Nurse Log: A Winter Solstice Gift of Quietude

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A decorated nurse log (stump) on Orcas Island, Washington. Photo credit: Josephine Ensign/2015

Recently, I spent a week ‘off the grid’ on a solo writing retreat at one of my favorite places on earth: Orcas Island in Washington State’s San Juan Islands. In my experience, going off grid, off e-mail, off social media, off any news is both deeply restorative and refreshingly loopy. Restorative, of course, because the electronic umbilical cord connection with the world creates a constant anxious buzz that is typically only apparent when it is absent. Refreshingly loopy because the cessation of that baseline buzz creates space for our brains to make sudden strange connections and leaps into uncharted territory.

One of these loopy leaps for me happened through the nurse log. Anyone who has ever lived in or traveled through the soggy, glacial-scoured forests of the Pacific Northwest, is familiar with the term ‘nurse log’–an example of which I include in this post. Nurse log, as in a decaying part of an older tree (log, or stump, as in this photo) that provides the ideal environment of moisture and nutrients and even shelter from competition, for a new tree to start its life. An example of resilience, adaptation, and thriving in the face of adversity. An example of the circle of life.

A metaphor for where I am in my nursing and teaching career: on sabbatical, gone fishing, taking a break, lying fallow and untilled, at least from my usual clinical and teaching responsibilities. More time to study important things, like the state of homelessness, the role of narrative in health and healing, the history of charity health care–and the lifecycle of evergreen trees. More time for travel–not to faraway lands–but to places right here at home. More time to cultivate and appreciate quiet.

It strikes me that we don’t allow enough space and time for quiet. We now recognize the importance of quiet in hospitals to allow patients to heal from illness, trauma, and surgery–although actually providing this for patients is spotty at best. I was reminded by Health Care for the Homeless, Seattle/King County Public Health nurse Heather Barr recently that emergency and transition shelters for people experiencing homelessness are often chaotic and cacophonous places. She advocates the addition of quiet rooms and quiet hours when she works with shelter staff around implementing trauma-informed care. People who are struggling with PTSD are often triggered by noise. I’ve often observed the role of a healing quiet space in public libraries for homeless and marginalized people who otherwise don’t have such sanctuaries. As health care providers, as caregivers, as teachers we should remember the gift of stillness and of quiet.

Gratitude for Mentors

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Dr. Lorna Mill Barrell (1931-2014), a nursing mentor of mine, after lunch in the Jefferson Hotel, Richmond, Virginia in 1996.

We now have the ‘science of gratitude’ to back what we’ve already known: gratitude is good for us, both individually and collectively. That we have a national holiday named for gratitude is something that–despite the complicated colonization and empire-building historical roots–I am thankful for.

Over the past four months, I have had the privilege of interviewing a variety of people in the Seattle area who work (or live) at the intersection of health and homelessness. These interviews are part of the oral history component of my ongoing Skid Road project, exploring the historical roots of ‘charity’ health care in King County, Washington (the county within which Seattle is located). One of the first open-ended interview questions I pose to people is, “Who or what has most influenced your work and life?”

People I interview typically pause for a moment after I ask this question, they gaze at some corner of the room as if seeing pleasant ghosts, and then they launch into detailed descriptions of people and events essential to who they are as people and to the work they do. Most people identify one or two key people in their lives who provided a sort of moral compass steering them in the direction of compassion–for their own humanity, as well as for other people. Parents. Teachers. Counselors or therapists. Professional mentors. They can easily tell a specific story of lessons they learned from these key people. And due to my use of snowball sampling–asking them to identify people I should try to interview–I have been able to complete oral history interviews on several generations of mentors.

These interviews have led me to reflect more deeply on the people in my life I am grateful for, people who have influenced who I am and what I do. I am also reminded of the wisdom of Rachel Naomi Remen, MD and her healing work with physicians, nurses, and other caregivers. I often introduce my students to her Heart Journal daily practice. For this, she advocates a 10-15 minute quiet time at the end of the day where you review your day, then write the first things that occur to you when you ask yourself three questions: 1) What surprised me today? 2) What moved me or touched my heart today?, and 3) What inspired me today?  Attention and gratitude.

As a nurse and a teacher, I remember two people who have had the most influence on my work, my life. One is Lorna Mill Barrell, RN, PhD who came into my life when I was seriously considering dropping out of nursing school. It was in November of 1983, my final year of the BSN program at MCV/VCU, and I had just been informed by my community health clinical instructor that she was giving me an ‘F’ on my final clinical rotation project paper. “I don’t see how this has anything to do with nursing,” she wrote across my project paper’s title, “The Health of Richmond’s Homeless Population.” I contested her grade and that’s how I met Lorna, who was the chair of the department my instructor worked in–she was my instructor’s boss.

I remember Lorna’s welcoming and nonjudgmental attitude towards me when I came into her office to meet with her about my grade. I’m sure I came across at first as indignant, haughty, and angry. At the time, I wasn’t just contesting my community health grade, I was also contesting my desire to be a nurse at all. She offered to read and re-grade my paper. Thanks to her intervention, I not only passed community health (she changed my paper grade to an ‘A’), but she helped convince me to finish nursing school and go straight into their master’s program for becoming a nurse practitioner. She was my thesis advisor and the co-author of my first published academic journal article. Within a year of graduating and starting my first job as a nurse practitioner working with homeless and marginalized patients at Cross-Over Clinic, Lorna hired me to teach a community health clinical course.

The other mentor I draw on as inspiration for my current work is another MCV/VCU teacher–from the medical school though–who I only remember as Chaplain Bob. During my first semester of the BSN program, fresh out of a brief stint in a MDiv medical humanities program, I convinced him to let me take his medical school elective course on death and dying. He approached this topic in our small seminar-style class, from a health humanities perspective, having us read and discuss Tolstoy’s The Death of Ivan Ilyich, among other works of art and literature. He also encouraged us to write our own poetry and short stories. I took that assignment seriously and wrote a chapbook-length collection of poetry. Chaplain Bob gave me an ‘Aa’ (not entirely sure what that grade really is) for the course, but he also enthusiastically encouraged me to continue my creative, reflective writing. I kept that chapbook. And here, impossibly at age twenty-two (meaning–not that it is great poetry but that is impossibly so long ago) , I wrote:

The Process

Sitting by the hour/ listening to the drone: “The Patient. The Client./And don’t forget the Significant Others./ By all means, keep in mind the Nursing Process.”

“We’re training you to be/ Professionals./ We want you to think/ Independently./ Here, take this test/But don’t think too much/just fill in the dots/the computer will understand.”

We learn to forget,/ to not feel, to not know./ It will hurt too much,/ and it certainly won’t help /us to be professionals.

and…

Waiting 

Sitting on park benches/writing their hands/trying to forget the ill one inside/that hospital there/ the building you just stepped out of/ the one you walk by every day/ that structure that has become/ a part of the skyline/ seen from the window of a dorm room.

It is a lab/a place to practice/the proper way/to give drugs/ to make beds/to become a nurse.

But reflected in the eyes/of the park-bench individuals/ the building becomes/ one room/one bed/one person/one fear/one hope.

____   To all my mentors, named and unnamed (and in Bob’s case, half-named): thank you. Remember to pass it on.

 

 

 

Prostitution: The Oldest Oppression

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Gloria Steinem/Sponsored by Hedgebrook at Seattle’s Benaroya Hall, 11-8-15. Photo credit: Josephine Ensign/2015

Gloria Steinem reminds us that prostitution is not the oldest profession for women, but rather it is the oldest oppression of women. This is not just some catchy, smart play on words by a feminist icon. It contains powerful truths. It contains powerful truths that affect public health and policy. It contains powerful truths that affect all of us, even if we prefer to think that it doesn’t.

I’m writing this post the morning after TV actor Charlie Sheen publicly announced he is HIV positive, and linked his infection to his history of alcohol/drug use combined with his ‘use’ of prostitutes. (See NYT article “Charlie Sheen says he has HIV and has paid millions to keep it secret,” by Emily Steel, 11-17-15.) Considering the fact that ‘use’ of female prostitutes by heterosexual men is correlated with high scores for men on different masculine hostility measures, it strikes me as ironic that Sheen’s last–and now cancelled– TV series was titled Anger Management.

Hopefully, most people know that prostitution is not the twisted Cinderella Hollywood version Julia Roberts portrays in the movie Pretty Woman. But Pretty Woman was written and directed by two fairly macho men, and it was released in the dark ages of 1990. Surely the portrayal of prostitution is much improved today. But no. Even the women’s rights advocate, TV screenwriter and producer Shonda Rhimes, is woefully disappointing on this issue. I recently watched the first season of Scandal (which Rhimes wrote and produced) in which the main character–the professional ‘fixer’ played admirably by Kerry Washington–puts on her white hat/gladiator woman power suit and successfully defends a Washington, DC high-class escort/prostitution madame, allowing her to retire as a rich grandmother in Boca Raton, Florida.

In my thirty-plus years work as a nurse, I have worked with many young women involved in prostitution. I was always clear that it was sexual exploitation for underage girls, but within the progressive subculture of clinics/agencies I worked in, we called adult prostitution ‘sex work,’ and erred on the side of harm reduction: trying to help minimize the harms of prostitution to the patient and the public. In many ways–as I view it now–we were supporting their lifestyle, enabling it, and becoming part of the problem. I remain a strong advocate of harm reduction, especially as it pertains to drug/alcohol addiction, but not applied to prostitution.

I know prostitutes who call it a profession, who say they freely choose their work. I’d like to believe them because it would make my work easier. But so many prostitutes (female, male, transgender) have histories of previous sexual abuse as children. Their bodies are not their own; their bodies have been stolen from them. In such situations free choice is not possible. This, combined with the growing evidence that prostitution–even in countries where it is legal and regulated (including health screens/care)–is one of the most hazardous ‘jobs’ in the world, has led me to the conclusion that prostitution is the oldest form of oppression. Prostitution is part of violence against women.

So, what to do about it? In my hometown of Seattle, we have begun to adopt the ‘Nordic Model’ of intervention: decriminalizing (and diverting to supportive care, including housing, health care, counseling, job training) prostitution for the women/transgender people involved, and stepping up criminalization efforts directed towards the customers–or ‘Johns’–and the pimps/BackPages/brokers in whatever forms they take. And along with stepping up legal ramifications for the buyers and the brokers, Seattle has innovative programs, such as OPS: The Organization for Prostitution Survivors. OPS has a drop-in center for women, survivor support groups, art workshops for survivors, as well as community-based service provider trainings, and the new Stopping Sexual Exploitation: A Program for Men (SSE).

Last week I visited OPS and talked with OPS co-founder (with survivor/activist Noel Gomez) Peter Qualliotine. Peter has taken the lead in designing and facilitating the SSE workshops. He explained that the SSE program was designed and piloted for two years and then began full operation in January 2015. He receives self-referrals as well as court referrals, and he’s hoping to be able to move it more heavily towards referrals. As he put it “8,000 men a day in King County are customers on BackPage,” so waiting for men to be ‘caught’ by either their wives/partners or the police and referred in to a ‘John’s School’ such as SSE, will not be very effective.

The SSE consists of a telephone intake conversation that Peter has with the men. He uses a motivational interviewing technique and asks the men, “How has this been a challenging time for you?” He said that with the rare exception of a man with psychopathic tendencies (my term here), the vast majority of men soliciting sex feel at least some qualms about it and also suffer negative consequences (sexually transmitted infections, guilt, relationship/legal/money issues).

The SSE program is based on the social-ecological model of violence prevention, and includes information and role-play on gender socialization and manhood training. It’s a support group model of three hour sessions over eight weeks, and is purposefully limited to ten men at a time. So far this year they have had sixty men complete the program, with some of the men so positively affected/changed by it that they have volunteered to help with further advocacy. (Stay tuned, because local and national news coverage on SSE is coming soon.)

Meanwhile, I know many people who work within public health realms in Seattle/King County who continue to advocate for legalizing prostitution, as if it is similar to ‘legalizing’ marijuana. And the otherwise admirable social justice/human rights organization, Amnesty International, is also advocating this stance–although they cleverly call it “protecting the human rights of sex workers.”

White People Have Culture

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“Mauri” or life principle, illustration by Nancy Nicholson in Dr. Rangimarie Turuki Pere’s book, te wheke: A celebration of infinite wisdom. Awareness Book Company, 1997.

The word ‘culture’ is misused and abused. We often use the word ‘culture’ as some strangely polite code word for race and ethnicity, for people who are somehow ‘not like us.’ And those of us white people, part of the dominant culture, typically don’t even believe that we have our own culture–like racism, we can’t see it because of our own power and privilege.

Within health care, we have trainings, courses, (and silly multiple-choice tests) on ‘cultural sensitivity’ and ‘cultural competence.’ As if being sensitive to or competent in this thing called ‘culture’ is possible, and if possible, as if it is a good thing. When what we should be doing is teaching to cultural humility and its Kiwi sister, cultural safety: building in self-reflection, life-long learning, and work to see/undo institutional racism.

I’ve written about different aspects of this issue in previous blog posts: “Cultural Competence, Meet Cultural Humility” (8-16-11), “Cultural Humility Redux” (2-2-14)  and “Cultural Safety: A Wee Way to Go” (3-12-14). Until recently, I much preferred the name/concept of ‘cultural humility’ over the name/concept of ‘cultural safety,’ mainly because I didn’t comprehend the need for the word ‘safety.’ My white privilege comfortable blindness there. But the escalating, deeply disturbing litany of racist violence in our country has forced me to see–duh!–the need for ‘safety.’ My recent return to New Zealand, the birthplace of the term ‘cultural safety,’ also opened my eyes to deeper layers of nuanced meaning of this term, of this work.

Jim Diers, MSW and I co-led an international service-learning study abroad program, “Empowering Healthy Communities,” on the North Island of New Zealand this past summer. We had a group of twenty-two engaged university students, across a range of health science and ‘other’ academic disciplines, and from a rich diversity of self-identified race/ethnicities. As many of them pointed out in their final written reflections, they learned as much from living with our group for five weeks as they did from interactions with New Zealanders. We spent a lot of our time working alongside and listening to community members on various Maori marae (villages), as well as Pacific Islander and other marginalized groups in New Zealand. We learned of their strengths, considerable community non-monetary assets, of their hopes for the future–as well as their challenges and historical traumas…the subtext being the need for cultural safety within health care, as well as within all other New Zealand institutions.

As part of a traditional Maori greeting, people introduce themselves–not by our typical name and credentials/work/university, but rather by details of where you are from: the names of the mountain and river of the land of your family/tribe. So for many members of our group, it was “My mountain is Rainer (or Tahoma as local tribes call it) and my river is the Duwamish (currently an industrial dump/Superfund site..).” And “My people are from Italy, England, Nepal, Mexico, the Philippines (and wait–why ‘the’ with Philippines?–important history lesson of oppression there), China, Israel….” Lovely diversity, except that none of us, unfortunately, could claim Native American/Indian ancestry. We were always asked about that by our Maori hosts–another important history lesson that wasn’t lost on our students. Through participating in this seemingly simple ritual of greeting, we all learned about our own cultures.

At the end of our study abroad program, we received an amazingly powerful talk on cultural safety from Denise Wilson, RN, PhD, a Maori New Zealand nurse and Director of the Taupua Waiora Centre for Māori Health Research at AUT School of Public Health and Psychosocial Studies here in Auckland. She talked to the students about her work with cultural safety in New Zealand–about the need for the ‘cloak’ of cultural safety. She told the story of well-intentioned Pakeha (white/European New Zealander) nurses asking their Maori or Pacific Islander patients, “What are your cultural practices,” and being met with polite, blank stares. “Because that’s our language, our terms, not theirs,” she added. She gently admonished our students to get to know themselves, their own cultures and biases, and to practice humility when working with people they perceive as ‘different’ from themselves–to listen, and “really listening takes time.”

Her closing quote, from Dr. Rangimarie Turuki Pere, whose book I reference in the photo caption in this post, was this:

“Your steps on my whariki (mat)/Your respect for my home/opens my doors and windows.”

Words to live and work by.

BE Uncomfortable

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Sliding doors/front entrance to the Nelson Public Library, South Island, New Zealand. Photo credit: Josephine Ensign/2014

“BE uncomfortable. That’s how you learn!” was one of the final exhortations to our students by Pepe Sapolu Reweti at the conclusion of our”Empowering Healthy Communities” study abroad in New Zealand program this past summer. She was describing the fact that there are many Pakehas (‘white’/European descent New Zealanders) who do not personally know any Maori people, much less ever been on a Maori marae (‘meeting place’ similar to our U.S. Indian ‘reservation’ except that it is the ancestral home of the Maori iwi, or tribes), much much less ever have been in a Maori home. She pointed out that our students had all been on a marae (several, in fact) and had been inside a Maori community meeting house, and had shared ‘kai’ (a meal–several, in fact). That’s an honor and a privilege and something for us to learn from, to take back home–to apply in our own country, in our own daily lives. If the students learned nothing else from this study abroad experience, I hope they learned this.

I was reminded of Pepe’s words this past week as I listened to Ta-Nehisi Coates talk about his latest book Between the World and Me, written in the form of a letter to his son about being a black man in the deeply scarred and racist modern day America. His talk was in the sold-out 2,900 seat McCaw Hall at the Seattle Center, as part of the Seattle Arts and Lectures literary series. The interviewer asked Coates about his article “The Case for Reparations” in the June 2014 edition of The Atlantic, and why he thought it had ‘gone viral’ and been so popular among white people. He replied that he thinks people like the fact he doesn’t sugar-coat things, that “It’s a sign of respect the way I talk directly about things.” And he added, “Reality is uncomfortable. Period.”

Looking around the packed auditorium in one of the whitest cities in America, I wondered how many of us white audience members were now wallowing in white guilt: white guilt which is itself a white self-indulgent privilege. How many of us white Seattleite audience members are willing to push past white guilt to do anything constructive to confront racism in our country, in our city, in our neighborhood, in our own homes? And what are we as health care educators doing to ‘teach meaningfully to’ the effects of personally-mediated and institutionalized racism?

“…as Americans we are so heavily invested in shame, avoidance, and denial that most of us have never experienced authentic, face-to-face dialogue about race at all.” (“To Whom It May Concern” by Jess Row in The Racial Imaginary: Writers on Race in the Life of the Mind edited by Claudia Rankine, Beth Loffreda, and Maxine King Cap, Fence Books 2015, p. 63.) In this same essay, Row states she once saw a book on classroom management for college teachers with the title When Race Breaks Out. “As if it’s like strep throat, as if it has to be medicated, managed, healed.” (p62.)

We need to allow ourselves–and our students–to be uncomfortable, to confront uncomfortable truths in order to learn any lessons that are worth learning.

Carrying Stories: Beyond Self Care

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Girl with Balloon, street art by Banksy. This one found at intersection of K-Road and Queen Street in Auckland, New Zealand. Photo credit: Josephine Ensign/2015.

What to do with difficult stories? Stories of refugees, victims of mass shootings, of hate crimes, of rape, of torture victims, of people dying alone and unnoticed ?  It all gets overwhelming and depressing to hear or read these sorts of difficult stories, to carry them in our hearts, to bear witness to so much suffering in the world.

Of course, for many fortunate (perhaps unfortunate?) people, there is the option of tuning out these stories, turning off the news, unplugging from any non-vacuous form of social media. Taking a break from difficult stories.

But what about all the other people who cannot or choose not to disconnect? What about people whose work involves listening to these stories on a daily basis? Frontline health care providers who work with people experiencing trauma (physical, emotional, sexual). First responders. Counselors, mental health therapists, lawyers. Human rights activists. Researchers working on social justice issues. What can they do to, if not prevent, at least deal effectively with, vicarious or secondary trauma? And for those of us who teach/train/mentor students in these roles, how do we prepare students to be able to carry difficult stories while maintaining well-being?

In a previous blog post, “Burnout and Crazy Cat Ladies,” I explored the issue of ‘too much empathy’ and of pathological altruism, linking to some of the (then/2011) current research. After writing that post and some related essays, I began incorporating a new set of in-class reflective writing prompts for soon-to-be nurses in my community/public health course. I used these in a class session I titled “Public Health Ethics, Boundaries, and Burnout.”

The first writing prompt: ‘What draws you to work in health care? What motivates or compels you to do this work?’ And then later in the class session– after discussing professional boundaries (how fuzzy they can be), individual and systems-level risk factors for burnout, and asking them to reflect on how they know when they are getting too close to a patient, a community, or an issue–I gave them the follow-up writing prompt: ‘Referring back to what you wrote about what draws you to work in health care, what do you think are the biggest potential sources of burnout for you? And what might you be able to do about them?’

Feedback from students about this in-class reflective writing exercise and the accompanying class content on boundaries and burnout, was invariably positive. Many of them said it was the first time in their almost two years of nursing education that anyone had addressed these issues. I understand that patient care, electrolyte balances, wound care and all the rest of basic nursing education takes priority, but it makes me sad that we don’t include this, to me what is fundamental and essential, content.

“…people who really don’t care are rarely vulnerable to burnout. Psychopaths don’t burn out. There are no burned-out tyrants or dictators. Only people who do care can get to this level of numbness,” Rachel Naomi Remen, MD reminds us in her book, Kitchen Table Wisdom: Stories That Heal (Riverhead Books, 1996). Something to remember when we are feeling overwhelmed by difficult stories.

******

Here are some excellent resources:

 

Empowering Healthy Communities Through the Arts

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Mural by a student in the Henderson South Studio MPHS (after-school art program for young people ages 9-18). Photo credit: Josephine Ensign/2015

“Art is the outward manifestation of human experience in the world. Art is necessary for survival. To be human and alive is to be an active art maker. Everything that humans create in their act of living is art.” -Tamati Patuwai, MAD AVE ‘Healthy and Thriving Communities’ Glen Innes, New Zealand

It was a happy accident, an unintended yet very welcome consequence of studying ‘how the Kiwis’ do community health from the ground (literally) up, from the community members’ perspectives. The recent experience has changed how I think about community health, has deepened my respect for the power of art (and libraries) to change lives, and has even altered how I view my own community back home in Seattle.

First, a brief recap of the experience to provide some perspective. What I’m referring to here is the recent University of Washington Study Abroad in New Zealand 5-week immersive program I co-led with Jim Diers, a social worker and internationally-acclaimed community development expert. Here is what our course description said about the study abroad program:

“Empowering Healthy Communities is an interdisciplinary Exploration Seminar in New Zealand, focusing on how various communities organize and advocate for overall health and wellbeing. In this seminar, we will combine community-engaged service-learning, community case studies, readings, reflective writing, student independent projects, and immersive living experiences, to challenge students to think more broadly and creatively about participatory democracy, civic engagement, sustainability, and the social determinants of health. This course is grounded in an international, community-engaged, service-learning format aimed at creating opportunities for transformational student learning. We will address the meanings of ‘diversity’ within global and local communities; issues of power and privilege; social justice; what it means to be civically engaged at the local and global levels; and the tensions and differences between tourism vs. travel, and community service vs. engagement.

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“The Oarsmen” wall mural on K-Road by Miriam Cameron, 2006. Part of the ‘Visual Artists Against Nuclear Arms’ series. “The idea is we’re all in this together.” Photo credit: Josephine Ensign/2015

New Zealand is an ideal location for this Exploration Seminar. The country has a unique blend of indigenous and immigrant cultures, and its people have a rugged, “number eight wire” can-do, and highly creative approach to solving individual and community problems. In 2014, New Zealand ranked number one in the Harvard Business School’s Social Progress Index for overall wellbeing, while the U.S. ranked number sixteen, just above Slovenia. New Zealand spends one-third less per person on health care than we do in the U.S., yet they have much better population health outcomes. How do they do it? That is one of the main questions we will ask and explore through our work and study in New Zealand. In addition, as New Zealand is a world leader in environmental sustainability efforts, we will challenge ourselves to go ‘as green’ as possible: living in youth hostels, recycling, walking and taking public transportation, and eating a mainly vegetarian diet for our group meals.”

As we discussed with the students at the beginning of our program, New Zealand slipped somewhat in the 2015 Social Progress Index, but is still in the top tier/top ten of the 133 countries with sufficient comparison data to include. In 2015 for the ‘Health and Wellness’ category, New Zealand ranked 9th and the U.S. ranked 68th. And somewhat ironically in light of our study abroad program, the U.S. ranks first world-wide in the Access to Advanced Education category, and is weakest in Health and Wellness and Ecosystem Sustainability. I tried to remind students of this fact, especially when some of them grumbled about the vegetarian meals and relying on public transportation.

Using connections through the amazing New-Zealand group Inspiring Communities, we focused our time on a variety of local community groups working to empower and improve the places they call home. The Central Business District/ Karangahape Road in Auckland. The Avondale and Henderson communities on the outskirts of Auckland. Devonport and Waiheke Island, both more affluent communities. The Ruapotaka marae in Glen Innes. Then south to the Wellington area communities of Porirua, Bromphore School, and Epuni. Consistent through all of these communities was an emphasis the community members placed on the use of the arts to catalyze positive change and to enable community wellbeing. That and public libraries, which community members treasured as being the heart and soul and ‘mind food’ of their communities. Places where true democracy happens. Places to “dream up and enact crazy ideas.” Places that nurture “the freedom to change.”

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Mural by schoolchildren at the true ‘community-building’ Berhampore Primary School, Wellington. Photo credit: Josephine Ensign/2015

Art, including literary art, was literally everywhere we turned in these communities. And not just the typical government-sanctioned commissioned public art we are used to seeing in the U.S., but also much more grassroots , low barrier, “anybody can participate” community art shown in my photos in this post.

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A new version of “Girl with Balloon” street art by Bansky. On building on Karangahape (“K-Road”) Road, Auckland. Photo: Josephine Ensign/2015
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P1010020 First photo is of poetry by young people at the Te Oro youth community arts center in Glen Innes. Second photo is a ‘cast off’ (in the trashcan) poem by a rough sleeper/Auckland Central Library ‘Poetry Corner.” Photo credit: Josephine Ensign/2015

This sort of art not only beautified the communities, it also built community identity and promoted wellbeing. Walking around my hometown of Seattle this past week, I’ve been searching for similar sparks of community wellbeing through art and have had a hard time finding them. Yes, we do have some great bus shelter artwork, as well as some building and wall murals–and our public library system has been one of the best in the country (and hopefully will remain so despite a very silly rebranding effort), but I cannot find the same level of  empowering healthy communities through art. Perhaps this is an important ‘take home’ message, one we could use to improve community health and wellbeing in the U.S. More art, less guns.

 

 

The Empathy Tool: Thinking Outside the Square

P1000936With income inequality, urban poverty and homelessness rising rapidly in New Zealand, creative and compassionate Kiwis across different sectors are banding together to do something about it. While in New Zealand this past month I ran across a series of innovative interventions: the Auckland-based Family 100 Project, its companion Empathy Tool, and the research report An insight into the experience of rough sleeping in central Auckland.”

The Family 100 Project was a collaborative research project co-led by staff from the Auckland City Mission and a group of researchers from Waikato University, Massey University, and the University of Auckland. The Auckland City Mission is downtown Auckland’s largest non-governmental social service agency focusing on people marginalized by poverty and homelessness. They provide safe shelter through their drop-in center, food parcels, social worker screening and referrals, a homeless outreach team, and a drug/alcohol treatment center. In conjunction with the Auckland Primary Health Organization and the Auckland District Health Board, they operate the Calder Centre, a low-barrier health clinic. Most all of their services are located in central Auckland near the Aotea Square, the main town square and heart of the city.

The Auckland City Mission staff became concerned with the growing number of people accessing their services on a long-term, versus a short term crisis basis as had been the norm. They wanted to understand more of the lived experiences of people in chronic poverty and homelessness. What prevents people from moving out of poverty? was the main question they had.  So several years ago they partnered with the university-based researchers, and drawing from their database of 15,000 clients they selected 100 families to follow for a year (2012-2013). Reflecting the demographics of their overall client base, the sample consisted of 80 female-headed households, 40 were Maori, 25 were Pacific Islander, 22 were European/white, and 13 were Asian. The research team completed frequent in-depth interviews and mapping exercises. The interviews and mapping exercises focused on housing, debt, food insecurity, health, education, and employment.

From what must have been mounds of data, the university-based researchers and Auckland City Mission staff analyzed and interpreted the results and then presented their findings in a series of fascinating scholarly articles (linked here at the end of the page) and in more easily accessible reports, including the summary report Speaking for Ourselvesand the intriguing and highly visual Demonstrating the Complexities of Being Poor: An Empathy Tool.

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The Empathy Tool was developed by Mondy Jera, Executive Researcher of the design consulting firm ThinkPlace. I visited Mondy at her ThinkPlace office in Wellington to find out more about how the tool was being used and evaluated. Mondy and her team were also responsible for the design of the rough sleeping in central Auckland report, which has a series of wonderful graphics including the ones shown here.This was based on a research study focusing on the experiences of rough sleepers in central Auckland and was completed in February 2015. She said that a homeless rough sleeper man in Auckland pulled the report out of his backpack and showed it to a librarian at the Auckland Central Library and told her he uses it to help him navigate services. Not an intended use of the report, but a very clever one. P1010063

She also told me that the library staff saw ‘library’ on her graphic of a house (shown here) representing research findings on what happens when public and private domains meet on the street. The library staff decided to set up special training for them on how to work effectively with rough sleepers, and they have started a movie night at the library for their homeless patrons.

The Empathy Tool is being used in ongoing training with housing groups in Auckland, with Maori Affairs, and in special poverty sensitivity trainings with staff of the New Zealand Ministry of Finance, which is responsible for setting economic policy for the country.

Mondy, who has a Masters in Public Health from Otago University and a bachelor’s degree in sociology (criminology) from the University of Utah, designed an 8-week ’empathy experience’ for a group of eight people from the Ministry of Finance. They first did classroom training using the Empathy Tool and practiced role-playing scenarios. She then gave them each $2 NZ to take the cross-city bus to the soup kitchen for lunch. Most of them had not taken a city bus since their college years and by the time they figured out transportation to the soup kitchen, the kitchen had run out of food. So they pooled their money and bought a communal lunch at the grocery store, commenting on how expensive any healthy food choices were and how time-consuming it was to meet basic needs while ‘being poor.’ They then did a series of on-the-street intercept interviews with people in more impoverished sections of Wellington and finally had an in-depth de-briefing session to talk about their experiences. They were then tasked with designing an innovative intervention to address a common poverty-related problem. They completed this training program a year ago and Mondy plans a follow-up evaluation of it soon.

The Kiwi ‘Can Do’ Community Cafe

IMG_5776As I prepare to leave New Zealand to return to my hometown of Seattle, I reflect on some of  the innovative programs and people working to address the growing problem of homelessness here in the land of milk and honey (and insanely good chocolate).

Yesterday I had lunch, a terrific soy latte, and community fellowship at Auckland’s Lifewise Merge Cafe on Karangahape (‘K’) Road. Lifewise is an Auckland-based community and social development agency that works on issues such as child abuse, domestic violence, addictions, disabilities, poverty, and homelessness. They provide direct services and also lead advocacy activities. One of their current advocacy campaigns is to urge the New Zealand government to change the age of ‘aging out’ of foster care. Currently, foster care ends on a young person’s 17th birthday; Lifewise is advocating that age to be increased to 21. They have ample evidence to show that this policy change would help many young people avoid ending up living on the streets.

Lifewise operated a soup kitchen for homeless people in Auckland since 1885. By the early part of this century they were serving over 40,000 meals a year. They realized that their soup kitchen was effectively maintaining rather than solving the issue of homelessness. So in late 2012 they closed the soup kitchen and opened the Merge Cafe on K-Road. The Merge Cafe is one of the few community cafes in the world. They say this of the cafe:

“The café aims to support Lifewise’s one-stop-shop approach to tackling homelessness by connecting patrons with wrap around support services that would in turn provide pathways out of homelessness. Secondly, the café aims to provide both the homeless and the housed alike, the opportunity to enjoy meals alongside each other, in an environment that embraced choice, dignity and respect.”

From what I saw, heard, and experienced there yesterday, the Merge Cafe is a success on all these fronts. They have tables set up to be longer community tables, not the typical isolating small tables. I sat next to a Maori middle-aged man, who told me that he had become homeless at age 16 when he ran away from an abusive home in a rural part of the North Island. He then became involved with a gang–“They gave me a sense of family that I didn’t have growing up”–but through outreach from Lifewise workers he got a “real job” and an apartment ten years ago. “I come back here to this cafe because it’s friendly and I remember what it’s like to be homeless.”

IMG_5777The cafe had a cozy corner ‘book nook’ lined with bookshelves full of paperback books and magazines to read in their comfy-looking chairs. A hot lunch consisting of an entree and a vegetable and roll cost $4 NZ ($2.50 US). The cafe was full of people eating and talking and seeming to be from a cross-spectrum of race/ethnicities, and socio-economic levels. People in the all black business suits so common in New Zealand. People in ‘high-viz’ orange vests of the road crews taking their lunch breaks. Flamboyant, paint-splattered artist-types. Jeans-wearing ‘suspiciously social worker-looking’ but laid back staff mingling around. And many familiar faces of the many rough sleepers I’ve seen around downtown Auckland.

The community cafe. What a great concept. Perhaps we should try to create one in the University District in Seattle? A worthwhile Kiwi can-do spirit souvenir to pack in my suitcase and take back home.

Rough Sleeping in the Land of Milk and Honey

HomelessnIMG_5722ess, literal on the street homelessness (‘rough sleeping’ in the local and UK vernacular) and doubling up/less visible homelessness, is on the rise in New Zealand. New Zealand, the world’s first welfare state, the land of milk and honey. What’s going on here?

When I visited here two years ago there was little attention paid to homelessness by government or non-governmental agencies. I met some homeless adults who were using the Auckland Central Library and there were a few people sitting in doorways along Queen Street who were asking for spare change.

This time, especially in and around Auckland–including here in the public library–people who are experiencing homelessness  are very much in evidence. So much in evidence that our University of Washington students on a study abroad program commented that between the prominent Space Needle-like structure (the Sky Tower), the amount of construction of high-rise condominium buildings, and people who are homeless, they felt as if they were still in Seattle instead of in Auckland.

A few studies have been done recently looking at the rise of homelessness in Auckland. Their version of a One Night Count found 68 rough sleepers within a 3 kilometer radius from the Sky Tower. A similar count in January 2015 found 147 rough sleepers within the same geographic area; the largest increase in rough sleeping was in young adults ages 18-25 years. New Zealand government and community members I’ve spoken with about this say that homelessness in New Zealand is a recent phenomenon. They attribute it to the country’s rapidly rising income inequality (the fastest increase of any industrialized country), neoliberal government policies weakening the country’s social support system.

Despite these distressing trends, I have found a refreshingly creative and ‘can do’ attitude towards addressing the problems of rising poverty, homelessness, and income inequities. In a series of subsequent blog posts I’ll share some of the most innovative I’ve come across while here in New Zealand.