Tag: Health policy

Apolitical Intellectuals Teaching Health Policy?

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Collection of health politics and policy teaching materials on my desk at work.

Is it desirable, indeed, is it even possible to teach health policy without also teaching politics? What would it mean to be an apolitical intellectual teaching health policy to future health care professional students?

As a lyrical definition of ‘apolitical intellectual,’ here are the first stanzas of  a poem by the Guatemalan poet and revolutionary Otto Renee Castillo, translated by Francisco X Alarcón. The full text of poem is available here and a powerful ‘spoken word’ version using a slightly different translation is available here .

APOLITICAL INTELLECTUALS
One day
the apolitical
intellectuals
of my country
will be interrogated
by the humblest
of our people.

They will be asked
what they did
when their country was slowly
dying out,
like a sweet campfire,
small and abandoned.

Basically, as I would interpret it, apolitical intellectuals have a lot of book knowledge and an escapist ‘life of the mind’ sort of attitude, but no practical, down-to-earth working knowledge of power and privilege. I do not aspire to be an apolitical intellectual teaching health policy to future health care professionals.

But I do aspire to be balanced and fair in my approach to teaching health policy. That is one of my prime duties as a teacher. Since I lean towards the Progressive side of politics, especially as politics relates to health and social justice issues, I bring that lens to the teaching of health policy. Many of my health policy current events articles come from the NYT or the (non-partisan but still left-leaning) Kaiser Family Foundation, and many of my videos (as in the photo above) are produced by PBS. I have tried, with limited success, to bring in more Conservative-leaning course readings, videos, and guest speakers. I find that it is difficult to find credible, intelligent, research/data-backed Conservative sources.

If I were teaching health policy at a university in close proximity to Washington, DC, I would probably have better luck finding good Conservative-leaning guest speakers. For instance, the DC-based Heritage Foundation has much different politics from my own, but they are credible, intelligent, and thought-provoking. They currently have an interesting section on their website: “Stop Obamacare Now.”

Since I am about to go on a year-long sabbatical in order to focus on my Skid Road and Soul Stories research and writing projects, I get to put away my health policy teaching materials. Both projects are public scholarship focusing on health policy for homeless and marginalized populations. As such, they are taking me even further away from being an apolitical intellectual. I consider that a good thing, but I do wonder how it will affect my teaching of health policy once I return to the university.

Health Care Bucket Lists

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Bucket list: a list of things you want to accomplish before you die. Derived from the saying, “kick the bucket,” a euphemism for dying–although no one seems to agree on the derivation of “kick the bucket.”

I recently ran across my own bucket list that I wrote when I was twelve years old. I wrote it as part of a seventh grade creative writing assignment. My mother kept all of my childhood writing and presented the packet to me before she died–something for which I am eternally grateful. My short stories about toothbrushes coming to life give me glimpses of my younger self that cannot be accessed through any other medium. Here is my bucket list at age twelve:

  1. Own a pair of sandhill cranes
  2. Have a zoo where all the animals can run free
  3. Have a greenhouse as big as a football field
  4. Learn to ride a unicycle
  5. Go to Australia
  6. Keep an otter
  7. Build my own house over-looking a lake
  8. Write a children’s book

I believe that I wanted to be a writer, a naturalist, or a veterinarian–most definitely not a nurse. My favorite books were (not surprisingly by my bucket list), Aldo Leopold’s A Sand County Almanac and Gavin Maxwell’s Ring of Bright Water.

What would my bucket list, my hopes for the future of health care be like? Since I am no longer young and idealistic, my health care bucket list comes out sounding way too jaded and cynical. So I turned to question to my younger and hopefully still idealistic senior nursing students. “What are your hopes for health care?” was my specific in-class reflective writing question to them a week or so ago. I asked them to write out a list of their top ten hopes.

Out of the 140 or so students, the vast majority listed some version of “universal access to quality and affordable health care.” Another frequently listed item was “provision of culturally humble health care,” as well as “eliminate racism in healthcare.” Many included ‘an emphasis on community-based primary health care,” and “more funding for public health.” Improved patient safety efforts, especially through good interprofessional health care team communication and safe nurse-to-patient ratios in hospitals, was a top-listed item. Closely related to that was “improve working conditions to reduce nurse burnout.” Improved access to better mental health services (including the astutely stated question “why are mental health units so ugly?”) and reducing stigma for mental illness and substance use issues, were also frequently mentioned. “Improving end-of-life and beginning-of-life care” as a way to improve quality of life as well as better use of our health care dollars was another top choice.

Here are some additional student ‘hopes for health care’ that make my heart sing and that give me more than a bucketful of hope for the future of health care:

  • To see the person, not the illness.
  • To create a nursing image that represents our smarts and not just our compassion (and nurses aren’t asked, “why didn’t you become a doctor?”)
  • To have more nursing involvement in policy change. Use my knowledge of the challenges faced by my patients to inform policy advocacy.
  • To ensure that ‘the least among us’ receives the best care possible, and “that I am courageous and prepared enough to advocate for the least among us.”
  • That we realize our patients have backstories that need to be recognized in order to provide the best care for them.
  • Full scope-of-practice for nurses uniformly across the country.
  • I hope I still have hopes for the health care system.

Spring Blue(s)

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Photo credit: Josephine Ensign, 2015

Why do spring and depression go together? The seasonality of illness is fascinating and is proof that our environment matters quite a lot to our individual and collective/public health. In temperate regions of the world, injuries and drownings go up in the warmer months, and deaths from influenza and carbon-monoxide poisoning go up in the colder months. These make sense. But when we think of depression and suicide risk, most of us would guess that these peak in the fall and winter months–what with decreased hours of sunlight and the stresses of some of the major holidays. In the U.S., September is National Suicide Prevention Month and October is National Depression Awareness Month, and many news reports continue to falsely link higher rates of depression and suicide with fall and early winter.

Yet studies worldwide find that depression and suicide rates peak in late spring and early summer. High pollen counts, increased hours of sunshine, higher temperatures, and even an increase in thunderstorms (ah–that Shakespearean pathetic fallacy!) have been linked to higher rates of depression and suicide. Within psychology and sociology circles, this seasonal link is theorized to be from the fact that people generally have increased social pressures and interactions in the spring, which can increase stress. (see “The Season of Renewal and Suicide” by Brian Palmer, Slate, 12-7-12).

The most current statistics from the CDC on the leading causes of death in the U.S. (for 2013), list suicide (intentional self-harm) as the tenth leading cause of death, with the total number of deaths by suicide as 41,149. (Suicide is the second leading cause of death for young people ages 15-24 years.) This continues the upward climb of suicide deaths in our country since the start of the Great Recession, with the largest increase being in people 45-64 years of age (peak wage-earning years.) With the possible exception of unintentional injuries, such as motor vehicle accidents, suicide is our most preventable form of mortality. And suicide deaths have serious impacts on the family members, friends, co-workers, and care providers who knew and loved the people who killed themselves. Note: they did not ‘commit’ suicide as is still too commonly used; suicide is not a crime or a sin–it is a preventable travesty. Using the term ‘commit suicide’ adds to the already debilitating stigma of mental illness.

So what are interventions that work to help prevent deaths by suicide?

1) Train healthcare providers to screen for depression, drug/alcohol use, bullying at school (for young people), history of adverse childhood events (especially sexual abuse), and suicidal ideation and attempts. In primary care screening for depression and suicide risk (as well as intimate-partner violence), a standard question is “Do you have access to a firearm?” This screening question seems so obvious, as access to a lethal weapon is an important part of the overall risk assessment. Over half of all deaths by suicide are by firearms. But now in Florida that healthcare screening question is illegal for physicians and nurses to ask their patients. (See James Hamblin’s 8-11-14 article in The Atlantic, “The Question Doctors Can’t Ask.” ) And other (mostly Southern, no surprise) states have similar legislative ‘healthcare gag orders’ pending.)

2) Educate the general public about the warning signs of severe depression, problematic drug/alcohol use, and suicide–and give them the proper tools to be able to intervene effectively. Reinforce the fact that talking about suicide in a supportive way does not encourage suicide (just as talking about sex or drug use with adolescents does not encourage them to have sex and use drugs.) An excellent (free and 24/7) resource is the National Suicide Prevention Hotline at 1-800-273-TALK (8255). They can connect people with local crisis centers and assistance.

3) Implement a community-wide public mental health promotion (and depression/suicide prevention) program. One such model program that is cost-effective and that could be replicated in the U.S., is New Zealand’s All Right? Wellbeing Campaign, a Healthy Christchurch project that is being led by the Mental Health Foundation and the Canterbury District Health Board. As they state, “All Right is a social marketing campaign designed to help us think about our mental health and wellbeing. It’s about helping people realise that they’re not alone, encouraging them to connect with others, and supporting them to boost their wellbeing.” Although targeted at earthquake recovery efforts in the Christchurch area, this public mental health campaign could be most effective at building community resilience before major disasters occur.

My students and I stumbled across the work of the All Right? Wellbeing Campaign while we were in Christchurch last year studying community health. I wrote about it in a series of blog posts, including “New Zealand Postcards: The Allrighties” 2-3-14. Some of our health-focused students ‘brought this home’ to Seattle and started the student-led “What’s Up UW?” community for promoting social and emotional wellbeing.

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From the All Right? Wellbeing Campaign, Christchurch, New Zealand.

 

 

 

Collective Sites of Memory: New Orleans

Storm clouds over the Mississippi River, New Orleans. Photo credit: Josephine Ensign/2014
Storm clouds over the Mississippi River, New Orleans. Photo credit: Josephine Ensign/2014

New Orleans, Louisiana, French Quarter, May 2014.

I returned to New Orleans in May 2014 to attend the National Health Care for the Homeless Conference and Policy Symposium. The last time I was in New Orleans was in the summer of 2005, less than a month before Hurricane Katrina tried to return the city to the sea. In Seattle, in the first few years after Katrina, I had taken care of many homeless and near homeless patients who had been displaced by the storm. I knew that most of these patients were among the more than 100,000 former residents of New Orleans who left in the aftermath of Katrina.

Now, almost a decade after the devastating hurricane and the national tragedy of how it was handled, I wondered how the citizens of New Orleans had chosen to remember it. I went back to New Orleans to participate in the conference and policy symposium, but also to track down their Katrina memorials, their collective sites of memory. Hurricane Katrina was, of course, both a natural and a man-made disaster, what with its socially determined patterns of protection and vulnerability based on race, class, and gender–not to mention the effects of environmental degradation and Global Warming. How individuals and communities deal with the aftermath of a large-scale and complex disaster was something I’d been pondering. I had recently visited the Christchurch, New Zealand post-earthquake sites of memory (and written about it in a series of blog posts, the most popular one here).

How do people deal with and bear witness to trauma?

I went in search of the National Katrina Memorial Park. No one, not even the concierge at my mega French Quarter conference hotel had ever heard of this memorial. With hazy directions and a very silly-simplified tourist map from my hotel, I hopped on a streetcar not named Desire and headed up Canal Street towards the Cities of the Dead.

The Katrina National Memorial Park is located at 5050 Canal Street, across the street from some strange Herb import store painted bright green (reminiscent of the Green Pharma’ing of Seattle since our state legalized marijuana). Entering the black wrought-iron gates and reading the first marker/sign greeting me inside, I realized that I had arrived at Potter’s Field, or the ‘City of the Poor and Forsaken Dead’ as I prefer to call it.

Potter's Field Crematory, New Orleans. Photo credit: Josephine Ensign/2014
Potter’s Field/Charity Hospital Cemetery, New Orleans. Photo credit: Josephine Ensign/2014

It is the site of the Charity Hospital Cemetery, on land purchased by Charity Hospital in 1848, and called Potter’s Field in the lingo of the time. “It has historically been used to bury the unclaimed from throughout the city, including the victims of several yellow fever and influenza epidemics,” proclaims the sign. It also contains the ashes of people who “donated their remains to the Louisiana State Anatomical Board for medical education.”

Walking farther into the cemetery, I was greeted by these strange, shiny black marble structures, which another sign identified as the Katrina Memorial mausoleums. They contain the ashes of the dead.

Katrina National Memorial Park, New Orleans. Photo credit: Josephine Ensign/2014
Katrina National Memorial Park, New Orleans. Photo credit: Josephine Ensign/2014

A sign states that the swirling pathways lined with these strange structures is supposed to mimic the shape of the hurricane. It is designed to “create a meditative labyrinth, a healing space for reflection.” The fact that the Katrina mausoleums most strongly echo back to the Nazi concentration camp boxcars for extermination of Jews, Gypsies, disabled, homeless and other ‘undesirables,’ did not make this space–this site of memory–either meditative or healing. Who, I wondered, was responsible for the design of this place?

Ah, of course! I thought, as I read a sign stating that this Katrina Memorial was created by Dr. Frank Minyad, Coroner of Orleans Parish. Dr. Minyard, an OB/GYN physician by training, a white man dubbed “Dr. Jazz” as well as “friend of the police” because of love of both trumpet-playing and covering up controversial ‘accidental’ deaths of black men while in police custody. Dr. Minyard, the self-proclaimed “community servant,” upholder of what he calls “the Palace of Truth,” at the time of Katrina our county’s longest-serving big city elected coroner (and not a forensic pathologist,) and a rather loathsome interviewee in Frontline’s 2011 stark, startling, and effective video episode Postmortum: Death Investigation Crisis in America. I show and discuss this video every spring in my undergraduate nursing health policy course, so I remembered Minyard very well.

As sat on a bench waiting for the Streetcar Not Named Desire back to my French Quarter tourist hotel, I felt sad, empty, and duped. This was not the community/collective site of memory of proper remembrance of the national shame, of “Is this America?” of post Hurricane Katrina that I had come in search of.

The Travelator of Racism

indexA few blog posts ago I wrote about the use of metaphor in health policy, focusing on the Cliff of Health analogy developed by Dr. Camara Jones. (See “Falling off the Funding Cliff of Good Health”). Dr. Jones is a family physician and epidemiologist who until recently was Research Director on Social Determinants of Health and Equity at the CDC in Atlanta. She resigned from that position in December to become President Elect of the American Public Health Association. She also IMG_3541teaches at the Morehouse School of Medicine. This photograph, which I took on Friday this week, shows Dr. Jones on the right with my colleague and epidemiologist Dr. Wendy Barrington.

Dr. Camara Jones was in Seattle to consult with the University of Washington School of Medicine on diversity issues. She gave a riveting (and standing room only) Grand Rounds talk “Achieving Health Equity: Naming, Measuring, and Addressing Racism and Other Systems of Structured Inequity.” And on Friday she talked with School of Nursing students, faculty, and staff about these same issues. In person she is warm, engaging, funny, and a gifted storyteller. As she says, she uses stories–allegories (which are really extended metaphors with a ‘lesson’)–to distill and clarify complex public health concepts and ‘difficult to discuss’ topics like racism. I highly recommend watching her recent (July 10, 2014) TEDxEmory videotaped talk “Allegories on Race and Racism,” in which she tells four stories: 1) Japanese Lanterns: Colored Perceptions, 2) Dual Reality: A Restaurant Sign, 3) Levels of Racism: A Gardner’s Tale, and 4) Life on a Conveyor Belt: Moving to Action. Conveyor belt, or moving walkway, is also called ‘travelator’ by those clever Brits.

The conveyor belt allegory is one of her most recent, and as far as I can tell she has not yet included it in any of her published articles. Dr. Jones said she has extended the ‘conveyor belt of racism’ analogy from the work of Beverly Daniel Tatum, author of Why are all the Black Kids Sitting Together in the Cafeteria? And Other Conversations About Race, Beverly Tatum (1997). Tatum writes about what it means to be antiracist:

“I sometimes visualize the ongoing cycle of racism as a moving walkway at the airport. Active racist behavior is equivalent to walking fast on the conveyor belt. The person engaged in active racist behavior has identified with the ideology of White supremacy and is moving with it. Passive racist behavior is equivalent to standing still on the walkway. No overt effort is being made, but the conveyor belt moves the bystanders along to the same destination as those who are actively walking. Some of the bystanders may feel the motion of the conveyor belt, see the active racists ahead of them, and choose to turn around, unwilling to go to the same destination as the White supremacists. But unless they are walking actively in the opposite direction at a speed faster than the conveyor belt- unless they are actively antiracist- they will find themselves carried along with the others” (pp 11-12).

It is highly telling that many of the online quotes of this passage from Tatum’s book conveniently delete both sentences that include ‘White supremacist,’ as if  it is ‘that which cannot be spoken.’ Camara Jones extends the conveyor belt/travelator of racism allegory by pointing out there are three stages of anti-racist action: 1) name it–look for and point out the racism inherent in the conveyor belt; 2) ask ‘how is racism operating here?’–not only walk backwards on the conveyor belt, but seek out the mechanisms and the history behind the building of the conveyor belt; and 3) organize and strategize to act with others who are trying to dismantle the mechanism behind the conveyor belt–to stop it. In her Grand Rounds speech, Dr. Jones pointed out that we have to talk about and understand history, we have to ask ‘how did this problem get to be this way?’ “Often knowing and uncovering the history behind how we got this problem can give us ideas of how to address it.”

I continually struggle to find ways to include meaningful course content and discussions about racism and health in the community health nursing and health politics and policy courses I teach, as well as in my narrative medicine/health humanities courses. Using the allegories on racism developed by Dr. Camara Jones has been among the most effective teaching tools.

If you haven’t done this already, try taking the Implicit Association test on race, available online through Harvard University. Make sure you are well-rested and feeling both left-right hand coordinated and willing to have your world rocked before taking this test!

 

Falling Off the Funding Cliff of Good Health

cliff-475661_640Words, and especially metaphors, fascinate me. They are powerful and oftentimes unexamined. Take cliff for example. The OED definition of cliff is: “a perpendicular or steep face of rock of considerable height.” Cliffs are both dangerous and exhilarating-seductive. Think of the aptly named Heathcliff (Emily Bronte’s in Wuthering Heights that is, not the rather insipid comic-strip cat). Cliffs represent the edge of the known and comfortable world. Cliffs are good places to gain some perspective.

Cliff, as a metaphor in the health policy world, is used in various ways. First, there is the ‘funding cliff,’ and specifically the current ‘primary care funding cliff,’ also called the ‘community health center funding cliff.’ Community Health Centers across the U.S. are facing a potential federal funding cut of up to %70 this coming fall (for a good and brief article on it, see the Commonwealth Fund’s Washington Health Week in Review, “Health Centers Push for Remedy to Avoid the Funding ‘Cliff,” by John Reichard, 11-3-14). The National Association of Community Health Centers has a policy issues website on the primary care funding cliff with more information and links to policy advocacy that individuals and groups can get involved in. Funding-Cliff-Infographic-1And here is the RCHN Community Health Foundation’s infographic on the primary care funding cliff.

 

 

 

 

 

 

 

 

 

 

I am a big fan of community health centers (CHCs)  and have worked at three different CHCs in the Seattle area over a period of fifteen years. They typically have very passionate, social-justice oriented people working for them, and they emphasize the use of interdisciplinary teams. CHCs provide comprehensive community-based health care for over 25 million people living in poverty, people who are homeless, as well as immigrant/refugee, and migrant farm workers in urban and rural areas throughout the U.S. CHCs are far from the ‘perfect’ model of care–they are high professional burnout workplaces and they often have much more ‘heart’ than ‘head’ (as in sometimes struggling with good leadership/administration). But they are as close to perfect that I’ve experienced in our country. Not surprising to me is the fact that one of our earliest models of CHCs was the Frontier Nursing Service, started by nurse midwife Mary Breckinridge in 1925 (and still in existence) to provide primary health care in an impoverished rural area of Kentucky.

But to return to the cliff metaphor, a second and important use of ‘cliff’ in the health policy arena is Dr. Camara Jones‘ ‘Cliff Analogy’ framework for levels of health prevention at a population level. Dr. Jones is a family physician and epidemiologist, and currently Research Director on social determinants of health and equity at the Centers for Disease Control. She distills down and illustrates complex health policy/health systems issues through the use of stories and metaphor–the Gardener’s Tale for levels of racism, and the Cliff Analogy for the social determinants of health and of health equity.

In a recent journal article/commentary, Dr. Jones states, “The social determinants of health equity differ from the social determinants of health. While the social determinants of health are the conditions in which people are born, grow, live, work, and age, the social determinants of equity are systems of power. (…) The social determinants of equity govern the distribution of resources and populations through decision-making structures, practices, norms, and values, and too often operate as social determinants of in-equity by differentially distributing resources and populations.” (“Systems of Power, Axes of Inequity” in Medical Care, October 2014, 52(10): S71-S75). In a graphic depiction of these concepts included in her ‘Cliff Analogy,” she shows that the cliff is not a flat, 2-dimensional cliff (as in the infographic above), but is 3-dimensional–differing in how resources, populations, (and, I would add, even the cliff’s physical contours/environment) are distributed.

So on this official President’s Day in the U.S., or Washington’s Birthday for all federal workers, take some time away from the shoe and cars sales and school holiday to consider what actions you can take to make our communities healthier and more equitable places.

Shame on Anti-vaccinators

IMG_3414A few years ago I wrote a blog post “Nurses and Anti-Vaccination” (6-4-12). The post stirred up some interesting and impassioned reader comments.  I said then that as a health care provider I consider it my professional duty to stay current on recommended vaccinations, including the annual flu vaccine. I still believe that. In fact, I’ll extend it to state that I believe it is a basic ethical and civic duty for everyone within a community to stay current on recommended vaccinations–unless they have valid medical reasons for an exemption. And, it is a basic duty of our public health/ health care systems to ensure equal access to safe and affordable vaccines.

With the current mutli-state serious measles outbreaks caused by anti-vaccinator parents opting out of vaccinating their children (and then taking them to Disneyland), there seems to be growing public sentiment in favor of stricter vaccine regulations. An important aspect of this ‘hot topic’ which is left out of most news reports, is the fact that it is mainly affluent, educated, white parents who are the anti-vaccinators. They typically believe in everything ‘natural,’ including how natural it is for small children to get really sick (and die) from ‘natural’ childhood communicable diseases. For the truly paranoid/OCD, this would be yet another good reason to never shop at Whole Foods, since I am convinced their shoppers have some of the highest rates of anti-vaccination anywhere in a community.

But on a less strident note, I do understand that anti-vaccinators (parents or otherwise) are not evil or stupid–and that it does no good from a practical and public health perspective to try and shame them into changing their minds. As I teach my nursing students, in approaching this topic with friends, family members, and patients, it is helpful to step back and use positive communication techniques from motivational interviewing–of establishing basic respect first, then exploring the motivations, fears, and beliefs behind the action. Only then can possible positive changes occur.

This past year, Eula Biss’ book On Immunity:An Innoculation (Graywolf Press 2014) addressed the issues related to anti-vaccination. I had high hopes when I first purchased her book and began to read it. While the book is well-written and mostly a pleasure to read, it was almost too easy to read. It felt more like I was eavesdropping on informal chatty banter from a neurotic new mother, albeit from an intelligent (and likeable) neurotic new mother. And while I understand her choice to not include real citations/footnotes for sources, that made me not trust many of the things she claimed to be ‘facts.’ I got really annoyed with how many times she inserted random quotes from her oncologist father. Other quotes/comments she included from various ‘experts’ seemed to be straight out of Frontline’s ‘video ‘The Vaccine War’ from 2010. Frontline’s website is an excellent and more updated resource for discussion and education on this topic. Michelle Dean posted the interesting piece ‘A Q&A With Eula Biss’ with further insights into why she wrote the book (Gawker Review of Books, 9-30-14).

The national debate on vaccination continues. Epidemiologist Saad B. Omer from Emery University wrote an important NYT op-ed piece “How to Handle Vaccine Skeptics” (2-6-15) advocating for policy-level changes to address high ‘opt-out’ rates. And poor Mississippi even made the news recently in conjunction with this topic: they have among the strictest state vaccine ‘opt-out’ laws and “the country’s highest immunization rate among kindergartners.” (Alan Blinder, “Mississippi: A Vaccination Leader, Stands By Its Strict Rules” NYT, 2-4-15).

Of God and Toilets

Public_VIP_latrine_(photo_taken_in_2011)_(5529288428)As I finish grading student papers for an undergraduate  community health course, I am reminded of the two most influential courses in all of my undergraduate and graduate education: 1) Comparative World Religions taught by Clyde Holbrook, Oberlin College in 1980; and, 2) Water and Sanitation taught by Clive Shiff at Johns Hopkins School of Public Health in 1992 (in which we applied a problem-based learning/case study approach to a Zimbabwe village water and sanitation project in a team-based approach with health care providers from mostly resource-poor countries). These two courses on seemingly disparate topics were the most personally transformative for me in terms of expanding my worldview and enhancing my critical thinking skills. Those, in turn, are two of the most important educational outcomes or standards that I aim to teach to in my work educating future nurses and other health care professionals.

As a society, as a world, what do we most want and need in health care providers? Yes, of course, we want and need intelligent, highly competent providers who are up-to-date on all of the latest scientific, evidence-based practice guidelines. But robots can do that. What we really want and need are flesh-and-blood, compassionate, grounded, and questioning humans who understand at a visceral level what it means to face existential questions of life and death; what it means to face complex personal and community-level ethical issues; and what it means to wrestle with the visceral, practical questions such as how to best to take care of basic bodily functions (like pooping and peeing) and how a community can obtain safe, clean drinking water (and the complex political, cultural, social, and historical issues related to that access).

In order to have more health care providers capable of such things, in order to ‘humanize health care,’ we need to have better support of the humanities within basic primary education, undergraduate education, graduate education, and continuing education…. Ah yes, and we need to have more health care (especially nursing) educators who have meaningful exposure to, education in, and orientation towards the humanities. By humanities I mean “the study of how people process and document the human experience” (source: Stanford Humanities), which typically includes the academic disciplines of: philosophy, literature, religion, art, music, history, and language/linguistics. Humanities and a ‘liberal arts’ education are foundational to our country and to democracy; they are also currently being undermined by a focus on ‘practical’ jobs-based education in STEM (non-humanities) subjects: Science, Technology, Engineering, and Math. As an important counterpoint to that trend, I encourage you to view the brief (7 minute) video “The Heart of the Matter” by the American Academy of Arts and Sciences (to accompany their 2013 report of the same name).

Remember to ask the important questions: who are we? where did we come from? why are we here? where are we possibly going? and where is a safe place to poop?

What is Public Scholarship?

IMG_3174My irreverent answer: work done by nerdy, bookish, abstruse (yes, abstruse), people with way too much formal education who can get over themselves enough to care about the ‘real’ world, what’s going on in it, what they might have to offer it on a more practical level, and what they can learn from that big, scary ‘real world.’

Here is one of the more reverent official answers:

“Publicly engaged academic work is scholarly or creative activity integral to a faculty member’s academic area. It encompasses different forms of making knowledge ‘about, for, and with’ diverse publics and communities. Through a coherent, purposeful sequence of activities, it contributes to the public good and yields artifacts of public and intellectual value.” (From: Ellison, J., and T. K. Eatman. 2008. Scholarship in Public: Knowledge Creation and Tenure Policy in the Engaged University. Syracuse, NY: Imagining America.)

The photo above is of me looking very happy yesterday at the University of Washington Odegaard Library (first floor) in front of my public scholarship multimedia exhibition Soul Stories: Homeless Journeys Told Through Feet.
This is a collection of poetry, prose, photographs, and digital storytelling videos about my work as a nurse providing health care to people marginalized by poverty and homelessness. I understand homelessness at a visceral level, having lived through it myself as a young adult. I also readily acknowledge that just because I ‘made it out of homelessness’ doesn’t mean everyone can, nor that it is an easy thing to do, especially within our society.

The Soul Stories exhibition will be at Odegaard Library (opposite Suzzallo Library on ‘Red Square’) through March 20, 2015. Odegaard Library is open to the public during regular library hours. Many thanks to the wonderful librarians at Odegaard who opened this space for me, and thanks to 4Culture for helping to fund part of this project. I was looking happy in this photograph because this has been the most challenging, fun, and soul-satisfying scholarly project so far in my career.

Public or community-engaged scholarship has never been valued by ‘high brow’ university types, especially not at research-intensive universities. It generally doesn’t ‘count’ as a valid activity for those pursuing graduate degrees. It generally doesn’t get you tenure. But that all seems to be changing, albeit at the achingly slow speed of any change within higher education. The catalyst for this change seems to be less from sudden altruistic enlightenment on the part of the academy, and more from public pressure for universities to show tangible positive impact at the local, national, and international levels. Within medical science scholarship, you can see this outside pressure manifested in the embrace of ‘translational research.’ Research within the realm of public scholarship doesn’t need to be translated.

Within the area of health-related public scholarship, a terrific resource I have used throughout my career is the Community-Campus Partnerships for Health (CCPH).  Check out the free, no membership required resources on their website, especially CES4Health, for peer-reviewed products of community-engaged scholarship.

Ebola: Not In My Backyard

ebola-suit1Until very recently in the United States the general feeling among most people (and among most news reports) was that the catastrophic Ebola epidemic was only a problem ‘over there in the poorest countries of Africa–all of those uneducated Africans who can’t even keep their food from getting contaminated by bat droppings.’ This summer, we were happily dousing ourselves with buckets of ice water in the (dare I say ‘silly and oh so contagious social media’ hype) of the ALS Ice Bucket Challenge. (see my previous blog post: ‘Ice Bucket Challenge for Ebola‘ 8-26-14 for additional perspective on this in light of the global health burden of disease.) At the time that I wrote that blog post we had not yet had any patients tested/confirmed with Ebola in our country. Now, of course, we have multiple confirmed cases in the U.S., including two young nurses who had cared for a patient with Ebola in a Dallas, Texas hospital.

This morning in my community health nursing class of 150 students, I asked how many of them had had any training or preparation or discussion of Ebola in their clinical rotations. Only one student raised her hand and she said that was training through her job at a hospital (presumably Harborview Medical Center in Seattle which supposedly has done a good job of Ebola education and preparedness for its employees). The majority of students said they had been asked by friends or family members for information on Ebola. I encouraged them all to read the excellent training materials for the general public and for health care providers on the CDC website–and to ask for preparedness training in their clinical sites. I also encouraged students to be attuned to subtle and not so subtle racism in news coverage and general conversations about Ebola. Even infographics about Ebola on the CDC website depict only impoverished rural African people with Ebola, in one case showing a man defecating on the ground.

The fact that it is two hospital nurses who are the first confirmed Ebola cases to be contracted in the U.S. should come as no surprise to anyone who knows and loves nurses or who has spent any time in a hospital. Nurses are the front-line, down-and-dirty direct patient care providers. These two nurses were following current (at the time–they have been updated today) Ebola infection control procedures. And whereas the latest nurse with confirmed Ebola, Amber Joy Vinson, was first reported as having breached CDC protocol and flown on a commercial plane while she had a fever, CDC officials are now confirming that she first phoned them when she had a fever and was due to fly: “I don’t think we actually said she could fly, but we didn’t tell her she couldn’t fly,” CDC director Dr. Thomas R. Freiden is quoted as saying. “She called us, (…) I really think this one is on us.” (NYT ‘New Ebola Case Confirmed, U.S. Vows Vigilance’ by Manny Fernandez and Jack Healy, 10-15-14.)

It is always ironic that it takes ‘big scary disease’ epidemics like Ebola to remind us all of: 1) how connected we are to everyone else in the world–their problems are literally our problem, 2) the importance of sustaining a robust public health infrastructure, and 3) how vital nurses are to our health care system.