Body, Soul, Survival

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University of Washington, Seattle. Photo credit: Josephine Ensign/2017

“Health is politics by other means,” asserts Columbia University professor of sociology Alondra Nelson in her fascinating book Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination (Minneapolis: University of Minnesota Press, 2011). Nelson acknowledges that her statement is inspired by French philosopher and scientist Bruno Latour’s assertion that science is politics by other means. For anyone who ever doubted either of these assertions—or thought they were alternative facts—you must live in the Land of Narnia.

Before reading Nelson’s book I knew that Black Panther Party for Self Defense had created community-based primary care health clinics in many major U.S. urban areas in the late 1960s/early 1970s. But I did not understand the true breadth of their healthcare activism. I worked as a nurse practitioner for about six years at Seattle’s Carolyn Downs Family Medical Clinic , originally formed in 1968 as a Black Panther clinic. It is located in the Central District of Seattle, a traditionally black neighborhood that is now significantly gentrifying. It is named after an early Black Panther community organizer, Carolyn Downs, who died at an early age of breast cancer—something that most likely could have been detected and more effectively treated if she had had better access to the primary care now provided by the clinic she helped develop. A highlight for me of working at Carolyn Downs Clinic was being able to care for one of Carolyn’s granddaughters.

The Black Panther Party for Self Defense was formed in Oakland in 1966 as a survival tactic “to afford protection for poor blacks from police brutality and to offer varied other services to these same communities.” (pp. 5-6) These services included the establishment of no-cost community-based primary care clinics, sickle-cell and blood pressure screenings, free breakfast programs for children, and after-school and summer tutoring programs. They also formed teams of patient advocates who accompanied their patients to hospitals or specialty care, heralding our current system of patient navigators. The Black Panthers were also instrumental in challenging the formation of the Center for the Study and Reduction of Violence at UCLA, a research center backed by the California governor Ronald Reagan, and which promised to find the origins of violence. It was to be headed by psychiatrist Louis Jolyon West, whose previous research included experiments with sleep deprivation, LSD, and correlating the era’s student activism with antisocial behavior. (pp. 153-154) The Black Panthers contended that aggression for people within marginalized communities was a legitimate response to oppression. They, along with many other activists, were successful in blocking funding for this center.

The American Journal of Public Health (AJPH) dedicated its entire October 2016 special edition issue to the public health work and legacies of the Black Panther Party. As physician and AJPH editor-in-chief Alfredo Morabia writes:

“Now that a new generation is carrying on the ideals of the health activists of the 1960s, it is time to revisit this history, understand the strengths and weaknesses of the BPP public health initiatives, and have a frank debate about what really happened. The stakes are huge for an emerging generation unwilling to accept that certain lives matter less than others, and that, as the recent massive lead contamination of the Flint, Michigan, water system shows, many poor (and Black) communities still remain defenseless against such overtly aggressive assaults to their health in a context in which, as Angus Deaton puts it, the infamous one percent is not only richer but much healthier.”

Read more in this AJPH special issue: http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303405

Additional resources:

The Seattle Black Panther Party History and Memory Project, part of the University of Washington’s Seattle’s Civil Rights and Labor History Project, led by UW professor of history James Gregory—contains videotaped oral histories, historical photographs and news coverage and more.

 

Homeless Feet Come Full Circle

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Josephine Ensign/ foot care at Cross-Over Clinic, Fall 1986, from Freedom House brochure.

“I did a lot of foot care at the clinic… Of course, it had its Biblical roots, but there was something about foot washing that most people found comforting and even pampering…I knew that having your feet cared for could somehow make you feel better all over…Almost all the homeless patients I saw had foot problems. They had to walk around town to get to different agencies, meal sites, and day-labor pools. They walked in the rain and the snow and the heat, usually in ill-fitting, secondhand shoes with dirty, holey socks, and carrying heavy backpacks.”~ from my book Catching Homelessness: A Nurses Story of Falling Through the Safety Net, pp 86-87.

In this excerpt, I was referring to homeless patients I cared for when I worked as a nurse practitioner at the CrossOver Clinic in my hometown of Richmond, Virginia in the mid to late 1980s—over thirty years ago. But I could be (and indeed, am now) writing about currently homeless people and foot care here in my adopted hometown of Seattle, Washington.

There is this brief part of a haibun (prose mixed with haiku) reflection I wrote after helping with a foot clinic at ROOTS Young Adult Shelter in the University District near where I work: “Tonight in the homeless shelter a 19-year-old man from Georgia says, ‘My momma always told me not to go barefoot and I didn’t listen. That’s why my feets so bad. And I have to walk everywhere on them now.’ He reaches down and gently rubs his brown gnarled feet soaking in a white plastic basin. His feet are darkly scarred and calloused: the feet of an old man.

walking barefoot/we find our way/though cruel paths scar”

(From Soul Stories: Voices from the Margins, in the haibun/chapter titled “Where the Homeless Go”).

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And there is this description of a foot care clinic I helped with at Mary’s Place, a downtown Seattle women and children’s homeless drop-in center: “The most delightful—and tender—foot clinic patient we had that morning was the petite three-year-old daughter of a young North African immigrant mother. The child pushed around a pink plastic toy shopping cart from the shelter’s playroom, and she wore a dress, bright striped tights, black Mary Janes, and a huge pink feather boa around her neck. She came and sat on a metal folding chair while one of the students washed her mother’s feet. The little girl wanted her own feet to be given the same attention, so her mother removed her shoes and tights. Baby toes! So cute!… I wanted to scoop her up and protect her from the traumas, the abuses of the world. But, of course, I knew I couldn’t do that. It made me sad to watch her toes curl up in delight as she splashed her feet in the basin of soapy water.”

(From Soul Stories: Voices from the Margins, in a chapter titled “Walk in My Shoes.”

IMG_0678And finally there is this King5 TV news report on the University of Washington School of Nursing foot clinic I helped with a few days ago (“UW Nursing Students Host Tent City Welcome Party” by Heather Graf, January 13, 2017). Rusty, the homeless resident of nearby Tent City 3 (currently on the UW campus), told the nursing student working with him that he had never felt so pampered. Small things go a long way. They always have and always will.

University Student Mental Health

Version 2In these uncertain and anxiety-provoking times, our universities have an increased responsibility to support student mental health and wellbeing. This is not about the issues of “spoiled and coddled” Gen Xers, helicopter parents, and the endless debates over the use of trigger warnings in higher education. This is about having a positive impact on not only our future workforce, but also our future leaders and change agents.

William Pang, a second-year student at McGill University in Montreal, wrote a moving NYT op-ed piece “The Season to Be Stressful” (December 19, 2016). He discusses his experience of learning to deal more effectively with overwhelming anxiety exacerbated by the highly competitive atmosphere of his university. He states, “I don’t think we should demonize an entire generation as reliant and narcissistic. We should instead celebrate a generation that is coming to realize the importance of initiating conversations about our mental health.” It is dismaying to read through the NYT comments to Pang’s op-ed piece with so many people basically telling him to buck up and become an adult.

The photo above is of me with the amazing UK nurse and PhD student Josephine NwaAmaka Bardi  with her social media campaign, “Raise Awareness of Mental Health in Higher Education” (#RAMHHE)  I met NwaAmaka Bardi this past September in Seville at the 5th Annual International Health Humanities Conference: Arts and Humanities for Improving Social Inclusion, Education and Health. She also works in the area of mental health cafes as an effective alternative community mental health service. London’s Dragon Cafe is a good example of a creative, welcoming, and supportive community cafe with a focus on mental health and wellbeing. It would be great to have a similar community cafe open to university students.

Universities UK is developing a mental health framework for universities to embed mental health and wellbeing across all university activities with the goals to decrease stigma and increase access to a variety of mental health and wellbeing services. (See: “New Programme to Address Mental Health and Wellbeing in Universities” December 2, 2017.) They point to the need of “getting universities to think about mental health and wellbeing across all their activities, from students and teaching, through to academics and support staff.” It doesn’t end with the provision of mental health and support services for students but needs to permeate the entire campus.

Doris Iarovici, M.D., a psychiatrist at Duke University Counseling and Psychological Services has written a book titled Mental Health Issues and the University Student (Baltimore: Johns Hopkins University Press, 2014). Although geared towards college mental health professionals, it includes useful information on the variety of mental health issues that our students face in universities—from anxiety, drug and alcohol problems, sexual assault, eating disorders, and relationship problems, to depression, suicide, and schizophrenia. She concludes by stating, “If we provide a range of services, including individual, group, and community programs, we will be in step with the goals of health care reform to focus on both prevention and optimizing outcomes.” p. 219

Commit to Mental Wellbeing

 

As we begin a new year, my wish is that we commit to mental health and wellbeing. This should start with our own individual mental wellbeing, but we need to use that as a base for supporting the mental wellbeing of our families and our communities. In the midst of so much turmoil, anxiety, bigotry, misogyny, and xenophobia in our country and our world, nurturing mental wellbeing is not a luxury—it is a necessity.

An essential ingredient for mental (and physical) health and overall wellbeing is social inclusion and a sense of belonging to a caring community. The adverse health effects of increasing population-based levels of social isolation and loneliness are now being highlighted. Dhrav Khuller, M.D. writes in “How Social Isolation is Killing Us” ( NYT December 22, 2016) that social isolation and loneliness, is linked in recent studies to a 29% increased risk of heart disease and a 32% increase in stroke.

Objective measures of social isolation include quantity and quality of social network ties, as well as living situation (living alone, whether housed or homeless). Loneliness is a person’s perception of social isolation and is, therefore, a subjective measure. Researchers point out that loneliness and social isolation are often not significantly correlated even though we commonly think of them as such. A recent large meta-analysis (a study of research studies) that included 70 independent prospective (following people longitudinally) studies representing 3,407, 134 participants, revealed a significant effect of social isolation—whether measured objectively or subjectively— on mortality. The researchers for this study also found that the largest detrimental effects of social isolation were for middle-aged adults as opposed to older adults. They call for social isolation and loneliness to be added to lists of public health concerns. (See: “Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review” by Julianne Holt-Lunstad, et al. in Perspectives on Psychological Science, Vol 10, issue 2, March 11, 2015.)

In the U.S. we are good at doing yet more research documenting the adverse health effects of social isolation and loneliness; we are not so good at finding constructive and sustainable ways to intervene. Many industrialized countries, including the U.K., Australia, New Zealand, Spain, and Canada are way ahead of us in terms of implementing cost-effective, community-based interventions. (See: “Researchers Confront an Epidemic of Loneliness” by Katie Hafner, NYT September 5, 2016.) In the U.K. there is the Campaign to End Loneliness. In New Zealand there is the public mental health campaign that I love: the All Right? campaign implemented in the aftermath of the Christchurch earthquakes. And addressing gendered issues, there is the Men’s Sheds movement that began in Australia and has since spread to the U.K., Ireland, Canada, and New Zealand. Another lovely and creative community-based solution I learned about this past year is the Art Hive (La Ruche d’Art) in Montreal, as well as in many other communities, including in Spain. My other wish for 2017 is that we learn from these sorts of programs and find ways to implement them in our own communities.

** A note on my (intentional) spelling of wellbeing as one un-hyphenated word: I find it both fascinating and telling that all English-speaking countries except the U.S. have moved to the use of “wellbeing” instead of the Americanized “well-being.”

Evicted

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“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.

Who Will Tell the Story?

DSC00528“My hometown of Richmond, Virginia is a city anchored to its past by bronze and marble Confederate shrines of memory, by an undying devotion to the cult of the Lost Cause. I was born and raised in the furrowed, relic-strewn Civil War battle fields on the city’s tattered eastern edge. A captive of its public schools, I was taught official Virginia history from textbooks approved by the First Families of Virginia. But I came to understand the shadowed history of my state by caring for its outcasts.

These lessons began while I was in nursing school. The modern hospital of the Medical College of Virginia curled around the former White House of the Confederacy like a lover. My clinical rotations were nearby in the crumbling brick former colored-only hospital, which then housed indigent and homeless patients, as well as prisoners. Most of these patients were black, so I called it the almost-colored-only hospital. The prisoners, shackled to their beds and accompanied by brown-clad guards, were from the State Penitentiary, located across town. One of my patients was a death-row inmate. When I spoon-fed him his medications, I was simultaneously afraid for my own safety and ashamed of being an accomplice to murder. I knew I was nursing him back to health only to return him to be killed by the state. I wanted to talk to him, ask about his family, about his life in and outside of prison, but the stone-faced armed guard loomed over me. I knew from experience not to discuss my ambivalent feelings with my  nursing instructor. She considered these to be inappropriate topics. I wanted to finish nursing school as fast as I could, so I kept silent.” (pp. 57-58, from my forthcoming medical memoir Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net, Berkeley: She Writes Press, August 9, 2016.)

I was reminded of this passage from my book this past week as I read the NYT article “Who Will Tell the Story of Slavery?” (Lorne Manly, June 29, 2016). Manly describes the (sadly to me, oh so familiar) political dueling going on in my hometown of Richmond over the location of the National Slavery Museum. Former Virginia governor L. Douglas Wilder (our nation’s first elected African-American governor, who was more recently also the Mayor of Richmond (2005-9), wants to establish the museum in the former First African Church (now owned by the Medical College of Virginia/Virginia Commonwealth University and located next to the main hospital I describe above). But the current powers-that-be, including the current Mayor Dwight C. Jones, want to locate such a museum at the historic site of the notorious Lumpkin’s Jail, a former slave prison, dubbed ‘The Devil’s Half-acre,’ the site of which was recently located and excavated. (see the Smithsonian Magazine article “Digging Up the Past at a Richmond Jail,” by Abigail Tucker, March 2009.)

The Richmond indie bookstore, Fountain Bookstore, where I’ll be doing a Catching Homelessness author event (Tuesday October 11, 2016 at 6:30 p.m.), is located a few blocks from the site of the former slave prison in the Shockoe Bottom area of Richmond. Perhaps I’ll include a reading of this section of my book. And not keep silent anymore…

The Pebble in My Shoe

IMG_1805“I write about what most fascinates me right now,” said John McPhee, by way of Robert Michael Pyle, both amazing trail-blazers, or perhaps trackers, of that strange beast that is creative nonfiction. McPhee has written books on subjects such as oranges, the island of his Scottish ancestors, family doctors, college basketball players, the shad as Founding Father fish, and the history of the birch-bark canoe (my personal favorite). Pyle, who is also a biologist, a lepidopterist (butterfly expert), and founder of the Xerces Society for invertebrate ecology (saving our butterflies and bees), has written about butterflies and trees and Big Foot and life. My favorite contemporary female trackers of, or perhaps more fittingly, expanders of the boundaries of creative nonfiction are Terry Tempest Williams and Rebecca Solnit. When Women Were Birds: Fifty-Four Variations on Voice (New York: Farrar, Straus, and Giroux, 2012) by Williams and A Book of Migrations (London: Verso, 211) by Solnit remain two of my all-time favorite books.

Each of these great writers of creative nonfiction sweep us along on explorations of their own current fascinations, obsessions, questions–the pebbles in their shoes, as one of my writing mentors, Stephanie Kallos puts it so aptly. What is it that you carry with you, that at each step insistently reminds you of its existence? The pebble of obsession doesn’t have to be a large rock-sized, inscribed with the muse-whisperer one as shown in the photo here (my historian son made that for me a few years ago–coolest present ever!). But is should be of sufficient significance to be likely to matter to other people besides yourself.

My pebble, my obsession, is and has been for many decades now, the wicked problem of homelessness. I call it a wicked problem, not so much because it is evil or immoral (which I happen to think it is), but because it is so vastly complex a problem that it defies easy solution. Hence, all the well-meaning but expensive and time-consuming ’10 Year Plans to End Homelessness’ implemented (much more than 10 years ago now) in so many U.S. cities, and that largely failed. The term ‘wicked problem’ was coined by two UC Berkeley professors of urban planning, Horst W.J. Rittel and Melvin M. Webber, to describe difficult social policy issues such as poverty, crime, and homelessness. (Read their still surprisingly relevant journal article “Dilemmas in a General Theory of Planning” Policy Sciences (4), 1973, pp. 155-169.)

Rittel and Webber write, “As distinguished from problems in the natural sciences, which are definable and separable and may have solutions that are findable, the problems of governmental planning–and especially those of social or policy planning–are ill-defined; and they rely upon elusive political judgment for resolution. (Not ‘solution.’ Social problems are never solved. At best they are only re-solved–over and over again.)” (p. 160)

But who would we be, as individuals, as a society, if we didn’t even try? That is the core question, the obsession, the pebble in my shoe.