The Long View

This, unfortunately, is the season for despair for far too many people in our country. We have the recent health policy and population health news that, for the third year in a row, life expectancy in the United States is going down. Our overall life expectancy began to stagnate in the 1980s, then decline for certain groups, and more recently to decline more broadly. (see: “‘There’s something terribly wrong’: Americans are dying young at alarming rates” by Joel Achenbach, The Washington Post, November 26, 2019)

And, as researchers point out, this decline cannot be blamed solely on the opioid epidemic. Neither can it be blamed on Democrats or Republicans. Diseases and deaths of despair in our country are something we are all responsible for, what we all can do something about.

History teaches us to take a long view. History training, in the words of one of my favorite contemporary British historians, David Hitchcock, is also “empathy training among other things.”

Recently, I have had the pleasure of immersing myself in the oral history interviews I have conducted with a variety of people working and living at the intersection of homelessness and health in Seattle-King County. You can view the names and photographs of the people I have interviewed so far for my Skid Road project, as well as a few videos, here.

As an antidote to despair, I offer you an excerpt from my interview with one of my mentors, the social worker and civic engagement teacher Nancy Amidei. This interview was conducted on June 16, 2015 at Jack Straw Cultural Center in Seattle. This was her response to my question of what gives her hope for the future:

“I’m old enough to be able to say that when I graduated from college, there was no Medicare, there was no Medicaid, there was no Head Start, there was no WIC [Women, Infants, and Children] program. Food stamps was a pilot demonstration project in seven counties. What else? Oh, school lunch was only in the schools that could afford it, only the rich schools. There was no senior nutrition program. There was no American with Disabilities Act. There was no Civil Rights Act. There was no Voting Rights Act. Oh, there were no women in professional sports because there was no Title IX.

So, if I had to guess, I think all of those things passed within maybe twenty years from when I graduated. Well, if you had lived through that kind of change and you’ve seen that happen–and most of that is stuff that helps people who are not rich, who are not powerful. Food stamp recipients are not rich and powerful. Welfare moms are not rich and powerful. We can do things in this country, and you don’t have to be rich and powerful to make it happen. But you do have to vote, and you do have to pay attention to who’s in office. You do have to pay attention to the candidates. And you do have to speak up.”

No Time to Be Silent: On Radical Nursing

There is a time and place for silence, but only when it is freely chosen, not imposed. But now is not the time for silence. Now is the time to step us, speak out, and, at least in the United States, to vote. It is time to remember that progress on human rights and social justice issues in our world is not a given. That basic respect for girls and women is not a given. That universal abhorrence of gender-based violence is not a given. We all have to work for it—even when (and especially when)—our lives are turned upside down.

Nurses are the most trusted professionals in both the U.S. and the U.K. (although tellingly, nursing was only added as a legitimate profession to these polls in the U.K. two years ago). As nurses, we have always prided ourselves on being truthful, for speaking out and advocating for our individual patients or communities. But for various reasons (including a lack of contemporary role models or inclusion in nursing curricula), nurses have not be so good at political advocacy and activism.

Historically, nursing does have some amazing examples of nurses who bucked the status quo, spoke truth to power—who were radical nurses. Florence Nightingale in the U.K.—and especially her work after the Crimean War in bringing nurses to work in poor/workhouses in England. And in the U.S., my favorite historical role model is Lillian Wald in New York City. Lillian Wald founded the Henry Street Settlement in the poorest section of New York City, and she founded public health nursing. Public, community, population health nursing is what drew me to nursing in the first place and it continues to be my passion. Public health nursing work is always political work.

In the U.K. in the 1980s there was the short-lived but influential Radical Nurses Group (RNG). Some of their archived material was the subject of a (again, short-lived) blog, “The Radical Nurses Archive” written by a former NHS nurse using the lovely pseudonym, The Grumbling Appendix (with another blog on nursing and politics in the U.K. that ended in 2015). Where have the radical nurses in the U.K. gone? I am currently on a quest to find them.

Back in the U.S. we have the NurseManifest website and resources on nursing and activism co-founded by Sue Hagedorn, Peggy Chinn, and Richard Cowling. Beginning in the summer of 2018, they have added the Nursing Activism Project with a growing list of historical and contemporary nurse activists “Inspirations for Activism.” In addition, they have a dynamic list of resources for nurse activism.

No excuses. All you nurses out there in the world: Get informed. Get inspired. Get active.

I include a recent interview I had with my colleague here at Edinburgh Napier University School of Nursing and Social Care, Dr. Peter Hillen, on nursing and activism.

Read Like You Give a D@#n

Empathy is in short supply. Anti-empathy, racism, xenophobia, misogyny and all things ugly are being modeled and stoked by too many people and institutions—including, of course, the President of the United States. Effective resistance to all of this comes in many forms. It is not enough and is self-indulgent to be simply outraged. Fire and fury is not the answer. Do something: Read like you give a d@#n.

You do not need to read or re-read Ray Bradbury’s dystopian novel Fahrenheit 451, or review the history of book-burning, book-banning, author suppression and outright killing (as by Hitler during WWII), to know that books and the mind (and empathy) expanding knowledge they contain is powerful stuff indeed.

My beloved local library system, Seattle Public Library (SPL), has a gutsy and well-read patron who posted “Sh**hole Countries: A Reading List” on their BiblioCommons site. The SPL has added a disclaimer that the post and the list of recommended books is not a publication of the SPL, but kudos to them for supporting the sharing of diverse opinions and resources. Even if you happen to find the content of the brief post either too in-your-face or borderline offensive, be sure to look at (and hopefully read) some of the amazing books on the recommended reading list.

Of course, reading real literature (non-fiction, fiction, poetry, plays) does not necessarily build empathy and equity. Mind and heart expansion require having at least a doorway or a window or a crack in the walls of mind and heart for them to open and expand. But good books and reading them like you give a d@#n do have amazing, lovely, powerful, radical effects on not just the individual reader but also the world.

For the past three summers I have posted a summer reading challenge list of books that have a social justice, global, and health humanities bent. (See “Summer Reading Challenge with a Health Humanities/Social Justice Slant” from June 2, 2015; “Summer Reading Challenge 2016” from May 28, 2016, and; “Summer Reading Challenge: Global to Local” from June 11, 2017.) You don’t need to wait until the summer or a vacation of some sort to start reading real books, radical books, world-view changing books.

Summer Reading Challenge: Global to Local

For my third annual summer reading challenge list of books with a social justice slant, I’ve decided to focus on global to local from my Pacific Northwest (Seattle) corner of the country. These are all excellent books to read no matter where you happen to live. Here they are from the top of the pile working down:

Murray Morgan’s classic on the underbelly of Seattle, Skid Road: An Informal Portrait of Seattle (New York: Viking Press, 1951).
Jamie Ford’s lovely historical novel about Japanese internment camps and Seattle’s International District, Hotel on the Corner of Bitter and Sweet (New York: Ballantine Books, 2009).
Jane Wong’s first collection of poetry, OverPour (Notre Dame, Illinois: Action Books, 2016).
Elizabeth Austen’s book of searing poetry, Every Dress a Decision (Selah, Washington: Blue Begonia Press, 2011).
Kathleen Flenniken’s poetry collection Plume (Seattle: University of Washington Press, 2012) focusing on her life and work around the Hanford Nuclear Reservation in Washington State.
Pramila Jaypal’s reflective memoir Pilgrimage: One Woman’s Return to a Changing India (Seattle, Washington: Seal Press, 2000). Pramila is our newly elected U.S. Congresswoman for Washington’s 7th congressional district (my own).
Coll Thrush’s enlightening Native Seattle: Histories from the Crossing-Over Place (Seattle: University of Washington Press, 2007).
Alondra Nelson’s Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination (Minneapolis: University of Minnesota Press, 2011). Dr. Nelson’s book includes extensive historical information on Seattle’s Black Panther Party and the formation of the Carolyn Downs Clinic which is still in existence in Seattle’s Central District (and where I worked as a nurse practitioner for five years).
Quintard Taylors’ The Forging of a Black Community: Seattle’s Central District from 1870 through the Civil Rights Era (Seattle: University of Washington Press, 1994).
The lovely and powerful book Our Table of Memories: Food and Poetry of the Spirit, Homeland and Tradition, edited by Merna Ann Hecht (Seattle: Chatwin Books, 2015). This book includes poems and short prose pieces by participants in The Stories of Arrival: Refugee and Youth Voices Poetry Project at Foster High School in Seattle.
Another local collection of important stories and poems, Words from the Cafe: An Anthology, edited by Anna Balint (Seattle: Raven Chronicles Press, 2016).
An eclectic collection of little known histories, More Voices, New Stories: King County, Washington’s First 150 Years, edited by Mary C. Wright (Seattle: Pacific Northwest Historian’s Guild, 2002).

Nursing Mile High Club Take 2

Meliorism: The doctrine that the world, or society, may be improved and suffering alleviated through rightly directed human effort; a policy embodying this doctrine. (Source: OED) Meliorism, as in this statement by William James in his book (or really his collection of Gifford lectures given in Edinburgh) The Varieties of Religious Experience (1902): “The idea of a universal evolution lends itself to a doctrine of general meliorism and progress which fits the religious needs of the healthy-minded so well that it seems almost as if it might have been created for their use.” (p. 90) I recently re-read this book for an essay I am writing on science and religion, but it also has come in handy as I process the recent backsliding (yes, a religious term) in social justice progress in our country. Meliorism as a doctrine was, of course, dealt a serious blow with WWII and the Nazi atrocities as revealed during the Nuremberg Trials.

My own ‘belief’ in meliorism has been dealt a serious blow, but my resolve to work towards social justice is strengthened. And I look for evidence of progress wherever I can in order to bolster my resolve. Including in the somewhat dusty archives of this blog. “The Nursing Mile High Club” (originally published February 11, 2011) is one of my personal favorite blog posts to research and write. Re-reading it (and re-viewing the accompanying photo) makes me smile because it reminds me of how far nursing as a profession has come. Plus, it reminds me of how far my “real writing” career has come in the six years since I started this blog/website. Enjoy.

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Nurses are a lot like flight attendants. Imagine the modern hospital as a large flying spaceship. The physicians are the pilots, or perhaps they would contend that the administrators are the pilots. The hospital patients are mostly all the passengers packed into economy class, with perhaps a few VIP hospital patients in first class patient suites. So, of course, the nurses are the flight attendants of this hospital spaceship. They keep passengers comfortable by bringing them coffee, tea or soft-drinks, they help passengers in and out of bathrooms, they answer call bells, they ensure safety by keeping bed guardrails up, and they help to avoid a mass stampede of panicked passengers/patients running for the exits.

In fact, the first flight attendants were nurses. From 1930 to 1945 Boeing Air/United Airlines hired nurses to be flight attendants—called stewardesses then. Nurses were hired to calm passengers’ nerves in the early days of flying, and to attend to their comfort by bringing passengers food and drink, and tucking them in at night on long flights. Perhaps they gave sedatives to really nervous passengers. They wore the iconic white nurses’ uniforms, replete with the winged nursing caps left over from the nunnery roots of nursing.

But ramping up after WWII, stewardesses were mainly hired for their sex appeal, and soon became one of the most sexualized female lines of work—even more sexualized than nursing. Until the mid-1960s and the Civil Rights movement, flight attendants were all women. They were all pretty, thin, young, unmarried and un-pregnant women. They wore designer uniforms ranging from hot pants with patent leather go-go boots, to futuristic spaceship suits. Euphemistically known as “tarts with carts,” “trolley dollies,” and ‘flying mattresses,” stewardesses regularly endured pats to their derrieres as they worked the aisles, and it was common for frequent flyer businessmen to marry a stewardess. National Airlines had an infamous and financially successful “Fly Me” TV ad campaign in the early 1970s, with sultry female flight attendants declaring “I’m going to fly you like you’ve never been flown before.” The feminist NOW organization picketed their headquarters.

Currently, about 30% of all US flight attendants are male, and the median age is 44. These changing demographics, coupled with more enlightened cultural mores, successful unions, and post 9-11 increased seriousness of air travel, have all helped to raise the professional status of US flight attendants. In other countries, most notably Asian countries, almost all flight attendants continue to be young attractive females, although an enterprising new Thai airline is recruiting and hiring ‘kathoeys,’ otherwise known as ‘ladyboys,’ “third sex” male transgender people.

Flight attendants and nurses are both service-oriented professions with roots in traditional female roles. Flight attendants have a history of being much more overtly sexualized than do nurses. So how have flight attendants managed to come so much further than nursing in terms of gender parity—and in only eighty years? As I mentioned in a previous post “More than a few good men needed in nursing,” currently only 7% of the US nursing workforce is male. Although I was not able to find specific data on attrition rates by gender and profession, my sense is that male nurses have much higher rates of leaving the profession than do male flight attendants. So it’s not just a matter of recruiting, educating, and hiring more male nurses in the US, we also need to do a better job at retaining male nurses. Otherwise, perhaps they will all go join the friendly skies.

See also: “Tracing flight attendants’ path from nurse to model to professional” blog post by Aubrey Cohen 1-28-11, Seattle-PI‘s Aerospace News, about Seattle’s Museum of Flight’s display of flight attendants’ uniforms over the years (“Style in the Aisle”).

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Note: 2016 statistics on gender parity for flight attendants is difficult to find, but most updated reliable sources seem to place male flight attendants at 25-30%. For nursing, the Robert Wood Johnson Foundation January 2016 policy brief “The Changing Face of Nursing: Creating a Workforce for an Increasingly Diverse Nation” states that the 2014 RN workforce was 10% men. So at least for nursing in the US gender parity—and work attire—is improving.

Endurance Test II

Safety pins are not enough—not even the giant safety pins I managed to dig out of my possessions this past week. For anyone working on social justice issues, the world has just become a much less safe, less just, less sane place. Even less so for anyone who is not a white, so-called Christian, “able-bodied,” “straight,” born in America male. Again, the wearing of silly safety pins is simply not enough. And wallowing in grief and sadness and depression is not going to help. Righteous indignation leading to considered action is what is needed.

That, and the appropriate attention to self-care. Not the banal bath-taking-day-at-the-spa sort of self-care, but the authentic self-care of trauma stewardship as taught by the amazing Seattle-area social worker, Laura van Dernoot Lipsky. Her book and resource guide, Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others (San Francisco: Berrett-Koehler, 2009), is a permanent and oft-used part of my own resource library. I use it in my teaching. I dip back into its underlined, dog eared, sticky-noted treasure trove whenever I’m feeling the too-familiar crispy edges of professional burnout. Like now.

I highly recommend watching (and re-watching and sharing) her inspiring Tedex talk, “Beyond the Cliff,” from April 23, 2015. In it, she reminds us that in the midst of chaos, “one of the things in your ability is to bring your exquisite quality of presence to what you are doing, how you are being.” She reminds us of a whole host of inspiring people (including Thich Nhat Hanh, Malala Yousafzai, Viktor Frankl, and Maya Angelou) and the fact that “when they could not change anything external, they were able to shift everything as a result of where they put their focus.” She ends her talk by encouraging us to take care of our own part of the web, and to focus on what makes us come truly alive and go do that.

And there is the recent Washington Post (November 12, 2016) article by Karen Attiah, “Self-care tips for those who are terrified of Trump’s presidency” in which she ends with a quote by Audre Lorde: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

On Hope

Detail from mural “Sonoran Desert:Yaqui Home” by Mario Martinez

Today was absolutely the hardest day to teach out of all of my decades of teaching. I have a class of about 150 nursing students for a course on community/public health nursing. They are a very diverse group in terms of race, ethnicity, religion, country of origin, sexual orientation, gender, and even age. Today’s topics were cultural humility and the social determinants of health equity. How appropriate. One of my students also pointed out to me how helpful it was that I had also assigned a training module on disaster preparedness, which included PTSD prevention. She found the content helpful in terms of facing the outcome of our national presidential election. This made me remember the highly effective CDC Zombie Apocalypse disaster preparedness public education videos and materials. There is a zombie-like mindset within our healthcare system, within academic nursing, and within our society that I find highly disturbing. It would be so much easier to just yield to zombie ways.

I take diversity seriously in my teaching and strive to promote a class climate of respect for all differences, including different political views. But the profession of nursing as a whole, and especially of community/public health nursing, is built on the value of social justice and health equity. And higher education at a public university is based on inclusion and social justice. To now have a president-elect whose political platform included openly racist, xenophobic, homophobic, and beyond-misogynistic-into-sexual-assault-on-women values, takes us—takes me as a teacher—into an entirely new and uncharted territory.

Today in class I tried to acknowledge this in a transparent and respectful way—and to emphasize our responsibility to do our part to make the world, to make our country and our community a better and healthier place. We had terrific trainers from the NW Network of Bi, Trans, Lesbian, and Gay survivors of abuse who helped us address some of these issues directly. And a group of nursing students are continuing a Knitting for Change community group, an idea my UW Study Abroad in New Zealand students brought back with them last year. My co-teacher for that program was the community empowerment “Neighbor Power” expert Jim Diers. And then after class today I received notification of this recent mention I made in a Seattle-area community event of the New Zealand concept of community cafes as places to help strengthen our communities. “Experts offer ideas to help Seattle area’s homeless youth” by Neal Morton (Seattle Times, November 9, 2016).

I choose to hold on to all of these examples of the goodness and compassion in the world. I choose hope and a renewed energy to work for a socially just society.

Evicted

“In languages all over the world, the word for ‘home’ encompasses not just shelter but warmth, safety, family—the womb.” ~Matthew Desmond

Part of my Summer Social Justice Reading Challenge included reading Matthew Desmond’s powerful nonfiction book Evicted: Poverty and Profit in the American City (New York: Crown Publishers, 2016). Although I finished reading the book a month or so ago, I’ve been letting my thoughts about it percolate before writing a review.

First, it is a formidable book, with the hardcover edition being 341 pages with an additional 62 pages for a detailed “Notes” section. Since the author is a Harvard University professor and Evicted is based on his PhD dissertation research, the scholarly weightiness of the book is not surprising. As Desmond points out, there has been a dearth of research on the practice, policies, and consequences of eviction on individuals, families, and groups in the United States. Through his research and policy work, he seeks to address this issue. He has established the Just Shelter website to highlight additional stories of evictions around the country and to direct people to ways of helping at the local and national levels. For that I admire him.

In an effort to tell the stories of people he studied and lived amongst (in order to study them), Desmond uses a third-person detached narrative approach similar to the one used by Katherine Boo in Behind the Beautiful Forevers: Life, Death, and Hope in a Mumbai Undercity (New York: Random House, 2012). In the “Notes” section he acknowledges that he declined to write in the more current first-person ethnographic narration, a “…postmodern turn in anthropology, which focused attention on the politics and biases of the author.” He goes on to invoke “classic” policy-relevant ethnographic books, such as Elliott Liebow’s Tally’s Corner: A Study of Negro Streetcorner Men (New York: Little, Brown &Company, 1967), in which he claims the authors “are hardly on the page.” (p. 405) This is a strange statement, since Tally’s Corner is written in first-person, despite it also being written from Liebow’s dissertation.

Evicted reads more like a novel (Sinclair’s The Jungle comes to mind) than a heavy-duty social policy book. But as a reader, I was distracted by the frequent use of derogatory descriptors of people (moon-faced, redneck, etc.) and the fact that I could easily tell the places in the story where the not so behind the scenes author would play the role of the Great White (male) hope and bail people out of difficult spots. In the “Epilogue,” Desmond acknowledges both of these issues, but not in particularly convincing or reassuring ways. For instance, he mentions that people sometimes call him on the fact that he includes not so savory details about “poor people” and he replies that it doesn’t help anyone to try to gloss over realities—and that the tendency of kind-hearted liberals to portray poor people as saints is belittling and disrespectful. I agree, but there’s no need to describe people in a pejorative way.

The strongest part of Evicted comes in the “Epilogue: Home and Hope.” It is here that Desmond does an excellent job of highlighting the negative health effects of eviction on people, including the higher rates of depression and suicide among recently evicted people. And he has these things to say about the role of home for all of us: “The home is the center of life. It is a refuge from the grind of work, the pressure of school, and the menace of the streets.(…) The home is the wellspring of personhood. It is where our identity takes root and blossoms (…) When we try to understand ourselves, we often begin by considering the kind of home in which we were raised. (…) America is supposed to be a place where you can better yourself, your family, and your community. But this is only possible if you have a stable home. ” (pp. 293-4) Yes, housing is health care and yes, everyone deserves a safe and stable home.

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