Cooling

Gloves colour-on-bwThe Ethiopian government says that 23 million citizens planted 350 million trees Friday, which would be better than the 220 million a province in India got in the ground earlier in the week. The Ethiopians plan to have 4 billion trees planted by October. This is a good start to the trillion we need (https://www.trilliontreecampaign.org/ ). You probably didn’t notice this planet-saving activity amid another week of grim and silly American behavior.

The next two decades may well write the story of the next million years. The story could be an autopsy about our tragically missing survival gene. Jonas Salk wrote an optimistic book called, “Survival of the Wisest” in which he argued that our species can adapt at the cultural planetary level precisely because we are not hard-wired for any one set of environmental circumstances. We are not doomed by our genes to repeat the ugly Cro-Magnon versus Neanderthal racial conflicts. We can eclipse one season’s best ideas (bronze clubs) with another’s more appropriate one (the United Nations). Mr. Trump does not tweet because of his genes; and we need not respond to him because of ours. Granted Dr. Salk did not imagine Mr. Trump. But he was familiar with World War Two, sickle cell on the Mississippi Delta, numerous pogroms and our dalliance with nuclear Armageddon. He still thought we could be wise. Not likely, but possible.

We might stupidly squabble past the time that any number of trees could prevent a planetary boil-off. Life would become impossible for all but a few hundred thousand clinging to some isolated niches. Human civilization would collapse of thirst, then hunger. Visit Mesopotamia, if you want a preview. Meanwhile the trees that got planted in the 2020’s will have kept growing. Long after civilization stops pumping carbon into the air the trees will keep sucking more out, triggering a deep chill. The few surviving the bake-off, will face a doozie of an ice-age turning our temperate blue marble into an iceball.

Fortunately, nothing will disturb the orbit of earth, which is perfect for life. So, in a few hundred thousand laps around our little star, life will try again. That future homo sapiens sapiens sapiens might have better instincts (if not quite a gene). Maybe they’ll find it impossible to steal from their grandchildren. Perhaps they will know not to pee in their own soup or that of their neighbor. They will again evolve libraries and librarians (probably not academics) to serve their instinct to understand the wondrous planet they will be grateful to live on. They may wonder about the thin layer of plastic marking our thin season in the archeological record. Maybe in one of the grand canyon caves where we find 4,000 year old grass figurines, they will find one of our plastic trail maps, full of ignored warnings. Who would ever be so foolish to need them?

Or maybe we will follow the Ethiopians and plant some seeds of compassion along with the trillion trees. If we don’t plant some compassion fast, nobody is going to be around to water the seedlings. I don’t mean shouting at the Neanderthals with tactical gear in the Wal-marts to get compassion. Of course, they’re dangerous, but mostly because they are in the way of saving the planet for both of our grandchildren—millions of them.

Stupid fear-based violence is like smallpox, once the leading cause of death planet-wide. We need to surround those spreading the disabling fear with a sea of grown-ups wise enough to de-escalate conflict and make it difficult to spread. Just like violence, smallpox is actually difficult to catch and slow to spread. Bill Foege noticed this when he was a missionary in the Biafran war and realized that if people were armed with the knowledge about smallpox, they could alert community health workers who could inoculate everyone nearby and stop the spread. Violence is like that. Surround it by its opposite. Make it hard to spread.

If the planet spins on without us, it won’t because we lacked teachers–King, Mandela and Gandhi, of course. You have dozens of people in your life to learn from, too. All the great ones annoyed their followers by teaching us to focus first on our own anger. Only then try to forgive those that threaten and then build a bridge of respectful practical kindness to another. Take care of their thirst and hunger. Over and over and over.

This is the most first and most fundamental work of public health. You can’t do public anything without a public that can talk. Read this article in the Journal of Public Health Practice by public health lawyers, no less! (Gandhi was a lawyer, too.) This is the creative capacity better than a survival gene that Salk was hoping for.

Wouldn’t you rather do this this than plant four billion trees in the rocky dust of Ethiopia? Take the temperature down a notch. Be the messenger we need. Plant a tree. Today.

 

 

 

Posted in Uncategorized | Leave a comment

The passage

Zack Stewart. Barefoot Guide Collective. Generative Leadership: Releasing Life in a Turbulent Time. https://www.barefootguide.org/barefoot-guide-6—generative-leadership.html

El Paso at 2am, last November. We reached El Paso along dusty I-10 swept by heavy winds across the southern desert. We were traveling for Stakeholder Health, curious about how life, health, mercy and justice grow in tough towns. We were a bit dazed from the wind and long miles, late night and very early morning. But also still eager to understand how the idea of Positive Deviance had taken root and produced global fruit in what seemed to be such an unlikely place. We could see the border and the low mountains beyond out the window.

The team of brilliant faculty working with Dr. Arvind Singhal of the University of Texas El Paso named the obvious opportunity as the coffee took hold: let’s look through the duel lens of Positive Deviance and Leading Causes of Life at these tough and beautiful streets on both sides of the border. et’s go back and forth across the border right here and find the life breaking through right where others only see conflict and death.El Paso has for many decades been a place where you can see that happen despite seasons of fear brewed up elsewhere to solve somebody else’s electoral problems.

Even in the impossible hours after Saturday’s spew of violence, you can already see the healing come from among the people of this special place. You’ll see that much more the months ahead as the people in his hard place find the way toward healing. Here they have long practice in finding life amid death. The very name speaks of passing over.

In a time so soon after the bullets, it seems so powerless to offer up the leading causes of life to the bloody streets? But that’s the best I’ve got. Last Sunday we released a book, Generative Leadership: Releasing Life in Turbulent Times. It’s written by people living across all sorts of boundaries, eyes wide open to the traumas and fears burning from the Tundra to South Africa.

We know there is much broken that cries out for fixing, blood flowing from wounds that need to be healed. And we know our small voices seem overwhelmed by the trumpets of the violent and those who gain from their fear. Mr Trump didn’t invent that process and isn’t even the best at it today. This poison is as American as the Thanksgiving gravy. It is amazing the violence is as low as it is and practiced by isolated and damaged people acting on their own. American history is full of much worse. Ask the Navajo. Ask the Chinese who built the railroad across Paiute and Lakota land and were then excluded for their labors. American ugly.

It is not clear that people gathering peacefully to organize, tell the truth and vote is a great plan to heal a culture on fire. But it is our best one. The voting that might heal rests on a politics the opposite of fear; practical and transparent realism focused on what works for most people, their families and neighborhoods. You have to appreciate difference, listen and speak across tribal lines. Politics works when it

Zach Stewart. Interviewed in the Warehouse.org Bog (https://www.warehouse.org.za/2019/07/24/art-faith-and-burden/)

tells the truth about life and what makes it possible.

This is the same in Dayton, Winston-Salem or Cape Town. And it is different in each place, tuned to local possibilities. This is what we saw happening from coast to coast on our Road Trip. It isn’t being force bed down. It is rising up.

In November, we’ll be driving another lap of our See2See Road trip, this one in the land the First People called the Inland Sea. Up from Winston to Huntington, Pittsburgh, Cleveland, Dayton, Indianapolis, Nashville, Knoxville, Asheville–cities built by on Native American land by immigrants who now fear others.

I work in a job in a healthcare organization and mostly run with folks who do the same, some in hospitals others in public health. We have oddly unhelpful language to talk about the deep and powerful forces driving the health of our communities. In these times it is striking how shallow words like “population health” and “social determinants” are. They feel like shreds of tinsel on last year’s Christmas tree. We need much more powerful ideas to guide our work.

Bobby Milstien is on to something with his focus on “vital conditions,” as is Tyler Norris and Soma Stout‘s hard labor at crafting wellness indicators strong enough for long term policy development. This is the driver beneath our long work on Leading Causes of Life. None of this would stop one particular killer in Walmart or Dayton. Someone else is simmering even as I type.

The practical labor needed to turn around and go another way–together–doesn’t come from just fixing this or that obvious problem. Life doesn’t work because it stops bad things, but because it generates new ways out of old ways. It out-generates the conditions that would otherwise close down all the possibilities but death. Life is the thing that finds a way. You can see this most clearly in the very toughest places where the violent and their anger seem so powerful.

Our new book on Generative Leadership was mostly written by people old enough to be cynical—but aren’t. The oldest soul among us was Zach Stewart, the illustrator who is just graduating from high school in Cape Town. Before our book, he completed his senior project by illustrating a bible with the characters normally left out (the illustrations on this blog). His language is as sharp as a surgical laser, interviewed in the Warehouse blog

“The theologies that create and justify injustice and empire are not strong. They don’t hold up when they’re bent against the reality of humanity and the longing for real good news. They are weak theologies applied forcefully. Perhaps inhuman theologies.

“Originally I was gonna draw the faces of the oppressors in the Bible. That would have been a different project that would be powerful in its own way. Honestly I got bored at the idea of drawing a lot of white men. However, in the process I began to work with the idea that the Bible is more a home for the oppressed than the oppressors. That is hope.”

In times of fear and violence we must help each other think more clearly. Together. That’s what well do next April 16-18 in El Paso for our UnConference. We’re be there next month to plan it, visit the Walmart as well as the neighborhoods on both sides of the border where life is finding a way. There will have been other tragedies in other towns simmering with other unhealed traumas by then, much less next April. Let me know, if you want to be part of this.

Today, we think of our friends and colleagues cleaning the blood off the sidewalks, tending to the wounded, burying the dead, consoling the families. Do not hurry past the sorrow.

But tomorrow we must make the choices that lead to life.

Posted in Uncategorized | Leave a comment

Clear cut

IMG_3479

Mural in Southside Pittsburgh, PA

Rockwell, Pennsylvania is right where you’d cross the “t” in Trump. Like other small towns along the abandoned rails between Pittsburgh and Cumberland, Maryland, the town was rich in the past, now mostly broke. One of the few heartbeats is found in the least expected place, the Great Allegheny Passage bike trail, which carries thousands of spandex-clad bikers, including no small number of liberals, Europeans and rolling pods of Californians. We crossed the American Legion parking lot from the trail to our BnB. An 8 foot trump flag waved across the street as we parked our bikes.

The Casselman and Youghiogheny rivers—and new trail—tunnel through cool green hardwood now as dense as when young Washington walked the wild way. Here was the first push of desperate English through the mountains and tribes to the vast American interior.  Over the next twenty decades the streams ran fast in blood, sweat and more blood, shed in a hundred native and immigrant dialects.

IMG_3503Canals and rails bludgeoned their way across impossibly rugged terrain burning money and lives, most immigrant. The hills were covered in fuel wood and were covering fuel of the most potent kind–coal. Long before there were any laws, the mines went deep, some cooked nearby into the coke needed for steel, millions of tons shipped overseas. The Dar Mine disaster  killed 239 Slovak immigrant miners (none compensated) just a few yards from where my carbon bike spun past. This trail rides the roadbed of the Western Maryland Railroad, which my dad took care of for my first quarter century of life. I wish I knew what he knew about these valleys.

Today most of these towns resonate with Mr. Trump’s angry rants about people who come to work hard while speaking new languages. I know why he’s doing it. It works and always has. But I don’t understand why people who know so much about how the rich use the workers, like kindling for their bonfires of vanities, would listen. They do.  People have gotten elected here–and everywhere–since at least the time of George Washington by blaming one’s problems on the next group that looks like they’re coming for their supper, land, women or coal. Those who carve a living from beaver, lumber, coal or whatever get confused about who to blame when that way fails, as every way eventually does.

The tribes were in the way of British and French land claims given to royal supplicants to pay off war favors. The rails served Rockefeller and Gould dreams of a transcontinental trail to hurry coal to Pittsburgh and the steel overseas. The surviving Slovak descendants  knocking down beer in the American Legion have way more in common with the Hispanics coming with the same relentless desire to work of their grandfathers. Why would they believe a dude renting luxury hotel rooms to Russians who has never been inside of a mine or hung Sheetrock? But he’s got them fearing each other, instead of joining to change the rules of what is very surely not a game.

trail falls

Milepost 43, just outside Rockwell.

Things change fast here. These rivers of steel, blood and coal are now a tunnel of green with more birdsong than steam. The tunnel called Big Savage opened up the rails to coal country; now it’s topped by spinning wind generators. Along the Allegheny every single tree, even the tallest, has grown from seeds left in the frenzied clear cutting. The rally rants are just social clear cut. Burn the whole culture down to the ground in order to burn out the new ones. Ugly. But social clear cut can grow back too. Generative social forms–democracy, normal churches and non profit helping organizations–explode into every possible niche, just as naturally as the oak and bird cover the land.

The world needs people who are not afraid of the future and not afraid of each other. And they get there not just by watching on some screen. Faith works like a drill at a coal face. It chips away down deep and finds the vein worth bringing to the surface where it can lend power to what comes next. Or maybe it is where the fingers touch the bruised soil, clearing the way for the roots of a newly planted tiny oak to have a chance.

//Let me ask you to do something right now. Got to this website to give money to The Shalom Project. Growing in the social clear-cut, it helps the undocumented and left-behind in the most immediate and practical ways possible: Give here.

Posted in Uncategorized | Leave a comment

Bridges

mile 99

Only 99 miles to go to Cumberland! Greg at Cycle Your City bikes did an amazing job setting up my TCX for the 42,624 pedal strokes. 

About four months ago I was rocking and jolting along Amtrak rails from Chicago to New York. We were passing over the Alleghenies when I noticed an article in the Amtrak magazine about the conversion of the railroad on the other side of the river into the Great Allegheny Passage bike trail. I was shocked to realize that the railroad that had been converted was the very railroad that my father had worked on while I was growing up—The Western Maryland. He was not the kind of railroad man that drove the train or drove spikes with a 6-pound to drive spikes. He didn’t even design the bridges and the tunnels. He took care of the bridges and tunnels that other people had had the privilege to design, the structures that now carried bicycles up and over the great mountains.

So last Saturday, I found myself in downtown Pittsburgh standing next to my city bicycle loaded with camping gear ready to ride through the abandoned steel mills, past all the coal mines, then up and over the Great Allegheny Passage trail 148 miles to Cumberland—about 42,624 pedal stokes. It seemed like more.

I thought I would find my father’s name somewhere along that railroad, but I did not. About 20,000 pedal strokes up the grade I realized that he was better than famous; he was a grown-up. Grown-ups take care of things that someone else designed, someone else built, that carry someone else’s name.

salisbury now

Salisbury Viaduct stretches high over the Casselman River. Once the key to the “fast freight route” of the Western Maryland Railroad, now a bridge for thousands of long distance bicycles.

If you look up Western Maryland Railroad, you will almost certainly find a picture of the Salisbury Viaduct just east of Meyersvale in a very rugged part of Southern Pennsylvania. You pretty much have to come this way if you want to get from the Atlantic into the Ohio Valley. The way is obvious, but hard, unless you have a lot of dynamite. George Washington tried it as a green 21 years old officer and accidentally started the seven-year French and Indian War in the process. He was utterly humiliated by the wet rocky terrain that made movement almost impossible, especially dragging wagons and cannon and supplies for fighting the French and even worse, the Native Americans. His little army got turned into prisoners who escaped scalping only by the intervention of his French enemies. He learned by the humiliation and turned into the leader we now revere for selfless honor (and who would gag at the brazen bleating we’ll hear tomorrow in the city that wears his name).

A hundred years later the B&O railroad carved a steep and winding track over same Allegheny Indian paths, essentially following Washington down the Casselman and the Youghiogheny to Pittsburgh. Another four decades later, powered by robber baron money, the Western Maryland blasted a route on the other side of the river though a 3,000-foot tunnel through “Big Savage” mountain and even more amazing, a viaduct just as long and nearly two hundred feet above the same Casselman River that tortured Washington. They crafted an impossibly gentle grade over the mountains, never exceeding 1.5%, which let the freight run fast through baking heat and blizzards. My dad took care of those rails for a quarter century.

Dad was tall, thin, quiet and careful. Just who you’d want tending to a high bridge above a mountain river in the winter. Others in the family were more famous, especially my Uncle Lou who led part of the Normandy Invasion. Dad was stateside where the rails were deemed as critical to the war effort as rifles. You won’t see any civil engineers in the July 4th parade, but there wouldn’t be any victories to cheer, if they had not done their quiet work.

Dad taught me that if you want to see a bridge, you have to look under it. Notice how it fits the land, braces for the weight of the fast-moving heavy freight. How it anticipates all that weather and weird people can bring over time.

I hope my dad would see that my day job, like his, is all about building and sustaining structures over time. But I tend to social structures which are not made of steel, but the sinews of trust, meaning and compassion that also need to be tended diligently. We are in an era when even hospital finance people talk about “the social determinants,” as if they can be bought and bolted together.

Two days after I got off my bike I was in the pulpit of Oak Grove Missionary Baptist Church between Winston-Salem and Walkertown, not far from Walnut Cove, which is to say in between and nowhere at the same time. Pastor Graylin Carlton is one of our chaplains and friend. The church is like one of the hundreds of bridges along dad’s railroad that aren’t important enough to have fancy pictures. How do you sustain that kind of social body so that it does its intended work?

Look under the bridge, certainly not at the roof. Look at the people, not the steeple. It is the people who sustain relationships by giving themselves generously year after year after year, not so that they have their name up high and not because it softens their ride. The Spirit of the Loving God that needs those relationships so it can flow through to those who have never heard that someone loves them. It needs a social body that that someone can see will give graciously and freely without any expectation of return because God loved first. You can believe that “God so loves” only when you see that God sends somebody to be the tangible hands and feet of God’s love.

summitTwo scriptures come to mind. I love John 5 scripture because of where we normally stop reading. The guy is waiting for the waters to roil. Jesus comes up and the paralytic whines a little bit; “there’s nobody to put me in the water!” Jesus rolls his eyes. “Do you want to be healed? Well, get up and walk. Quit whining. Dude, get up and walk.” The man walks away. Normally, we stop right there.

Healing disturbs the natural drift that accepts disease and trauma as gravity. A well-maintained bridge does that, too, allowing a freight train to fly over a valley in a way that gravity would call impossible. You might think that everyone would appreciate such reversals, but people who like the way things are find healing and bridging disturbing.

On a Sabbath, Jesus is standing where he wasn’t supposed to be standing, doing what he wasn’t supposed to do, for people who weren’t valuable to anyone but God. God loves people more than the formal worship, a point made for a couple thousand years by every single prophet. But this still disturbed the Pharisees. So they came after the healer, the bridge. “Who are you to be healing?” You could put a period right there. “Who are you to be healing on Sunday morning in Walkertown?” Jesus replies in his trademark “make-my-day” kind of way: “My father works on Sunday morning, so I’m going to work on Sunday morning.”

When someone needs healing, the first thing to go is the ritual, then the calendar, and then clock till daylight is gone. Jesus’ favorite people lay claim on the heart of a loving God who did not deny his son, and sure is not going to deny healing, either. God heals 24/7, seven days a week, if, if, if God can find somebody willing to come to the Pool and ask the question, “Do you want to be healed?” God can heal if, if, if, there are those willing to be God’s hands in that moment. This is not usually a personal act of heroism. Mostly God needs some social body, tended over time, to carry the weight of the Spirit so that God’s healing can flow into the community; a social bridge.

The Pharisees knew exactly who was mocked by Jesus’ healing. So they were all the more determined to kill him. Not only did he break the Sabbath, but he claimed that his heresy reflected the healing DNA of God—who didn’t care for their self-aggrandizing anal rituals. The rest of the Gospel of John is a tale of the struggle between religious people who resisted the healers and the Jesus movement that raised up two millennia (and counting) of healers giving themselves away for the people God so loves. They killed him twenty chapters later, which you knew would happen as soon as the dude walked off with his pallet. They could kill Jesus, but not his healing, which goes on because people tend to the social body through which healing moves.

Any bridge or church, that lasts, suffers through seasons of weather and strife, better and worse management. Which brings us to Second Timothy, one of the little letters in the back of the New Testament. Paul, by the time this letter is written, is in prison waiting to be killed by the Romans. He hopes that the movement of Jesus that to which he gave his life would be sustained. Paul is writing—like an engineer giving instructions to a young engineer—about how to take care of the bridge that Paul designed but would not be there to tend.

IMG_3342

Pinkerton Tunnel, just north of Meyersvale

It’s actually better than that. The letter was not written by Paul and not to Timothy! The real author didn’t even care if his name showed up. And, in turn, he didn’t think the reader needed to have his name in lights either. That’s the point. The social structure of the faith was more important than anyone’s name. I’m disappointed that Paul wasn’t a Roman engineer or he would surely have used the bridge metaphor! And he would have said: don’t worry about your name, focus on what the bridge makes possible.  Take care of the social body so that it can carry the weight of the healing work that God has yet to accomplish. Focus on the hope for the healing that has not yet had a chance to happen.

The end of Timothy tells us much about the loving kindness that has always sustained a movement. The scholars think that woven in to the very end of the letter are some scraps that feel exactly like they were written by an elderly Paul in prison in Rome, looking at his own death right smack in the face. I love the fact that you could put at the very end of this little letter some bits of Paul that everyone would recognize as the DNA of the Church. Like his thumbprint, “Yep. This is exactly like Paul we know.”

Paul writes to young Timothy in a plaintive tone: “Do your best to come to me as soon as you can.” My favorite verse: “bring with you the cloak that I left in Carpus, and the books, especially the manuscripts.”

Feel his vulnerable humanity, the tenderness, the little bit of an edge. These testify to the bruises of life in a real movement that is sustained by heart, not steel. This is the reality of what it means to be inside a social body, of what it means to be inside a church that is capable of hurting each other even as it’s trying to do the right thing. Dad would only add that you can’t even sustain a steel bridge without heart.

Hospitals have bricks and stainless steel, but they are actually more like social bodies.

There was a time when Baptists in North Carolina thought that it would be a healing idea to build a hospital, which ended up in Winston-Salem. It does medicine with lots of machines, but also a non-medical heart where you recognize the tenderness that you see in Timothy. And you can see the practical, do-whatever-it takes even-on-a-Sunday morning Spirit that is going to heal if there’s a chance to do it; kind of spirit of Jesus that you see in John.

That’s the essence of Faith Health as it lives in Baptist Hospital, now spreading across the state. I would be remiss not to point out that long before there was a hospital called Baptist, there was a hospital on the campus of Shaw University The first four-year medical school in North Carolina was not at Wake Forest, or UNC or Duke. It was the General Baptist State Convention—the Black Baptists—that laid the bricks of a medical school at Shaw. They expressed the healing hope of the healing movement in North Carolina that had been fired and hardened by everything that slavery could do, then all the bitterness of Civil War and then by all klan terrors after the Civil War.

There’s a ugly racial history to why Shaw does not have a medical school today. But it remains a place of healing, partly through the work of Dr. John Hatch, a sacred name in the history of the Body of Christ in North Carolina. He was the first African-American professor of public health at UNC, coming to North Carolina after starting the very first community health center in the United States, on the bitter mud of the Delta where TC grew up. Dr. Hatch knew that the healing of North Carolina rested on the churches of North Carolina, not on the hospitals of North Carolina.

His name—and the hundreds whose name we do not know as well—continues in a stunning array of work that was so tightly woven into the church, that the church named it “ministry.” And it was so academically grounded that even today there are doctoral theses being written about that work. Great medicine and great ministry.

Roy and Bea Gunderson

Roy and Beatrice Gunderson at the beginning of their journey.

Dr. Hatch learned from his mother and his grandmother born in slavery; stories of resilience, intelligence and strength that arises up out of any time you have two or three praying together. These stories tell us that we do not just hope in a disembodied God, but can see God in the sustained social body that knows how to care for each other in the same practical loving ways that Jesus did standing at the Pool of Bethesda saying, “It’s Sunday morning, but pick up your pallet and walk, dude.”

That same DNA was in the spirit of Paul instructing Timothy to build and care for the structure of the church long after the Romans killed him. You can sustain a bridge of faith across the centuries, if, if, if you don’t forget to bring the coat to somebody cold.

Two thousand years after Jesus, Paul and Timothy, there remains a social body capable of this caring, recognizable by the DNA of compassion. The Spirit of the Living God continues to flow, so that we do not have to, are not mean-spirited, not hard-hearted, do not echo the venal meanness of our time. The promise of God—that we see fulfilled—is that we may not overcome the world, but neither do we have to be conformed to the mean-spirited, racist, economically driven inhumanity. That is gravity, but the bridge allows us to move above it. Jesus promised that right into the very eyes of religious power. Paul promised the same thing writing in prison, knowing he was going to be killed. God overcomes because God gives us power to build social realities above the ugliness, that reflect the loving-kindness of the suffering servant named Jesus, who saves us from gravity day by day by day. Sometimes even on a Sunday morning.

Posted in Uncategorized | 1 Comment

Citizen

Salem Lake

Springtime by Salem Lake

A revolution is breaking out where you’d least expect it: North Carolina. This one started as an accident, as many do. The McCrory administration pushed through a commitment to outsource the NC Medicaid program to managed care organizations, then caught its gender-appropriate appendages in the bathroom door and got laughed out of office the next election. Democrat Governor Cooper couldn’t reverse the policy, but his Secretary of Health Cohen got the national HHS to approve a tweaked version focused on the “social determinants” and accelerating the integration of mental health.

This is once-in-a-generation change in the relationship between the government (city, county and state), the large healthcare providers, public health, social service and the rich ecology of community organization and entities. This bets many billions of dollars on social science relying on a complex array of policy, practices and people negotiated and aligned very quickly.

All of this has to work somewhere first. So, way down in the weeds of the policy is a $650M experiment piloting the social sector integration in a few multi-county regions, one of which is likely to include the rolling hills of the Piedmont ,where FaithHealth happens to live. We’ve been meeting for a year, but last week about 140 people from the hospitals, government and social sector spent a day figuring out what this might mean. We gathered at Salem Lake, a city reservoir that earlier civic minds had created so that the citizens could drink clean water. We think the same way about helping our most vulnerable find other things as important to health.

moment_photo_6a86f46eI am amazed that the winding path of Medicaid transformation has led to this opportunity align and connect these sectors differently. And this pilot comes with enough money to do something new at scale : $2-300M to the social sector partners—not hospitals.

Two caveats give pause. First, while this should be enough cash to do something new, it is only about 20% beyond the run-rate of the social sector in these counties today. It is possible—even likely—that those millions would disappear like water into hot sand, merely filling in the current gap in funding that every social sector organization struggles with already.

Secondly, the money is still tethered to medical Medicaid. It is for members of the program who will experience “case management” for social stuff just as they do for pills. A doctor with a computer prescribes social things from a short list.

Here’s a science tip about social determinants. They are social. If they are not social, they do not determine anything. The state has identified four kinds of “healthy opportunities” to aim hundreds of millions of dollars at very narrow set of predetermined services. They will not be healthy, if the money just triggers computer-directed interventions at people with no names living on streets with no names. Social.

This bold—and noble—social experiment is taking place very early in the field of social determinants. We’ve discovered that you can put social indicators in our computers and spit out lists of things that are missing in hopes that people will cost less and do better. People are not things who just need things. We humans need, above all, to have other humans in our lives when we enter a time of dependency, on our friends, family and the kindness of strangers, such as insurance companies. Wires fool us into thinking we are doing social when we are just doing wires.

Most human phenomenon are more complicated then they seem at first touch. Our current phase of engaging “social determinants” –healthy opportunities—is rather like adolescent sexual opportunities, which are experimental and clumsy. It gets better when the relationship does.

img_2907Salem Lake is ringed by a wooded seven-mile trail because when the citizens needed water, they built a dam and let the forest grow. In early spring you can see the wounded and down trees amid the tall ones. The loam through which the rainfall moves to the lake is from oaks long past. The trees are why the lake is clean. There is another way: you can clean all the crap out of the water with machines and chemicals rather like a hospital does with ill populations. That mind would see the trees as 2×4’s standing as a poorly organized lumber-yard.

James C. Scott, writing about the German Black Forest, described this as “seeing like a state,” which are usually not smart about how living systems produce trees and healthy humans. Citizens and neighbors have to be smarter.

Nobody in the room behaved normally, beginning with Mayor Joines who was the one to guide the leadership of the pilot toward the Piedmont Triad Council of Governments where Blair Percival flipped his skills honed with senior programs toward the moms and kids of Medicaid. All three health directors were involved even though Medicaid is not theirs. Tim Gallagher, a former Deloitte consultant now working through the NC Association of Free Clinics under Randy Jordan (who is helping the free clinics understand their stake in Medicaid transformation). Jamilla Pinder opening with a personal story that turned all the professionals into humans. Hospital folks saying “we.”

The piedmont of North Carolina has been integrating medicine into social and vice versa since the Moravians came South on the great wagon road a quarter millennia ago. One of those 14 men was a physician smart and humble enough to learn herbal wisdom from the Cherokee. The Greensboro Quakers and High Point Methodists had their own way. It is now a crazy quilt of government, schools, industry with layers of immigrants finding how to blend into the old neighbors. The forest of assets mingle and dance with possibilities.

The Medicaid pilot is an invitation to think to the limits of what works and then reach beyond. It would be silly to expect one five-year pilot to heal all the wounds of poverty and race with only $200 million. It won’t do that. For one thing, the members of Medicaid don’t stay in the program very long. Four out of five “churn” in and out every year. Any one of them is a moving target. But while the individuals move, the phenomenon of poverty does not—it pretty much stays in the same, obvious, known neighborhoods. Medicaid, which is still tied paying for services to its members, can’t break the cycle of poverty, because that phenomenon is social. It happens to types of people living in neighborhoods. The current Medicaid challenges are the best our system can do at this time, but not tuned to the real drivers of cost and care.

img_2905We should be grateful for what we have to work with, but not expect this one program to do all we hope for. It doesn’t need to. Dr. Kevin Barnett, who keynoted at Salem Lake suggested that if we get the relationships right, we could unleash way more to weave with. Getting the social, governmental, health and faith systems into alignment would all by itself free up another $200 million worth through efficiencies and synergies currently trapped in our siloes. Then, we might be able to see the neighborhoods as places ripe for investment in affordable housing and economic development.

Hospitals are required to have hundreds of millions of dollars in the bank to guarantee their reliable operations. They can’t give it away with current thin margins. But Wake Baptist, Novant and Cone’s could put 2% of their required investment corpus into community-smart development corporations focused on the neighborhoods that matter most. That would put another $200M in motion—a healthy opportunity, indeed. Forward thinking banks and corporations, of which the Piedmont has many, could see the opportunity to add to the momentum with employment and training.

This is thinking like citizens, not merely professionals trapped in our disciplines and jobs. Seeing like free citizens, we can realize how much we have to work with.

img_2901I’ve had enough birthdays (and another one Saturday) to know what is likely to happen. Expensive water disappearing into hot sand. On Saturday we watched Camelot with one eye and the Mueller report with the other. The people in Raleigh who opened the possibilities of Medicaid also seem to see our neighborhoods less than potential 2×4’; more like mulch for their golf courses. But you may remember that Camelot ends with Arthur claiming victory because one young boy ran free from the cynicism to tell of a time when it was possible to do the right thing and the right people did.

I’m uploading this on Easter, which reminds me that we believe even stranger things have happened.

This is just us citizens, choosing to be more than professionals trapped in our disciplines and jobs. Seeing like free citizens, we can realize how much we have to work with.

 

Posted in Uncategorized | Leave a comment

The Stranger

john-kilzer-axOne of the things I miss most of Memphis is John Kilzer. Memphis is missing him today, too. After a life larger than life, John found a way to die yesterday in an out of state rehab center tangled one last time in the poison that was his demon since he learned drinking from his railroad father at nine.

Every Memphian has a Kilzer story. I lived there long enough to have some myself, but probably not the best ones. Elvis helped recruit him to play for the Tigers. Teenie Hodges, who played with Al Greene, taught him to play guitar in a trade for his season tickets.

I met John in his more religious phase, when we were both condemned to the weirdly long process of gaining ordination in the United Methodist Church. I was under suspicion because I was a Baptist; John because of his past drinking. We both relapsed eventually. Perhaps my greatest honors was that he told his wife Stacy that he had met his match. He had not, but I found in him the voice of the Leading Causes of Life and a guide into Memphis. A legit scholar, John read everything and walked every day with a lyrist’s mind seeing the whole spectrum, purple to orange, deep shadow and hilarity. All one.

John was the musician intellect who helped create the Life of Leaders along with Scott Morris and TC. Built on the leading causes of life, the experience was for clergy and lay leaders to help them find their place in their own life, including all that bio-medicine could illuminate. That’s about 10% of what you need, which is where the life logic picks up and that John tuned us toward. He and TC toned the experience beyond medicine toward the light of Jung, especially the part about finding a second life, continually emergent. But no happy talk; emergent is not certain. Possible, but nobody gets out alive.

Some–not all–do live before they die. John did. He let me listen to some of the raw cuts that eventually turned into his album Seven as he was finding his musical voice again. All his addictions were tangled into the musical talent that took him so high and then low. So he was feeling his way to how to sing and preach, too. It is that a musician gets better after finding Jesus. They normally turn sweet, dumb and dishonest. John was still getting better. He dropped a new album in January, Scars, which was maybe his best music since Red Blue Jeans in 88. Pull up his whole library on Spotify and savor.

I cried this morning when I listened to The Stranger, off his album Seven: “I’m not one for higher thinking, I’m not one to bend the truth. But when I was sinking, that Man made me move. Stranger, what do I owe you for lifting such a load? Pass it on, brother, to one beside the road.”

John did that until he just could not do it one more time. Nobody, not even John, can save themselves.

I’m sorry beyond all words for John’s death. But so grateful for the life, now that we can see it complete.

john-kilzer-ax

 

Posted in Uncategorized | Leave a comment

Not done

IMG_2100 2I’m a follower of Jesus, as best one can two millennia on.  Most days, it’s not very impressive as far as discipleship goes. But holidays such as Christmas are like speed-bumps that slow me down to notice what matters most and Who I’m following. The birth is a strange one, of course. It was centuries before the church managed to convert an emperor and get an official national imperial holiday declared. They scrambled, and for reasons historians are still sorting out, decided that December 25th was Jesus’ birthday. None of the gospels cared, although they literally nail his death to the calendar. Walmart and Amazon, stretching the buying season, have effectively moved the birth to Halloween. They didn’t notice the real Christian holiday the next day, when we reflect on the saints and loved ones dead, but still powerful in our lives).  A commercial buzz-kill as prophets tend to be.

The one thing we know of Jesus birth is that it scared the hell out of Herrod, who shut the government down to kill the boy-child when the wise (but politically naïve) men from the East told him about Jesus. From then until they rolled the stone over his tomb, Jesus made those whose life depended on blending state violence and complicit religion very nervous. Who fears a baby in a garage or a wandering preacher with one coat and no donkey? Turns out the God of Jesus provoked fear among those who know they’re killing children with poverty, stealing the fruits of the abundant creation for themselves.

Still does.

More than three hundred thousand babies will take their first breath on this day that we celebrate Jesus’ birth. A very large fraction of them will be just as poor as he was. What does his birth have to do with theirs? Who should be afraid and who not?

Every birth—especially Jesus’—is a sign that God hasn’t given up, is always beginning and then starting over again with a new lifespan of possibilities. These are hard times for optimists and those arguing humans can save ourselves with rationality. The pessimists have all the footnotes from governmental and global bodies. Mary had no footnotes, except God’s promise. So it is not less preposterous for Jesus to say that God will not be denied in his love for the whole people. This or that temporary big man can steal, but not keep. As the prophets hoped and Jesus embodied: “A child will be born.” And all the creative possibilities open up. All castles are of sand. No wonder Mary wept in wonder. No wonder Herod slaughtered.

We only save what and who we love. And we can only be saved by who we love. This is why any time any angels have a chance, they say, “do not be afraid.” Angels are not stupid; they watch CNN and know we have good reasons to be afraid. But they also know we need more than fear. We need love which gives us hope which gives us power to move, do, choose and act. Fear paralyzes. Love releases the imagination so we can see the possibilities. Nothing like a birth to break us open.

Tova table

Tova Coffeehouse “furthering holistic poverty solutions in Lubbock.”  And the coffee is good! We gathered with leaders working with the local Providence Health System affilliate to talk about exactly that.

A month ago TC, Jim and I walked onto the beach near Wilmington after driving 3,400 miles talking with people giving themselves to the work of life and hope. Few would described themselves in big words. They were just doing the next right thing right where they lived with people they knew. Our visit was like a thread connecting beads into a necklace worthy of a young god who loves love, justice and mercy.

Only a month before our road trip a hurricane unlike any other had stalled out over Wilmington dropped feet—not inches–of rain. We listened to the tearful witness of the chaplains of New Hanover hospital as they spoke of their time in the storm dealing with trauma too big to think about. This was not an act of god, but rather nature weirded out by human foolishness.

We only save what and who we love. And we can only be saved by who we love. This is why any time any angels have a chance, they say, “do not be afraid.” Angels are not stupid; they watch CNN and know we have good reasons to be afraid. They know we need something far more powerful than fear—we need love which gives us hope which gives us power to move, do, choose and act. Fear paralyzes and narrows, love releases the imagination so we can see the possibilities. Nothing like a birth to break us open.

three at the beach

We had started our drive amid the smoke of California fires rightly called wild. Only months before I was on the Arctic shore standing on melting ground that had been frozen for two glacial periods.  As in Wilmington, the wind off the ocean behaved without precedent. I could literally see the planet melting. Weird.

When I think of children these days, I think of two grandsons, Charlie and Asa, who will live into a wild and weird century. And I listen to the call of young Jesus to change, to turn from foolish ways, to live in a way that gives the world a chance. If you love, change.

I stood on the Wilmington beach, picked up a broken conch and decided that I would become a vegetarian. What I wanted to do was buy an electric car. As he tends to do, Jerry Winslow, poked a hole in my holiness by noting that I could have the same environmental impact for free by simply giving up meat. So for the last month, that’s what I’ve done. I have learned that almost everything we can do that would help the planet is, like going meatless, better and cheaper for us individually. Like Jesus’ call, it is not a sacrifice, but a turn toward life. This turns out to be abundant and good.

xmas davis

Linwood Davis and Martha Bassett in Davis Memorial Chapel Christmas Eve.

TC gave me a book by Paul Hawken called Drawdown, “the most comprehensive plan ever proposed to reverse global warming.” It’s actually one page after another of, “well, duh!” Why aren’t we doing this already? Solar, wind, geothermal, biomass, quit wasting stuff, up-cycle, and yes, go electric and quit with the meat. To that last point, it turns out that the big problem with cows and pigs is that they fart so much they will kill us with methane even before we die from the crap in our arteries. I do not digress here, for it underlines the point common to all the components of the plan: it is all for the good. But just have to turn around. Humans are built to do change our minds when we love someone enough to do so.

On Christmas Eve, as we have for many years, we held a service in Davis Memorial Chapel in the hospital. Martha Basset and her band sang, this year with the Dan River Girls. No sermon; just straight up scripture and songs that cut like surgical steel through disbelief. Simple: Don’t be afraid. A child is born.

Later I watched the service out of Rome which also has a nice chapel not to mention many white people in funny hats. In spite of the goofy guildedness, the same revolutionary message  rippled through the air. Multiple languages spoke to the heart with the Pope bringing the most ancient Good News.

IMG_2107God has not given up, not on any one child, not on the mean and melting planet, not on us. Not even on us.

I walked off the Wilmington beach and had a vegetarian enchilada. I was going to make a big righteous deal out of it, but it was pretty good. I haven’t missed the meat since.

Posted in Uncategorized | 1 Comment