faithhealthnc – Page 2 – garygunderson Blog

Improbable Lessons

This palm was planted at the Garfield Conservatory in 1926. It takes time and tending over generations to get something like this. — This palm was planted at the Garfield Park Conservatory in 1926. It takes time and tending over generations to get something like this.

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.

The Zaban Room at The Carter Center has held hundreds of creative, improbablyy hopeful meetings. This one anchored by Ray Fabious, CareNet and Ron Mandershieim on integrating Spirit into Population Health. — The Zaban Room at The Carter Center has held hundreds of creative, improbablyy hopeful meetings. This one anchored by Ray Fabius, CareNet and Ron Manderscheid on integrating Spirit into Population Health.

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.

Dr. Kimberly Dawn Wisdom of Henry Ford Health System is one of the springs of intelligence within Stakeholder Health.

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.

This is what a man looks like, paralyzed as a teen-ager now giving his life twenty years later to interrupting the cycle of violence: "don't tell me you're too tired." — Levon Stone is what a man looks like: paralyzed as a teen-ager now giving his life twenty years later to interrupting the cycle of violence: “don’t tell me you’re too tired.”

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.

Dr. Carrie Nelson and Dr. Bonnie Condon unpack the complexities of aligning thousands of physicians for the health of the community.

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.

Even naming a collaborative learning document with seventy authors is hard! Stakeholder Health will find a way.

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.

Martin Luther King as a potential student to Colgate Rochester Seminary, long before he came to know of arcs of history and mountaintops.

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.

Carolina tears

Sprouts find their way through the bullet holes in an old refrigerator in North Georgia.

Hearts break today in North Carolina.

I think of atheists as slightly over-educated modernists who are harmless, almost quaint, in their ardent non-belief. It had not occurred to me that non-believers were inclined to shoot people over parking slots. But now the Associations of Non-Believers have to explain, just as we Baptists have had to do for centuries, how their style of belief in UnGod can make one mean enough to be kill.

Of course, Atheism doesn’t make you mean any more than Islam, Christianity, Bhuddism or Hinduism. But every one of those structures of meaning have given harbor at some time to dangerous people who kindled the energy of belief into the fire of violence. Belief—and unbelief—can warm or burn.

Someone who believes in nothing is indistinguishable from one who says they believe in God but who do not believe in what that God tells them to do toward others. Groups of people, whether Islamic or Christian, can claim to follow God, but actually believe in their guns, banks, drones or grinding, blinding anger.

No French cartoonist, or student trying to park their car can be entirely safe from delusional nutters. Mental illness often hides in the fog of ardent belief and unbelief. It deserves pity, prayer and, often 21^st century pharma. Turning this man’s delusions into a reason for religious or anti-religious rant only serves the demons.

The most dangerous nutters are the ones who gain control over the instruments of state power. The mentally ill man who shot three students in Chapel Hill is not as scary to me as the elected wackos 25 miles away in Raleigh where an unhinged legislature is considering a bill to prevent Muslims from imposing Sharia Law on the good Christians of Northern Carolina. These guys have a whole police force, not just some guns in a closet. They don’t want your parking place; they want the whole enchilada.

We Baptists remember times when we were strangers in this land, too, and know to fear any government that thinks it is holy enough to know who to punish on behalf of God. The first duty of any Christian—or believer of any other faith—is to work to make their own faith safe for the world and especially for anyone who does not share your faith. You or your children might be a refugee someday, too. This is why every religion that lasted longer than a few seasons raising high the priority to care for the stranger, the weak, the poor, the widow or motherless child.

The actual followers of Islam who pay taxes here are mostly students and a previous generation of students now serving as our doctors, nurses, dentists, computer programmers and anchors of our civilized way of life. There is no clinic or hospital in the entire state (or any of the other United States) that could operate an entire week without the medical professionals from many faiths well beyond my own Christian circle. Our community strategy of “proactive mercy” depends on the powerful faith of saalam-seeking healers of Islam. So our grief extends to the families and friends of the UNC students in a double portion because we share their commitment to the healing arts their entire family so obviously embraced.

I’m a Christian, trying to follow Jesus. He said that God would sort out the right and wrong, sheep and goats later on. The twisting plot of the story made clear God’s decision would surprise everyone involved. Don’t guess God. In the meantime, love mercy, do justice and walk humbly.

Cry with us and lend us with your prayers of mercy.

City of Light

Carolos Latuff, one of hundreds of visual jounalists speaking into the horror of Paris.

Every religion is dangerous. Like fire, wind and water, religion is a fundamental element of human life that can drown, blast and burn. Religion guides our fear and frames our shame. And it can also strengthen our capacity for the courage shown in generosity, compassion, kindness and decency. It can be a wicked brew and also be like warm French cider on a bitter Winter day.

What are those of us who find our hopes in faith to do this week? What do we do when faith has been the language for nearly unspeakable acts? Do we just huddle behind the soldiers, or is there any place for our own actions to be as brave and relevant as the cartoonists like Carolos Latuff poking his pencil into the muzzle of terror?

Can mercy be brave as violence?

Although it filled up the CNN cash register this week, violence between religions is relatively rare and getting more unusual year by year. I’ve quoted the finding of Daniel Pink in earlier blogs, but worth remembering that all forms of violence continue to decline year over year over year. Most religious violence is between those who share a religion but find its variations deeply threatening.

While dozens died in Paris because of their secular differences from Islam, hundreds, probably thousands of moderate Muslims died last week because their 1,500-year-version of Islam embodied the radical hospitality, kindness and sacrificial generosity that fills up the pages of Islamic sacred writings. This is true of every religion. John Calvin burned–literally set fire and watched die–Christian theologians that it would take another theologian to figure out the minor differences in doctrine they were arguing about. He killed Christians not Muslims. I’m a liberal protestant writer who not have survived a week in Geneva. I thought about this when worshipping down the hill from Calvin’s towering grey church with an ecumenical gaggle of english-speaking Christians last July. He would have locked the doors of the World Council of Churches, torched the whole place and everyone in it….and than sung a hymn about it. And Presbyterians are relatively nice people. I’m a Baptist…….which I’m just guessing is more common among the Klan than their up-market Christian cousins.

It is always safer to have a radically different idea about god than a moderately different one using the same language. ISIS kills many more moderate Muslims more eagerly than Christians or those who believe in no god at all but humor. Every now and then they may travel to Paris for some especially flamboyant act of horror. But their every day killing is focused on the vast majority of fellow Muslims they find nearby who understand Islam as a faith of mercy and healing.

There is not much a Christian can do about radically violent Islam. But it would help to avoid accidentally strengthening the most despicable by implying they know anything about Islam. The “terrorists” aren’t radical about Islam, which is a religion of hospitality and charity; they are radical about their own projected fears, insecurities and delusions which are then wrapped in a weird and horrible way in the vocabulary of Islam. Christians know all about this process. Christian politicians are masters at wrapping their reptilian greed with Jesus’ words. But we don’t say of our nutters “those folks who blew up the Federal building in Oklahoma sure were radical about following Jesus!”

Do something to strengthen the moderate Muslims, for whom this is a special time of danger, not only from their traditional nut-cases on the far boundaries of Islam, but now from those of other faiths, including secularity, that will fear anyone they think is a Muslim no matter where they’re from (including Sikhs who stupid Americans confuse with Muslims all the time because of their turbans)(Oh, good grief…..).

TC and I took a check over to our friends at the Muslim Free Clinic on Waughtown Street that I’ve mentioned in my blog before. They were today, as they do twice every month, caring for whoever walked in from the neighborhood that needed healthcare, medical counsel or a clue about where to their pill prescription renewed. It is very mundane, as most mercy tends to be. The physicians and volunteers show up and do it because their faith has thought them to do so. They aren’t aiming for martyrdom; just happy to settle for basic grown-up integrity. They are, as a Christian philosopher once said, “grabbing the near edge of a great problem and acting at some cost to themselves.” It is all a Christian, Muslim, Jew, Sikh, Bhuddist, Zoasterian or cartoonist can hope to do with their lives.

Do this.

Soak in the TV, then turn it off and go find someone who isn’t of your tribe, class, color, faith or opinion and be kind to them in some practical way.

Do this.

And the God known by every name any human has ever uttered in hope will heal your fears and count you among the living.

Do this.

New blade

Six decades later I can still hear the screaming whine of this saw as my dad crafted cabinets with it.

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.

Now wobbling, smoking and whining, the saw prevents, not enables, good work. Dad would not be happy.

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!”

Surely dad is glad I finally put down the nostagia and picked up a decent tool for work that honors him. — Surely dad is glad I finally put down the nostalgia and picked up a decent tool for work that honors him.

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.

Twice a day the tides wash the in-between land of the marshes.

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.

Old maps tell the tale: the beaches move; the marshes live on.

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.

The scope points 8 miles away and a quarter mile off shore where the lighthouse once stood.

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.

Roots are a kind of anchor that serve for a time and then not.

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.

The lighthouse just across the inlet above the gull. Everything moves; life finds a way.

Pompless patriotism

Earl Williams led the gathering in prayer, reminding us that the first July 4th observance celebrated the end of a war, not the triumph of military. The two looking on would not have been allowed to vote, own property or be considered human, much less citizen then.

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 never miss a chance for brass music.

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.

We prayed now, as then, for peace and practical fruits of faithful virtues.

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.

The site of the very first July 4th celebration, then on the edge of the American wilderness.

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.

Warren, Kenny and Barney

Warren G is a 43-year old rapper looking for a new song. He should not be confused with Kenny G.

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.

Kenny G is a very talented jazz musician know for his mellow music. I have no idea how anyone could confuse him with Warren G.

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.

Barney Fife and Andy Taylor of Mayberry, modeled on Mt. Airy, just north of Winston-Salem, NC

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.

A hint at what might be worth knowing comes from the very latest Institute of Medicine roundtable on accelerating the movement to health and health equity. With bold humility it looks at past social movements—many religious—in seek of wisdom to guide the movement we all know we need to seize the opportunity 21^st century science and policy opens up. They are looking for a new song, indeed : ><http://click.newsletters.nas.edu/?qs=0303e74e5f82782dc8ae27ef1e77b6dcc341581cc00a5d2976e414ffa228bb3db9b9a4653daf7745>.

Reverend Dr. Fred D Smith an authentic man of Oakland. — Reverend Dr. Fred D Smith, an authentic man of Oakland.

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 7^th 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 dhall@wakehealth.edu)

Sin and Liberation

Didn’t expect that title did you? liberating structures

There is something about Good Friday coming in the same week as a day-long medical center budget meeting that turns my mind toward sin; and then, just when you least expect it, toward liberation.

Tom Peterson of Thunderheadworks turned me onto the book The Surprising Power of Liberating Structures by Henri Lipmanowicz and Keith McCandless in his brilliant blog about social change (http://www.thunderheadworks.com/liberating-structure/ ). The book is the fruit of years of work by a way smart group of social change-makers focused on making meetings and events smart and liberating. You may have noticed that most organizational meetings are not very liberating indeed, usually deadly.

Human gatherings can be powerful if built on their 10 basic principles and then artfully crafted with some of their 33 tools. It is easier and more natural than it sounds, because we are built for liberation. We use these tools in many of our FaithHealth trainings and retreats. We will use them in the Stakeholder Health Chawumba event in July (http://stakeholderhealth.org/chawumba/ ). We are looking forward to one of the masters of the craft, Arvind Singhal, being with us next month to teach us in person.

The ten principles of Liberating Structures in the book The Surprising Power of Liberating Structures by Henri Lipmanowicz and Keith McCandless.

The point of all this is not better meetings but a whole new world.

As soon as I read the principles I recognized what I experienced in Memphis through Bobby Baker, Chris Bounds and the hundreds of practical geniuses on that tough ground. The Memphis Model wasn’t just liberating meetings; it was a web of liberating relationships built over time in structures held together by trust. As Bobby would say, real work, not show.

The liberating relational structures of Memphis,–and now North Carolina–aren’t happy accidents. They are built on purpose for the purpose of setting people free from the bondage of what are usually called “social determinants” by healthcare professionals. Things like poverty and broken families are bad enough, but are especially insidious when experts believe they are so powerful that they determine lives. Left to drift, the patterns and privileges of race, wealth, education and law will replicate overtime with the predictability of gravity. However, social factors do not determine the future if a community builds liberating structures strong enough to bend Dr King’s “arc of history” toward justice. Humans can stand up on two legs and walk—even run and jump. But we have to choose to do so. And we can invest our time and resources to new relational architecture, but we have to choose to do so.

Do I even need to point out that budgets usually give in to organizational gravity? How often do you see a liberating budget? (Please don’t mention this column to anyone remotely linked with Wake Forest until after my Division budget closes in a few weeks.)

This gets us to sin, specifically the “deadly sins” of the health industry . Catherine Panter-Brick and Mark Eggerman of Yale University and Mark Tomlinson of Stellenbosch University have just published a bold piece in Global Health Action sure to generate a storm of uncomfortableness by looking at the field of global health through the lens of sin and virtue language. They are looking at global health, but every syllable pertains to the healthcare organizations in the United States that usually don’t think of ourselves as part of the world. The authors are tough: “Structurally, global health has broken faith with its core ethical mandate of addressing the root causes of poor health outcomes, falling prey to four main temptations—coveting silo gains, lusting for technical solutions, leaving broad promises largely unfulfilled, and boasting of narrow successes. These are capital sins in the sense that they engender serious misdeeds and careless misdemeanors, and necessitate a change of heart.” Sin does not get the last word, for there are cardinal virtues, too: “A sharper focus on values and dispositions—aligned with the cardinal virtues of justice, courage, prudence and restraint—is needed to transform global health action.”(http://www.globalhealthaction.net/index.php/gha/article/view/23411 )

The opposite of sin is liberation, which needs the human structures so that the waters might roll down into the parched lands as every prophet for several millennia has envisioned. Earlier this week some of our FaithHealth staff borrowed a church bus and road the tougher streets of Winston-Salem where our data indicated many of our “charity care” patients lived (those are Leland Webb’s ears). Even those of us who are strangers to these neighborhoods could see what is missing that determines so much suffering. We expected that. We were more surprised that once you get out and look, it is actually not hard to see the abundance of assets scattered in the very same neighborhoods.

The scattering of good works has not managed to achieve justice, of course. It is never wrong to give a bag of food or box of meds to someone in need. But surely, it is sinful to be proud of the narrow services that merely ameliorate suffering when so much more is possible—Panter-Brick’s uncomfortable point.

With some some humility (another virtue!) we can imagine liberating relationships that are not there, yet, but could be, if we applied art, discipline and time to bringing the possibilities to life.

Morning Star Missionary Baptist Church, a vital health asset co-led by Rev Charolette Leach, one of our CPE residents at the Medical Center. It sits only blocks from apartments considered to be the epicenter of hopelessness.

Could we imagine new structures, pathways and patterns that would amplify freedom and responsibility? Of course, we can. We just have to choose to do so.

It is impossible to think about sin and liberation this week and not notice that the whole point of Easter is that life breaks out where you least expect it; where you had given up all hope. Spoiler alert: he is alive and we are free. Why are you still satisfied poking around in the tomb among the dead?

Mapping Curiosity

These are such interesting days for hopeful people in our wildly dynamic world. Never before in the history of the species have we seen more radical emergence of vast numbers and forms of relational webs. More than two million non-governmental organizations have emerged in the last quarter century. Most of those are now morphing into a complex ecology of financial forms, mostly somewhere in between the old distinctions of faith, government, non-profit and for profit.

The technical name for our current version of we humans is homo sapiens sapiens: we are the creatures who know. And we know we know. I actually think we don’t know….much. But we are absolutely curious!

Jim tells of the curious story of the role of faith in the novel idea of "health for all." — Jim tells of the curious story of the role of faith in the novel idea of “health for all.”

Jim Cochrane leads the leading causes of life initiative. He has long argued that play should be one of the causes of life because from our first breath we poke, explore, crawl, play with our everything we can reach. Yes we do!(leadingcausesoflife.org). In recent months he has pretty much been captivated by…Emmanuel Kant because of the way he places creative freedom at the very center of human capacity.

Hope is possible because we have the capacity to think of entirely new things, and bring them to be. Almost everything nearby you this very moment is product of that creative capacity. The flat screen monitor or iPhone you are reading on which you are reading this are evidence, but indoor plumbing reflects quite a large number of creative moments, too. And there is still profound creativity going on at that end (so to speak) of human process that dwarf the iPhone for life and death significance: check out http://www.peepoople.com/ .

Because it is human, this capacity for creative freedom is social. It is rare for any of us to have a totally autonomous seminal thought of our very own. WE are creatively free, not just me or you. And the root of that social creative freedom is curiosity. When we are young it looks like play, beginning, I think with our body parts: ever watch an infant discover their toes? They are curious about them; study them and then start to figure out. Walking and the long journeys of life come quite later once we learn to talk and read.

We are curious about each others’ curiosity, which is how great creative teams thrive. My favorite new book, “The Surprising Power of Liberating Structures” (www.liberatingstructures.com) is a users guide to the social micro-structures that break and hold open the social space for us to explore what is possible in social webs. What opens up that space is not first imagination, but curiosity about what the group as a whole might discover is possible.

What you know is less interesting than that tickle just over the edge of your knowing just as the eye notices things on the periphery of clarity. The mind notices what moves, quickly ignores anything that stays the same. This isn’t always brilliant, of course. We forget things that matter and are easily distracted. The reason why we have so many rituals and reminders is precisely because we so tuned to what it not known and what might be possible. Nathan Wolfe calls that “adaptive novelty,” suggesting that humans can learn about this strategy for the billions of years virus have used that strategy.

Our most vital relationships and networks form on on a map of our curiosity. This is the terrain we walk from what we know to what we might be creatively free to do. The map of that terrain is rarely conscious, almost never on paper or even scrawled on a wall. Why not invent curiosity maps? Those would be dynamically generative and inviting.

Criterion Institute is a place of such generative mapping, which will be evident as it gathers for one of its astonishing “convergences” in Connecticut this week (http://criterioninstitute.org/convergence/). Later this week a different–but intersecting– map will emerge at the intersection of faith, peace and health at Lake Junaluska in the North Carolina mountains (www.lakejunaluska.com/peace/ ). Meanwhile, Stakeholderhealth.org vibrates with a constant flow of curious new findings about what is possible for faith and mission-driven hospitals to…..do.

Old Salem is still a place where new things might happen.

FaithHealthNC.org is a riot of things nobody thought possible that turn out to be very doable–and that we are creatively free to do. Nobody is planning all of it. We are finding ourselves living on a map of possibilities that is being drawn in real time by unlikely people asking, “what is we did ……together?” We closed the Global Health Symposium yesterday full energy because we were beginning to tune ourselves to the social network emerging from our shared hopes relationships.

Do you want a map of the future? Do you want to know what’s possible?

Map the networks of curiosity. And then live into and on that map with those you find there.

Brick Stone Seed

North Carolina clay is richer soil than you’d think. (Thanks to Tebo Cochrane for the drawing)

On the longest night of the year we humans have always wondered whether we are part of something dying or living. There is an oddly appropriate logic behind the decision of the Christian bosses to move the celebration of Jesus’ birth from the summer, when it more likely happened, over to the winter solstice where we really needed it.

We need a seed now.

It is a seed, not a brick or a stone. Hospitals and governments are good at bricks; witness any hospital or the Wall of China. Bricks are all the same size and have edges the keep them from rolling around so they stay pretty much exactly where you put them. You can stack them and build floor after floor of square rooms. Once bricks are in place they are difficult to transform when times change. People are not like bricks although I have seen some departments of “human resources” spend enormous effort trying to make them so. And then wonder why their organizations struggle with change.

Pilot Mountain is part of the Sauratown range that predated the Appalachians.

Stones are also good for things intended to stay put. Universities like stones but usually carve them up to work more like bricks. Robert Frost admired the way stone fences built of carefully chosen stones worked with gravity to make good neighbors. If you want to build with stone, you let the particularity of that one stone at a time guide you to its place in the overall structure. If you are good at it, you don’t even need mortar; gravity and thoughtfulness can hold for centuries.

God likes to build with stones. The sturdy wall on Pilot Mountain predates the Appalachians and may outlast them, too.

It helps to think of working in community as more like building with stone (and always without mortar)(no, money is not like mortar).

This acorn wants to be a North Georgia Oak tree one day.

If you want something to live and spread, you need to think more about seeds than either bricks or stones. The Jesus Movement, as Clarence Jordan called it, is a seed that surprises us fearful ones every single year (“Don’t be afraid,” the Angels had to say.) It surprises the brick-loving tyrants, too. (The cry of Mary was celebrating their surprising collapse.)

Seeds can be planted, but not made. They can be protected, nurtured, fed, watered and given space. But they are miracles of wonder built for becoming Oak, Kudzu, grain and ideas that live. Seeds last because they create generations of seeds.

Don’t make the metaphor do all the work here. What matters most in our time is to nurture the seeds of hope already alive among us. The seeds of the Congregrational Health Network in Memphis (more like Kudzu now if the New York Times story on Friday is right: http://www.nytimes.com/2013/12/20/health/tackling-a-racial-gap-in-breast-cancer-survival.html?_r=0&hp=&adxnnl=1&adxnnlx=1387548390-ULxVXPXDQ2cxZXdCXfFtHw ). That seed has blown across the mountains onto Piedmont clay, catching root and heading toward fruit fast (FaithHealthNC.org).

Tim McKinney tells Heidi Christensen of HHS about the childrenss' programs in Bithlo: "we never give up on anyone ever...." — Tim McKinney tells Heidi Christensen of HHS about the childrens’ programs in Bithlo: “we never give up on anyone ever….”

Look at the ridiculously improbable seed sprouting in Bithlo, Florida where Tim McKinney has planted himself in the literally toxic soil and finding root, too. (http://stakeholderhealth.org/transformative-partnership/case-study-bithlo/ ). Oakhurst Baptist which birthed Seeds Magazine in my youth and Green Street Methodist and Glide Street open late last night in the Tenderloin of San Francisco—all seeds many, many generations alive and thriving. Look at dozens of faith-inspired health ministries, some grown into huge institutions with a simple hope still in their heart.

These are long nights and short days, but the seeds are in the soil.

Bugs in the System

The core idea behind FaithHealth is not even smart.

It’s just not dumb.

How could there be anything dumber than a system that assumes that when people are sick, troubled and vulnerable they should be able to figure out the wild complexity of professionals and providers to get the help they need at the optimal time? In our life’s journey, every single one of us will experience times when we are dependent on the compassion of others. Some of those people may be paid, but mostly not. And some of those most trusted (family and congregation) maybe competent as well as caring, but many not.

FaithHealth focuses on weaving together a fabric of compassion that is also competent and connected to the many, many parts of the system originally designed for the noble purpose of healing and health.

This is breathtakingly… not dumb.

And it leads to breathtaking vulnerability of the most unpredictable kind because there are bugs in the system. Sometimes those bugs are metaphors for the peculiar behavior of electronic medical record systems that can humble the smartest proudest academic medical system (we know this to be true). And sometimes the bugs are the kind we hate even more—the ones with little legs.

The leading edge of FaithhealthNC is in Lexington, a tough southern town. While care teams in most churches are led by nurses, the team at First Baptist is led by Jim Tate, the former police chief of nearby High Point. Jim isn’t afraid of bugs of any kind. Recently, a community member who needed a medical test came to the attention of the church. The man had a number of mental and physical challenges, the most dramatic of which was the terrible condition of his apartment. Jim called out the men of the church, including the preacher, to do the thousand things needed to get the man to the right place at the right time ready to be treated and for sure, not alone. (FaithHealth 101). And a few bugs came along, too. Of course they did.

Who knows this better than our environmental workers who are leading us out of our antiseptic walls into the tough and troubled neighborhoods? As this issue goes to press we will be blessing the hands of the “agents of health”—the workers agreeing to accept another level of training to equip them to be our eyes, ears, hands and hearts on those tough streets where health wants to happen.

People all over the country, indeed the world, are finding their way on this new path. In April, a meeting of hospital CEOs completed an 18-month learning process in collaboration with the White House and Health and Human Services. The learnings confirmed that their faith-based and community-oriented systems could fulfill their mission even in these tough times if they learned how to move toward the socially complex patients in their communities in large-scale “weight-bearing” partnerships and, finally, committed to funding proactive mercy instead of reactive charity.

Neither faith nor health can blink or look away from complex human reality, not in one person and not at the level of the community that God so loves. We are called to the tough places and tough questions. It turns out we do not go alone. We have friends there.