Saturday, January 14, 2012

Red Boots in a Biker Bar

Winter woods are my favorite because you can see the ground, the old roads, the contours of what used to be fields. And you can see that even in the cold days of January, Springtime life is finding its way. A couple of years ago on New Year I walked the woods near the cabin, slipped and fell in the deep leaves. I noticed, laying there, tiny little red flowers growing up out of some moss on an old stump. They seemed outrageously out of sync with Winter, like bold red boots in a biker bar. Life works that way.

This is a dreary and desperate time in public caught between strands of cynical incivility. I'm not sure which is worse, the candidates or Marines.

But life pops up amid it all, patiently breaking through the drifts of waste.

Last week I was honored to be included in a meeting of orthodox jews talking about how we could make Memphis a magnet for medical students, residents and faculty by carefully constructing "Sabbath friendly" residency programs. This mainly means scheduling so that the orthodox residents are not required to work between sundown friday and sundown saturday. That's a lot trickier than you'd think, but is possible if everybody wants to figure it out. And we do. I love that a hospital with a seven story "Methodist" topped by a two story cross would would do that in collaboration with the University of Tennessee. So gloriously out of sync with the intolerant times!

This week the Agency for Healthcare Research and Quality turned on the lights about what a tiny fraction of the population incur so much of the overall cost of healthcare: 10% of us account for nearly two thirds of all the cost. They (it should be "we") run up about $24,000 each, while everyone else costs almost nothing. The costly 10% are sixty percent women, with the same percent under 65 and 80% white. Only one in five of the costly citizens remains in the category for two years in a row--they die or get their conditions under control.

I don't know why this is newsworthy. It is like saying that 1% of the cars on the road cause 90% of the repair bills (the ones that get into wrecks), or that the .1% of luxury cruises result in 99% of the deaths (the ones that run aground on rocks and flip on their sides). And really sick people cost more than people who aren't.

It is more helpful to know that year after year the same neighborhoods have the highest concentration of very costly--which is to say sick--people. Our hospital is interested in that kind of knowing for two reasons. Those neighborhoods are where a very large amount of care we provide is not paid for by anybody. And that is another way of saying they are places that need a lot of mercy usually as a last resort.

Our friends in Camden New Jersey examined their data on most costly patients and it led them to large public housing sky-scrapers. Here in Memphis it leads us to streets with bad single homes, often broken up into duplexes. What kind of knowing would help us know how to do a better job at mercy. It is obvious that mercy delayed is mercy denied, or at least provided with far less quality that 21st century science permits. Especially when in these neighborhood are so dense with our congregations, we know somebody who knows them. Why wait for people to stumble into the emergency room in acute pain when we can pretty well guess what street they live on?

The question is so out of synch with the cold times. Doesn't everyone know there is not enough to go around, that we must distain the poor for being so inconveniently needy?

Spring begins when a tendril starts to feel its way toward the sun. And it begins when a question of mercy starts to feel its way toward the light that data, logic and science sheds on the neighborhoods. You can feel Spring on the way.



Sunday, January 1, 2012

Unlikely Webs of Trust

Note: this was originally posted yesterday as a column in the Faith Matters section of the local Memphis newspaper, edited with his usual graceful touch by David Waters.

EAST JERUSALEM -- It seems naive to speak of “religious health assets” here in a place where religion has caused so much damage to health and well-being.

But that is exactly what a group of leaders of faith-based health care systems came to this sacred and tortured rocky hill to discuss, traveling from Taiwan, India, Zambia, Norway, Germany, Kenya, South Africa -- and Memphis.

We had no illusion of understanding how to bring shalom or salaam to this troubled land, but we were curious about how we might learn how to do that in our own troubled homes.

I was here to talk about the Congregational Health Network -- Methodist HealthCare’s coalition of about 400 congregations, community health centers and privately funded clinics to promote public health in underserved communities. We call it the Memphis Model.

I always feel naive to talk of building a web of trust among hundreds of congregations on the same Memphis streets where Dr. Martin Luther King Jr.’s blood flowed. Putting trust and faith in the same sentence attracted even more curiosity in Jerusalem than it did a few weeks earlier when I was at the White House.

But the Memphis Model offers a tantalizing vision of linking comprehensive technology -- such as that offered by the West Clinic -- with hundreds of volunteer caregivers and prevention experts (mostly grandmothers) in the neighborhoods. The entire CHN network costs less than one mid-range linear accelerator, used for radiation treatments, but probably extends the lives of hundreds of people that will never need one because their church helped them to quit smoking.

This sort of faith-based, trust-building approach to medical care was lauded at the conference by Dean Pallant, head of external relations for the Salvation Army, which has 134 hospitals around the world, mostly in places far more troubled than Memphis on a bad week. Pallant suggests that faith-based systems should focus on conditions that need longer term relationships of trust -- addiction, depression or chronic conditions such as diabetes, AIDS, or sickle cell.

Such trust-building turns our attention away from the fantastically costly technologies. Science actually points in the same direction as the greatest gains in life span come from the relatively simple management of conditions over decades, not the heroic and often futile interventions near the end.

We saw similar examples here. We met in the Augusta Victoria Hospital on the Mount of Olives. The hospital had just installed a mid-range linear accelerator. Hospital officials also have also worked with the Council of Imams to get people immunized; rates improved from 20 percent to 90 percent.

The Memphis Model is being adapted even here in the bitterly tough streets of East Jerusalem.

In a city of walls and a world of need, it might be shocking to think that religion can help to create pathways for people to get health care and attention they need when they need it. But it is happening. The faith and health communities are learning from each other.

One morning, I watched the dawn light up the ancient stones and wondered how many layers of civilization lay beneath the ones I could see. Then I noticed that I was sharing the view with a young Muslim couple trying to balance their camera on one of the stones, setting the timer so they could both be in the picture.

I dropped my weighty deliberations and offered to help. I clicked and then we all stared at the back of the camera and declared it good. Maybe that's the point; to look around and notice who else is looking at the same past, present and future and help each other get it in focus.

May it be so.
Direct link to the Commercial Appeal website: