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 further 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.

World Storytelling Day: Wishes

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World Storytelling Day 2015 logo. Design by Mats Rehnman.

Once upon a time…Happy World Storytelling Day. Happy first day of Spring for those north of the equator and happy first day of Autumn for those south of the equator.

The theme of this year’s World Storytelling Day: A Global Celebration of Storytelling is wishes. The fun logo (shown here) for this year’s events is by the Swedish professional storyteller Mats Rehnman. What a fun job title to have!

Richard Kearney, in his gem of a book On Stories (Routledge, 2002), begins with, “Telling stories is as basic to human beings as eating. More so, in fact, for while food makes us live, stories are what make our lives worth living.” He then ends the book with, “There will always be someone there to say, ‘tell me a story’, and someone there to respond. If it were not so, we would no longer be human.” Kearney (Professor of Philosophy at Boston College and University College Dublin) also points out that all of us are in search of a narrative, a story–not only to try and make sense of this messy thing called human existence/life, but also because, “Our very finitude constitutes us as beings who, to put it baldly, are born at the beginning and die at the end.”

But on to this year’s World Storytelling Day theme of wishes. Wishes, as in the fairytale line “I’ll grant you three wishes”? Or wishes as in the Five Wishes healthcare end-of-life (end of the story) advance directives advocated by the U.S.-based group Aging With Dignity? The line ‘if wishes were horses’ kept coming to me this morning as I fished for wishes–for the meaning of wishes–for stories about wishes–in my head (pre-coffee).

The saying or maxim “If wishes were horses, beggars would ride” seems to be of Scottish derivation, first recorded in the 17th Century. It was–and is–an admonishment for hard work instead of ‘useless’ daydreaming/wishful thinking. It was used as a heading in copybooks for British schoolchildren to practice their penmanship with by ‘writing this out 100 times’ or whatever their schoolteachers had them do.

Here is a stanza from Rudyard Kipling’s poem (published in 1919 yet so very relevant today)  The Gods of the Copybook Headings:

“With the Hopes that our World is built on they were utterly out of touch,

They denied that the Moon was Stilton; they denied she was even Dutch;

They denied that Wishes were Horses; they denied that a Pig had Wings;

So we worshiped the Gods of the Market Who promised these beautiful things.”

Tell a story (not a lie) today to a child or someone ill or dying or to a random person in your life who needs to hear a good story. Or to yourself. About wishes. About dreams (of the moon as cheese). About what it means to be human.

The End.

Hospital Healing Gardens

Sheltering Arms Hospital labyrinth and park. Richmond, Virginia. Photo credit: Josephine Ensign/2014

Our hospitals are bustling, intimidating, drama-filled, miraculous, expensive, technology-driven, antiseptic, and confusing places. Anything that can make them more ‘grounded’ and healing should be a welcome thing.

The first photo here is of the walking meditation outdoor labyrinth and wheelchair accessible park/paracourse that was associated with the (now closed) Sheltering Arms Hospital in Richmond, Virginia. This is where I would go for stress-reduction and perspective-seeking when I worked as a rehab nurse at the hospital (1980s), and then much later when my father was in home hospice nearby.

Paul Farmer, physician, anthropologist, global health activist, and founder of the Harvard-based Partners in Health, says that he has two main markers of quality of health care in a hospital that he visits anywhere in the world. His are not the usual quality of health care indicators those of us who work in health care and health services research think of. For hospitals, these include such things as: 1) timely and effective health care for conditions such as heart attack, 2) lower complications (and deaths) from surgeries, 3) lower hospital-acquired infections, and 4) patient report of good communication with doctors and nurses (see the very useful and consumer-friendly online tool based on national Medicare data, Hospital Compare). No, for Dr. Paul Farmer a hospital’s restrooms and gardens are what reveal its overall quality of care.

The fascinating topic of restrooms I will leave for another time, but hospital gardens are something I want to focus on here.

Modern hospitals trace their roots to the cloistered buildings of religious monastic orders that took in those too poor or disabled to be taken care of in their own homes by family members. These early hospitals were often built around a courtyard with a medicinal/herb garden, fruit trees, and a kitchen garden.

Garden of the Hospital in Arles 1, by Vincent Van Gogh. Public Domain license Wikimedia Commons.

The hospital healing garden shown here was an inner courtyard garden of the psychiatric hospital in southern France where Vincent Van Gogh was a patient. The view is from his hospital room. He also painted his famous series of blue irises from the hospital’s gardens. In letters he wrote to his family, he relayed how these gardens were an important part of his tenuous hold on mental and physical health.

Florence Nightingale knew the importance of nature in hospital reform and redesign. She emphasized the role of fresh air, sunlight, flowers, and of patients being able to see out of the window instead of looking at a wall. “She wrote, ‘I shall never forget the rapture of fever patients over a bunch of bright-coloured flowers’ she noted, adding ‘people say the effect is only on the mind. It is no such thing. The effect is on the body too'”(quote from the Wellcome Trust blog post ‘Why every hospital should have a garden,‘ 11-8-13). I wonder what Nightingale would say about our ‘modern’ hospitals banning the delivery of fresh flowers or plants to patients for fear of allergies or mold or whatever it is they fear.

Yesterday I went in search of the healing garden at the University of Washington Medical Center (UWMC) where I work (and where I have been a patient–for a bit more on that see my Medical Maze photo description in Pulse: Voices From the Heart of Medicine 1-23-15 ). I remembered it as an almost shockingly calming and contemplative space near the coffee shop adjacent to the main surgery wing. The UWMC healing garden was a rooftop garden designed by local UW landscape architect Daniel Winterbottom who specializes in healing/restorative gardens. I sought the healing garden in vain, as it was torn down several years ago to make room for yet another wing to this already massive hospital and medical center (at over 6 million square feet of mostly concrete, the UWMC/Health Sciences complex is the world’s largest single university building). The very helpful UWMC information desk staff directed me to this spot (see photo below) as the ‘backup’ healing garden. It appears to be a series of mud puddles with a no smoking sign and smokers happily puffing away. Clearly, there’s much work to be done.

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UWMC mud puddle ‘healing garden.’ Photo credit: Josephine Ensign/2015

Resources:

The Therapeutic Landscape Network has a searchable index ‘Gardens in Healthcare and Related Facilities.’

An excellent (and expensive! see if your local library has/can get a copy) book on the topic is Therapeutic Landscapes: An Evidence-based Approach to Designing Healing Gardens and Restorative Outdoor Spaces, by Clare Cooper Marcus and Naomi Sachs (Wiley: 2013). It includes an extensive collection of case studies of different types of healing and therapeutic gardens associated with hospitals, rehabilitative facilities, nursing homes, and hospices.

Harborview Art Walk and Ekphrasis

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Harborview Medical Center, Seattle Photo: Josephine Ensign/2015

What do art and poetry and Seattle’s largest public hospital have to do with each other? My colleague, poet Suzanne Edison, and I set out together this week on a mission to find possible answers to that question. We spent a half day doing our own art walk through the lovely and eclectic collection of public art at Harborview Medical Center in downtown Seattle. Then we sat in one of the hospital’s street-side cafes facing the Medic One emergency bays, sipped coffee amidst the occasional swirl of red lights and sirens, and wrote Ekphastic poetry in response to pieces of art that particularly moved us.

Our wonderful King County-based arts and culture organization, 4Culture, has a useful webpage with links showing photographs and describing some of the major pieces of art at Harborview. As they state:

“The Public Art Collection at Harborview has been growing since 1977 and is based on the belief that the arts can counterbalance the emotional, psychological, technological and institutional intensities of the medical center by reducing stress and conveying a sense of individual dignity and worth upon all who enter its doors.”

In choosing the artwork for display in public spaces–busy hallways, specialty clinics, and the numerous waiting room areas–careful consideration is given to things like inclusion of a diversity of artists, artistic styles, and themes. Peggy Weiss, who directs the art program at Harborview, explained to me that they have to try and balance having art pieces be interesting and healing across the wide range of patient populations they serve. (See my previous blog post “A Photo Ode to Harborview” from 1-31-15 for another ‘take’ on Harborview and for photos of its outdoors View Park artwork).

I took photographs of pieces of art and of particular spaces inside and outside the main Harborview (old) hospital, being careful to exclude any people in order to respect patient (and staff and patient family member’s) privacy. Here are some photos of art that I found most engaging and moving:

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Artist: Dempsey Bob “The Wolf Helper” 1999 cast bronze and horsehair location: atrium in main hospital. Photo: Josephine Ensign/2015.

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Artist: Sultan Mohamed “Royal Family,” 1997 oil on canvas The placard explains that he was inspired by the saying by Ethiopian elders, “Religious beliefs are an individual right but the country belongs to everyone.” Location: in hallway outside entrance to cafeteria Main hospital.

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Artist: Peggy Vanbianchi “Journey: Hands” Mixed Media Location: waiting room of Radiology/outpatient, second floor of main hospital

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Artist: Peggy Vanbianchi “Journey: Journal” mixed media Location: waiting room of Radiology outpatient department second floor of Main hospital.

This piece, ‘Journal,’ with its collection of enigmatic words, such as ‘refuge,’ ‘passage,’ ‘quest,’ ‘search,’ and ‘restore,’ lent itself to our first writing prompt: Take a word from the journal and write from it. I chose ‘refuge’ and wrote a free form poem that took me in surprising directions. The other writing prompts that we came up with were: 1) Write as if two pieces of art are in conversation, 2) Take one piece of art and write from its perspective, and 3) Have a figure in a piece of art be in conversation with the artist.

My main poem that came out of our art walk/Ekphrastic poetry writing day is titled “Harborview Refuge,” and has somehow manifested itself back into its own piece of art of the same name. Using my black and white photographs on various photo transfers (packing tape and acrylic gel medium), along with bits of my poem written on strips of bandage tape, here is my work-in-progress:

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As you can see from these three photographs included in my mixed-media art piece, I am taken by the Art Deco architecture and details of Harborview’s main hospital, which opened in 1931. The almost Gothic gargoyle-looking figure on the right adorns the top of the pillars at the main entrance to the ‘old hospital,’ next to the emergency department.

Harborview Medical center has a tradition of ‘poetry happens.’ Seattle-based writer Wendy Call was a Harborview writer-in-residence in 2010/2011. She worked on a project Harborview Haiku and American Sentences. As part of her project, Wendy shared her poetry with patients and staff and also encouraged them to write their own haiku/American Sentences.

And for anyone who wants to read some recent examples of ekphrastic poetry (and perhaps be inspired to write/submit your own poem in response to a photograph), take a look at Rattle‘s Ekphrasis Challenge.

The Crazy-Making Quantified Self

number-70828_640“Know your numbers” proclaims the American Heart Association, health care providers, employer ‘wellness’ programs, and multiple well-meaning but annoying relatives. We are continually admonished to monitor our weight, blood pressure, hours of sleep, caloric intake, and blood sugar/cholesterol levels–even the numbers of steps we take every day. It is becoming easier to self-monitor many of these numbers, what with the Fitbits, Jawbones, Fuelbands, Nudges, and the soon-to-be released and oh so aptly named iWatch. There is even a pregnancy monitoring app, Wildflower (really? who picked this name?), which keeps track of pregnancy weight gain and other pregnancy milestones. We have entered the age of the Quantified Self, the Quantified Self being a term, a movement, and a blog of the same name developed Wired Magazine San Fransisco-based journalist Gary Wolf. But is the Quantified Self craze making us healthier and more self-aware or just making us crazier and more self-absorbed?

As medical sociologist Deborah Lupton writes in her forthcoming book chapter/article You Are Your Data: Self-Tracking Practices and Concepts of Data  (see resources below), quantified self-tracking discourses:

include the notions that quantified data are powerful entities; (…) data (and particularly quantified or quantifiable data) are an avenue to self-knowledge; (…) quantifiable data are more neutral, reliable, intellectual and objective than qualitative data, which are intuitive, emotional and subjective; self-tracked data can provide greater insights than the information that a person receives from their senses, revealing previously hidden patterns or correlations; self-tracked data can be motivational phenomena, inspiring action, by entering into a feedback loop; (…) and data about individuals are emblematic of their true selves.

Besides the very real and potential misuses and abuses of self-tracking health data, including bias and discrimination by the U.S. Big Brothers of employers and health insurance companies, the use of these health data devices can become addictive and can trigger distorted body image and eating disorders. They also feed into our propensity to fall into the traps of ableism and healthism: judging and blaming people (and ourselves) when they (or we) aren’t thin enough, fit enough, happy enough, ‘able’ enough, healthy enough, fill-in-the-blank enough. We start to aim for the highest attainable and measurable ideal of bodily health instead of viewing health as something that allows us to do the things that give life meaning–things like family, community, spirituality, and fulfilling work.

I love health promotion and public health, but those of us working in this field can be a boring and sanctimonious lot. I stopped attending American Public Health Association (APHA) national meetings because I always felt I was joining a cult or attending a mass religious revival. Flocks of people wearing sensible shoes. I imagine many if not most of the APHA members are early adopters of all these get fit and health monitoring gadgets.

People like Deborah Lupton have conducted research and written wise critiques of the Quantified Self movement. I haven’t seen much discussion of the inherent classism of the movement, besides people pointing out the barriers of cost of all these gadgets. But beyond the purchase price cost of the gadgets, access to the internet for tracking and analyzing and comparing data, there’s also the fact that poor people don’t have the luxuries of eating good, healthful food, or the time to exercise. And then there’s the ‘bigger picture’ fact that all these self-monitoring health activities have much less impact on our health and longevity than we believe. Even access to high quality health care doesn’t matter as much as we think it does. One of the biggest factors in our health status–especially here in the pull-yourself-up-by-the-bootstraps U.S.–is where we are on the socio-economic ladder. The other little known fact is that the decidedly subjective self-rated overall health status of people remains the single best predictor of future morbidity and mortality. So, instead of wedding yourself to a Fitband, consider asking yourself on occasion, “In general, I would say my health is: Excellent, Good, Fair, or Poor?”

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See the 3-5-15 post “Changing Representations of Self-Tracking” by Deborah Lupton on her blog This Sociological Life.

The quote included above is from Lupton’s chapter in the forthcoming book Lifelogging: Theoretical Approaches and Case Studies About Self-tracking (tentative title), edited by Stefan Selke to be published by Springer Press.

For a rather alarming report on the uses/misuses/abuses of self-tracking health data, read the Forbes article Wearable Tech is Plugging Into Health by Parmy Olson (6-19-14).

For an excellent and now almost ‘classic’ academic but accessible book related to this topic, I highly recommend Deborah Lupton’s The Imperative of Health: Public Health and the Regulated Body, Sage, 1995. I pulled my copy off of my bookshelf (along with her excellent Medicine as Culture book), and discovered this most interesting and ironic bookmark. It is a YMCA promo brochure cover photograph of me holding my toddler son. This was the year I taught Jonathan to swim. This is the year I coped with a messy divorce by swimming 2,000 miles. I logged them on the YMCA competition bulletin board  (yes, I won) and I wore a Nike waterproof heart rate monitor….IMG_3598

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!