Service-Learning Changed My Life

Version 2I am forever grateful for the liberal arts education that included meaningful community-engaged service-learning. (Thank you Oberlin College!) I continue to wrestle with ways to bring the humanities and real service-learning* into my own work teaching undergraduate nursing students. The combination of a grounding in the humanities (in my case medical ethics through Biology and Religion majors) and service-learning, changed my life—and my career—for the better.

In my sophomore year at Oberlin, I took a child psychology course with Dr. Friedman that included a service-learning opportunity of working as a Big Sister or Big Brother to a child or young teenager at a children’s group home on the outskirts of town. Starting in that course and continuing until I graduated and left Ohio, I was the Big Sister for a young girl (she was 12 when I started working with her and I was just 18). I took her on weekend outings around the college town, taught her to swim in the college pool (I was a lifeguard and swim instructor), and visited the town’s Santa for a photo that I treasure. At the time I started working with my little sister I was a pre-med Biology major and thought I had my future life and career clearly charted. But that service-learning experience, accompanied by further private reading study on child abuse with Dr. Friedman, led me to medical ethics and on into a career in nursing.

It is instructive to re-read one’s college term papers. I am fortunate that my mother, who was my best proof-reader, kept all of my early writing going back to my age 7 haikus, and she gave them to me in a package before she died. (Thank you Mom!) Here is an excerpt from a term paper titled “Child Abuse: A Wider and Closer Look” that I wrote for Dr. Friedman in 1979:

“Who would contest that poverty creates the most stressful situation imaginable? If we want to truly treat child abuse, we have to face the fact that poverty is a very real influence. How can anyone possibly cure poverty? That question touches a sore spot in all of us comfortably full and well-clothed individuals. We recognize an inconsistency in our moral structure and in our social structure. The harming of children—all of the legislation, psychoanalysts, psychiatrists, and self-help groups in the world won’t cure it. The idea of changing our society is radical and frightening because we would have to risk losing what we have and feel safe with. How long will the present interest in child abuse last? Will we take the chance and try to cure child abuse, or will we continue placing Band-Aids on the sore, with our heads turned away from the real problem?”

Indeed, four decades after writing that paper I continue to ask similar questions—and to work towards finding solutions to those big, wicked problems. But it was my foundational liberal arts education combined with service-learning that is what prepared me for my life and my career.

* Real service-learning is (as defined by the University of Washington Carlson Leadership and Public Service Center):

“Service-learning is a learning experience that combines service with the community with structured preparation and reflection opportunities. Service opportunities are tied to academic coursework and address concerns that are identified and articulated by the community.

As students engage in service-learning, they learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as community members.”

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 Ugly Underbelly of the Health Humanities

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“Release Your Plans” oil on canvas by Denver-based artist Daniel Spricks.

Ugly, as in ‘unpleasantly suggestive, causing disquiet, likely to involve violence of some sort, repulsive.’ Underbelly, as in ‘beneath the surface, hidden, vulnerable, corrupt, sordid.’ Health humanities, as in the relatively new transdisciplinary field linking the arts and humanities with health and healthcare. Health humanities is both the term and the international movement intended to widen the more traditional field of medical humanities with its focus on physician practice and physician education. (See The International Health Humanities Network for more information.)

I have just returned to my life in Seattle after four days in Denver spent pondering the ugly underbelly of the health humanities. I was a participant-observer at the 4th Annual International Health Humanities conference, Health Humanities: The Next Decade, held at the University of Colorado School of Medicine Center for Bioethics and Humanities. The stated purpose of the conference was to “…bring together scholars, educators, clinicians, health advocates, students, patients and caregivers in an effort to identify the core issues and guiding values as well as define the expanding scope of the health humanities.”

Out of 100 or so conference participants, I believe I was one of only three nurses. Professor David Flood from the College of Nursing and Health Professions at Drexel University served as a conference committee member, but there were no nurses (unless they were deeply closeted nurses) who presented at the conference. The third nurse was Jamie Shirley, PhD, a terrific nurse ethicist and lecturer at the University of Washington Bothell campus. At the risk of adding to the tiresome ‘whiny nurse syndrome/trope in academese,’ I can’t help asking, “Where were the nurses?” As this was hands-down the best, most thought-provoking conference I’ve ever been to–and was, correctly I think, proclaimed as a historic conference with far-reaching consequences–why weren’t there more nurses at ‘this table?’

What I most loved about the conference was that the planners, speakers, and participants all openly acknowledged and explored the ugly underbelly of the health humanities. Not just who/what groups of people are included and excluded within the theory and practice (and international conference) of the health humanities, but other and perhaps more uncomfortable questions, such as:

By attempting to train medical, nursing, and other healthcare professions students in ‘narrative competence,’ are we turning this into yet another skill to include on a checklist? (The ‘tyranny of competencies’ as it has been called.) And, as Katie Watson, JD of Northwestern University Feinberg School of Medicine pointed out in a session on narrative advocacy, is a focus on narrative competence ignoring the fact that perhaps this is intrusive, itself a form of violation–of violence? Do we as teachers of the health humanities understand what it costs our students (as well as ourselves) to be opened up/made more vulnerable to the emotional pain of patients, of families, of communities, and of the world? Do we do enough to help our students ‘learn how to carry’ (or perhaps how to carry and then let go of) traumatic patient/community stories? Where does the ‘enterprise of narrative medicine’ fit within the health humanities? What are the professional consequences of doing radical art, radical writing, radical practice, and I’d add, radical teaching? By attempting to widen medical humanities to health humanities, are we adding to the cult of healthism?

And an ‘ugly underbelly’ question that I asked in a session yesterday (when I stepped outside of my observer role): why is religion/spirituality seemingly a taboo topic within the health humanities? Throughout the conference people tip-toed around religion and spirituality. Don’t people see that the privileging of secular humanism, the marginalizing–or worse, belittling–the role of religion and spirituality within our world, within healthcare practices, within health policy, within our own lives, is a grave danger? I’m not referring to a grave danger to our ‘souls,’ whatever that may mean, but rather to our lives together in communities, to the common good, to the civil discourse necessary for democracy.