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.
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.
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.
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.
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.
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.