts of fatiguing depression that often accompany trauma. And there are also unconscious attempts to return to the previous trauma to “get it right this time”—to do what we wish we could have done the first time, to master our trauma.

Seattle social worker Laura van Dernoot Lipsky points out that these unconscious attempts to master our traumas often backfire and simply reinforce our old traumas. She says that many of us in health care and other helping professions are often using our work as a form of trauma mastery, and that by doing so, we may set expectations for ourselves and others that are “untenable and destructive.” (1) She advocates ongoing efforts aimed at self-discovery and self-empathy, and points to the many positive examples of “people who have been effective in repairing the world while still in the process of repairing their own hearts.” (2) Eve Ensler, with the combination of personal work and “world repair” work that she describes in her powerful book In the Body of the World, is one of my favorite examples of this sort of balanced approach. (3)

 

Sources:

1 and 2, Laura van Dernoot Lipsky with Connie Burk, Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others (San Francisco: Berrett-Koehler Publishers, 2009), page 159.

3, Eve Ensler, In the Body of the World (New York: Metropolitan Books, 2013).

 

Homelessness Visible

IMG_4667Our latest point-in-time count of people experiencing “absolute” homelessness in King County tallied 12,112 homeless individuals on January 26th, 2018 (see the All Home King County‘s 2018 report “Count Us In”). By the term “absolute” I refer to the fact that they use the strict HUD definition of homelessness, which excludes the considerable number of people (especially teens and young adults) who are couch-surfing, doubled-up with friends or extended family members and who do not have a safe, stable, affordable place to live. In this respect the HUD definition differs from the official definition of homelessness for healthcare services funded through the U.S. Department of Health and Human Services (see the various definitions compared here by the National Health Care for the Homeless Council).

The 12,112 homeless individuals counted for 2018 represent a 4% increase over the 2017 homeless count (which represented a 19% increase from the 2016 count). Some politicians claim that the slowing percentage increase in people experiencing homelessness can be counted as progress—although as a reality check, the 4% increase in homelessness is much larger than the total population growth for King County. The most recent published statistics show a 2.3% population growth for King County for 2016-17 (source: Washington State Office of Financial Management). As another significant reality check, the homeless count survey methodology changed considerably for 2017 such that comparisons with 2016 numbers should not be made.

Significantly, the 2018 homeless count found that over half (52%) of homeless people were unsheltered the night of the count, with many people living outside in tents and in vehicles. Having participated in the survey this year, I can attest to the difficulty of finding and assessing whether or not parked vehicles are being lived in between the 2-5 a.m. timeframe the day of the count. It is much easier to count the number of people staying overnight at an emergency shelter. And homeless people living in tents tend to find thickly wooded areas in which to live—and not, as in the photograph above, more visibly along well-lit streets and bike paths. But for all of us who live, work, study, and play in Seattle and throughout the rest of King County, we didn’t need the official homeless count to tell us we have a growing problem. We have homelessness, abject poverty and despair, quite visible.

Note: In a series of subsequent posts I will address intriguing, intelligent, and excellent questions which I have received lately about our homelessness crisis. They were too numerous and complex to address in one post.

 

 

Prostitution: Exploitation, Not Work

IMG_2219A few weeks ago I participated in a powerful healthcare system training titled “Beyond Sex Trafficking: Responding to Commercial Sexual Exploitation and the Role of Healthcare Systems.” Commercial sexual exploitation is the exchange of sex acts for money, or for anything of monetary value, including basic needs such as food, clothing, or shelter. Therefore, it includes survival sex, pornography, escort services, exotic dancing, stripping, and street or hotel or house-based prostitution. Often referred to as “sex work,” this is a mighty misnomer, because it is not a form of work; it is exploitation and violence. And it is gender-based violence since most, but not all, of the victims are girls and women, and the overwhelming majority of buyers are men.

The evidence is clear: no matter what city or county or country (including countries where prostitution is “legalized” and regulated and sanitized), upwards of 90 percent of “sex workers” have histories of childhood sexual abuse, untreated post-traumatic stress disorder, and are disproportionately persons of color from lives of poverty, including homelessness. They often come from backgrounds of violence and exploitation, and once they are in the “life” of sex work, they are once again victims of violence and exploitation. And those male buyers of sex? They are disproportionately white and well-off financially. Many buyers are married and occupy high status positions in society, including doctors, lawyers, and politicians. Another interesting fact is that the majority of buyers of sex at some level feel remorse and would like to stop.

The conclusion is clear: There is no such thing as a happy, healthy hooker. Julia Roberts’ character of a prostitute in Pretty Woman is a sick, twisted version of the Cinderella fairytale—a romantic comedy that has nothing to do with true romance and that is decidedly not funny.

Healthcare providers, including nurses and physicians, are on the front-line of caring for victims of prostitution and all forms of sex trafficking and exploitation. We need to learn about these issues and do something about them. A terrific new online healthcare provider training module series on human trafficking (includes sex trafficking) using a public health approach is SOAR, which stands for Stop, Observe, Ask, Respond. Offered free-of-charge through the Department of Health and Human Services, Administration for Children and Families, Office on Trafficking in Persons, it includes three training modules (for CE/CME): 1) SOAR to Health and Wellness, 2) Trauma-Informed Care, and 3) Culturally and Linguistically Appropriate Services.

For any nurse, physician, social worker, teacher (and other professions specified by law) in Washington State, it’s important to note that mandatory reporting of known or suspected child abuse includes commercial sexual exploitation of children (CSEC) and teens under 18 (1-800-ENDHARM  https://www.dshs.wa.gov/report-abuse-and-neglect). In Seattle/King County, there is the CSEC Hotline: 855-400-CSEC with community advocates 24/7 for sexually exploited youth ages 12-24 in King County; and the Human Trafficking Hotline (24 hrs) at 888-373-7888. Also in King County we have the innovative and nationally-recognized resource, Stopping Sexual Exploitation: A Program for Men. 

Sources and Further Resources:

Ending Exploitation Collaborative/ References and The Harm of Sexual Exploitation 

Organization for Prostitution Survivors 

National Human Trafficking Hotline

Polaris Project

The Life Story, including the powerful video for healthcare providers Medical Emergency 

 

Summer Reading Challenge 2018

IMG_4854This is the third installment of my annual summer reading challenge with a social justice (and feminist) slant. These ten library books include ones related to my current research and writing project, Skid Road: The Intersection of Health and Homelessness, as well as works by women authors I am delighted to discover. Here they are in the order (bottom up) they appear in the photograph. Happy—and meaningful—summertime reading!

  1. Race and Medicine in Nineteenth and Early-Twentieth-Century America, by Todd L. Savitt (Kent, Ohio: The Kent University Press, 2007).
  2. Tuberculosis and the Politics of Exclusion: A History of Public Health and Migration to Los Angeles, by Emily K. Abel (New Brunswick, New Jersey: Rutgers University Press,
  3. Imperial Hygiene: A Critical History of Colonialism, Nationalism and Public Health, by Alison Bashford (New York: Palgrave Macmillan, 2004).
  4. Body and City: Histories of Urban Public Health, edited by Sally Sheard and Helen Power (Burlington, Vermont: Ashgate Publishing Company,  2000).
  5. Good Woman: Poems and a Memoir 1969-1980, by Lucille Clifton (Brockport, New York: BOA Editions, Ltd., 1987.
  6. Woman’s Place: A Guide to Seattle and King County History, by Mildred Tanner Andrews (Seattle: Gemil Press, 1994).
  7. Whose Names Are Unknown: A Novel, by Sanora Babb (Norman, University of Oklahoma Press, 2004).
  8. How to Suppress Women’s Writing, by Joanna Russ (Austin: University of Texas Press, 1983).
  9. Half a Yellow Sun by Chimamanda Ngozi Adichie (New York: Anchor Books, 2007).
  10. Purple Hibiscus, by Chimamanda Ngozi Adichie (New York: Anchor Books, 2003).