Hope: Dream a Better World

IMG_1230 - Version 2Amidst all the Year in Reviews and New Years Resolutions and post Christmas/Hanukkah/Kwanzaa/Festivus consumerism hangovers, I’m thinking a lot about the power of hope. The power of dreaming a better world. The power of dreaming and then doing something concrete to help bring about a better world. Direct service, political advocacy, and activism: we need a healthy combination of people involved in all three areas of civic engagement. And just because we might be drawn to one area (like direct service) and repelled by another (like in-your-face activism) doesn’t mean that they aren’t all equally as important.

Brought to you by the U.S. government (with the amusing tagline “Government made easy”) is the website page “Popular New Year’s Resolutions.”  They list thirteen resolutions with the first being the all too familiar ‘lose weight’ and the second being ‘volunteer to help others.’ The ‘volunteer to help others’ links to the Tumblr blog for the Corporation of National and Community Service, the federal agency responsible for national service programs like AmeriCorps and SeniorCorps. Continuing with the hope-inspiring web-surfing, I discover Tublr’s Year in Review 2014/top blog posts and sites. Under ‘activism’ I find some terrific blogs, including Seattle-based Citizenship and Social Justice, CultureStr/ke (arts and activism around immigration), Pioneering Justice (photojournalism on human rights issues), and 100 Days of Activism. There are also some amusing blogs, such as Cats Can’t Be Vegan, Idiots.

Art and writing as activism. The living writer who best exemplifies what it means to dream a better world (and to write great literature about it) is science-fiction writer Ursula Le Guin. This year at the National Book Awards, Le Guin received the Medal for Distinguished Contribution to American Letters. In her powerful acceptance speech (YouTube video of it here), she states:

“Hard times are coming, when we’ll be wanting the voices of writers who can see alternatives to how we live now, can see through our fear-stricken society and its obsessive technologies to other ways of being, and even imagine real grounds for hope. We’ll need writers who can remember freedom — poets, visionaries — realists of a larger reality”

For a good article related to her speech, read Bill Moyer’s article “Ursula Le Guin’s viral video: we will need writers who can remember freedom” 12-27-14. And for a link to the complete transcript/copy of her speech, Le Guin has it on her author website here.

Happy New Years. Resolve to dream (and write and create and serve and agitate) a better world.

Resource:

A terrific training module/activity guide I use (in an adapted form) in my undergraduate community health course is the Bonner Foundation’s Bridging the Gap Between Service, Activism, and Politics.

Radical Public Health Nurse Rocks Health Care for the Homeless

IMG_2284This past week I attended the National Health Care for the Homeless Conference and Policy Symposium in New Orleans. I had the great fortune to share a room with a friend of a friend, a stranger who became my roommate and has ended up feeling like a kindred spirit and a long-lost friend. And she makes me very proud to be a community/public health nurse.

Catherine (Caitlin) Margaret May is a family nurse practitioner who works at Providence Community Health Centers (Rhode Island), providing care to people experiencing homelessness. Caitlin and I were both at the conference to present our work related to health and homelessness during the poster sessions. Caitlin’s nontraditional, non-stuffy/academic poster rocked the conference! She used the (new to me) format of cantastoria to tell/sing the story and history of homelessness in the United States. Caitlin did an excellent job channeling the spirit of anarchist and radical nurse Emma Goldman. And she dramatized something that our keynote speaker, Bechara Choucair, MD (Chicago Department of Public Health) said in his eloquent speech: “We created the policies that got them there” (referring to people experiencing homelessness).

Another conference presenter was social media guru Mark Horvath, founder of InvisiblePeople.tv, who spoke about his use of social media for his advocacy work with homeless people. His talk was a bit too Hollywood glam and ego for my taste, but it did help to push me further into the social media advocacy fray by filming Caitlin’s performance with my iphone, editing it, and uploading it to YouTube for your viewing pleasure. In the video Caitlin is teaching the words to two friends/colleagues, Seth Ammerman, MD  and Ivan Wolfson, MD.

According to the Museum of Everyday Life (a delightful place whose Chief Operating Philosopher and creator is Clare Dolan, RN), “Cantastoria is an Italian word for the ancient performance form of picture-story recitation, which involves sung narration accompanied by reference to painted banners, scrolls, or placards. It is a tradition belonging to the underdog, to chronically itinerant people of low social status, yet also inextricably linked to the sacred. It is a practice very much alive today, existing in a wide variety of incarnations around the world, and fulfilling very diverse functions for different populations.”

I doubt I’ll start taking singing and dancing and painting lessons, but Caitlin’s poster presentation/cantastoria has added a new dimension to my understanding of narrative advocacy and of radical nursing.

 

Storytelling for Policy Advocacy

PoppyStoryTimeWhen I tell people that my work focuses on narrative advocacy, they mostly look at me funny and ask, “What’s that?” It is a more concise way of saying ‘storytelling for policy advocacy.’

A common definition of narrative is a story with a teller, a listener, a time course, a plot, and a point. Storytelling is as old as campfires and cave-dwelling. (The photo here is of my father telling Appalachian ‘Tall Tale’ stories to his grandchildren). Storytelling is how we learn about our world, about ethical living, about history, about ourselves. Within the healthcare arena patients and family members tell their stories to nurses and doctors and other members of the healthcare team. It is still a truism that something between 80-90% of the information needed to make a correct medical or nursing diagnosis comes from the patient’s history, from their story.

Storytelling and story-listening are not only important at the individual patient level. They are also important at the community and public health level. Stories can be effective ways to educate and persuade the public and lawmakers on a variety of health and policy topics. Storytelling  (pathos) is part of Aristotle’s three essential components of rhetoric: the art of persuasion. The other two components of rhetoric are logic/reasoning/facts (logos) and the credibility of the speaker (ethos).

Several years ago at The Examined Life: Writing and the Art of Medicine Conference at the University of Iowa, I co-led a workshop “Narrative Advocacy: Writing Lives, Making Changes.” My co-leaders were Marsha Hurst, PhD, a core faculty member in the Program in Narrative Medicine at Columbia University, and Carol Levine the director of the United Hospital Fund’s Families and Health Care Project in NYC. Here’s the abstract of our workshop, which I still refer back to as my own guide and articulation of what I am passionate about:

“Narrative advocacy is the practice of using narrative competencies to advocate for improvements in care. It involves moving beyond the individual stories, to include the connections made within the wider community, and acting upon common interests in order to effect positive change in clinical care, in institutions of caring, and in health policy. In the U.S. there is a long history of health advocacy built on narratives of lived experience of illness and disability, and more recently, grassroots narrative advocacy has expanded through the use of social media. For health care providers and students in the health sciences, narrative advocacy can be a powerful avenue for engagement in health policy because it connects the unique individual experiences with larger issues. As powerful as narrative advocacy can be to engage and persuade policy-makers, it can and has been misused. It is important to have both knowledge and skills in how and when to use narrative advocacy responsibly and ethically.”

This past week I had the opportunity to participate in an excellent online training “The Role of Narrative in Public Health” sponsored by the Center for Digital Storytelling located in Berkley, California and facilitated by Amy Hill. She gave four reasons personal stories are so powerful: 1) stories are universal and typically follow a familiar structure, 2) stories are intimate and touch the heart in a way facts/figures can’t, 3) stories are honest and aren’t as slick and sensationalized as they often are in journalism, and 4) stories don’t (typically) tell us specifically what to do. The Center for Digital Storytelling uses a participatory media and group process to help people create and share their personal stories. Working in groups makes the individual stories more powerful, and the process can be empowering and healing for the participants.

The Center attends to the ethical practice of digital storytelling (would be the same for any type of narrative/storytelling work I think). They ensure storyteller well-being, use principles of cultural humility, and adhere to a set of guidelines in working with people impacted by trauma. They point out that consent is an ongoing process, that the question of story ownership and of sharing and distribution of the stories should be clearly addressed from the very beginning of the project. Amy showed us several powerful digital stories from their various projects. My favorite was on motherhood and women’s rights from their “Silence Speaks” project: Dear Ayhan by Rawan Bondogji. A perfect story for Mother’s Day. It is beautifully done.

Here are some additional narrative advocacy pieces that I use in my teaching: