Fever

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Martyrs Park on the bluffs of Memphis. Sculpture by Harris Sorrelle, honors those who remained in Memphis, TN during the Yellow Fever epidemic. The plaque reads: “In grateful memory of the sacrifice of the heroes and heroines of Memphis, in the 1870’s, who gave their lives serving the victims of yellow fever.”

Important things slip past amid the superficial chattering glances of our news cycle. August 13th deserves more.

Only a hundred and thirty eight years ago, Kate Bionda died of Yellow Fever in Memphis after William Warren jumped off a quarantined steamboat and ate at her restaurant. This wasn’t the first epidemic to hit the river town, which was why the city had blocked traffic coming up river from Vicksburg where the fever had broken out. By this time, a week later, 138 year ago twenty five thousand people—half the city—had fled, leaving the blacks and the poor or stubborn whites behind. Soon 200 of them were dying every day, making partners of the prostitutes and priests who stayed to care. The epidemic ended with the first frost in October after 20,000 had died, many buried in the mass graves of Elmwood Cemetery. The whites had almost no immunity, so they died fast, often tended by those of African descent whose blood had long ago acquired some protection. Half of all the doctors died trying their best with almost nothing but good intentions to work with.

At the time they didn’t even know to fear the mosquitoes—same as us with Zika. Fearing is less complex than hope; it takes more time and thought to figure out what is possible. But our first hope is makes everything else possible: we hope someone will show up. That part of the Memphis story is almost impossible to comprehend. People of faith—different faiths and races—showed up from across the nation, rushing into a pestilential horror they did not understand to give what they could to people they did not know.

The highest point in Memphis overlooking the still-flowing Mississippi is Martyrs Park, honoring those who came at the worst possible time to give their best.

People still do that. People are on the highways to flooded, mudded, Louisiana as I type.

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Kinshasa, Congo where Yellow Fever is exploding today. Even when you know about mosquitoes, you still have to remember buy the drugs.

Mosquitos still do their thing, too. Today in Kinshasa, Yellow Fever is erupting, finding the puddles and sewage neglect that it loves so much to take down those left behind. No lack of knowledge here. Shamefully, many of the early cases were missed as basic diagnostic supplies were missing, allowing the epidemic to blow up. Global politics has brought 100,000 Chinese rail workers to the Congo these days who have as little immunity as did the white Memphians. When they head home, some ill, and get bit by the Chinese mosquitoes, the Fever could explode to a scale to which Memphis would be a tiny footnote.

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The Lorraine Motel a few blocks from the Mississippi where Dr. King was assassinated while defending the sanitation workers of Memphis.

The answer to Yellow Fever in Memphis and Kinshasa was and is sanitation, sewage and clean water. Take out the trash, then bring in the scientists. Scientists in Memphis risking their lives and reputations to figure out the mosquito linkage, fighting their way through a swamp of controversy and stubbornly opinionated ignorance. Engineers invented a revolutionary system of handling water: one pipe for the sewage, one pipe for the rainwater runoff. Memphis was first on the planet with that idea. Treating the sewage before dumping it in the Mississippi came quite some time after. The man who invented the Memphis pipes died in Havana—of Yellow Fever—designing their system. Organized trash collection became nearly obsessive and turned Memphis into the nation’s cleanest city (for a while). Those sanitation workers, responsible for the very life of the city, themselves were denied a decent life until they drew another man of faith to show up amid fevered virulent racism, Dr. Martin Luther King.

Kinshasa, Baton Rouge, Milwaukee, Orlando and Dallas. Deadly fevers flourish when good people look away, walk away and don’t show up.

 

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Devone Boggan of AdvancePeace speaks to the Roundtable on Population Health Improvement about “transformational opportunities” for young men involved in gun violence.

A couple months ago a committee of people showed up in a small Lutheran church in Brooklyn to figure out what to do about community violence. The National Academies of Science Roundtable on Population Health Improvement left our marbled environs in DC to get nearer to the contagion, so that we could have a more informed grasp of what to fear and what to hope. Our fears were jangled by the massacre in Orlando only days before. But we were drawn to less dramatic violence; the daily grinding kind that made a walk to the grocery fraught with fear, the kind that nearly every young black man knows. How do we drain that swamp of appropriate fear? What can we do to make hope from being happy talk? Different things are learned in churches than academies of science, even when the subject—violence—is the same. Faith folks think about life and death a lot. A guy hung on a cross 70 feet from the microphone which stood in front of a quilt the kids in the church had made in hopes of peace. So even when you have the same world class scholars critically engaging each other’s rigorous piles of data, they think differently when they show up near the street.

You can skip CNN for a couple of hours to watch hope emerging from the fear in the roundtable’s deliberation. (Click here for the videos.) If you look closely, you’ll see some tears, which doesn’t happen very often in DC. What you’ll learn that the most important thing to do in our epidemic of violence is to show up. There is a lot more to do, but somebody has to move toward the fear. Devone Bogan brought testimony (double meaning intended) from Advance Peace in Richmond California about the most revolutionary, if obvious, idea: go talk to the one doing the shooting. It turns out that about 100 people were doing the vast portion of the killing. This wasn’t a cloud of millions of mosquitoes, but a handful of knowable people who could be sought out and talked to. Granted they were heavily armed, but they had had mothers. They were invited to city hall and offered a vision that only a human could offer; a path out of gang violence based on radical relationship. And concentrated daily engagement, coaching, social services, mentoring, stipend and exposure to bold alternatives. Radical to the extent the killers were offered a chance to fly to Robben Island to see where Mandela made the decisions in prison to give his life away to something great. Radical. It’s not that hard to find someone and shoot them dead; it takes a real human to find someone and love them to the point they change. The whole story of Richmond is astonishing, but not unique any more than volunteers driving into the floods of Louisiana is. People do this kind of thing all the time. The little church we met in had been doing that kind of thing for a century or so.

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Daniel Webster of Johns Hopkins speaks at Good Shepherd Lutheran Church in Brooklyn about the effectiveness of community based efforts.

We learned from Dr. Daniel Webster of Johns Hopkins that the most mundane things—cleaning up the neighborhood—make a huge difference to the scale and pattern of violence, just as it does with other contagions. Violence is much lower in blocks where the vacant lots have been planted in grass and gardens, especially when the people hired to do the cleaning live there. Normal people know this kind of thing already. You could carpet bomb the rough neighborhoods; but it works better to pick up the trash. Our friends at Bon Secours learned this when they asked their neighbors what they needed most to improve their health—help us pick up the trash (Baltimore Grit).

Follow your heart, but bring your brain.

Recently some of us hospital executive types were meeting to brew a plan for managing hundreds of thousands of Medicaid members in North Carolina. There are billions of dollars in motion, and we have computers, so anything seemed possible. But people with computers can lose many hundreds of millions of dollars selling naively crafted insurance policies to previously uninsured people whose lives they knew nothing about. Ask Aetna. And it’s not Obama’s fault that insurance companies had never met poor people. Is there a way to do this well?

A wise physician from Sentara has done Medicaid work for three decades. He counselled us that the challenge isn’t medical as much as it is social and emotional. It’s humans, not the microbes. The evening before we had talked about our FaithHealth ground game that is so excruciatingly mundane and practical. He got a bit carried away when he described the work of FaithHealth as a “silver bullet.” Silver bullets were once thought to be only way to kill a werewolf, but the wicked tangle of poverty and health is harder.

Memphis didn’t need a bullet. It needed plumbing. Until the Fever and the fetid water decimated the city, they didn’t realize the city sat on “the Memphis sands” which held the largest most pristine source of water in the nation. So what? You still need plumbing. In every community there is a social acquirer of people glad to help others in practical ways. So what? We need social plumbing—roles and relationship and values—to connect the compassion to those who need it.

You can’t shoot bullets at mosquitos and you sure can’t shoot bullets at Medicaid. But you can show up. You use your brain (and computers) to build patterns of relationship systematically street by street, neighborhood by neighborhood, county by county, region by region. Those relationships are the trellis on which our most relevant science grows into the lives of human communities year over year that tends toward mercy and maybe even justice. The trellis is very carefully crafted with the intelligence of those that know those streets. The Supporters of Health were former environmental workers at the hospital not unlike the heroes Dr. King gave his life for in  Memphis. The Connectors are even closer to the ground—they come from and work in the neighborhoods and networks most predictably in need one or two days a week. They show up systematically, methodically, consistently in a pattern of organized compassion.

Show up. Then ask what’s possible and follow that thread and weave it with another and then another and then do it again. That’s what works when you see that your thread is part of a pattern, and it is the pattern of hopes and fears that matters.

A hundred and thirty-eight years ago was like another world but it’s really not that long ago. My parents were married on August 13th 85 years back, closer to the days of yellow fever than to my daily work. They stayed married until dad passed nearly 23 years ago. Neither they or any of their children were without flaws, but life grew up around them year after year.

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Rev. Dr. Bobby Baker of Memphis and the Congregational Health Network.

The Martyrs of Memphis are alive in another generation of heroes who have not left the poor and wounded behind. “The Memphis Model” –the Congregational Health Network–inspires people from around the nation to travel to see the plumbing of compassion looks like when you get 600 diverse congregations working as one.

Something about a fever, yellow or the blinding rage of violence, brings out the best in us. It activates the whole body; the social body, too. Without the plumbing of well-built relationships science has nothing to grow on. Today we have lots of science but a paucity of relationships. It’s also easier to go buy some science, software and clever gizmos than it is to win the trust block by wounded block. But we can do it.

 

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Body politic, limping

Life through the bullet holes

Sprouts find their way through the bullet holes in an old refrigerator in North Georgia. Maybe life can sprout after an election, too.

Ninety or so days from now our body politic will be on the other side of the most dangerous passage since the Civil War. (Here’s an exact countdown.) I think that Mr. Trump will have found a way to abandon the process between now and then (he’ll think of it as firing democracy). I’m not interested in what he’ll do on November 9th, but very interested in everyone else in a position of public responsibility and how we play our roles in a bruised and disoriented body politic. Every elected official in every county and town, every public officer responsible for public health or law enforcement, all of us with public roles in key institutions such as hospitals, major companies, press and religious leadership face the question: how do we do public work in a broken public body?

Our social and political body will walk with a limp. We’ll have a split mind with both sides almost incomprehensible to the other; like symbiotic twins of different species unable to find any words or gestures that are not interpreted as hostile. Forty percent of our fellow-citizens resonate to Mr Trump’s views, even if they might hope for better manners. But the intransigence could continue for a long time.

This is why we need to shift our attention from the battle, to how we live together afterward. Nobody has a bigger stake in this—or is in a better position to do something useful—than those of us working health, prevention, public health, healthcare systems. In gross financial terms, we are more than a trillion dollars of the economy, with millions of people working as nurses, janitors, researchers, doctors and the whole panoply of roles across our thousands of institutions. Those of us in faithhealth are even more relevant, because we live across so many boundaries of both faith and health.

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Kathryn’s sketch of the many channels the Mississippi cut over time, always finding a way.

There is hardly any more possible diversity of faith and politics than inside one of our institutions, so we don’t have to go looking for someone who doesn’t agree with us. The nature of our work puts us in the midst of the most profound moments of hope (birth!) and shock and lament and sorrow on the human journey. We don’t just see the traumas. We can see many of them simmering in grinding poverty and the brokenness that passes from one generation to the next, the predictable implications of the insults of race, class and stigma.

As health organizations, we find ourselves right in the middle of the most contentious public policy issues. All of the third-rail issues run right through our buildings. We care for the undocumented immigrants (of course, we do) and the beaten up women, and the veterans with all the wounds that you can’t see. We know the eyes of those who can hardly recognize themselves because of addictions and dependencies. We know those surprised by vulnerabilities of age and the disconnections of the 21st century family. Those of us in public health know the streets where all these patterns live and we ache with the knowledge of how much of the suffering could be prevented or buffered.

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Sprouts find their way through the bullet holes in an old refrigerator in North Georgia. Maybe life can sprout after an election, too.

We know a lot about bruised and broken people. Now we need to focus on our role in a bruised and broken body politic. To heal that body requires a new humility in our language and a quiet tenacity in our work.

Gene Matthews, now faculty at UNC School of Public Health, spent many years as the General Counsel for the Centers for Disease Control, many of them working for Dr. Bill Foege. I also worked for Bill at The Carter Center, so when I came to North Carolina a few years Gene reached out to me. Gene introduced me to the writing of Jonathan Haidt and his recent book The Righteous Mind, which turns on very bright lights on the way to much healthier public dialogue about the things that matter most. Haidt, a professor of moral psychology, says there are six “moral intuitions” that function like taste buds for all people. Liberals (my people) tend to have a taste for caring and fairness (meaning equality) which we prefer with a touch of liberty. Conservative have a broader pallet, which includes caring and fairness (to the surprise of we liberals). Conservative have an equal taste for the virtues of liberty and also loyalty, respect for authority and “sanctity.” This last one is not just religiosity, but a sense that some things are sacred and deserve protection. Haidt argues that conservatives—and conservative political movements—have an advantage in that they can appeal to all six, while liberals aren’t even trying on three of them. This was true at least until the Democratic convention last week with all the flags, religious singing and Mr. Khan whipping out his pocket copy of the Constitution.

It’s not a perfect book. Haidt wanders off the rails in his description of religion as a kind of social Elmer’s Glue. As much as he values sanctity, he left the whole field of faith somewhat less than sacred. And he takes some odd detours to pick an argument with Kant. You can skip those parts. But don’t skip his core gift to us, which is a hugely helpful framework that helps us see and talk across our otherwise impossible divide.

Haidt argues that we humans are prewired for righteousness so deeply that we can sense these six moral flavors intuitively way before we shape logical moral arguments. This is basic to how we humans form highly complex social bodies far beyond the simple ties of blood and clan. And this is also how we can map the pattern of traumatizing bruises which mark our body politic today. And this is how we can see the need for urgent humility by which those of us in positions of influence in our complex human body can create a new pattern of deep listening and dialogue about the things that matter most. Haidt begins and ends his remarkable book by quoting Rodney King’s immortal question, “can’t we all get along?” Less quoted, but not overlooked by Haidt, was King’s follow-up counsel: “we’re all stuck here for a while, so let’s try to work it out.”

Some think our only common language is money—what things cost and who should pay. I’ve even watched churches collapse under the heavy and highly visible hand of economics squeezes the air out of otherwise adult discussion: “be realistic and act like a business.” Health organizations often succumb to this even though our daily life is filled with evidence that when life hangs in the balance, money often matters the least. What we actually have in common is not money, but the human journey of health, frailty, dependence, pain and the fear of pain, loss and the fear of loss. What we actually know is how our life is shaped by those we share it with, those who care despite all boundaries of blood and coin. This is why I think those of us in the health fields–including the massive number of community and faith partners—are in such a profoundly key role in this moment when our body politic suffers so deeply. We can understand each other because we are all on the same short and fraught journey.

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The first celebration of July 4th was held in Old Salem while George Washington was passing through. It’s reenacted every year as a service of prayer for peace.

One thing health people know is that words are not enough. Words are not even the beginning and they are hardly important at all at the end. We may need Haidt’s counsel to talk among ourselves and then again when we have the chance to explain ourselves in public. But most of the time our eloquence is quiet. We keep our doors open to anyone all day and night. Despite the fabulously expensive technology and astonishingly prolonged training of thousands of staff, every non-profit and faith health system gives away tens of millions of dollars of care every year on purpose. We are required to do so as part of public trust, but most everyone of us goes well beyond the minimum bar. This passive waiting in readiness kind of witness is part of the glue that holds society together, that defines us as a moral people at all. It is good, indeed very good. And it is not enough for this broken moment. For we know we can be proactive with our mercy; we need not wait, we know better.

The Stakeholder Health book, “Insights from the New Systems of Health,” looks like a kind of textbook based on our collaborative learning; and it is. I expect dozens of courses to use it in the next few years (TC and I will be teaching one ourselves at Wake). But more than a textbook, it is a collaborative witness that is map for healing out social body. Its 44 authors wrote about the social drivers that shape the health of people and neighborhoods. They wrote of population health as the common ground for those professing public health and those running healthcare organizations and hospitals. The book did not quite say the obvious and most profound thing. The social body itself is bruised, but resilient. The social body itself is defined by biological, psychological, social and spirit aspects, inseparable as the facets of an emerald. The social body itself cries out for the practical, on-the-streets intelligent love found in the daily walk of community health workers. The social body itself thrives when generosity is humble and smart.

This is already happening all over the nation and world everywhere I look. The wild organic sprawling testimony of 100 Million lives is hitting on all six of Haidt’s cylinders. There was not a syllable in the Stakeholder book that you could not go and see on Monday morning. We were describing, not imagining.

Even in fractured North Carolina the heart of the body politic is beating even as the political bruising continues. Every single day I see a truly astonishing level of serious collaboration quietly crossing over all the supposedly impossibly treacherous chasms. Competing hospitals share data and teach each other about how to come alongside the poor. Black, white, liberal and conservative Baptists are working together on the meanest streets–some paved, some not. Republican sheriffs and way liberal Hispanic activists are quietly helping each other keep faith with all six of Haidt’s moral intuitions. With just a little bit of humility and decency very different kinds of people find a way when the work is about real people. That’s the NC Way.

Haidt would ask us to describe our work and witness not just in the liberal flavors of care and fairness (as we usually do). We could—and thus should—embrace a more robust and compelling witness that resonates with the broader values that honor the sense of loyalty so typical of healthcare teams, the sense of respect for authority of many kinds that govern the practice of medicine and public health.

And we should claim in humility our deepest intuition that our work is sacred because we humble ourselves before the ultimate human mystery of life and death and the life of the common body that goes on beyond us all.

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Dawn over Winston-Salem. It happens every day, if not always this pretty.

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Venom and the balm

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Tuolumne River just above Glen Aulin in Yosemite

Venom will find a snake to strike. Beware the venom. But do not feed it with your fear.

These are deeply sad days to be an American. And deeply sad days to be a person claiming one of the great faith traditions which are proving to be pools of venom despite the vast and constant instruction of Gospels, Koran and Torah to protect the stranger, love mercy, do justice and walk humbly before God. The other virtues have a chance without that last one, walking humbly before God. So let’s start there.

I try to follow Jesus, but hardly break a sweat most days, usually rolling out the Bible to gift wrap something I want to do anyway. Or I use it to sharpen the edge of my complaint against someone who annoys me, anyway. This makes me pretty pretty normal, at least within the Jesus tribe. I’ll focus on my own people here not in pride, but lament, for the easy way we tame and hobble Jesus’ way over against violence, greed, satisfaction and ethnic confidence. We should take down every cross in every church in America until we have earned them again by doing something Jesus would recognize as turning around, metanoia. Until then we should simply shut up about the failings of any other faith.

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Bristlecone Pine live longer than any tree in conditions hard to believe. This one surely would have predated democracy. And probably outlast it, too, if we don’t get our act together.

Our globe has shrunken to the size of a very small pea. There are no strangers, no foreigners, nobody from a place nobody has ever heard of before. Forget the vast human tossed salad of LA and New York. There are dozens of languages spoken in the schools of Winston-Salem every day—and it is not easy for anyone to even find Winston-Salem. We don’t even have an airport! The secondary urban nodes like Atlanta, Dallas and Minneapolis have entire neighborhoods of people from every kind of culture and sub-nation on the globe. We may not know each other, but we are not strangers to each other. If only we’d open our eyes, say hi and ask about the kids.

We don’t have forever to figure out how to live on our shrinking marble. The glaciers really are melting, the seasons going all wobbly. I have two grandsons who will quite likely live long enough to ask what in the ever-loving hell I was doing back when humanity had a chance to turn toward healing of their burning planet. They will know I loved them in the simple dumb way grandfathers everywhere do. But they will also know I squandered the years in which love demanded walking humbly before the Creator of such a finely tuned, wondrously made planet with such an intriguing array of different kinds of people. What was I doing more important than protecting their future?

Two weeks ago today I was on my way down from McCabe Lake in the high Sierra following the Pacific Crest Trail through deep forest and open meadow. The Tuolumne River was in full of the ice melt from the snows we had seen high on the ridge. The evening before Kevin Barnett and I watched the last of the sun creep up the rocky caverns of Sheep Peak when we noticed a single eagle circling the lake as if to bid us eventide before heading over to his kids across the way. The cliffs looked sculpted and they were over millions of cycles around out small sun. “Magical,” we said. And then caught ourselves. This is no magic. Reality is far better. And tougher, smarter, resilient, adaptive, too.

Surely we humans can be at least as smart as a stack of rocks or feathered friend. We can do that. But we have to focus and work at it. Many in our midst are flush with rabid fear, which we dare not ignore or worse, echo. Now is the time to show up with the intelligence rooted in mercy, justice and humility.

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One of the McCabe Lakes in Yosemite, still mostly frozen in late June. Getting to this spot was not imaginary, but about 55,000 steps, many of them up.

Those are not abstractions, but rather design specifications for the bridge we must build across the yawning chasm of fear and violence. We can build across divisions with diligence and artful labor. North Carolina has added no small flood of venom to the national pool in recent months. We don’t have to travel to Orlando, Dallas, Louisiana or Minnesota (or wherever else will burst into flame before you read this) to find work to do. Here in the big hospital started by Baptists nearly 100 years ago we have every kind of person and persuasion you can think of, especially if you count the patients coming from all 100 counties in the state and doctors from nearly as many nations. We have 1,811 clergy who visit our patients (we know because we give them free parking) and they range theologically from here to way out there. They probably have 3,622 opinions about everything it is possible to disagree on. But we are all on a walk through the valley of the shadow and will certainly need another along the way. In America today that other will almost always be someone not quite like us, perhaps very, very unlike us—or at least we think by appearance. My doctor probably thinks about God differently than me, perhaps thinks of family differently, too, maybe has lived on the other side of a racial fence I hardly know exists.

So in our little domain we work consciously every single day to knit together threads of empathy and weave them into patterns of forgiveness, compassion and even kindness. That is not far from mercy, justice and humility. We do so with any and all who for their own reasons, logic and language do so, too. In our funny little town “we” includes a long serving Republican Sheriff who is former FBI– William T. Schatzman–and another elected Republican State Legislator–Donny Lambeth–who used to be CEO of our hospital. For many months a highly diverse group of people from the police, to the city DA office, to senior leaders at our competing hospital (Novant) to faith and civic leaders all across the spectrum has worked to create a very basic step for those living here who are undocumented. Nearly all of those living without documents are working, but in the shadow economy, paying taxes—usually, even social security—but with no legal status at all. They are the “strangers” the tribal venom would have us fear. And they are the strangers every single faith tradition says to protect and show kindness.

You don’t show meaningful mercy at a microphone, but in committees in which new policies and practices are hammered out. In this case, the simple idea is to give an identity document with a picture on it that establishes their identity. But somebody—a committee, actually–has to figure out how to print the picture ID with what camera. Another committee has to recruit and train the lawyers and other technical volunteers to vet the supporting documents so that the police and hospital will have confidence enough to accept them. Somebody has to find a room big enough to host the ID drive and make sure the plumbing works. Another whole raft of committees has to go to work inside the hospital so that when someone shows up at the ER, the admissions people will know what to do with the ID (we were, we think, the first hospital anywhere to figure this basic step out). Building bridges is more like plumbing than singing “we shall overcome” (although singing helps the plumbers remember the point of it all). When the horrors of Dallas woke us up this week, the committee members instinctively reached toward the members on the committee in uniform to express sorrow for their loss, too.

That’s happening with just the Hispanic strangers. We have other historic strangers, even among the people called Baptists. You may have noticed we have Black ones and White ones who have had very different experiences of being Christian in two very different Americas. In recent years the mostly white Baptists have elected an actual Black man as their President, Rev. Fred Luter. But religion is designed to change slowly and nothing moves slower than race and class. But quietly, again through about a billion hours of committee meetings, black, white and brown Baptists are finding a new grip on the tools of mercy and justice. And not just in the big cities where we tend to do this kind of thing recreationally, but in Ahoskie, Lumberton and Lexington where there is no time for anything but real work that will help real people. Most Baptists of every color are poor and quiet, not rich and loud as the TV would suggest. Our experience of finding our way among the shards of broken systems has usually been separate. But now we are blending our intelligence, sharing our learning, jointly building new systems that are finding the pathways for the poor and isolated to get practical help. The goal of what we call FaithHealthNC is not cosmic, but so practical we print it on coffee cups: right door, right time, ready to be treated and not alone. That is what mercy is. The patterns and policies that make it possible are justice. And it only happens when we drop our tribal pride and walk humbly with each other.

As we try to walk out of the dark shadow of the past weeks, do not flail about for big answers. Think small and mundane. My father, a methodist with a soft racist edge all his life said that you could tell what a man believes by what committees they show up at. I think he was wrong about pretty much everything politically (thank god he didn’t have the chance to vote for donald); but he was right about that. Go find a committee that needs you to figure out something real that would be part of a bridge for somebody to cross over.

Love mercy. And join a committee to do justice. And walk humbly, as is appropriate for all of us frail and frayed humans.

Alpine Glow - Yosemite NP

Sheep Peak, a no-big-deal mountain among many better known ones. Only 11,842 feet above a few lakes nobody much knows either. Just one measly eagle family and a timid bear. Just one hardly noticed part of a world more wondrously made than we can grasp.

 

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New systems of health

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Sometimes when you’ve been walking a long time you forget how far you’ve come and far you can see from the crest. This happens more in the folded and forested Blue Ridge than in the wide open west. But even there above the tree line where it seems you can look right around the curve of the planet, you still have to remember to look up and notice the view.

That’s what I felt when I held the new book Stakeholder Health, Insights from New Systems of Health. It is collaborative learning at its best, edited by Teresa Cutts and Jim Cochrane, two synthetic thinkers who make everyone around them smarter. They were surrounded by 44 authors who were already pretty smart, but together the voice is brave and sure.

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Dr. Teresa Cutts at the Rolling Release of the book at Chicago Theological Seminary.

In a time of fear and anxiety, Stakeholder Health writes with collective confidence that we—a very big we—are already well on the way to being new systems of health. We are certainly far enough along the way that we can see what we have to work with: a deep well of tested intellectual tools, street-smart tools for mapping community assets, clarity about the powerful integration of body, mind, spirit and social.

What is new about the new systems? Nearly everything. The new systems are marked by realizing they are systems, not just structures. And we are systems of systems interwoven in complex ways that are impossible to map neatly. But the chapter by Maris Ashe describes the tools we are finding useful in living into such complexity. The next chapter (not as smart, but not bad)(I led the writing team) describes the new ways of leading rapidly emerging in the upper reaches of hospitals today. The next, led by Dora Barilla and Eileen Barsi dives deep into the electronic connectional apparatus, which is how these sprawling systems find coherence and get work done at very large scale. Information technology (IT) is giving way to Relational Technology (RT), which changes everything.

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Kirsten Peachey, of Advocate Health Care, outlining the chapter on Integrating Care to Improve Health Outcomes: Trauma, Resillience and Mental Health

The next three chapters are a sweet suite on intellect and testimony vibrating with hopeful, practicality. Nancy Combs of Henry Ford Health led the chapter looking through the lens of community navigators and the radicalizing affect they are having turning the new systems of health inside out. Teresa Cutts (“Dr. Honey” in our home) led a global quality team laying out the extraordinary depth of logic and practice allowing up to map community assets with as much rigor as we’ve long had to map needs. This chapter by itself will change the future of “community benefit” and its tame model of Community Health Needs Assessment. The chapter on integrating trauma, resilience and mental health, led by Kirsten Peachey, will likewise radicalize the thought and practice of “integrated health.” The three chapters together are positive bombshell with energy and intelligence released because of who is in a position to act on the new synthesis. It is profoundly good news, except for the old in-bred guilds trying to hold their power.

Kevin Barnett led the team building the case for a new financial accountability; indeed, a whole new financial logic that synthesizes all of the above so that we are a whole new business—health, and at large scale. This is taken to another radical edge by Doug Easterling and Alan Smart’s chapter on philanthropy. Between the two chapters, we can for the first time see the flow of money at the level of the whole system called health. We can begin to see how the old patterns of tame complicity can be cracked open to let the money flow through to the biggest opportunities.

Jim Cochrane led the writing for the chapter that puts all this American chatter into global context and thus accountable to world class intellect and practice. So much of what is old and creaky in our systems is peculiarly American; so much of the new now emerging is global. This sets up the chapter led by Jerry Winslow – a global citizen who happens to live in California—on mission and the heart of healthy community. Every bit of the book is a call to bold mission, not because of who started them, but because of who needs them—the world that God so loves. All the science, technique and technology fit the work of mercy and justice. Let it roll down.

Even the appendices have some bright lights where you wouldn’t expect them! The first appendix lays out the learning journey of Stakeholder Health, which began in a blizzard in Memphis, turned into the Health Systems Learning Group and found our way through an extraordinary array of learning experiences. I don’t think any of us realized how many steps we had take to the get to the the view (hence the mountain metaphor above). Appendix two is a rich collection of population health screening tools, sure to help many hospitals—and no small number of graduate students. The last appendix has numerous mission and vision statements new guiding hospitals and religious bodies in the field.

The book is in a “rolling release” in Chicago, Winston-Salem and next Tuesday in Oakland. Each bounce gives voice and visibility to the local authors and engages the networks most relevant to the local institutions. You can track it all, of course, on the stakeholderhealth.org website.

Most of the authors work for one or another of the new systems of health, so there is optimism but no happy talk. Most of the new systems are surprised to learn they are new because all of us spend the vast majority of our working days engaged in very old problems. Even when you are near the clearing at the summit with the great view, you have to watch where you put your feat rock by rock or you’ll hurt yourself. I happen to know that is true. The caution is not the whole story, however. It is significant that those of us inside the beast(s) can see the new emerging.

The book will be available for free download chapter by the chapter on July 1, which makes it a kind of textbook likely to be integrated into courses of many disciplines. And it is also available now to purchase on Amazon for $19.95. Just click here. Today.

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Rev. Francis Rivers, the Faith Health Division’s lead  organizing an Identity card drive for the Hispanic/Latino community. Part of what is very new in our New System of Health

The cover picture was taken on a chilly morning in Winton-Salem where one of the New Systems of Health—our own little Wake Forest Baptist Health—found ourselves in the position of having done something really smart and right. We had lent our name, presence, religious voice and political weight to a program offering validated picture ID cards to hundreds of undocumented Hispanics. They were part of the new system of how our city works and who mattered. They honored us by trusting us enough to show up. We were helping each other find our way into the future we were already partly living in.

That’s why that gorgeous picture is on the cover: we are far enough along that we can learn from the journey, pause and testify that we’re on the right path.

Posted in 100 million lives, religious health assets, stakeholder health, Uncategorized, Wake Forest Baptist Health | Tagged , , , , | 1 Comment

Runaway heart

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High Mountain Cherry Burl Bowl

My daughter Lauren is about to give birth to my second grandson, which, with her sense of dramatic timing will probably happen on Mothers’ Day. This also kicks off Nurses’ Week in hospitals. My wife and my (now former) first wife are both clinical professionals and moms. Most of my staff in the FaithHealth Division are women and the men are in touch with their feminine side or they couldn’t do their work of care for the bio-psych-social-spiritual dynamics of the thousands about whom we care. For ninety years our largest partner–the NC Baptist State Convention–uses Mothers’ Day to collect an offering for our most vulnerable patients.

So I’ve been thinking about the expansive caring going on; and the unknowable, but real limits to our reach.

Last Saturday it was my turn to lead the Medical Center’s daily “safety huddle”—the mundane miracle in which every operating unit of the health system from chief medical officer to security to food services and everything in between gathers to report on whether each of us has an event, concern or need to report. Even if we don’t, we have to say so out loud to our colleagues. Usually it moves fast, but sometimes it just stops the heart. Someone reported a situation with a runaway kid who had been compelled to come to the ED by her mom, who promptly run away herself, leaving the kid in our care. Except then the kid ran away from us, too. Everyone hurt hurt. We all dealt with our sense of profound limitations even when the 14,000 hospital people were multiplied by the police and social services. I couldn’t get it out of mind, so the next morning slipped in a prayer amid all the operational chatter:

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As Jerry Winslow has noted, it takes a lot of sawdust to find the second life of a tree.

“Mother God, we pray today with thanks for the big heart and strong muscles you have given us so that we might be healers amid so many lives. Every morning we see how big a family of colleagues we have that is constantly present to do what is possible for all who come. Today we pray for all events that raise our concerns for all the needs we cannot satisfy that we cannot get out of our minds, hearts and bones. The runaway kid from yesterday with the runaway mom who left her. All the husbands without words sitting next to their wives with cancer about to leave the whole world behind. All the people who have lost their way to any hope except for the medical miracles that lie beyond us, too. Keep our hearts tender like a mother for all that love lets in. But keep it beating and open for each other and your great spirit so that we might be smart, gentle and kind for this one more day.”

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The first cut through the pith lays open the astonishing grain of the burl.

The British Medical Journal has been thinking about this, too, although in grim language of “multimorbidity:” “Across the world healthcare systems are struggling to cope with increasing demands and costs. Rising life expectancy has been accompanied by an explosion in the prevalence of long term conditions and multimorbidity.

“Clinicians are working within legacy systems that were developed to deal with 19th century problems—they provide specialised responses to acute illness and infection. At the same time daily practice is strongly influenced by an ever expanding array of disease centred guidelines that don’t map neatly to the realities of clinical practice, in particular the ubiquity of multimorbidity. The result is fragmented, poorly coordinated health services for those most in need—vulnerable patients with multimorbidity. Today’s healthcare professionals are faced not only with rising disease-disease, drug-drug, and disease-drug interactions in multimorbid populations but with the increasingly evident consequences of socioeconomic disadvantage.

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The rough and twisted bark hints at the pattern.

“Meanwhile, patients, their families, and their extended social networks experience not only the burden of symptoms but the burden of treatment. This is an emerging but underi-nvestigated phenomenon. It has received increasing attention recently, and interest has been growing in how to define and better understand the concept.” ( (BMJ Published 10 November 2014)

We could join the public chorus of complaint and rage about what the world is doing to us and demanding of us, as if expanded life span were a mean trick on all of us. Or we could work on what lies between us, the weak ties that could be strong, the empty spaces that could be filled with compassion and carefully tended connections. Even in our mean and stupid time, we are witnessing the dramatically hopeful emergence of webs of trust where you’d think they would be impossible—North Carolina, where you can’t even pee without the government telling you how or where. Good grief. But even here—maybe especially here, where powerful elites have told stigmatized and despised people where they could drink water and pee for generations—webs of compassion spring up on the bitter soil like desert blooms in random rain. Don’t ever be surprised by what a privileged but anxious elite will do badly. And don’t ever be surprised by the fruits of compassion, either. That’s what we are coming to call the North Carolina Way and it is big, strong and unafraid of tough neighborhoods and runaway everything.

When I hurt myself last June, I was drawn into being a partner in the healing of my own body. I have been learning in wonder how we – even me!—are made for healing. Of course we are, since we are also made to be bruised, wounded and broken. All of us, sometimes at others’ hands, but usually a mélange of our own mistakes along the random human way. (That dumb overreaching tennis decision wasn’t my only one!).  I’ve been learning to turn wood on a lathe as I healed and found myself drawn to the wonder of hardwood burls, the growth that emerges where a tree has been broken or violated with some sort of trauma. The wood in the burl has a weirdly complex grain pattern, twisty, dense and wondrous. The mysteriously beautiful grain reduces me to respectful awe as the smooth cherry takes a beeswax polish. I think, of course, of Lauren’s pain and that of every woman in my life, of every nurse in every hospital, of every broken heart that manages to stay tender to the pain of the world.

No mom I know stops at the pain. They lend their life and every fiber to what remains possible for those they love. They never cease forgiving and hoping. They teach us not to stop at lament even though so much of what we see is deeply lamentable. They teach us that compassion is the heart of prophesy, of lovingly holding up what remains possible for each person, neighborhood and peoples alive.

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The burl is what grows around the trauma experienced by the tree.

Posted in 100 million lives, Beloved Community, boundary leaders, deeply woven roots, leading causes of life, stakeholder health, Wake Forest Baptist Health | Tagged , , | Leave a comment

Mainsail

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Charlie Wolfe, among my very favorite humans. His future is not determined, especially by any of the other 7 billion.

Perhaps you’ve met a human. You have noticed that we can be hard to help. Perhaps you’ve been to a planet like Earth and noticed the same thing, except 7 billion different ways. How do you help something with 7 billion moving parts be healthier?

Advancing population health depends on understanding not just the medical problems, but the drivers of health ….at community scale …over time. Those drivers are largely social and they are not determinants because none of the 7 billion of us humans are determined. Words guide our imagination, shape our ability to talk about what to fear and what to hope for. So it is a big deal to see the 100 Million Lives Campaign “determinants” for “drivers.”

It important for every grown up in any position to influence a single life to talk about life as changeable and chooseable—but shaped by power drivers that have to be confronted.  This is especially true for the grown-ups in positions to influence the big social structures like hospitals or faith networks. Monday in Washington DC the Association of Academic Health Centers met to explore how their huge organizations can align themselves wit the leading edge understanding of the social drivers of health. This is a huge shift for them (us, as I am a VP of one….). They brought in the big voices including none other than Dr. Michael Marmot the author of the stunningly powerful studies of social position over time (The Health Gap.). And our friend Dr. Denise Koo one of the principle forces behind the new array of useful tools emerging from the CDC such as the Community Health Improvement Navigator. (http://stakeholderhealth.org/cdc-community-health-improvement-navigator/).

salamisThe closing panel of the whole conference was our “ground game” in Winston-Salem. This was explained AND embodied by Jeremy Moseley our Director of Community Engagement and Annika Archie the lead Supporter of Health, with Dr. TC laying down the data beat like a bass player in a jazz ensemble. I had two minutes at the end to set a metaphor like a sail to catch the wind of the spirit moving where you wouldn’t expect it.

The social drivers engage the role of an hospital not just as a provider of therapies, but as a social presence—usually the very largest social/political/economic structure in a community and region. This requires us to see ourselves from a community perspective: inside out and upside down. In Memphis we found ourselves in a covenant relationship with more than 600 congregations that pulled us inside out. In Winston-Salem we have followed the deeply grounded intelligence found in some of our lowest wage workers into relationships that are not just inside-out, but upside down or, better, right side up. We were steering toward life, not just away from death.

Proactive mercy is way cheaper than reactive charity. That’s the whole and complete logic of “population health management.” But if you don’t understand the humans, you can’t expect to be proactive. Being proactive depends on the intelligence about– and trust with– the neighborhoods where the costs of reactivity are concentrated. This requires not just the preeminent brilliance of our surgeons, but of all 14,000 humans on the team. Dr. McConnell and Annika Archie embodied this new deep discovery in the video interview he did with her (and me) last week (click here).

That’s what works.

It is new for big organizations to hold ourselves accountable for social factors. That has always been on the side, a by-product, an unintended consequence. Now it is central. Some say we should think of ourselves as “anchor institutions,” but that image reinforces our worst habits of domination. What could be worse than focusing on anchors of determinants? I’m depressed just typing it!

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The mainsails are the ones low and large. You leave them up so the ship can keep moving even in heavy seas.

We should be mainsail organizations.

The mainsail is the large sail on a clipper ship low and strong that you leave up even amid the heaviest weather and hardest storm. This includes the storm-tattered neighborhoods you can see outside the windows of urban medical center. You leave the mainsail up because in deep and heavy water you have to keep going or the waves will overwhelm you. The last thing you need is to drop an anchor. That’s what you see in Annika, Jeremy and TC and their hundreds of colleagues setting themselves to catch the same wind of Spirit– surgeons, nurses, social workers and revenue cycle VP’s– that share a hope and mission.

You can even hear it now from some our community partners, glad that we have finally joined them in their journey toward health. They don’t want an anchor; they want to go somewhere new.

Last Saturday our own Rev. Dr. Francis Rivers received the major award from the Hispanic League of Winston-Salem honoring him (and the FaithHealth team) for leaning way into the heavy seas of anti-immigrant venom surging currently in North Carolina in creating the ID Drive. Francis’ award honored him, but also his mainsail organization–and not just the tiny part of it called FaithHealth. The medical center put up a big sail amid very heavy seas that helped other key institutions do their critical work. The Sheriff, police, DA, a network of churches called Love Out Loud, many Hispanic organizations and Que Pasa media). And don’t forget the most important FaithAction—the small faith-based organization that does the actual work of validating identity so that an ID card can be issued and trusted.

shipA fully rigged sailing ship is a very complicated thing with many sails and miles of rigging. So, too, is any network of partners committed to helping their community move away from the rocks and into a safe harbor. But none of the partners could have stepped into the heavy wind themselves, much less alone. That role was for the mainsail and a ship built for deep water.

You might be so embarrassed by all the mean hateful things religious people are doing these days that you want to stop the metaphor right there. But you’d be leaving out the most interesting part of sailing—the wind. The sail doesn’t have any power; it only catches the wind. Greek traces the same word for wind to breath and… Spirit.

We know in North Carolina that the Spirit can blow toward or away from the rocks; it depends on the skill of the sailors and the courage of those who climb up the rigging and set the sails. These are days filled with stupid religious venom, so I don’t blame anyone who wants to move culture and institutions and society without faith. But nothing at cultural scale ever happens without Spirit blowing really hard. You can stay below decks and hope for the best. Or you can find someone who know how to set a mainsail and head to deep water. Francis, Annika, Enrique and the others on the edge, live way up in the rigging where the wind blows with raw power. They teach us to its respect power, but not to fear.

Dr. King spoke realistically when he said “the arc of history bends toward justice.” It is a slow bending curve, more tectonic than sharp. We don’t choose this way or that, but lend our days to the slow bend, helping each other keep courage for the long turning. We set our sails for heavy seas and a long arc toward a horizon worth the journey.

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Practice Resurrection

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Gustovo is in charge of the ducks at Hausbar Farms in East Austin. Don’t even think about doubting it.

Now that the Easter show is done we can get back to practicing resurrection.

Jesus death and rebirth weekend has gotten to be almost as embarrassing as his birth, this year so  banal it didn’t even affect the basketball tip-off. The public figures most likely to talk about Christ act more like Jesus’ executioner than the guy who went into and then—astonishingly—out of the tomb. You’d think Jesus went into and out of a Texas voting booth. A clue from Darrell Adams: the more a person talks about Christ, the more it has to do with power; the more they talk about following Jesus, the more it has to do with laying down your life so mercy and justice might rise up. The disciples wanted a Christ, so they holed up in a little room scheming to get out of Jerusalem before Pilot found them. And why the women knew they could go undisturbed to the tomb. The powerful don’t care about yesterday’s Christ. Let a few women tend the grave.

The surprise—even to the women—was they guy who told them they could follow—not just honor—Jesus. But “why look for life among the dead?”

Still a great question.

The only reason to even bother being disappointed in the microphone christians is that they’ve wrapped a tepid bundle of dead ideas with language designed for life. There aren’t better words than salvation, repentance, forgiveness and resurrection. They vibrate with sacred vitality. I want those words out of the tomb and back into the wild.

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Borage flowers. Humans eat them, too.

They are accurate descriptive words for what I have experienced at Oakhurst Baptist, and on the mud and flood of Memphis and in the weekly wounded gaggle of saints of Green Street UMC. Salvation is what I saw rising up in among the 600 undocumented people the south Winston-Salem parking lot fearlessly waiting for their identity cards. Resurrection is what I see happening in the lives of the Supporters of Health, who nurture life where nobody looks. Grace is what won’t quit happening in Conetoe and what keeps Richard Joyner in the fields with the kids who won’t quit. Grace is what our community partners extend to the old Baptist hospital.

Life—not death—is what drives the Fellows of the Leading Causes of Life. It drives the collaborative learning among four dozen Stakeholder Health authors. You can see in the impossibly sprawling coalition known as 100 Million Lives. The real goal is all 7 billion of us. Revelations 21 sings with the same vitality: “the leaves of the tree of life are for the healing of all the people.” Of course, they are.

Don’t look for that kind of life among the dead ideas buried under gold, guild and guile. Turn around (“repent”) and you’ll start to notice resurrection oddly right under your shoes. On Easter I visited Hausbar Farm  in east Austin with Kathryn and Fernando. It s not a Texas ranch. It is a couple of acres surrounding a former crack house. Surrounded by a chicken-wire fence is an organic miracle led by Gustavo (a very protective guard-goose ), ducks, bunnies beyond counting and a couple of waist-high burros. The improbably verdant garden supplies most of the high-end restaurants across the freeway with thyme, rhubarb and exotic ingredients (radish flowers) of all sorts of healing for the people.

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Rosa and Julian.

I thought of Wendell Berry’s Mad Farmer.”Manifesto: The Mad Farmer Liberation Front” )

“So, friends, every day do something
that won’t compute. Love the Lord.
Love the world. Work for nothing.
Take all that you have and be poor.
Love someone who does not deserve it.

….

“Say that the leaves are harvested
when they have rotted into the mold.
Call that profit. Prophesy such returns.
Put your faith in the two inches of humus
that will build under the trees
every thousand years.”

The summary instruction: “practice resurrection,”

How?

  1. Quit staring at the tomb. Turn away and seek among the living.
  2. Do not turn away from the wounded. Follow Jesus—and all who love life—to the bruised, broken, left aside and overlooked. Like seeds in soil, life tends to arise from the dark. Look under the bridges, on the wrong streets, into the eyes of those broken-hearted and poor in spirit. They will be surprised. And you will be surprised by the life you find rising up between you.
  3. Trust the Spirit that stirs in everyone still breathing. The Spirit Africans name accurately as energy; that the religious professionals mistakenly confused on Pentecost with spirits (even though it was only 9 am); Kant saw this universal human capacity for creative freedom as the possibility for liberating creativity. The future is alive and thus unknown because the Spirit moves.
  4. Don’t contain Spirit. Be like the ancient desert Jews  and Muslims afraid to even to name the sacred. Don’t grasp enough to hand it to another. Let it flow through you.
  5. And then let it flow across all the boundaries dividing us from each other and all life. Nothing is divided; all boundaries imaginary. That’s why we have to educate so hard to create them and then build them up with violence. And why they melt with one true glance. Love casts out fear, blurs all the lines.
  6. Life moves, so beware anything in your life that feels like an anchor. Hold your institution and identity lightly. Beware “anchor institutions” trying to manage living communities like Frankenstein. Don’t do that. Set your mainsail with for some pilgrims unafraid to catch the wind of the spirit of life. That wind will blow surprising and true.
  7. Move toward the generative nodes in your life and neighborhood. Trust that which generates your own complex humanity. You will find the Spirit leading you toward communities of spirit where you will find  life.
  8. Do not overlook the Baptists and the Methodists. Or those without brand. Or the Muslims and their healers giving away medicine on Saturday mornings. Or the Sikhs’ generously eclectic intellect. Or the artists who measure life in light. Or the farmers who love compost.
  9. Expect surprise.
  10. Love life. Find fear left behind as wrappings in the empty tomb. Do not look back.

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    Kathryn and a resurrection bunny.

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