The life of Reverend Dr. Christopher Patrick Bounds doesn’t fit in a blog; it hardly fit into Memphis! He and the Bounds brothers once opened for the Temptations on Beale Street and he knew the labyrinth under those streets working with public works department. And, oh my, did he do public work as the soul of the “Memphis Model.” He and Dr. Bobby Baker built a meshwork of trust in a city with almost none, certainly none that crossed over the broken boundary zone between the powers, principalities and structures of faith that kept dreaming of mercy and justice decades after Martin preached his last sermon down the street at Mason Temple.
I knew only a shred of this great life. Technically, he worked for me as a chaplain at Methodist LeBonheur Healthcare, but I was never confused about who knew what to do and why. He and the Reverend Dr. Bobby Baker once took me to breakfast after the Congregational Health Network was rising up from the delta mud; they told me I needed to hire more white people to balance the risk of the work being dismissed and targeted as just Black: “surely you can find some!” Chris lent his considerable store of trust to CHN, Methodist Healthcare and me. He once took me to preach at the Historic First Baptist Church of Millington (the white people named their later thing First Baptist, too). The congregation had come for church and found me in the pulpit; they were skeptical based on a few centuries of history. Chris explained in his introduction that I talked softly and, frankly a bit oddly about the leading causes of life; but it was worth leaning in and listening.
Dr. Bounds was never surprised by the ugly claws of injustice. He closed the door of my office and told me that while he knew I was a liberal and did not have room for Satan in my cosmology, I was dangerously exposed without some way to understand that chaos fights back when justice and mercy begin to rise up. It did and does.
He was the lead chaplain at University Hospital which put him inside rooms where justice could be carefully titrated and found inconvenient amid the pressures of big time healthcare business. He spoke in clear language that ripped the veil when quality wonks spoke of gross disparities as “opportunities.” We found, somewhat surprisingly, that our data showed equal treatment inside the ER; but that Black men died on the way at shocking rates. And the hospital had trouble keeping track of the ones that survived. Chris said these were his brothers and that they were dead.
It is hard to live with such clear vision and a heart of mercy. He was one of the few Black preachers to preach white funerals, including one for a recovering alcoholic chaplain. Their love for each other was a beacon fire in a dark land.
He spoke life in places that only spoke death. He preached leading causes of life in a funeral that released a family full of repressed anger and grief. The deacons and lawyers had to protect him. He warned me that these leading causes of life were a lot more powerful than they look.
TC and I got married in South Africa but with a blessing of the marriage on Mud Island in Memphis. Chris did the prayer which went on for quite some time. Several minutes into the prayer we realized he had wandered off into supplications for the Affordable Care Act, which somehow seemed appropriate given the many tribes attending. Pastoral love and politics were never far apart in the eyes of Dr. Bounds.
When I think of—dare I say brother—Chris, I can think of many times he spoke the urgency of justice. But I can only remember him with a smile and gentle eyes that did not give up on anyone. We knew when his love Bren passed last year, that Chris would not have much more use for this world. He passed at 10:30 Monday morning in the residential hospice he helped build, surrounded by many whose lives were dignified by his.
Jimmy Carter is not dead quite yet. Counting him out was almost never a good idea whether he was running for an improbable office (every one he ever held) or an improbable health goal (guinea worm, polio, smoking or handgun violence). Or embracing improbable relationships—the Allman Brothers Band so key to the first steps of his race for President, Charles Taylor, the Liberian Pariah President or North Korean Pariah President, Kim Jong-un. Carter was able to live across improbable boundaries because he was comfortable with his own complexities and complicities; he knows he is human like all of the 8,018,082,868 of us. And he is clear-eyed about his own death, which most of us ignore until the last final shock.
Carter was always misread as being somewhat simplistic and moralistic. In fact, he worked through his own complexities to still choose to act, speak and do what he thought right. He was not surprised that his relationships sometimes made that harder; he was a loyal to people who made his life more complicated than a more ruthless man would have (thinking of a few bankers and entrepreneurs who clung to him like barnacles). A religious man with eclectic curiosity, he often confounded Baptist Christians who feared the grey areas (most of life). And he confounded secular friends who loved the grey so much they found it odd that a man could choose commitment and follow through. Not satisfied with a simplistic stab at polio, he did the hard work decade after decade after decade. Never satisfied with pontificating in a hotel ball room, he took African presidents to left-behind places in their own countries they had never seen. And then he went back again and again. He knew the complicated reasons for homelessness, but he never failed to pick up his own hammer and build one more home. He loved one woman his whole life, even though he was honest enough to almost lose an election by admitting “lust in his heart” for others. He gave the word “human” a good name.
Like many thousands, my life would be unrecognizably different had it not met his. Not long after he was involuntarily returned to civilian life from the White House, he started The Carter Center as a launching pad, more than a museum. He and Dr. Bill Foege, who had run the CDC under him, held the first global conference called Closing the Gap, even before he had a building. An engineer’s kind of conference, it asked how much of the burden of premature morality could be prevented based on what was already known. What could we actually do with what we already know? About two thirds was preventable back in the 80’s, as your grandmother would have guessed. And who needs to act? Among others, the ubiquitous faith networks who he knew tended to sit around and wait for something terrible to happen and then act surprised at the most predictable things (cancer, war, diabetes, river blindness). Could religious people grasp the vast moral chasm causes by not acting on the patterns we know cause needless suffering? He and Dr. Foege got the attention of the Robert Wood Johnson Foundation and started the Interfaith Health Program, which I ended up leading. Why me, and not some famous academic bishop? Frankly, I’m not sure, but both men had a preference for action over formal qualifications.
The first thing we did was blow up the perfectly respectable grant plan of work, which began with a big formal conference at the new Carter Center. We replaced it with two years of scrappy meetings in dumpy basements and raggedy centers all over the nation (not unlike his run for president, now that I think of it). We asked the leaders actually doing things what they would commend to him as worth replicating. And we asked where they were stumped for lack of a clear vision of what might work. The two lists were identical, of course, which meant that the big innovation was having enough humility enough to realize that somebody down the road had probably already figured out the answer we thought we had to invent. It is actually harder to adapt something as it demands even more intelligence than simply plopping down another idea from somewhere. He called this a “mundane revolution.”
Carter is known for protecting the Arctic reaches of the Alaskan wilderness. I rafted the Canning River which borders that vastness and I was grateful; what other President even knew it was there, or would spend scarce political capital to protect it? It wasn’t just big nature he loved; he never missed participating in the Audubon bird count in Plains. He personally called the American Chestnut Society to get some hybrid seedlings to plant at The Carter Center, where they are improbably growing strong. He accepted some gift of Koi from the Japanese government but refused to purify the pond so people could see them. (A Georgia pond is brown.) Life, even the mundane, is spectacular when you have eyes like his.
My very best ideas are tiny footnotes in the extraordinary legacy left by this special man. These include the “Memphis Model,” emulated by dozens of major healthcare systems all over the nation, the “religious health assets” which paved the way for the WHO into activating faith networks all over the world and, of course, Leading Causes of Life, which I spoke about the first time at a Conference in Milwaukee to which the former President sent me to in his place (imagine their disappointment!). Carter created a physical and a mental space where it seems reasonable to imagine things that had never happened and then try to do them. And then keep trying, maybe even for 98 years.
After decades of one unbearably oafish Christian after another desecrating the very idea of faith, he quietly gave his life as a long gift to his church and all people of faith: an example of sacred dignity and integrity. Not that the oafs understood. When he was gracious enough to invite evangelical leaders to the White House, more than one publicly prayed that he would become a better Christian. However, when my secular friends think that anyone who tries to believe is foolish, I could always say, “No, I mean people like Jimmy Carter.” They had to nod.
He had little patience with superficial piety. Once he had all of us Directors reflect on whether Newt Gingrich had any good ideas in his “Contract with America.” I choked and noted this was not likely to go down well with the faith people who actually do the work on the streets. He snapped that the churches rarely break a sweat, while the government at least knows where all the poor live.
In the very first article for the Interfaith Health Program he wrote, “We must make the choices that lead toward life.” And who is accountable for those choices? Not just improbable Presidents, but hundreds of thousands of improbable grown-ups doing the right thing when people notice and when they don’t.
This is true, even unto the very end of their days, when the right thing means releasing into the love of one’s family, instead of the normal vain and fruitless medicalized struggle against death. James Carter was proud, but never vain, often overlooked, but few lives bore so much fruit. I hope he lingers in hospice to savor the deep joy of a life well lived.
It can all fall apart, this democracy thing. It’s not like gravity that makes rocks fall, even if you don’t believe in it. Democracy only lives in the mind and spirit and evaporates when we forget it. The belief that people can elect people who care enough to more or less do what they said they’d try to do rests on a fragile set of behaviors and values. For instance, that elected ones won’t lie and laugh at the same time. Basic stuff; it’s a low bar but one we have dropped below.
I was on a Delta flight to Denver Wednesday on my way to a meeting of the Stakeholder Health Advisory Council. Trapped in a middle seat between two suits who immediately turned the inflight video monitor on Fox News inches from my face. The guy on my left opened up a vast laptop with a powerpoint about the 10 things you need to know about illegal immigrants, including the “fact” that 79% of food stamps go to illegals. I’m pretty sure that in North Carolina half of food stamps go to Baptists, because half of everybody is a Baptist. I didn’t know how to begin the conversation, so I just turned on CNN. I’ll do better next time.
How do we craft a working democracy again; one where we can talk to each other? In a nation where hardly any of us came from here, you wouldn’t think that would be that hard. We are all a muddle, all some kind of mutt. My last name is Norwegian, but 15/16th is something else. Nobody is the same, even those that think we are. All the Evangelicals and Catholics turn out to have abortions and divorces at nearly the exact rates as the liberals, who are presumed to not be Evangelical or Catholic, even though many are. We are all just doing the best we can to be decent parents, brothers, sisters and citizens, the whole time we know we are not doing a very great job of any of those roles.
In such a motley group, it is important to avoid letting someone else tell you who to be afraid of. This is especially important when by any rational basis you have never actually met one of the fearsome people. I’m thinking, of course, of the many Muslim physicians without whom our hospitals named Baptist would have to close. And the many, kind family-oriented Spanish-speaking men and women who have found refuge in our city, rebuilding the south side of town with an entrepreneurial earnestness. Why be afraid of them? I’m more afraid of the people trying to make me afraid.
Of course, others want me to be afraid of white small town Baptists, who did, admittedly, vote for our current White House occupant, which I find mystifying. In my actual experience, these folks are kind and generous to any request for mercy, willing to drop anything to go build a wheel-chair ramp for a total stranger. The rural churches are naïve about the ecumenical nature of opioids addiction, alcoholism or poverty. If I needed food, I’d head to a church, confident they’d help no matter how inconvenient.
Here in gentle Winston-Salem, we had some very ugly, but predictable, outbreaks of threats against the two Muslim Mosques where our doctors worship. We don’t know who did it; but I’m sure they’ve never met a Muslim. I’m certain that, if we asked the Baptist Men’s groups to turn off Fox News and head over to provide protection, they’d do it. If they brought their wives, everyone would quickly find pull out grandchild pictures and complain about the teenagers. The kids would play soccer together as they do at school.
Sometimes, all it takes is an invitation to do better. Many of those claimed as friends of the mean have simply not been invited by to do anything else than put a dumb red hat. Shame on us for not asking more.
Jerry Winslow is the chair of the Stakeholder Health Advisory Council. He and I were together a couple of weeks ago at Loma Linda University Health’s institute for Health Policy and Leadership. Amid the heavy policy discussion we found some time to turn a gorgeous piece of maple burl and reclaim a piece of chestnut bowl I had managed to turn a hole in the bottom of. Jerry, the son of a German immigrant home builder, has been a master craftsman of wood for decades.
On Saturday Jerry took me over to the 1909 Gamble House, the epitome of “craftsman” architecture in Pasadena. It is a revelation in simplicity. Every single joint, lamp, door, handle, light, stair tread and attic beam was thought about and then crafted to express a perfect blend of form and function. The two architect brothers, Greene and Greene, were part of a vibrant global movement that saw in craftsmanship the hope for democracy, the possibility of a human culture. This was no small thing to believe amid the turn of the raw and violent century where industrial bigots had their way nearly unfettered. Something as modest as a well-crafted cottage might seem hopelessly irrelevant against the unstoppable tide of crass exploitation. But not if that cottage, or chair, or perfectly made lamp is an expression of integrity, consistent with a whole way of relationship to other people and the created order. What if such people outnumbers the mean crass ones? What if they—we—crafted a democracy?
In fact, the craftsman movement was a strong signal about what mattered most, a thoughtfulness about how to live a well and worthy life. Frank Loyd Wright (a man of no small number of peccadillos) said of the movement: “Do not think that simplistic means something like the side of a barn, but something with a graceful sense of beauty in its utility from which discord and all that is meaningless has been eliminated. Do not imagine that repose means taking it easy for the safe forest, but rather because it is perfectly adjusted in relationship to the whole, in absolute poise, leaving nothing but a quiet satisfaction with its sense of completeness.” (Architecture and Machine, 1894).
It is time to craft democracy again with the same thoughtful attention to form and function as our earlier teachers lent to working with wood and home. Some of the old tools work fine, if sharpened again. Jerry still uses tools he acquired decades ago, now sharpened to a fraction of their original length. I just bought some 100-year old Sears Craftsman tools on EBay for $25. Old tools still work: Precinct 601 met in the Single Brothers House of Old Salem where democracy has been argued for a couple centuries. We elected a new party precinct chair, Kate Hayden, who looks for all the world like Bernie’s granddaughter, but knows the craft of elections. First job is to get to know each other, have a party for the party, read some books and talk like humans who are capable of caring and thinking about what matters.
I have some very modern carbide tools, too. Likewise, we need to craft to the relational technologies like twitter that are too powerful to leave to the mean and desperate. This is how I think of 100 Million Healthier Lives, the unprecedented collaboration led by Dr. Soma Stout of the Institute for Healthcare Improvement. The craftsman movement has something of the same challenge to figure out what to do with industrial machines; but democracy is played for much higher stakes than any lathe. Respect the medium; watch the density and grain if on a lathe; watch the pattern of need if crafting public policy. If you don’t love the wood or the people, go do something else.
When there was much to fear in a culture gone to mere machinery, the craftsman movement trusted thoughtfulness and beauty from integrity and the life well-lived. These democratic and communitarian values stayed alive in the culture expressing themselves later in the practical compassion of the Civilian Conservation Corps (which turned Jerry’s German immigrant father into a craftsman), Social Security, the policies favoring religious hospitals and non-profit health insurance. They crafted institutions that removed abject fear of penury from aging and made it possible to fight a skirmish, if not war, on poverty itself. Think of it as graceful joinery the Greene brothers would have liked.
Democracy can all fall apart; But it can also heal and find its heartbeat. I think that is what is happening.
The meanest bully by the beach that we find so shocking today is nothing compared to the raw and untethered industrial power a hundred years ago. We have seen worse bluster fail before well-crafted policies and institutions built by people no smarter than us who wanted their life to simply be good.
They even left some tools behind that just need to be sharpened, put to the grain by hands willing to learn. Find your party precinct meeting, show up and get ready for the next cycle of voting. Make an appointment with your congressman just to tell them what you care about. Take your state representative out for lunch with a couple friends. Volunteer for a church mission committee and go find somebody to help. Plant a couple hundred trees like my brother did at his Presbyterian Church along with some Muslims up the block. Go read a book to a kid. This is how you craft a community, a culture, a life.
You can no longer watch championship basketball in North Carolina because of a political train wreck involving sex, bathrooms and religion. In spite of some of those same politics, this is a great place to watch something more important, a championship enrollment campaign. This may sound as exciting as an hour of Dean Smith’s four corners offense (ask someone from the ACC, if that doesn’t instantly make your eyes glaze). If so, you’re not one of the 613,000 North Carolina citizens who signed up for coverage under the Affordable Care Act last year, the vast majority receiving significant financial help to do so. Only four states have seen more people sign up, all with much greater population. This is an improbable success against all odds in an impossibly hostile arena.
But that was last season. Another season of enrollment kicks off in November, which you may have noticed is hyper-polarized and almost numb with clanging public din. So it was a good time for faithful people to gather at Fountain Baptist Church (“where God’s blessings never stop flowing) to pray and preach and study so that we are ready when enrollment opens up in November. Basketball is a complicated game, especially when strong tall people are determined to stop you from scoring. That’s nothing compared to helping someone buy insurance : Bronze, silver or gold? From who? With what money? Oh, I might get a subsidy? How much? When? From who? Why? It all makes my stomach hurt. Once someone screws up the courage—or desperation—to ask for help and actually gets in front of a trusted person, the conversation usually takes a bit less than an hour. But who to trust and how to find them? That takes a campaign. Simple steps done at exactly the right time in the right way–six hundred thousand times.
Teams that win aren’t perfect. They are carried beyond themselves to give everything for something greater than themselves. Even teenage boys bouncing a rubber ball can sense when the Spirit is present, moving and alive. That’s why we were at The Fountain. We need blessings to flow in a desert. We saw it flow last year 613,000 times. Could it flow again? It depends on why.
Johanthan Haidt, author of The Righteous Mind, says that we humans are born with six kinds of moral intuition. There are so many decisions to make that it would be impossible for any of us to rationally think our way through to the right thing even in the course of a normal Fall day. The human race would never have made it out of the caves into large groups of organized social life, if we had only reason to work with. We don’t. We come with six intuitions which Haidt says operate as quickly as does our ability to recognize a face (even if we can’t remember the name). There’s a lot to recognizing a face and at least six kinds of things involved in recognizing the right thing to do. Haidt thinks we recognize and instantly weigh any moral choice as to whether it is fair and caring, but also whether it resonates with liberty, authority, loyalty and sanctity. The first five are social, relational—human—but frankly, also found by Jane Goodall among the gorillas. This last one rises and raises to another level. The one that makes us truly human is called sanctity. Can organized public action be Right with a capital “R”? That’s what you’d be looking at last week at The Fountain.
Basketball prayers work better on behalf of tall fast people. But if you’re playing for high human stakes in which victory depends on trusted teams in Wilkes County or Lumberton, you’d better be praying on behalf of more traditionally shaped men of Spirit like Leland Kerr and Dean Carter. Rev. Paul Anderson is a wee bit short to be picked for a basketball team, but you sure want him on your team, if you’re trying for a movement. And you’d better be praying for the women of Spirit like Anita Holmes, Willona Stallings, Angela Cameron, Dianne Horton and Charlotte Leach. Give them the ball and your prayers are half answered because they’ve been formed in the Spirit for decades.
While the championship coaches at Enroll America told us the game plan for the enrollment campaign, I sat thinking about my small offering. I’m usually asked to give game plan type speeches, but this time I was asked to close with “why.” I thought this would be a good time to speak to Haidt’s “sanctity.” I had been reading about another improbable story told with hilarious detail in the book of Acts. This early Christian story—like the early stories of most movements of the Spirit—is one surprise after another involving one unqualified person after another. The heroes are in and out of jail because of all kinds of behavior wildly disrespectful of the dominant order. The story of Spirit rings most of the bells of Haidt’s five obvious moral values. everybody in the Empire then and since knew the Jesus movement embodied practical care (#1), especially for the most vulnerable, such as the widows. This was fair (#2) but only in the radical new perspective of God’s presence (hence also clicking off Haidt’s values of loyalty and authority. The story is all about the new freedom (click off #5, “liberty”). This did not from the human campaign design, but from the deep sense this was the unplannable inbreaking of God. It was a witness of something sacred: #6.
You see in Acts that the Spirit can move ahead of the understanding of the people involved. In chapter 12, Peter was once again in jail because of his long public sermons. Just make sure, he was sleeping in between two armed guards with another at the locked door. An angel lit up the room, but still had to nudge him awake, tell him to get up, put on his robe and then sandals and follow him outside. Peter did so. And then comes the punch line: “He didn’t realize the angel had actually done all these things; he thought he was having a vision!” Holy crap! So he walked down the street to where the Christians were busy praying for him and knocked on the door. Second punch line: the woman who came to the door recognized his voice and was so overcome by joy that she ran to tell everyone. She forgot to let him in. When the Spirit moves the ones most surprised are often those who think they’re praying for it. The Spirit isn’t something we use, it is the thing using us.
The law that resulted in the loss of good basketball in the state was cleverly designed to ring the sanctity bell of North Carolina religious voters, most of whom have never met a transgendered person. But they somehow sensed it was just out of kilter with everything else they knew of sanctity. There are things (not many) above basketball. I do know some trans people and so have more moral intuitions to work with, including loyalty to them. But I can understand why many of my Baptist friends are willing to watch basketball on TV instead of giving in to arguments that ignore their sense of divine order. An intuition about sanctity comes from and is reinforced by one’s experience.
An important clue to those who wish to use sanctity like a blunt club for their political purposes: if it is of God the campaign will likely resonate with the other five values, too, as you can see in Acts. When the Spirit breaks in, compassion breaks out, new loyalties form in light of new understanding of authority. New experiences happen, even to Peter.
More than six hundred thousand people in this nutty state managed to enroll in insurance. That’s not a vision; it happened to everyone’s surprise. But hundreds of thousands more are still knocking. This is not the moment to celebrate answered prayers, but to go open the door for those still outside.
Many of the heroes of Acts would today look a lot more like Mr Trump’s supporters than my medical center colleagues. This is true, except for the fact that the Spirit of the Living God didn’t make them angry, scared and mean; it transformed them into a community known two millennium later for its boundarylessness hospitality and mercy. That’s what liberated sanctity looks like. It’s not just raw energy; it is energy formed into a body that does what God would do. That’s what makes the work sacred and what makes sacred moral. This is why the humble, almost pedantic work of an insurance enrollment campaign is sacred labor.
Early in Acts the scale of constant compassion needed to be organized, so new roles were invented called deacons. That’s one way of understanding all the detailed new roles involved in the enrollment campaign. The community in Acts needed to manage food distribution; now we need to manage getting people connected to another kind of sustenance, full inclusion in 21st century care systems. That takes insurance, so we’re inventing mundane new roles to channel the spirit so we can do another 600,000 things correctly at the right time.
Acts tells an astonishing story of hospitality and mercy that emerged through the life of a despised religious gaggle that was almost too small for the Empire to crush. Open handed mercy was its miracle. The networks present in The Fountain this week are not like that. The North Carolina Baptist Convention has 3,600 congregations, the General Baptist State Convention another 2,000, the United Methodists another 2,000, while dozens of other faith networks have hundreds. More than 1,900 clergy are registered at our one hospital in Winston-Salem to visit our patients. What if the Spirit blew through all that? What if the that massive social reality developed a sanctified moral intuition that understood that the authority of God asked not just to love mercy and walk in humility, but to do justice?
I preached at the Fountain as a Christian because I am one. But the Spirit blows where the Spirit cares to go. One of my teachers is the long and just witness of the Community Development Resource Association in South Africa, Doug Reeler. They publish the Barefoot Guides, including one built on the book by Jim Cochrane and I about mobilizing Religious Health Assets. They are way beyond smart, built to catch and be carried by the wind of the Spirit blowing in some of the toughest places on earth. You’ll find this poem by Christopher Fry on the CDRA website.
A sleep of prisoners
The human heart can go the lengths of God.
Dark and cold we may be, but this
Is no winter now. The frozen misery
Of centuries breaks, cracks, begins to move;
The thunder is the thunder of the floes,
The thaw, the flood, the upstart Spring.
Thank God our time is now when wrong
Comes up to face us till we take
The longest stride of soul men ever took.
Affairs are now soul size.
Is exploration into God.
Where are you making for? It takes
So many thousand years to wake,
But will you wake for pity’s sake!
Could the wind of the Spirit move us beyond free clinics and insurance toward the partnerships with public health and the things that make for health? Maybe we are not having a vision. Maybe we are being nudged awake.
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:
“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.”
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.
“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.
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/).
The 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!
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.
A 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.
Between Pope Francis and the nine Charleston “Saints” whose deadly witness held us just as rivited a few months ago it is obvious to all that faith is not synonymous with stupid, mean and irrelevant. They are helping us see through the stars, bars and blather to something real. If you need forgiveness, intelligence, mature compassion, it is a reasonable idea to look toward an institution where faith has been nurtured over a few centuries, or, in the Pope’s case, millennia. If something lasts longer than one lifetime, or even a season in one lifetime, it is likely that there is a tradition involved, ecology not just of one, but many institutions. The Pope, for all his evident virtues, did not invent or elect himself to the role of Pope. The very institution that has been so egregiously, yes, criminally, complicit with some of the worst imaginable abuses of power and privilege turned around, found its best possible self and—who could imagine it—found a guy to fill the role that has electrified the nuns, nones and nearly anyone with a heartbeat. The Saints of Charleston who died–and the hundreds more that lived to forgive–were not a random gaggle of what really good people, but a fellowship born and formed with those easy-to-dismiss rhythms of bible study, song and prayer that turned out to be—when tested on a horrible afternoon—to be stronger than speeding bullets.
On Wednesday a small group of experts in behavioral and population health gathered at The Carter Center (named for a Baptist deacon who knows about formation even unto the edge of death). The “we” included Ron Mandersheid and Ray Fabius, who has literally written the textbook on population health (second edition!) before most of us heard the term at all. He was with us after gaining specific permission from his mom so that he could travel on Yom Kippur, a day held sacred across not two, but four millennia and counting. Why? Because the subject was how to integrate the sacred, the Spirit, into the work of behavioral health as it is integrated into large-scale population scale programs. One of the questions alive in the room was how to accelerate and shift “health” from being all about disease and preventing toward the positive dynamic we hope for.
What does “faith” know about that, given that from the outside, the institutions of faith seem to be mostly about not doing things? What does faith know about life that could be integrated into—maybe even illuminate—population health? The answer isn’t in the tricks of faith-based behavior modification that drizzle a bit of ritual razzle-dazzle over the dreary goop that “wellness” programs use. It is about the practices, disciplines—traditions—that shape we humans over the complexities of life together on this spinning and wobbly planet. Those traditions help us adapt to unpredictability, with a huge toolbox relevant to failure, forgiveness, resilience and hope. And the traditions themselves adapt—as Pope Francis is modeling in real time brilliant humility.
While the Pope was doing his best to tend to America’s soul one Speaker at a time, the leadership of Stakeholder Health was working in Chicago, where the FaithHealth movement was born, reborn and reborn many times, with another FaithHealth infant in the birth canal as I type. Stakeholder Health is a learning group of those who are living institutional lives, trying to find the shared intelligence, courage and community needed to nurture another round of transformation. What we want to learn the most is how to find and release the deep practical nobility found in the birth story of these hundreds and hundreds of faith-inspired healthcare organizations. Stakeholder Health includes a number of institutions that are not faith governed. Some of those, like Henry Ford and Nemours, spring from the social conscious of a vastly wealthy industrialist; others like ProMedica, MultiCare or Kaiser, express another community of social imagination. But all of us know we are drawing on more than our own toolkit of techniques and clever people. And we know we are doing so for a greater purpose than ourselves. All of us have an ear for the inconvenient cries for mercy rising up from the streets and neighborhoods we were born to serve. We know—as does anyone who has ever attended a church committee—that our institutions are deeply complicit with the banal evil of every status quo. Yet, we also know they are capable of nobility and of giving the moral energy of thousands of employees and their partners a chance to express itself at a scale unimaginable by one, two or a group of individuals.
We heard about the miracles born of wrenching change—the closing of Advocate Healthcare’s Bethany Hospital—with angry wounding community protests about broken trust. Out of which came the Advocate Bethany Community Health Fund, structured for transparency and partnership, to steward a million dollars a year into carefully defined West Chicago neighborhoods to strengthen the non-profit and faith organizations closest to those tough streets. We heard the radical simplicity of CeaseFire Chicago, which blends the power of ER chaplaincy (embodied by Richard James) with the brutally won integrity of one who has lived the life of violence and its paralyzing fruits (embodied by LeVon Stone). The “golden hour” is that which follows the bullet’s impact, doing all to break the cycle of retribution. If not forgiveness, maybe grace, at least resilience. It doesn’t always work; but it is almost the only thing that does work.
And we learned from Dr. Carrie Nelson of the mammothly hopeful and excruciatingly complicated task of turning 4,500 Advocate Health physicians toward the work of health in exactly the same way that got Ray Fabius on the plane to The Carter Center. How exactly does that come to be, not just outside the walls of the hospital, but also outside the doctors’ exam rooms and maybe even on the streets in between?
We learn of each other’s best attempts, still caught and partial, filled with frustration and inertia. We become braver, not just smarter. We look at our little lives and decide to risk our reputations as professional grown-ups on things that have never yet worked before. So, all across the vast warren of Chicagoland streets, dozens of hospital are working together to coordinate their community health needs assessments, struggling with the insane arcana of cleaning and aligning data so it can be made coherent at large scale (sort of like making oil and watercolors blend in one painting!). It seems just impossible. But then it is possible, at least enough to encourage those in the heart of it to try a bit harder, to invite a few more partners (let’s paint with acrylics, too!). It isn’t smart enough, yet. But certainly wiser than anything ever before.
There are some thing that one can absorb by listening and others that only become known through the laborious process of writing. And some by the even harder process of collective writing. Stakeholder Health is working on a second “collaborative learning document” that can help us name and claim the land we are in now. We wrote the first before the Affordable Care Act had passed through the valley of shadows known as the Supreme Court. We are in a truly new place drawing hospitals over their institutional moat and public health into partnerships only dimly imagined (with hospitals????). Stakeholder Health knows that one of the greatest and most hopeful unknowns is whether and how the quiet innovations among congregations and faith networks can be woven into the fabric. Like weaving behavioral health and Spirit (surely, we can do this!), weaving congregational intelligence and energy looks obvious until one tries. Even in Memphis where it has been nearly institutionalized, it has failed to become adapted across the full spectrum of competing hospitals (or competing faith ministries!). We need to learn more and far more quickly about integrating the full spectrum the hopeful arts of faith and health. So we are writing a not-book quickly emerging from the field, ready for the field with ten (or is it 11) chapters marking our learning edges.
This is holy and profane work, the only kind we get to do on this planet. It is the only kind any humans have ever hoped to do. We think in these days of Dr. King’s hopeful counsel about the arc of history bending toward justice.
Gene Matthews, who was the General Counsel for the Centers for Disease Control ended the recent meeting of the NC Citizens for Public Health with the quote behind Dr. King’s quote. Among his genius was King’s eye for the shards of wisdom born of previous battles, this one given in 1853 by Theodore Parker to a Congress on Abolition, an earlier chapter of the work still calling us beyond disparities: “I do not pretend to understand the moral universe;
The arc is a long one, My eye reaches but a little ways; I can not calculate the curve and complete the figure by experience of sight; I can divine it by conscience.
And from what I see, I am sure it bends toward justice.
I peered through a hole in our basement wall into a cloud of sawdust where my father fed a piece of wood into the spinning blade. The sound was painfully high loud and powerful, such that I can still hear it, now almost six decades later. I was two or so and learned later the wood was pine, as was all the rest of the cabinets in the home I grew up in, crafted with a mixture of love and parsimony by Dad. The saw, made by Rockwell, eventually became mine and used for most of my adult life as I, too, ripped, spliced, joined and paneled every place I’ve landed. The saw was a primal link to Dad, but over time whined, smoked and wobbled more and more. Once, back when I was earning my living with it doing remodeling, I was moving it from a job site when it bounced out of my nearly-as-old pickup truck, breaking on the pavement. Ken Sehested, knowing my despair, found a friend to weld the key cast iron gear back together, so it lived to wobble on in my life. But eventually the damn thing could no longer hold an angle, sometimes cutting a perfect 45, but more likely 50 or, the other day, 60 degrees. This makes very ugly joinery.
Dad would have hated the crappy quality the saw made inevitable and surely would have found any link with him something of an insult. I finally had to distinguish between clinging to nostalgia and actually honoring my Dad’s woodcraft. So I went to Lowe’s, channeled his spirit, and bought a solid Kobota table saw. I’m in the last stages of a new bathroom in TC and my condo near Old Salem and now have a chance at doing the finish work in a way that the Moravians and Dad would find acceptable.
Our lives are filled with the artifacts of those in whose shoes we walk, feeling our feet slightly too small for the journey. Just before Christmas I met with the ethics committee of the medical center, which had been established by the iconic surgeon, Eben Alexander, decades ago (he’s the dad of the recently famous one who wrote about “proof of heaven.”) The committee he started is still appointed by the chief medical officer, also a surgeon. Although medicine and the health sciences are less and less about what happens inside the medical hotel called “hospital,” the focus of the ethics committee continues to be almost entirely at the surgeon’s elbow. It thinks mostly about what the doctor should do or stop doing. Our current model of bioethics is not looking at the CFO’s spreadsheet, or COO’s deployment plans, or the Board’s capital decisions voting millions to build another office in the burbs, even those decisions shape the life and death for thousands of people over time. One can imagine Dr. Alexander shouting, “I started it; you go the next step!”
Every nook and cupboard among the health field is filled with guilds, national associations (with local chapters!), honoring this and that habitual practice and committee that made some sense long ago. They all have founders and officers—and sometimes even endowments(!)—but have long lost their capacity to cut cleanly or make useful connections. They have not moved with the science that gives more and more power to the integrated strategies managing conditions over time outside the professional enclaves. We live a long time now mainly because of better food and pharma not because we get surguries frequently. So there are way more ethical implications in the price of drugs than when or whether a surgeon does a procedure. They obstruct and no longer aid the joining of good science to good intentions. We need to honor our moral legacy with a new set of intellectual tools nearly as much as I needed a new saw.
We honor those who have given us life by acting with the creative courage they showed in their time; not by doing the same things their courage demanded then, but doing what courage demands now. We grown-up humans build things out of brick and steel. And we craft habits and patterns of power that guide the flow of money and time to the new glass towers. All these artifacts look solid and lasting, but they are as blowing sand at the beach.
I am typing this at St. Helena Island, South Carolina watching another morning tide move another day’s load of sand a few feet up the shore. These are called barrier islands because they protect the vital salt marshes which the tides wash twice a day, nurturing its wildly generative life. Very little important happens on the beach; all the life stuff happens in the muck and goop where the shrimp and a zillion other things are born and nurtured before heading to sea. The sand islands protect this vitality because they constantly move and adapt dynamically to the next big storm and even the next shift in climate rising the level of the seas.
In the handful of centuries white humans have settled here, the islands have moved miles. From the top of the 132 foot high light house you can see a few miles to the waves north east where the old one once stood. This new one (1889) is built to move again. Geologists know the whole chain of islands have moved back and forth for millennia. They last because they are dynamic; they serve life because they change. They are like tools built for a season of good craft.
Those of us holding positions of influence in institutions like to think our work and our organizations are the key to the life of our communities. Smart people at Stanford play to this pretense by suggesting adaptive change is dependent on “collective impact” organized by “anchor institutions.” These ideas are not just wrong, but dangerously misleading. Living communities don’t need to be impacted, but nurtured; they don’t need more anchors but heart, muscle and guts that serve movement. They do need protection from the raw tides, heavy winds and bitter storms, but protection in the service of change, not protection from it.
What else does any leader have to do that protect the creative energy so that it generates life? Do we have something better to do than that. Whether we are stewards of a church or hospital or public health agency or community health center, the life does not come from the edges, but the heart. I learned in Memphis that if I could protect the creative space for those who usually don’t have much power, they would craft beautiful and useful structure perfectly joined to the possibilities the neighborhoods needed. That process is the “Memphis Model” not the specific apparatus that emerged at that point in time. Don’t confuse the craft (mercy and care) for the cabinet (the structure) and certainly not the wobbly saw (me).
Leaders give life a chance by protecting the generative spaces in which life emerges, especially when those spaces need the complex processes over time. Any human community is way more complex than any salt marsh.
This is almost exactly the opposite of the role big institutions want to play. The leaders of the big things like hospitals can always rent consultants who are happy to tell us to tell the neighborhoods how they should live and how they should change, not us. The model for this is the old way that beach engineers tried to build concrete barriers to stop the tides and the natural shift of the sand (sort of like the one now under 40 feet of water a quarter mile from shore). The more we think like anchors, the more we’re in the way of life, which will most certainly have its way with us.
This is why I find surprising hope in the small stirring of faith and faithfulness in the faith-inspired healthcare systems of Stakeholder Health. Just about the time when you think smart and cynical are the same thing, along comes life to surprise us. In reality sometimes, large institutions such as foundations and hospitals can provide some shelter amid the raw power of the market forces (the “hurricane” in my extended metaphor). We can be barrier islands against the forces of raw money power, preserving the neighborhoods’ function as the salt marsh where life flourishes and creates the next generation. It actually does happen sometimes. It could happen more.
Francis Rivers Meza, one of our faculty in the FaithHealth Division, shared an article by Patricia Fernández-Kelly (2012): “Rethinking the deserving body: altruism, markets, and political action in health care provision,” in the journal Ethnic and Racial Studies. (click here for the article). She explores the way that religious organizations, including the huge ones such as hospitals, sometimes choose to act against the logic of the capital markets, providing crucial buffering for neighborhoods of poor and often stigmatized people. And they do this on purpose with craft and skill year after year. The authors cite one of our stakeholder health friends, Baptist Healthcare of South Florida and their long term work in Homestead Florida, a place that knows all about the need for barriers against storms.
Life finds a way, Jonas Salk liked to say. Jason McLennan, writing in Yes! Magazine this month says, “If there is one thing that’s certain, it’s that the future hasn’t happened yet.” Bingo! Honor both past and future by helping life finding its next way, not by protecting our old way.
Jefferson, the pompless patriot, would have approved.
Thanks to the Daily Beast and my brother Ron who forwarded their article, I learned that exactly 1,003 steps from my home near the Square in Salem, the Moravians had created the very first July 4th celebration in 1783. The war had ended allowing the busy little pacifist outpost on the American wilderness to go back to creating a peaceful Christian village. This afternoon they did it again with their hallmark quiet dignity, prayer and brass–the musical kind, not the kind that Jefferson hated. (Read the terrific article here: http://www.thedailybeast.com/articles/2014/07/04/the-first-americans-to-observe-the-4th-were-moravian-pacifists.html )
The Moravians, Jefferson and all of us citizens since are a curiously flawed and frayed, yet bold and hopeful, experiment. We’ve had better and worse moments. The failures have always and still do involve ones Jefferson knew well—race, global entanglements and religion that lived out its dumb and mean side rather than grace and hope.
The Moravians knew them, too, compromising on all of them at some point. Yet here they are 231 years later still trying with old prayers and renewed hopes.
This week marks my second July in Winston-Salem after seven in Memphis and many more in Atlanta. I am at home with humble prayers, flawed movements and compromised leaders who are still trying to do the right thing despite it all. I am divorced and remarried, with all the good people involved bruised yet healing and sometimes joyful. I have new work colleagues, too, some still reeling from my arrival, but mostly forming into a smart, tough and bold team.
The reason I came—to help a very good academic medical center with a great heart find its way toward fulfillment of its mission of healing the community…sort of like happened in Memphis. Since I came the medical center has had its two worst financial years since its founding in 1920. But it has not blinked or paused to take some radical moves beyond its walls. This reflects the deep commitment of Dr. McConnell, the Board of Directors and many faith leaders who have followed Ray Howell at First Baptist of Lexington, the first signer of the FaithHealthNC covenant.
Tomorrow morning some of our physicians who model the integration of faith and health will hold a free clinic at the Mosque a mile to the south of Salem Square. Their Mosque is right in the middle of one of the census tracts the hospital knows because of the high concentration of charity care—and all the predictable conditions of poverty and exclusion. There are no medical care facilities for thousands of people–a clinical wilderness as profound as when the Moravians came to town a couple centuries before. The Muslim physicians will pray for the healing of the neighborhood and also for the end of wars far beyond.
God, who hates religious pomp unconnected from practical compassion, is probably trying to answer both prayers, looking all the time for flawed and frayed people to have enough faith to keep trying.
Fred Smith is a Harvard-SMU-Emory PhD and United Methodist preacher. He grew up tough in Oakland playing football. When he and I were walking around Jack London Square Thursday night after a nerve-fraying couple of days, we went looking for some music at the jazz venue just a hundred yards from the water. Up we walked, me in REI garb and blue jean uniform and Fred dressed as Fred. We glanced at the ticket booth and saw Warren G, who we thought, without really thinking very hard, was….Kenny G. In we went, found ourselves seated way in the back looking like two poorly constumed narcs in a room of about 400 …. self-medicating socially complex consumers.
Warren and Kenny did not come from the same G family, nor do they share any musical dna. At all. Soon I realized that Warren wasn’t going to pull out Kenny’s jass flute thing. The wildly appreciative audience knew every syllable of every profane lyric and not-hard to discern hand motions with a rain of language probably not heard outside the Oakland Raiders huddle in a losing game. He couldn’t make it halfway through a sentence or musical phrase without a MFGDSht!??!??!?@#$%@@@@!!!MFGDSht kind of cadence. The audience, including the four young oriental women in the table in front of us and the two Indian couples next to us rocked and danced and shouted along. . I would show you a picture, but it just didn’t seem like a time to whip out my iphone and capture the moment.
I had the impression that Warren wasn’t really the bad ass MFGDsht dude he let on. I’m a Baptist and I know role play when I see it. The whole thing reminded me of one of those mind-numbing praise music servicesthat I witness in the small town Baptist meetings I find myself in from time to time. Warren used MFGDsht sort of like some Christians use Jesus, more as a sound to mark the beat and help everyone now they are in the right show—the one they know the words to.
We all sing songs that, as we age and gain life experience, may not be quite as authentic as they once were.
Warren is 43 years old now and probably has a couple daughters. He wants wants a new song. Being from Oakland, he thought his home town adulating fans would like to hear his newest song. They did not. That’s the main point of his new song, which is exactly why his old fans didn’t like it. It was like they turned the fire sprinklers on.
Most of us do not like it when our cultural, religious or intellectual idols sing new songs because it suggests that we may should consider singing something new, too.
The next day I went down to LA with the Association of Professional Chaplains, a more honorable group I cannot imagine. It was a KennyG kind of crowd until the dozens of newly certified chaplains received their certificates marking the end of years of their grueling and sometimes gruesome process. Board Certified Chaplains complete three years of seminary, been ordained and then begun 1,600 hours of intensive and invasive reflective practice in a hospital before going through rigorous and, again, invasive review of written and personal interviews. So at the end of the process they do not want to lie prostrate before the bishop on the cathedral stone. Nope. It is more like WarrenG,;“chaplains gone wild” as one APC organizer names it. A conga line whooping, shouting, yes even sort of dancing.
The Conga line marked an ending; where does it go next? Rev. Valerie R. Storms laid out with devastatingly clarity that the line leads away from all that has been the chaplains’ norm into a new world. Chaplains, because of the radical changes in their medical world context AND in their religious world context need a new song.
What is the kind of learning and knowing that helps us find the new tune when we can’t just pick up the beat from our elders?
We need Barney Fife research. We know about Barney because he and Andy lived in Mayberry, modeled after Mt. Airy just about 30 minutes north of Winston-Salem.
You can recognize Barney Fife data it because it offers up proof of the value of the old ways. It honors the crackling exoskeleton left hanging on the tree long after the living body of the insect has found new form and life. Barney found meaning, purpose and value by showing compliance to an extrinsic standard of behavior. He did the right thing by complying, and was scandalized when that right thing failed to be useful in real life. Hospitals need real help in finding their way to a new song, so are unimpressed and dissmisive of proof of mere compliance to their old life even when they pretend to honor it.
Anxious guilds and technology providers invest in research designed to prove their value in terms of the current business model. Of course, they do; the new business model doesn’t exist, yet. But that’s the one that actually matters most. That’s where the conga line is going.
Andy is comfortable with the complex messy pathos of humanity. He always looked for the truth and thus often found it in inconvenient places and unlikely people. Sometimes the truth didn’t make him look good, but he never blinked and made the choices that helped people do the next right thing. In technical research terms, Andy did “formative evaluation” which is designed to evaluate as the process lives, not after its finished and done. It fits what Tom Peters (via Tom Peterson) calls the “permament beta” we live in. The more fluid the situation and creative the process the more you need Andy and the less you need Barney.
Our work in North Carolina is about adapting the long legacy of faith and health to a new place and time. We know we are singing a new song and we are tuning all of our tools and techniques to it. We are using a wide array of learning tools and methods to give us as much short-cycle feedback as possible. We are stopping to look carefully at each cohort of a hundred patients we are seeing in our various lines of work; dialysis, Supporters of Health, FaithHealthNC in Lexington. We are beginning the always surprising process of participatory mapping of community health assets using the African model (now on its 7th iteration). We are doing deep data dives into the full patient populations from 2012 using two radically different analytical models. We are driving and walking the neighborhoods where we know our most vulnerable patients live. We are talking one-on-one to dozens of clergy and the care teams in their congregations. We are allowing all this to form us, not prove us.
The Chawumba event in Winston-Salem July 25-28 is a time for us to find an authentic song for our work and time. We want one that can disrupt our complicity to the old world so far from our hopes. Who knows what song will find voice?
(If you want to be part of Chawumba, it’s not to late to register. Go to StakeholderHealth.org. Or email email@example.com)