Dream big. Take calculated risks. Be innovative and creative. Work collaboratively. Be open to learn from other countries and other communities and support the global to local connections. Dare to be labeled woo-woo. Remember nurse power!
Those are the lessons I have been learning—or relearning lately as I help launch the Doorway Project, a campus-community interprofessional innovative collaborative project aimed at reducing if not ending youth homelessness in the University District of Seattle. It is a form of public scholarship and includes creative data-gathering and design modalities including participatory community mapping, photo voice, and participatory digital storytelling videos. It’s final product will be a youth-centric human/community designed community cafe modeled after the amazing Merge Cafe in Auckland, New Zealand. It is ambitious and audacious and it just might work.
We have our kick-off and first pop-up community cafe and community participatory design activities this Sunday, December 3rd, noon-4pm at the lovely community center University Heights in the U District of Seattle. Here is an edited down 4-minute version of a longer interview I did today with our local U District public radio station KUOW 94.9 FM. Many thanks to them and especially to Producer Andy Hurst whose mother happens to be a nurse.
The holidays are festive, fun, frantic, frolicsome, fleeting—frankly fickle affairs. The sheer number of holiday-themed, family-times-gone-wrong Hollywood movies attests to this fact. And then there is the endless loop of the still popular Christmas song, “I’ll Be Home for Christmas,” first sung by Bing Crosby in 1943 as WWII raged on. Supposedly, major record company executives at first refused to record the song, due to its final line, “I’ll be home for Christmas, if only in my dreams.” They felt it was a downer of an ending. But, of course, it tapped into the reality for many people—not just soldiers—who couldn’t go home and were left with only nostalgic dreams of snow and mistletoe.
It continues to tap into the reality for many people. Not just for people displaced from their homelands by wars, such as the current one in Syria. (For an excellent in-depth article on this for a Syrian refugee family in Canada, see the NYT article “Wonder and Worry, As a Syrian Child Transforms” by Catrin Einhorn and Jodi Kantor, 12-17-16. This makes me love my neighbor country to the north.) And not just for people who never had a safe, warm, protective home to begin with. Dr. Nancy Goldov of the Washington State Psychological Association talks about this, pointing out that some people “find the pressure to be merry and happy difficult,” and that a particular trigger this year is the “highly fraught political situation that’s polarized some families.” (see the Seattle Times article, “Alone for the holiday—and loving it” by Christine Clarridge, 12-16-16.)
Home, not just for the holidays but anytime, is also just a dream for so many of our community members who are home-less. I know this at a personal level, yet yesterday it took on a new level of poignancy. Working in sub-freezing, snow-flurry weather, we helped move in residents of Tent City 3 to a corner of the University of Washington (UW), Seattle campus. Community volunteers helped Tent City residents sort tarps and tents and cans of food. Others moved wood pallets into a line and hammered plywood on top to serve as partially dry and unfrozen “ground” for the tents that residents will sleep in for the next three months. Tent City 3 is part of the organization Seattle Housing and Resource Effort (SHARE), which is self-governed, democratic, grassroots, and led by homeless and formerly homeless people.
I am proud of the dedicated work of many of our UW students, faculty, and staff who have advocated for UW to host Tent City 3. I am proud of our public university for living up to its stated institutional values, including:
“World Citizens We are compassionate and committed to the active pursuit of global engagement and connectedness. We assume leadership roles to make the world a better place through education and research. We embrace our role to foster engaged and responsible citizenship as part of the learning experience of our students, faculty and staff.
Being Public As a public university we are deeply committed to serving all our citizens.”
All of our current ‘wicked problems’ such as racism, homelessness, environmental issues, human gene editing, violence against women, mass murders, and terrorism, cannot be addressed constructively by science or technology. As the late Donald Schon wrote:
“In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solution through the use of research-based theory and technique. In the swampy lowlands, problems are messy and confusing and incapable of technical solution. The irony of this situation is that the problems of the high ground tend to be relatively unimportant to individuals or society at large, however great their technical interest may be, while in the swamp lie the problems of greatest human concern.” (Schon, D.A. “Knowing-in-action: The new scholarship requires a new epistemology,” 1995, Change, November/December, 27-34.)
In order to muck through the swampy wicked problem areas, we need–more than ever–the humanities. Before we continue down the path of denigrating the humanities (Rubio wanting more welders/less philosophers) and decimating university programs in the humanities, we need to ask ourselves if this is who we want to be–both individually and collectively. Where would we be without grounding in history, language, literature, comparative religion, philosophy, ethics, archeology, the theory/philosophy of law, and the criticism/theory of art? The excellent short (7 minute/ June 2013) video “The Heart of the Matter” by the American Academy of Arts and Sciences explores this question. “No humanities? No Soul,” George Lucas states.
Adams was, of course, ‘preaching to the choir’ in that most of the audience consisted of academic-types from the different disciplines traditionally considered the humanities. I didn’t recognize anyone else from the health sciences, and none of the audience members asking questions identified themselves as being from science or technology fields. This was disappointing, although not surprising. After all, even physically the UW’s Intellectual House is surrounded by buildings that house the humanities and is a far trek from health sciences or any of the science and technology buildings. But as Adams emphasized towards the end of his talk, there’s a great need to increase the intersection of the humanities with science/technology/medicine (health sciences more broadly). The humanities bring the important tools of reflection. Reflection on what it means to be human. Reflection of what it means to be a citizen.
Entering our fourth and final week of this university study abroad in New Zealand program, “Empowering Healthy Communities,” I continue to reflect on how to incorporate service-learning in an international setting, and how to incorporate it in an ethical and meaningful manner. By service-learning with a community health focus I use Serena Seifer’s definition:
“Service-learning is a structured learning experience that combines community service with preparation and reflection. Students engaged in service-learning provide community service in response to community-identified concerns and learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as citizens.”(Seifer SD. 1998. Service-learning: Community-campus partnerships for health professions education. Academic Medicine, 73(3):273-277.)
Within a community health and health professions context, service-learning focuses on student engagement in non-clinically focused service work. Thus, our typical community health nursing clinical rotations are not technically considered service-learning, although the lines can get blurred at times.
In a health systems course I teach for senior nursing students, I have included a service-learning option. Students in my course have concurrently volunteered as emergency youth shelter overnight workers, assisted in food banks, and served as buddies for hospice patients. Through this work they can step out of their ‘learning technical skills’ nursing student roles and begin to make systems-level connections and practice critical thinking skills. It has worked well because I’ve partnered with our wonderful University of Washington Carlson Leadership and Public Service Center. They do all the legwork in establishing and nurturing community partnerships, defining student service-learning placements, and monitoring student progress.
Including service-learning in study abroad university-level programs can make for high impact educational experiences. Studies indicate that inclusion of service-learning in study abroad programs significantly increases students’ sense of connectedness with a wider world community. It also helps students confront their own biases and prejudices, and increases their comfort in working within diverse communities. But those benefits come from well-designed study abroad programs that include pre-departure workshops/readings, embedded critical reflective writing by students with faculty feedback, and debriefing sessions after service-learning activities.
Done poorly, international service-learning can be exploitative and can deepen cultural arrogance and economic disparities. As Sara Grusky points out in her article “International Service-Learning: A Critical Guide from an Impassioned advocate,” most international service-learning study abroad programs from the U.S. are done in poor countries, and can become nothing more than ‘poverty tourism.’ (From the American Behavioral Scientist. 2000. 43: 858-867.)
New Zealand is not a poor country and it continues to rank much higher than the U.S. on many health and wellbeing scales. Yet it suffers from rising socio-economic and health inequities. During our study abroad program we have visited a variety of communities–some have been in higher socio-economic brackets, but most have been within impoverished, multi-ethnic and Maori communities. Before doing any community-based service-learning projects, we’ve first learned about the local and national context, including cultural, political, and socio-economic factors impacting the community. Students learn this through carefully chosen readings, and from talks by community leaders.
My co-leader for this program, Jim Diers, is a social worker and an international consultant on community-led, asset-based development. He has a decade or so experience working with various communities throughout New Zealand. So between his contacts and those of the New Zealand based community-development group, Inspiring Communities, we developed this study abroad program. Jim believes in more upstream thinking, policy-changing work versus direct service. It’s an important point, but I think there is room for both in life and in educating university students for their role as civically-engaged change agents. Students have stated that they are now more interested in knowing about and getting involved with their own ‘home’ communities, and of doing service-learning in the Seattle area.
Here are photographs and brief descriptions of various service-learning activities the students have been involved with during the program. Some of the activities were planned ahead of time and others ‘just happened’ spontaneously. All of them were driven by the community members. They have expanded my notion of what ‘counts’ as international service-learning.
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 .
of my country
will be interrogated
by the humblest
of our people.
They will be asked
what they did
when their country was slowly
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 Roadand Soul Storiesresearch 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.
What would happen if you didn’t show up to work, if you walked out of work, if you went on strike? Would anyone notice? Would anyone suffer? Besides earning a (hopefully ‘living wage’) paycheck and (hopefully) decent benefits including heath insurance, how essential is the work we do? And just how expendable are we?
These questions have been on my mind over the past several weeks as a labor dispute rumbles along at the University of Washington in Seattle where I teach. Our faculty members are not unionized, but our teaching assistants are part of the labor union UAW Local 4121. They just voted (90% in favor) to strike if their union representatives can’t negotiate a new work contract with the university by April 30th. Among the union’s terms is one calling on the university to adhere to the City of Seattle’s new minimum wage ordinance that went into effect at the beginning of this month. They are also asking for better health insurance benefits. Their most recent (and first ever) strike was for fifteen days at the end of the academic year in June 2001. Fortunately, I was not teaching at the time, but I understand that the strike created a problem for final exams and grades. (See Columns: University of Washington Alumni Magazine article “Briefing: First Ever TA Strike Hits UW Campus.”)
By now we are all aware of the escalating cost of a college education. An increasing body of research indicates that the largest contributors to this tuition increase are the expansion of the number of university administrators and their inflated (six and seven digit) salaries. The increase in tuition certainly is not going to increased salaries/benefits for most faculty members or to graduate student employees (nor to improved teaching facilities/see paragraph below). An April 5, 2015 NYT op-ed article by Paul F. Campos, “The Real Reason College Tuition Costs So Much,” is refreshingly direct and clear on these issues.
There are approximately 4,500 teaching and research assistant graduate students who work for the University of Washington. My son is one of them, as is my current and best ever teaching assistant. She helps me keep track of and grade all the weekly writing assignments for the close to 150 senior nursing students in a writing-intensive health policy course. She also helps me do battle with the antiquated A-V classroom equipment. Just last week she helped me avoid being electrocuted by a malevolent, malfunctioning microphone that they had jury-rigged to a large boombox on the podium (because the A-V equipment had completely died). I am (still) here to attest to the fact that teaching assistants are indispensable.
And while union membership has been declining in the U.S. over the past several decades, it has been increasing for healthcare workers, and especially for nurses employed by hospitals. That hospitals, including the supposedly not-for-profit hospitals, are big businesses that run like factories, is a well-established fact. Healthcare reform efforts have placed increasing financial pressures on hospital administrators who typically turn these into ‘lean work’ initiatives for the hospital employees below them. ‘Lean work’ probably has some fancy management-speak definition, but it really means that those lower in the food-chain (such as nurses) run their butts off trying to do more work with far less resources.
As Alana Semuels writes in The Atlantic (“The Little Union that Could” November 3, 2014), the small but growing union National Nurses United (NNU) has been especially effective at battling the Goliaths of healthcare power and at winning many of these battles. NNU has pioneered the use of one-day strikes to pressure hospital administrators to provide nurses with the resources they need, such as safe nurse-to-patient ratios and adequate Ebola safety equipment. When Arnold Schwarzenegger was Governor of California and tried to block a state law that would provide safe nurse staffing levels, the nurses of NNU helped to block the Terminator’s block: California remains the only state to mandate safe nurse (RN)-to-patient ratios in hospitals. Yes! Power to the people/nurses!
Here’s some interesting food for thought: When physicians strike, patient mortality goes down; when nurses strike, patient mortality goes up. A physician colleague of mine always tells my students this when he gives a guest lecture in my health policy course. It always grabs students’ attention and it’s not just a random, sensationalized statement. It is backed by a growing number of studies from the U.S. and from other countries (see below). In healthcare, the work of nurses matters. In higher education, the work of graduate student teaching assistants matters.
A 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 teaches 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.
“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!