This relatively new group has provided a breath of fresh air in my life, as they manage to blend a not-overly-stuffy academic grounding with all the passion, creativity, and ‘meaning of life’ that the humanities has to offer. I’ve recently returned from their second annual conference and these both have easily been among the best conferences I’ve ever attended (and being an academic-type, I have been to numerous conferences). Great people doing great and important work to try and humanize health care and health professions education.
From their fresh-off-the press website:
“About: The Health Humanities Consortium is a community of scholars and institutions who work in the humanities and arts to promote, reflect on, and advocate health and health care in the world.”
Where did you sleep last night? Was it in a warm, dry, and safe place?
If you were asked to summarize the essential meaning of home to you in one word or in a brief phrase, what would it be?
As human beings we have to have rest–and sleep–in order to not only thrive, but survive. Sleep is the ultimate letting go and trusting that we will not be disturbed, that we will be okay until we awaken. The trust we have through undisturbed sleep generates hope.
What does it mean to be homeless when home was never a safe place? In such cases, it is not possible for young people to ‘runaway’ from home; they can only run towards home.
“Poor health (illness, injury and/or disability) can cause homelessness when people have insufficient income to afford housing. This may be the result of being unable to work or becoming bankrupted by medical bills.
Living on the street or in homeless shelters exacerbates existing health problems and causes new ones. Chronic diseases, such as hypertension, asthma, diabetes, mental health problems and other ongoing conditions, are difficult to manage under stressful circumstances and may worsen. Acute problems such as infections, injuries, and pneumonia are difficult to heal when there is no place to rest and recuperate.
Living on the street or in shelters also brings the risk of communicable disease (such as STDs or TB) and violence (physical, sexual, and mental) because of crowded living conditions and the lack of privacy or security. Medications to manage health conditions are often stolen, lost, or compromised due to rain, heat, or other factors.”
For those of us fortunate enough to be currently housed and ‘homed’ in a ‘fixed, regular, and adequate [and safe] nighttime residence’–for those of us who are able to have adequate, safe, undisturbed, restorative-of-hope sleep–let us all remember (or imagine if we’ve never experienced it) what it is like for people who go without these essential human needs. And let us use our rest, our trust, our hope to fix this ‘wicked problem’ of homelessness.
___________
Notes:
The blue tarp tapestry shown in this photo is from my Soul Stories project, and specifically from the ‘Way Out; Way Home’ installation art (in progress). I ask people who view/participate in this installation to contemplate the meaning of home for them. They then are invited to write or draw the word or phase on a strip of paper, the strips are then added to the blue trap tapestry wallhanging weaving.
The connection between sleep and trust and hope was inspired by my current research for the Soul Stories project on the role of narrative in health and healing in the context of homeless. Specifically, this concept comes from anthropologist Hirokazu Miyazaki’s essay/chapter, “Hope in the Gift–Hope in Sleep” in Anthropology and Philosophy: Dialogues in Trust and Hope, edited by Sune Liisberg, Esther Oluffa Pedersen, and Anne Line Dalsgard, (New York: Berghahn Books, 2015).
What helps us—as health care providers, as caregivers, as people, as communities— endure the various traumas and sufferings we’re exposed to indirectly and that we experience ourselves?
Resilience is something that is often cited as an answer to this question. Resilience is a term that has been adapted from engineering to describe the ability of a substance, such as a metal, to return to its previous state after being stressed—the substance is able to bounce back, to return to steady state, to normal. The American Psychological Association definition of resilience is “the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of threat.” Resilience is sometimes referred to as ‘good survival.’
Over the past several decades there has been an explosion of research on resilience, mainly focusing on individual risk and protective factors. The main protective factors are, not surprisingly: 1) the formation of a firm, secure attachment to a parent or caretaker figure within the first few years of life; 2) prosocial behaviors and personality traits, such as empathy, a positive attitude, capacity for forgiveness, and ability to ‘play well with others’; and 3) a sense of personal agency, of being able to act, to do something positive both in the midst and the wake of trauma. The main risk factors are, not surprisingly, the opposite of the protective factors.
Most research on resilience has focused on the individual, is Western-centric, and has increasingly become biologically reductionist, narrowing in on the epigenetics of trauma and resilience, finding individuals and entire communities of people with ‘short alleles’ and DNA methylation—genetic markers of increased vulnerability to the adverse effects of trauma. That these are most often individuals and communities already marginalized by poverty and racism and other socially-constructed vulnerabilities, serves to further label and pathologize people and communities. It marks them as damaged goods. As irredeemably, permanently damaged goods. It typically ignores the mounting research evidence indicating that such epigenetic damage is largely reversible and preventable with appropriate life experiences—with access to appropriate life experiences, including effective therapeutic interventions.
Resilience-building interventions include cognitive-behavioral psychotherapy; therapies focused on building the capacity for empathy and forgiveness; narrative storytelling and other meaning-making therapies; and therapies aimed at increasing social support—social support that includes social touch—the human version of primate grooming. Good touch: a handshake, a peck on the cheek, or a hug in greeting; a hand brushing a shoulder in sympathy; sitting close to a stranger on a bus; washing the feet of people who are homeless, people who are rarely touched in a good way.
This all sounds good, but resilience irritates me. The whole saccharine notion that the human body, the human psyche, and even entire communities can be like heated metal—stressed and stretched but not broken—that they can bounce back, return to steady state, and perhaps be stronger and wiser for the experience? Certainly, I believe that strength-based research and interventions are an important and sizeable improvement over our traditional deficit models so prevalent within health and social services. But resilience has its dark side.
Resilience tends to glorify trauma, and contributes to an addiction to pain and to suffering: What doesn’t kill you makes you stronger. Be the hero of your own life. Cancer saved my life, made me a better person. And Hemingway’s “The world breaks everyone, and afterward, some are strong at the broken places.” It glosses over the fact that trauma and resilience are not equal opportunity affairs, that some people (women, children, people with various disabilities, non-whites, and gender nonconforming people), and some communities (marginalized by homelessness, poverty, racism, and the effects of colonization) are much more likely to be exposed to traumas in the first place, and they have fewer resources to weather and recover from the traumas. It ignores the larger structural inequities, as well as the stigmatizing narratives we place on certain people, communities, and entire impoverished countries. As physician, anthropologist and global health champion Paul Farmer reminds us, “The capacity to suffer is, clearly, part of being human. But not all suffering is equal, in spite of pernicious and often self-serving identity politics that suggest otherwise.” (p 288)
Trauma never happens in isolation, even if it is a one-time trauma that occurs to one individual, trauma happens within the context of a particular family, community, cultural, social, and time period. An individual trauma ripples outwards as well as inwards. Suffering from trauma is always a social process; recovering from trauma is always a social process. If suffering is a universal yet unequal human experience, being able to tell and listen to illness and trauma narratives matters. But it doesn’t stop there. Physician, anthropologist, and expert on illness narratives Arthur Kleinman admonishes us that it is the moral and emotional cores of these experiences that matter much more, including the cores of social suffering that especially affect marginalized people.
Kleinman also encourages us to ask the question, What helps us endure? “And I mean by endure withstand, live through, put up with, and suffer. I do not mean the currently fashionable and superficially optimistic idea of ‘resilience’ as denoting a return to robust health and happiness. Those who have struggled in the darkness of their own pain or loss, or that of patients or loved ones, know that these experiences, even when left behind, leave traces that may only be remembered viscerally but shape their lives beyond.” (p 119)
Note: This is an excerpt from a work-in-progress, Soul Stories, a collection of essays on the role of narrative in health and healing.
Sources:
Paul Farmer. ‘On suffering and structural violence: a view from below.’ In: Violence in War and Peace. Edited by Nancy Scheper-Hughes and Philippe Bourgois. (New York)/ Blackwell Publishing (2004). pp 281-289.
Arthur Kleinman. “The art of medicine: how we endure.” The Lancet. January 11, 2014. Vol 383. pp 119-120.
Rooming house in Jackson Ward, Richmond, Virginia. Photo credit: Josephine Ensign/1988
The deeply disturbing underbelly of the American life many of us have the mixed-blessing privilege of not having to confront: the racist premises of and fallout from our War on Drugs.
The War on Drugs was begun by President Reagan in 1982, and was continued by both Bush administrations, as well as by President Clinton in between the two Bush presidencies. Remember all the crack houses, crack babies, crack crimes, and Welfare Queens that were invoked to stoke the fervor and the funding for the War on Drugs?
As Michelle Alexander points out in her excellent book The New Jim Crow: Mass Incarceration in the Age of Colorblindness (The New Press, 2011), President Reagan began the War on Drugs before crack cocaine was introduced into impoverished, mainly African American inner-city neighborhoods as a ‘cheap high’ substitute for the high-priced White Collar cocaine. All of the ensuing efforts to get ‘tough on crime’ and ‘one strike–you’re out’ have resulted in the U.S. now having highest rate of incarceration in the world. We also have the highest proportion of our racial and ethnic minorities incarcerated. In fact, we have a larger percentage of our black population imprisoned than did South Africa under the height of Apartheid.
The War on Drugs hasn’t made us any safer, as various politicians have tried to make us believe over the past thirty years. It has made us sicker in body, mind, and soul–all of us. It has contributed to a worsening of health inequities since incarceration leads to a never-ending system of debt, to permanent disenfranchisement by taking away people’s voting rights, and of making it almost impossible for people to find jobs and housing once they are released from prison. Not to mention the negative health effects of incarceration on families. I have worked in prisons and in juvenile detention and knew about many of these issues. But I had not really thought of it as a continuation of slavery, Black Codes/ Jim Crow until I read this book and participated in a University of Washington Teach-In on the topic last week.
Here is one of the more piercing passages of Alexander’s book:
“When the system of mass incarceration collapses (and if history is any guide, it will), historians will undoubtedly look back and marvel that such an extraordinarily comprehensive system of racialized social control existed in the United States. How fascinating, they will likely say, that a drug war was waged almost exclusively against poor people of color–people already trapped in ghettos that lacked jobs and decent schools. They were rounded up by the millions, packed away in prisons, and when released, they were stigmatized for life, denied the right to vote, and ushered into a world of discrimination. Legally barred from employment, housing, and welfare benefits–and saddled with thousands of dollars of debt–these people were shamed and condemned for failing to hold together their families.” p175.
At the end of one of the Teach-In sessions “No Sanctuary: Understanding Historical and Contemporary Intersections of Mass Incarceration, Racism, and Health,” Dr. Alexes Harris stated, “The U.S. has always had an insidious system of social control targeted at those who are racialized and poor,” and then she asked each of us audience members, “How do you perpetuate this system?” On this Presidents Day, what an excellent question to ask ourselves.
Harm reduction, properly applied, is a good public health and individual health strategy. Its focus is on reducing or minimizing harms to the individual, their partners, families, and communities–harms stemming from a whole range of ‘risky’ behaviors. This focus includes providing care in a non-shaming, empowering way, including through the use of motivational interviewing. Harm reduction principles and practices are most well-known for people using drugs and/or alcohol. There is the successful public health practice such as needle exchange in terms of reducing HIV and other blood-borne infections in communities–the lack of which was highlighted recently by the HIV-surge in Indiana. (See the May 16, 2015 NYT article by Carl Hulse, “Surge in cases of HIV tests US policy on needle exchanges.”) But harm reduction has been applied to other ‘risky’ behaviors, including tobacco adolescent sexual activity, and even for tattoos and body piercings.
I am all for harm reduction and have actively used this approach in my own work as a nurse practitioner for over twenty years. I am proud to live in Seattle-King County that is fairly enlightened in its public health approach utilizing at least some level of harm reduction.
But I have come to see the harm in harm reduction as applied to prostitution. What follows is the story of the evolution of my thinking about this topic, based on my work providing health care to homeless teens and young adults. It is an excerpt of my forthcoming medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net(SWP, August 2016):
“A large number of our youth clinic patients worked in the sex industry as exotic dancers and prostitutes. Most came to clinic by themselves, some were brought in by their pimps, and a few young females came in with their male high school teachers who were fleeing other states on criminal sex charges. I was never sure which I found more despicable: the pimps or the teachers. The prostitutes were mostly young women, although there were also young men and transgender youth. We called it survival sex or just plain sex work, and erred on the side of nonintervention, harm reduction, trying to keep the young people as safe as possible until they could exit “the life.” This was a laudable goal and one I believed in. But in effect there were times we were supporting their lifestyle, enabling it, and becoming part of the problem. We mostly used the neutral term “sex worker” instead of “prostitute,” thinking it was more politically correct, more respectful of the young people involved.
I often asked myself: Is it possible for someone to be involved in commercial sex work and have healthy self-esteem? Is there such a thing as a happy, healthy hooker? Is the character Julia Roberts plays in Pretty Woman based on any sort of reality, or is she just part of a twisted fairy tale? 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 their statements have the off-key clang of the false bravado I know so well, having used it myself over the years. So many young prostitutes 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.”
Cook Strait ferry crossing, New Zealand. Photo credit: Josephine Ensign/2014
The public health (and political) crisis in Flint, Michigan over their contaminated drinking water should be sending out much louder alarm signals throughout our country. Snowmagedden 2016–from a different form of water–is drowning out the dirty water, dirty politics, and dirty failures of our public health system. Note my use of ‘our’ and not ‘their,’ which would make it oh so more comforting and at arm’s length for those of us who are not living in Flint. Contaminated water supplies can happen in our own hometowns, especially with the widespread crumbling infrastructures and a diminishing focus on public health surveillance. Access to safe, clean water is a basic human need; it should be an equal opportunity necessity. But clearly it is not.
For anyone who has missed this part of our national news, the Environmental Protection Agency (EPA) three days ago issued an emergency order over unsafe public water in Flint, Michigan, and assumed federal oversight of water testing and water treatment in the city of 100, 000–a city where 57% of the population is African-American and 42% of the city’s residents live below the poverty line. This week President Obama declared a state of emergency over the Flint water crisis and has assigned an expert from the Department of Health and Human Services to assist in assessing the extent of lead ‘poisoning’ in children and then recommend interventions. As we know all too well, what with the effects of lead additives to household paint and gasoline, as well as other environmental sources, children’s exposure to lead has devastating effects on multiple organ systems, and especially on the developing nervous system. Lead exposure in infants (including en utero) and children is linked with cognitive deficits (lower IQ), learning and behavioral issues.
In 2014, city and state officials switched from using the nearby Detroit water supplies (which came from the much cleaner Lake Huron) to using the highly contaminated Flint River for Flint’s water, in order to save money. They also failed to treat the water appropriately to minimize lead leaching into the water supply from old pipes. And they failed to appropriately test the household water supplies, ignored residents’ complaints about green and brown and foul-smelling water. And the city and state officials, including public health officials, publicly denied there was a problem, even after Dr. Mona Hanna-Attisha, a local pediatrician, presented them with evidence of alarmingly elevated blood lead levels in children she was seeing. As reported today in the excellent NYT article, “When the Water Turned Brown,” by Abby Goodnough, Monica Davey, and Mitch Smith:
“Yet interviews, documents and emails show that as every major decision was made over more than a year, officials at all levels of government acted in ways that contributed to the public health emergency and allowed it to persist for months. The government continued on its harmful course even after lead levels were found to be rising…”
People have rightfully pointed out that this is clearly a case of a willful neglect of environmental justice. If Flint, Michigan was more affluent and ‘more white’ it is highly unlikely that this problem would have started in the first place, or at least it would have been more quickly and more efficiently remedied. As the EPA defines ‘environmental justice’ on its website: “Environmental Justice is the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. EPA has this goal for all communities and persons across this Nation. It will be achieved when everyone enjoys the same degree of protection from environmental and health hazards and equal access to the decision-making process to have a healthy environment in which to live, learn, and work.”
In his characteristic no-holds-barred truth-telling way, filmmaker and Flint native Michael Moore is calling for the arrest of Republican Governor of Michigan, Rick Snyder, claiming he helped create the water public health crisis in Flint. (See this MSNBC interview of Michael Moore by Chris Hayes, January 19, 2016.)
As a public health nurse, this complex and entirely preventable problem in Flint, makes me angry and sad. Not only because of the environmental injustice of it all. Not only for the longterm negative health consequences for the thousands of children of Flint exposed to lead through their town’s drinking water. Not only for the devastating effects on the parents of these children. But also because of how much it undermines any and all heard-earned trust people have in our public health system. That negatively affects the health and safety of all of us.
Josephine Ensign (Bowdler then) at Cross-Over Clinic. From The Bon Secours Courier/St. Mary’s Hospital June 1987.
In celebration of the 50th Anniversary of the establishment of the role of nurse practitioners, I want to share an excerpt from my forthcoming book, Catching Homelessness (She Writes Press, August 9, 2016 publication date). Young people contemplating careers in nursing often ask me if I am happy I ‘became’ a nurse practitioner back in the early 1980s. My answer is always a qualified and honest, “yes, but it has not always been an easy role to work within–mainly due to the rigid medical hierarchy.” Yet of all the health care roles in existence today, if I had the chance to do it all again, I would–without any hesitation–become a nurse practitioner. We are a tough breed, willing to work on the medical margins, and we are here to stay.
Here is the excerpt from my book, in a chapter titled “Confederate Chess”:
“Nurse practitioners are an American invention, and specifically they are an invention of the American West. The nurse practitioner role was started by a Colorado nurse in the mid-1960s during President Johnson’s War on Poverty, when Medicaid and Medicare were established to extend health care to the poor and elderly. Even before this expansion of health care, there was a shortage of primary care physicians. At the same time there were many seasoned, capable nurses who were already providing basic health care to poor and underserved populations. A nurse-physician team developed the nurse practitioner role, adding additional course work and clinical training for nurses. With this, states began allowing nurse practitioners to diagnose and treat patients, including prescribing medications for common health problems.
Not surprisingly, the emergence of the nurse practitioner role met with the most resistance in states with higher physician to population ratios, and in states with more powerful and politically conservative physician lobbying groups. The nurse practitioner role was protested both within the medical and the nursing establishments. Physicians didn’t want nurses taking jobs from them, and nurses didn’t want other nurses having a more direct treatment role—more power and prestige—than they did. But the role caught on and spread throughout the country. Nurse practitioners didn’t get firmly established in Virginia until the mid-1980s when I completed my training.
Why nursing? I often asked myself, and people continued to ask me even after I became a nurse practitioner. It was as if any sane, intelligent, modern woman could not want to be a nurse. I had stumbled into nursing while a master’s student at Harvard University, studying medical ethics and taking courses in the School of Public Health. I was gravitating toward a public health degree, but was advised by one of my professors to go to either medical or nursing school first in order to get direct health care experience. I didn’t like the approach of mainline medicine, but also had a negative stereotype of nursing. The only nurses I knew worked in my rural family doctor’s office. They were stout, dull-witted, and wore silly starched white caps, overly-tight white polyester uniforms, and white support stockings that swished as their fleshy thighs rubbed together. But in graduate school at Harvard I sprained my ankle, and went to the student health clinic. I was seen by a kind and competent provider who spent time explaining what I should do to help my ankle recover. I was impressed and thought she was the best doctor I’d ever seen. Then she told me she was a nurse practitioner and explained what that was. My negative stereotype of nurses was challenged.”
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.
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.
And for evidence-based individual ‘self-care’ activities taken to the community health level, New Zealand’s All Right? Campaign using the 5 Ways of Wellbeing: Connect, Be Active, Take Note (Be curious), Keep Learning, and Give.
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.
“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.”
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.
A new version of “Girl with Balloon” street art by Bansky. On building on Karangahape (“K-Road”) Road, Auckland. Photo: Josephine Ensign/2015 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.
This relatively new group has provided a breath of fresh air in my life, as they manage to blend a not-overly-stuffy academic grounding with all the passion, creativity, and ‘meaning of life’ that the humanities has to offer. I’ve recently returned from their second annual conference and these both have easily been among the best conferences I’ve ever attended (and being an academic-type, I have been to numerous conferences). Great people doing great and important work to try and humanize health care and health professions education.
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