Leading Causes of Life

Mercy -- and a hint of justice

2012-02-12T16:33:00.000-06:00

The Tennessee Healthcare Campaign alerted that on the 21st of themonth for just a few hours there will be a crack in the wall allowing a fewmore thousand people in the state to get covered under TennCare. From 6pm till8:30 pm the phone lines will open for the lucky poor who get their callthrough. Reminds me of the Buffet song about how the whole world lies waitingbehind door number three. But this is truly life and death.

This is our version of Medicaid, the government program for thepoor, but you have something similar--and similarly restricted-- where youlive. The brutality of the vulnerability is simply medieval.

Wealthy politicians swagger and blather about how we should quiteworrying about the the poor. So it is helpful to look at how vulnerable you haveto be to get covered: You must be either 65 or officially disabled AND havemedical bills about the same size as you monthly income AND have no more than2,000 savings (3,000 if married). The phone lines are expected to jam within an hour as thousands of people fitting that profile in just one state compete with each other to get through the eye of a needle.

It is not surprising that someone with an account at Tiffany's or the Cayman Islands may be a bit out of touch with the fact that there are somany people like that. But you'd think they'd at be curious about it.

This is the human reality behind the accountable care act thatPresident Obama has brought to life in the face of rabid opposition. Granted this is not artful legislation. It was ahighly compromised before it was even submitted and getting more compromised as itis written into rules and then into real programs on the streets. It is notbeautiful, but don't imagine it is not necessary.

The political dwarves are too easy to criticize; they can't helpthemselves. The fact is that I can't relate much better than Newt to thisdesperate vulnerability. If you are reading this on your home computer, you areprobably out of range of understanding their reality, too. But the poor are notfrom another planet; their lives are knowable by anyone who cares to know.

This is much on my mind as 28 health systems with a high level ofcare for the poor will be gathering under the auspices of the White Houseand HHS offices for Faith Based and Community Initiatives later this week.Every one of us carries tens of millions of dollars of cost for providing careto people who have no money and no coverage for their care. This is for people who don't even qualify for TennCare--another whole notch more vulnerable.

Systems likeMethodist Healthcare provide mercy and are proud to do so. But often the request for mercy is sodelayed that the care is too late to be effective or very useful. We know that what we give is rarely given at the time that21st century medical science would want it available. And the poor tend to gettheir mercy, such as it is, at the Emergency Room, which is the opposite of asustained relationship with a medical provider trained to manage care over alifespan.

Most of the "emergencies" we treat are entirelypredictable, if not preventable; they are usually conditions that have a longtrajectory easily managed with modern science--but through regular access to amedical provider and access to pills and supporting services. In our weirdeconomy those things are quite simply out of reach of millions of people unlessthey are covered under a decent insurance program (such as TennCare).

It isamazing to me that two-thirds of those asking us for mercy last year onlyneeded it one time. The poor are tough and proud.The Tennessee HealthcareCampaign wages a daily, grinding struggle to help our democracy do the rightthing for people who need mercy even if they cannot really hope for justice.Your state almost certainly has a similar band of prophetic mercy-makers andjustice-seekers. If politics permits and the accountable care act survivessomewhat intact, in a bout a year a half there will be millions--not justthousands--of people able to get covered under some level of insurance. Thatprocess will be ragged and difficult, too. But don't imagine that it will notbe live-saving.It is not even close to justice, but it is a start towarddecency.

Flashlights and hammers

2012-02-06T09:13:00.000-06:00

What counts matters, but not everything that matters gets counted. Just ask any United Methodist pastor these days. That denomination is under storm warnings after losing roughly 1,000 members a week for 43 years (I am not making that up). Even though there are still 7 or 8 million United Methodists on the rolls, that steady decline matters. But what exactly would you count if you wanted to map the opposite of decline? What would you measure if you were interested, not in pathology, but vitality? What is the arithmetic of life?

Counting can feel like a flashlight or a hammer depending on who is counting and whether they are trusted. If you are a pastor and the your are asked by a Bishop, Board or big deal committee, the counting can feel like a hammer, with you being a nail. This is exactly what is happening today in the denomination. The the ones wanting the numbers are not trusted by the pastors because the clergy don't think the people on the committee understand the parish reality enough to understand the numbers. The numbers are more likely to hide reality, than disclose it. They like to say that a parish is not like a corporation, so one can't count in the same way. But a parish is not the only organized entity where complex intimacy is the norm. Hospitals are, too.

We count many many things in hospitals every day, with greater and lesser usefulness. Mostly we count process markers so we can good quality from bad quality. And we count money pretty carefully. And we know that the things that matter most occur in the intimate human spaces where metrics are crude by comparison to the complex wonders that take place. Healing actions and saving behaviors cannot be compelled with anything like a hammer. But it is possible to hold a flashlight to help see whether the good intentions actually do result in good work. That's what matters.

Pastors, nurses, physicians, teachers all tends to be suspicious of data, trusting the high bandwidth of stories instead. The human mind is tuned that way. One of my senior colleagues' mom is in the hospital right now and he has noticed that even with the vastly detailed electronic medical record the staff still seem to lose track of what is actually going on with her--her real story.

Until a leader sees a pattern, they are powerless to do anything but react out of fantasy or fear. Their action is arbitrary or random. Even success is dangerous because it will result from action that is disconnected from reality. They can kill the ducks and grind the gears.

Good data helps sensitive leaders find the true patterns in the stories. Good stories help sensitive leaders find the true story in the data.

I used to work as a carpenter and had a toolbox filled with all sorts of tools. Sometimes in a hurry I'd grab anything I could reach and use it to pound something into place. Even a flashlight can be a hammer, if you hit hard enough. Bishops and executives do that, too.

Don't make the metaphor do all the work here. Member and patients are far more complicated, confounding and nuanced than a gaggle of french ducks. And any denomination or hospital is a far more intricate mesh of moving parts than any mechanical gear. Grab a flashlight, turn it on and pay attention.

Red Boots in a Biker Bar

2012-01-14T23:04:00.001-06:00

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.

Unlikely Webs of Trust

2012-01-01T10:19:00.003-06:00

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 causedso much damage to health andwell-being.

But that is exactly what a group of leaders of faith-basedhealth care systems came to thissacred 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 tothis troubled land, but we were curious about how we might learn how to do that in our own troubled homes.

I was here totalk about the Congregational Health Network -- Methodist HealthCare’scoalition of about 400 congregations, community health centers and privatelyfunded clinics to promote publichealth in underserved communities. We call it the Memphis Model.

I always feel naive totalk 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 thesame sentence attracted even more curiosity in Jerusalem than it did a few weeks earlierwhen I was at the White House.

But the Memphis Model offers a tantalizing vision of linkingcomprehensive technology -- such as that offered by the West Clinic -- withhundreds of volunteer caregivers and prevention experts (mostly grandmothers)in the neighborhoods. The entire CHN network costs less than one mid-rangelinear accelerator, used forradiation treatments, but probably extends the lives of hundreds of people thatwill never need one because their church helped them toquit smoking.

This sort of faith-based, trust-building approach to medical care was lauded at the conference by DeanPallant, head of external relations for the Salvation Army, which has 134hospitals 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 needlonger term relationships of trust -- addiction, depression or chronicconditions such as diabetes, AIDS, or sickle cell.

Such trust-building turns our attention away from thefantastically costly technologies. Science actually points in the samedirection as the greatest gains in life span come from the relatively simplemanagement of conditions over decades, not the heroic and often futileinterventions near the end.

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

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

In a city of walls and a world of need, it might be shockingto think that religion can help to create pathways for people toget 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 civilizationlay beneath the ones I could see. Then I noticed that I was sharing the viewwith a young Muslim couple trying tobalance 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 theback of the camera and declared it good. Maybe that's the point; to look around and notice who else is looking at thesame past, present and future and help each other get it in focus.

May it be so.
Direct link to the Commercial Appeal website:
http://www.commercialappeal.com/news/2011/dec/31/guest-commentary-web-of-trust-can-lift-up/

Look at all the stars

2011-12-21T20:10:00.000-06:00

Last week I was in Philadephia speaking to a conference sponsored by city's department of behavioral health and intellectual disabilities which has developed an interfaith collaboration across all sorts of lines which are supposed to be impossible to cross. A number of those involved in the conference would be thought of as

"consumers" in other places, a term that implies several steps down from "citizen" or "human." But in this city of brotherly and sisterly affection, the generative swirl sweeps up and transforms everyone.

I wore my Van Gogh tie for the occassion, commenting that he would have been at the conference himself, if he had lived in Philadephia in 2011. The tie include a pretty significant piece of his painting "starry night" which is on the bright and garrish side for a side. But those stars to pop out to be visible even from the back row. The outrageous size and almost pulsating energy of Van Gogh's stars was part of what got him classified as deranged back then. But the fact is that Van Gogh's stars look WAY more like what we now understand stars to be like today. Anyone who thinks that stars are teeny weeny little bitty dots of pale light is danerously detatched from reality. They are all--including our little sun-- impossibly vast, distant, wild pools of energy throwing light and energy beyond our capacity to measure all across the universe.

The universe itself is sort of like that, too. Stable, contained, predictable and cold are qualities only appropriate for minds and spirits untuned to the reality of the jumping universe. Anyone who has really paid attention to a neighborhood, much less a city, much less a region, or country knows that is true, too. But little minds like to think of all those things as stable, contained, predictable and cold, too. They are, well, crazy. How much they miss of what is possible!

Bill Mallonee and Muriah Rose (above ) opened our Innovation Studio last Winter with brilliant lyrics and deeply felt voice. They just released a set of songs for the season called Wonderland ( http://billmalloneemusic.bandcamp.com/album/wonderland ). This is from their WPA series which are more like a live performance than polished studio work. There is a painfully smart song "the king will see you now." This the only christmas song I've ever heard from Herod's cynical point of view, which helps retrieves the holiday from religious smaltz. But the song you need to get you through the next couple weeks is, "look at all the stars," which Bill wrote thinking of his dad, (but I think of Van Gogh).

My father often brought me here;

I loved to see him smile

it was hard to tell which one of us

was the little child

he would stretch his arms out wide;

he would hold me to his heart

he’d say, “Hey, look at all the stars!”

Life is n’er a path that’s straight;

there’s so much gets in the way

from here to Kingdom Come

there’s so much to make you numb

still I always had that light

forever etched inside my heart

I would tell myself at night

as I stood out in the yard

“Hey, look at all the stars!”

I’d say, “Hey, look at all the stars!”

This has everything to do with what moved the men called wise across the desert to the garage where Mary rested. And everything to do with with the man who did not listen to his friends and renounce her. His friends surely thought he was, well, crazy.

For the next few days at least, don't pay attention to anyone who tells you to act like a stable, predictable, contained and cold adult. The world is made for surprise and hope. Don't miss it.

Majestic

2011-12-18T18:37:00.001-06:00

A couple weeks ago I was in Washington DC and had a few hours before my plane, so I walked the Arlington Cemetery and then to the airport along the Potomac. I had walked that cemetery nearly forty years ago one Winter and remember reflecting deeply on the thousands that gave their lives for others in some brutal, violent and painful way, mostly dying far younger than I am today. From the hill through a gap in the trees you can see the Capitol in the distance. I don't get the impression that many people who work over there make it up the hill to where are the young men are buried. They may vote for the monuments and puff and rant as if they themselves would sacrifice, but its been a while since they actually did anything selfless, much less sacrificial.

But for the last 18 months we--the citizens of this nation--have actually been able to watch a civil servant at work, Dr. Don Berkick. The mean and dumb politics under the Dome ground succeeded in preventing him from holding office as head of the Center of Medicare and Medicaid Services more than that short time, but he has used every minute. And, judging from these excerpts of the speech he gave to the Institute for Healthcare Improvement right after leaving town, they did not manage to take away his spirit for the majesty of the work of government. I urge you to read the whole speech ( ). But a taste is attached here:

"Inscribed on the wall of the great hall at the entrance to the Hubert Humphrey Building, the HHS Headquarters in Washington where my office was, is a quotation from Senator Humphrey at the building’s dedication ceremony on November 4, 1977. It says: 'The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.'"I believe that. Indeed, I think that Senator Humphrey described the moral test, not just of government, but of a nation. This is a time of great strain in America; uncertainty abounds. With uncertainty comes fear, and with fear comes withdrawal. We can climb into our bunkers, each separately, and bar the door. But, remember, millions of Americans don’t have a bunker to climb into – they have no place to hide. For many of them, indeed, the crisis of economic security that we all dread now is no crisis at all – it is their status quo. The Great Recession is just their normal life."The rate of poverty in this country is rising. Over 100 million Americans – nearly one in every three of us – is in poverty or near-poverty today – 17 million of them children. I will tell you – state by state, community-by-community, and in the halls of Washington, itself – the security of the poor – their ability to find the health care they need, and the food, and the housing, and the jobs, and the schools – all of it, hangs by a thread. The politics of poverty have never been power politics in America, for the simple reason that the poor don’t vote and the children don’t vote and the sickest among us don’t vote. And, if those who do vote do not assert firmly that Senator Humphrey was right, and if we do not insist on a government that passes the moral test – the thread will break, and shame on us if it does.

"The choice is stark: chop or improve. If we permit chopping, I assure you that the chopping block will get very full – first with cuts to the most voiceless and poorest us, but, soon after, to more and more of us. Fewer health insurance benefits, declining access, more out-of-pocket burdens, and growing delays. If we don’t improve, the cynics win.

"On my last night in Washington, I visited the Lincoln Memorial again – standing at the same spot that I had stood at as a twelve-year-old boy 53 years ago. The majesty was still there – the visage of Lincoln, the reach of the Washington Monument, the glow of the Capitol Dome. It was still unbearably beautiful. Still majestic.

"But, there was one change. Chiseled in the very stone where I was standing is now the name of Dr. Martin Luther King and the date – August 28, 1963, when he gave his immortal 'I have a dream…' speech.

"When I first stood at that spot, the Montgomery Bus Boycott was only three years in the past, and Dr. King’s speech lay five years in the future. Rachel Carson’s book, 'Silent Spring,' was four years in the future. And it would be six years before the phrase, 'Women’s Liberation,' would first be used in America.

"I thought, standing there, of something I once heard Dr. Joseph Juran say: 'The pace of change is majestic.' And I mused about that majesty, and its nature.

"It occurred to me that the true majesty lay not just in the words – not just in the call – but also in the long and innumerable connections between the ideas that stir us – the dreams – and the millions and millions of tiny, local actions that are the change, at last. A dream of civil rights becomes real only when one black child and one white child take one cooling drink from the same water fountain or use the same bathroom or dine together before the movie they enjoy together. An environmental movement becomes real only when one family places one recycle bin under one sink or turns off one unneeded light out of respect for an unborn generation. Women’s rights are not real until one woman’s pay check stub reads the same as one man’s, and until my daughter really can be anything she wants to be. The majesty is in the words, but the angel is in the details.

"And that is where you come in. Here is the lesson I bring you from 16 months in Washington, DC. Your time has come. You are on the cusp of history – you, not Washington, are the bridge between the dream and the reality – or else there will be no bridge. Our quest – for health care that is just, safe, infinitely humane, and that takes only its fair share of our wealth – our quest may not be as magnificent as the quest for human rights or for a sustainable earth, but it is immensely worthy. You stand, though you did not choose it, at the crossroads of momentous change – at the threshold of majesty. And – frightened, fortunate, or both – you now have a chance to make what is possible real."

Thank you, Dr. Berwick. May it be so.

Triple Eligibles

2011-12-11T22:06:00.001-06:00

In health policy circles it is common talk about the "dual eligibles", meaning people who are both poor and old and thus eligible for programs that are meant for both types of health coverage. Normal 21st century societies where healthcare is regarded as a basic right do not have to go to such mental twists, but in the United States we do because the programs intended for the old (Medicare) are more like insurance which is deducted from one's wages. But it is not exactly like insurance because it doesn't normally actually cover anything until one is over 65. Other health programs are restricted to the poor, meaning, in reality, poor women or poor children. Real people come in more than two types--old and poor-- so there are roughly ten zillion wrinkles to who gets paid how much for providing exactly what kind of services when to whom, driving anyone who provides or receives care totally crazy every single day of the year.

All this gets especially complicated when one is both old and poor since programs intended for the poor are designed to be just a smidgen demeaning (signaled by lower payments to providers who are expected to be the demeaners). Programs designed for the old are intended to be at least a smidgen respectful (signaled by payments at least within shouting range of truly honorable private insurance). This all reflects the fundamental idea that there are people who deserve help and those that do not and that it is critical to the moral fabric of society to ever under any circumstance mix the two. Except for these darned "dual eligibles."

It might simplify things to add a complication: triple eligibles, those who simply can't be denied decent care no matter what. It is surprising to some policy dweebs that religious organizations and every single hospital is obligated by both higher and lower law to provide some level of care to every single human being on the planet whether you can tell if they deserve anything or not. Every hospital is required to give at least a cursory examination to anyone who makes it off the sidewalk and through the doors, and enough treatment to stabilize them to the point they can either make it back to the sidewalk under their own power or get shipped to another facility. Most hospitals do more than the minimum out of fear of God, government inspectors or lawyers who keep a sharp eye on those sidewalks.

People eligible for Medicare or Medicaid are covered not just for hospital care, but also a wide range of primary care, prevention and even home care. It covers a lot less than you might think, so the concept of "triple eligible" is still very important. Our Congregational Health Network is really built for these people knowing that many of the most important kinds of care and tending will never be reimbursed by anyone. It is provided by knitting together the mercies of family, members, neighbors and, yes, strangers. And trustworthy advice on where and when to go ask for help is almost never reimbursed, only available for free.

The people only qualifying for this last kind of decency are mostly men (because they are assumed to never deserve respectful help). And it includes the travelers and "aliens," which have always been afforded special status in most religions precisely because they are especially vulnerable. Mary, Joseph and their baby were in this category, as were the whole Jewish people for hundreds of years. You and I and everyone is eligible for human decency no matter what, always, in every circumstance everywhere. Thank God.

I mentioned this to a very high level Yale PhD in the Center for Medicare Services a month or so back and she confessed that administering the finances of dual eligibles made their head hurt and they just could not begin to think about those living outside those lines.

In reality, the most vulnerable people tend to live in neighborhoods that are triple eligible because they are triple vulnerable. Mitch Graves is the CEO of our home care company, a $100 million enterprise that is almost invisible because all of its activities are beyond the walls of our healing castles, the hospitals. We were going over the data concerning the people receiving "charity care"-- qualifying only for compassion. In just one zip code of less than two square miles in just one year there were hundreds of people mostly cared for in (and back out) of our emergency rooms. There were more than a few chalking up tens of thousands of dollars in care (one for $526k), but most everyone else was in the $1,800 range. Mitch's long experience told him quickly this meant that nearly everyone got some expensive imaging which probably was the quickest way for the ER physician to rule out a life-threatening condition so the person could be back on the sidewalk fast. Sounds a bit hard, but you and I would probably do the same.

When we restrict "eligibility" to the domain of immediate treatment services it makes everyone involved dumb and mean. Dumb because a quick look at the roster of "compassionate care" patients (isn't that better already?) shows that they often come back three or four times a year and they tend to come from the same streets and even buildings. It is dumb to not notice that and dumber to not act on it. Why not not figure out what compassion and decency might be able to see that the CT-Scan missed and can never see? This is dramatically dumb for those receiving treatment for free, but not any smarter for the other categories of eligibility which are also mostly, if not entirely, unprofitable. It is dumb to not widen the bandwidth of curiosity to see if a bit of social service might break the cycle.

And all this is surely mean. It demeans the humans who receive all this inappropriate and ineffective care. And It demeans the whole complicated and expensive apparatus of government programs and healing institutions that fall so short of their intended purposes. Intended for mercy and maybe even a taste of justice, these institutions fail to exercise the intelligence of compassion. Dumb compassion is way better than nothing. But intelligent compassion is way smarter because it opens our eyes to the complex reality of those in need. We see more and can then do more. Doing more is more likely to mean doing less over time since we are more likely to do the right thing--the complete and healing thing--first, rather than as a last resort.

This works whether you are eligible for one, two or three types of care; once, twice or triple eligible. May God save us all, together.

Gratitude is the way

2011-11-24T13:08:00.001-06:00

The paper arrived this morning with some news and three pounds of marketing to warning of the spending frenzy anticipated to start at midnight. A brief pause of thankfulness and then a mud wallow of desire. Yikes!

Gratefulness is the way, not just an emotional response to what happens along the way. Gratitude precedes, enables, nurtures and finally, completes, life. Thanks is not just a spirit that follows the harvest. It is also the critical insight on which all creative and useful work rests. This is the intelligence underneath the work of "religious health assets" and its hopeful labor of systematically accounting for what we have to work with to build community and nurture health (www.arhap.uct.ac.za). Steve DeGruchy liked to say that "you can't build a community out of what you don't have." So the very first act of leadership is to notice what we do have, what already is, and what it might be good for. The work of noticing is what I've come to call the "discipline of abundance."

We literally have to pay ... attention; invest our attentiveness on what we have. This suggests we don't get gratitude automatically like a burp after a big meal. This is especially true when we wake up to pounds of marketing honing the edge of unfulfilled desire for things we didn't know we didn't have. We have to take some of our attention span and consciously direct it away from what is missing toward what is not missing, toward what we are thankful for; toward what we are not afraid of, toward what we are confident of.

The plane was landing in Memphis about 25 hours after I left Tel Aviv last Friday. More than a bit dazed from all the miles, I glanced west out of the window and ... noticed. The sky was painted as if God was trying to imitate a Larry Pray watercolor (www.larrypray.com). I fumbled for my iPhone and snapped the picture, which is below unedited. I don't know how long God worked on that sky, but I'm glad I attended to it.

We have a lot, once you pause even a tiny bit of time to notice. The vast majority of what we have, we did not and could not pay for: the miracles of breathable air, living soil, light, color, food, consciousness, intimacy, clear-eyed friends and work worth doing. A riot of abundance. Plenty.

Jerusalem: History kills

2011-11-14T23:22:00.001-06:00

Nobody who does not live in Eastern Jerusalem should tell anyone who does anything at all. I have no idea what it would be like to try to raise children or care for a mother here. I am pretty sure that access to healthcare would be among my least worries; falling way behind worrying about my kids or mom getting shot, insulted or run over by a tourist bus on the way to get milk. But if you did need healthcare, you'd have to worry fast and deep, leaving plenty of time to negotiate the check-points and aforementioned tourist busses (and hope your physician did, too).

This is the home of every pathological and transcendent impulse that ever crossed the mind and spirit of a human being. Our hotel, on the Mount of Olives, is surrounded by graves for a half mile in every direction, interspersed with a monument or church marking something or another that happened one, two or three millennia ago that causes people to think of genocide today.

Of course, any disease condition linked to stress, poverty, inadequate housing, food, preventive screening is epidemic. More people surely die from unmanaged diabetes than gunfire; way more from undiagnosed cancer, too. But the problem is not the science and not even presence of clinical facilities and skilled, committed providers. It is hard enough to run a health care organization in troubled Memphis so I pause in wonder watching nurses, doctors and administrators showing up at work here and doing their best to care for those who need them. Showing up for work and giving one's competence to others is a mundane miracle that is far more wondrous to me than all the monuments put together (and here that is really saying something).

Jesus was killed for showing little respect for the extrinsic formalities of his religious traditions and the self perpetuating trappings of power that tradition had prostituted itself to defend. He attacked with sarcasm, disrespect, simple stories that cut through the deadly pomp like razors. He was deeply, transcendently maladjusted to the world we want to merely tweak and improve. He flipped over the tables of those that make money selling religious distractions amid injustice that mocks God's generous, creative shalom. He'd be dead again today for the same reasons.

Find somebody you disagree with today and ask them something about their life. Anything, really; but best to ask about their kids and what they hope for them. Ask what they are proud of; what they hope their children see in them; why they show up at work and give themselves to their labor. But, really, just ask anything at all. Don't explain anything about yourself at all, unless they ask. Your head is not the point. Ask.

You'll be laying down one thin thread of hope that God might weave with.

Jerusalem: Choosing the World

2011-11-12T23:02:00.001-06:00

Prayers begin early in this part of the world, long before the sun makes it over the horizon. In the early light you can see it all, hillsides of ancient graves next to walls built over millennia to protect this or that ruling clique from another aspiring one, both indistinguishable in the dust of time. And in the background construction cranes ready for another day. And, of course, religious symbols vast and tiny mark every corner the eye could find.

One stream of Jewish tradition says that every year God has to choose to continue to create the world again. It is amazing that God continues to do so given how quarrelsome and unappreciative we humans are on most days. But God does keep on choosing to create and by doing so invites us to create, too.

The group of hospitals gathering today tend to think of ourselves as old institutions. We have lots of pictures on our walls of old medical technology and nurses dressed up in garb we now think of as quaint. We feel modern and wonder that we have endured 120 years or so. That's longer than most of the tools of public health, although one could quibble that prevention preceded healing by millennia. It is a quibble among us moderns. Meanwhile, the dusty stones of these hills testifies that medicine, hospitals and most of our religious forms are very young. Most of the graves between the hotel and the Mosque and Temple across the history drenched ravine were filled without any medical professionals including executives making any difference at all.

For the vast portion of the journey of our religious tribes, the story has not had--or needed--us. Faith-based hospitals are a very recent fruit of God's imagination at work in the world. This should give us a bit of humility, but perhaps even more usefully, a certain lightness in our deliberations. We are young and perhaps the world and God are just figuring out what we might be good for. Maybe the future does not depend on our laborious efforts at innovation at all. Maybe we are at more basic level where we need raw imagination, focusing on opening ourselves to be vessels, conduits, receivers and amplifiers--social media through which God's imagination can work now and work next.

Perhaps we can hold ourselves, and especially our brief pasts, more lightly, with less anxiety and grasping. We can be, dare we say, somewhat playful, look at ourselves and our work with a beginners mind, a child like sense of wonder that we are here at all.

Process Theology (with capitals!) says that God stand with us at the boundary between now and the not yet, continually choosing the world from among many possibilities. We humans participate partly by choosing to giving privilege to some of those possibilities by our language, presence, attentiveness and of course where we put our money and time. And we also give privilege by what we hope and fear, what company we keep, who we listen to and what we count. The future is wild and ragged and uncertain; but it doesn't just happen to us. We participate in choosing it.

Bill Foege, who has taught me so much by reversing so many obvious sayings called the question on one of the most common to scientists: where the simple mind says "I'll believe it when I see it", the creative mind of both science or faith notices that you can's see something until you believe it is possible to be seen. Tentative believe opens eyes to possibility which can guide creaitive research, risk-taking initiative--innovation.

I was pondering all the stones and wondering how many layers of other civilizations' stones lay beneath the ones I could see. I noticed a few feet away 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, which they accepted with the same snapshot smiles I've shown in front of hundreds of tourist sites. I clicked and then we all stared into the little LCD on 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.

Jerusalem Two: SMAC

2011-11-11T16:16:00.001-06:00

I am writing this in the Atlanta airport, moving toward Jerusalem to gather with others from faith based healthcare organizations (http://www.faithbasedhealthcare.net/ejc2011/).

This makes me think of our work in Memphis in a global lens, which brings different things into focus. When we think locally, we're feeling pretty good these days, breaking ground on new hospital, coming into partnership with the premier cancer group (The West Clinic), going to the White House and being named by US News as the #1 system in the region. Cool.

But when we see ourselves in global context, it is clear that we’ve been decent, with the low but still respectable expectations of the #2 system in a small, poor city. Now we are #1 in a small poor city and have begun to move to good to very good, where we can see (on our best days) how we might be great. And not just great inside the walls, but great for the city and region that is defined by terrible health. "Great" in Memphis demands that we understand and implement intelligence about the drivers of population health, not just clinical treatment. We have begun to show faith—that we can get there. But we are also intently aware of the treacherous, fluid, uncertain political, policy, economic and competitive environment.

How do you continue to move boldly toward great in such a time. Shouldn’t we be okay with decent, print brochures about "great" and wait for better weather?

In this context I read Jim Collins new book, Great By Choice, which examines companies that far exceed their peers even when operating in radically turbulent settings—like ours. It is, I think, his best book filled with surprises, mainly that the lessons of his earlier books that have been so key to informing how this management team thinks, still hold: you still need hedgehogs and level 5 leaders, BHAGs, flywheels and such. But you also need, surprisingly SMaC: systematic, methodical and consistent: durable operating methods.

Now I’ll tell you that is not good news to me personally. I love the new, bold, innovative, frame-breaking, game changing---and so on. But greatness, Collins counsels, lies as much in knowing what not to change, as in changing—especially in radically uncertain times. Of course values and mission persist, but the greatest (Southwest), also hold steady in their SMAC, changing them slowly over time compared to their more nimble, but less great, peers.

The point of all this, is that we can choose our greatness, but have to choose it every day down in the little things that only matter when they are done pretty much every time over years. All this comes at a time when the Congregational Health Network is getting a lot of attention as if it was already great. It is something of a prodigy, growing to nearly 400 congregations in under 4 years, winning enormous trust from pastors and, even more remarkable, women of the church who have a pretty cold-blooded eye for whether something actually matters or not to people they love. Well over 1,200 people have completed at least one seven week class so far, mostly women.

So I'm wondering what our SMac is; what we will look back on in 20 years and claim greatness. It will probably be in things that I am personally not great at, even a little bit: making sure that every single CHN members who has been discharged from the hospital gets a phone call every day until they are well enough to call somebody else. We'll probably have been fanatic about ignoring the lines between physical, mental, social and spiritual health, relentlessly checking on all four facets of those who show vulnerability in any of them. These are the mundane revolutions going on in the lives of people blending what the hospital knows about disease and congregational caregivers know about life. We have begun to blend those intelligences, but not yet made the disciplines explicit enough that we make sure we do them over and over and over.

As I move to Jerusalem I'm going to be looking for those little things done well in India, Kenya, Germany, Taiwan and Norway. Do you know anything great like that in your neighborhood?

Jerusalem 1

2011-11-07T22:09:00.001-06:00

A week from now a group of hospital and faith people will gather on the Mount of Olives in East Jerusalem to begin an intense dialogue about the future of faith based healthcare organizations. This is a conversation that has been going on since the end of World War Two when church groups in Europe and the US had to figure out what to do with the mission hospitals they had accumulated during the time in which evangelism and colonial expansion were the same thing. The best guess is that we actually have more faith-linked hospitals today than 60 years ago and many of them have grown to extraordinary scale, complexity and technical sophistication. I'm thinking of the Christian Medical College in Vellore, but I work in a pretty obvious one in Memphis, too. In a world of extraordinary demands for compassion and justice, should faith groups keep such huge resources committed to hospitals? If we should keep them, in what way are they distinctive--faithful--enough to claim them as leaven in the social loaf?

For the next couple weeks I'll be blogging regularly about this event for two reasons. First, it is pretty historic (THAT Mount of Olives!). And, more personally, I need your help because I am giving the closing keynote....on innovation. Giving a speech on innovation on a hill marinated in history is a curious task all by itself. There is so much past in the present that there would hardly seem to be any room for the future. However, there is no lack of novelty and change today at any scale in any town in any country. The whole world and all its certainties seems fluid and turbulent. Many of those changes happen to us, not because they are chosen by us. How do we choose our innovations, focus our creativity on relationships that matter most; that are most distinctively reflective of our faith?

So I need some help from you thinking with me about how we choose the world--that's what we do when participate in creative work. I'll be posting fragments of the speech I'm thinking about and will hope you will help it become better, more useful, more innovative. In effect, you'll be helping give it (and if you do, I'll acknowledge you on the "credits" slide in what will inevitably be a powerpoint).

This reflects my first and most basic hunch, which is that innovation emerges from within relationships. The more unlikely, diverse and scattered the relationships, the more likely the innovation. This has certainly been my personal experience, notably with the religious health assets work and the wildly generative stew of Memphis. The social media that links us at this moment in which your eyes are playing over my words brings our minds within range of each other. We can create. Or not. We can tease novelty out of the present. Nathan Wolfe is a virologist who has risen to such fame as to have gotten on the Colbert Report this week (which is nothing compared to being my daughter's fiancé, but still a big deal) says that we humans can learn from viruses about how they create novelty that allows them to adapt, change and thrive. Viruses are generous with their very essence; where two or more gather, there will soon be a new virus blended from the essence of the the others. They are social innovators.

So, too, are religious movements, especially those that consciously open themselves to the essence of others' pain, suffering, hope and highest aspiration--such as institutions of health and healing that live in troubled parts of the the world like East Jerusalem and Memphis.

So, will you help us as we begin to move toward Jerusalem? I'd love a story about how you found a new way forward through an unlikely relationship with a colleague, friend or patient. How did this novelty turn into an innovation that changed your work in some way? (If you've got a picture to help the story, extra points!).

Thanks, in advance, for a bit of your essence.

Disciplines of Abundance

2011-10-31T21:19:00.001-05:00

What is the only sin pretty much guaranteed to get us killed? Youhave to wonder as our airways are so filled with swagger, spit and venom allfocused on what others have done or not done. I'd offer up a suggestion from one the prophets most familiar with nuttyimagination, Ezekiel.

Ezekiel describes a lively lovers' quarrel between God and hispeople ending (as lovers often do) in sorrow: "Cast away all the offensesthat you have committed against me and get yourselves a new heart and a newspirit! Why will you die...? For I have no pleasure in the death of anyone,says the Lord God. Turn, then, and live." (Ezekiel 18: 31-2)

God cannot save us when we live as if God is not creative enoughto create enough to go around. When we obey the law of not-enough fearcripples, blinds and then kills us.

There is obviously not enough to go around! So, of course I mustgrasp for my own. There is not enough land, water, money. Not enoughhealthcare, education or even food. It is folly to deny scarcity! And so we feeljustified in leading a life, a family, a congregation or an organizationassuming there is not enough for all, (but maybe enough for me). It would be downright irresponsible to act otherwise.From neighborhoods to nations you can see this fearful logic at work today.Just listen to the squabbling among the current batch of political dwarvesblaming their god for their own mean and shrunken spirit.

But before we feel too good about how bad they are, we should hearourselves whine about how hard it is to do church or health in the poorest,sickest city in the entire nation. God did a bad job from the start and thenmade it all worse by leaving us alone in a social wilderness. Blame God for ourlow ambition.

So Ezekiel speaks of the sorrow of God. Jesus wept, too, for hiscity did know how to live into shalom and its graceful abundance. God doesn'thave to exact revenge. We die when we deny God's essential generosity. We makedeadly choices rooted in scarcity, so fail to risk, invest and live into thefuture.

Franz Capra said that humans are dissipative systems that live noton what we grasp and hold, but on the stuff that flows through us. We eat anddrink, but it moves through us. So too, a church or healthcare system holdsnothing; everything flows through, living on the flow and only the flow. Anindividual can die from an impacted bowel, but a surgeon can fix that. What doyou do for an impacted spirit? Not even the master of the universe can saveus--unless we gain a whole new mind--of abundance. "Why will youdie?" asks God? Turn.

It is now so normal to live in fear and scarcity, that it takesdiscipline to live otherwise. But we usually associate discipline withscarcity. There is not enough time, so we must be disciplined; not enoughmoney, so we budget with discipline; not enough education, so we must make disciplined choices about who will learn andwho will not; not enough healthcare, so we must... harden our hearts anddiscipline our minds. If the world really did not have enough, that would beappropriate. But scarcity thinking is lazy; living in the world of abundancedemands disciplines that fit it.

Disciplines of abundance begin with a careful, thoughtfulappreciative inventory of our assets--both tangible and intangible. Then weneed a clear-eyed examination of what we could with them. I've learned thisfrom my colleagues in Southern Africa who developed and deepened the idea of"religious health assets." ( http://www.arhap.uct.ac.za/) Their disciplined thought changed thelanguage of the World Health Organization, World Bank and United Nations. Now,the global network of institutions haven't fully turned, in the biblical sense,but at least they've begun to notice that somebody (I’d say God) has placed aheck of a lot more stuff in the community than they thought was there. Thecareful methodology of mapping religious health assets in Zambia discoveredthat there were about six times more health organizations and networksoperating in the community than the government knew anything about. This isabout what we find anywhere we are disciplined enough to look. We brought that methodology to Memphis,adapted it and found the same thing. The model went back to Africa where it wasagain adapted and is now being used in all 135 health districts in South Africato guide government and community planning so that it is informed by realisticabundance and not just scarcity.

Discipline is needed when you start mapping the strengths andassets because you find yourself drowning in what is possible. Where fear asksus to subtract and do less, we actually have more hope than we know what to dowith. In Memphis' iconic Yellow Fever story, the city almost died from badwater while living on top of the greatest freshwater aquifer on the planet.

The most generative abundance is found in the relationships God'sspirit constantly moves in and through us to create. God is connected toeverything and everybody. So the connections among God's people--all those thatturn toward life--are infinite not just abundant. This is surely the abundance thatwe have been most undisciplined with.

The disciplines of abundance are a lot more fun than those rootedin bleakness scarcity.They live closely with all the creative arts, worship,celebration and the surprises generated constantly by faith, hope and love.Ezekiel and all the prophets of every religion knew it was a love story after all; of a God with noheart for vengeance, filled with sorrow for his people. “Why will you die?"

Scaling things that grow

2011-10-16T15:45:00.001-05:00

Since meeting him at Wake Forest two weeks ago, Fred Bahnson and I have been exploring different ways of thinking about how things spread, or get big enough to matter to communities. The question is critical to our work in Memphis because Methodist LeBonheur Healthcare is big: it is the regional referral hospital for a couple hours around, especially for children (LeBonheur is the only level 1 trauma hospital for hundreds of miles).

We want our congregational networks to be of the same scale as the clinical systems. We are not far from our initial goal of 400 congregations and now think the network will rise toward and perhaps past 500. A referral network is held together by guilds, protocols, legal obligations and vast amounts of money. Our young network of congregations is held together by trust, respect and shared compassion for people we think of as "patients" and the congregations think of as "members" or "neighbors."

Should we think of our web of congregations sort of like gardens? Here's where Fred has some insight:

"Scaling a community garden should be horizontal (connecting to other gardens) rather than vertical (getting bigger). I think too often when people look at a community garden or other highly-localized effort at agricultural shalom they say, 'that's great, but will it scale'? In other words, the garden is a quaint thing for a neighborhood, but you can't really feed people with it. Sometimes when people ask if it will scale, they are really asking "can we make it really huge"....which leads to the Wal-martization of life that people like you and I abhor.

"I am intrigued by how your emphasis on how your whole system in Memphis seems to hang on face-to-face relationships. Until learning about your project I didn't know that was possible on a city-wide scale. So my sense of scale has been expanded. But my hunch is that you're near your limit. Once you've included every willing congregation within the area of Memphis, you've hit the walls of scale and to go further would not only compromise the fragility of the network you've built, it would change its very nature.

"When we talk about how to scale community gardens, I think we need to recognize that the scale must have that human face-to-face connection you've demonstrated so well in Memphis, and get no bigger than the connectional ability of its members. But it also needs to take in the very real ecological limitations of scale which modern agriculture simply ignores. E.F. Schumaker's book comes to mind here. Small is beautiful, and ecologically it can also be much more productive than Big.

"A diverse garden is far more productive than a monocrop, and I've had the opportunity to see these all over (Cuba, Quintana Roo, Bolivia, California, Anathoth, my front yard...). Until recently, we Americans have had so much land that we haven't really had to think very hard about how to make a small piece of land highly productive. That's the new agricultural frontier. Currently, using conventional farming methods, it takes 1.2 acres to feed one person on a U.S. diet per year. That same acre can feed a) one cow for a year, b) fill up your gas tank exactly twice, or, c) with biointensive organic practices that same acre can feed 10 people for a year.

"So I guess what I'm getting at here is that we need to change what we mean when we talk about scale. Rather than think about scale as an expansion in size and space, we need to think about scale in terms of stacking and layering and creating densities of interaction. Which seems to be very much what you're doing in Memphis (at the big end of the Small is Beautiful spectrum) and what we did at Anathoth (at the small end)."

I'm a city boy and never seen anyone actually feed themselves with a garden plot, but smart people like Heather Wood Ion assure me it did and still does happen. It is hard for others who have never experienced the care of a congregation to take that seriously, too. But it did and does happen. We don't know exactly how to scale either gardens or congregations, but we are learning. With congregations there are two issues: connecting enough of them to make a difference (400, or 20% of them) AND build their capacity and competence (train, train, train, train) so they are truly useful and not just symbols. We want the bio and spiritually intensive type of generative relationships, sort of like one of Fred's intensive gardens.

(For more of Fred's intelligence find him at www.fredbahnson.com)

- Posted on the journey

Shalom wants to happen

2011-10-03T15:15:00.001-05:00

Commissioner Henri Brook and Rev. Dr. Chris Bounds are standing in a garden on nine acres of former cotton fields about a half mile from my house. I'd ridden within a hundred feet of it on my bike dozens of times and never noticed. I have no idea what kind of corn grows that high, but it is probably laughing at me along with Henri and Chris as they remind me how dumb I thought community gardens were only a few months ago. The Commissioner knew that Shelby County has more than 3,000 vacant lots; why not turn them into gardens? This one had already taken root in the the swarm of hopeful things happening in Binghamton. This garden was started by Peter Schutt (publisher of the Memphis Daily News) and Jim Townsend (former heating and air-conditioning executive) which is how they tend to happen. Each one is highly particular and even unlikely, but that is the pattern: unlikely people doing what seems (in retrospect) obvious: turn vacant land into a garden. And the pattern is that it never quite stops with the tomatoes: Peter and Jim started a farmers' market, too.

This is happening all over the place. I was speaking at Wake Forest friday and there it was again. Fred Bahnson (foodandcommunityfellows.org) writes like a well-tended garden and argues that food and gardens matter so much that the salvation of the planet may depend on them. Go back and find his rich piece in the July 2007 issue of Orion magazine. You'll come into the world of Jeremiah's Anathoth gardens reborn 2,600 years later just down the road from a killing outside Raleigh, North Carolina. Five acres given by a black mother to a white church provoked an outpouring of saving grace (and okra, potatoes, squash and, curiously, garlic scapes). Something like this is probably happening near you. Look around.

Are gardens a symbol of hope, or the first fruits of a renewed food system? The same question pertains to the many small scale faith-health initiatives such as parish nursing or volunteer caregiving. The Congregational Health Network is, as far as I know, the largest scale connectional strategy in the world, with 376 covenanted congregations (so far). But this year we will only see 3,000 of the the 65,000 inpatients at our hospitals. That is like a hundred community gardens compared to Kroger. So are we sending a message to the System or actually changing it? As for me, I find even the most clever symbols bitter fruit unless they give me hope for scale. To talk of change, we must have ideas that can function at the scale of the current system and a logic for getting from now to then. Mennonites have chosen radical integrity for centuries, refusing to take part in the war industry even though they know they will probably always be a minority voice. Is that what gardens--and health ministries--are?

The language of the Wake Forest event is like most other similar events, that assumes that building the new system to scale requires force of will, borrowed money and enormous efforts. Even the scale achieved in Memphis seems unlikely given that logic. When pushed to explain what efforts it took to align our hundreds of congregations I explained, "it wanted to happen; we aren't driving, but accommodating to the new system emerging through and around us." Shalom wants to happen; but it needs humans to work with it.

Forests find their way to scale when people stop chopping. They want to happen, so they once covered the continent and probably will again. I understand that the percentage of New England under forest is about what it was when the Pilgrims landed. Thousands of small farms turned into forests when everyone was busy doing something else. I'm sure we'd have 3,000 micro-forests in Shelby County if we stopped mowing, too.

Gardens are different than forests because of their complex organic dance between humans, soil, water and seeds. But that dance wants to happen, too. It is hard to hear the music and get everything out of the way, but things that want to happen tend to happen eventually. Scale in human systems--food or health--happen when the desire for life flows into and through systems that are built for life. People are born to plant, tend, harvest and savor. And people are born to care and be cared for. Make it possible and it will scale.

The picture looks like one of John Shorb's silhouettes he is becoming famous for. This particular willow had dropped all its leaves but the one down in the far left hand corner. Is it hanging there as the last leaf of the season or maybe the first to get a jump on Spring? I do know it is not sending a symbol; it is busy turning sun and water into life as long as it can.

I'm never sure which season I am working in either. How do we know such a thing? We are on the side of what is still growing, still wanting to happen. That is quite enough for me.

- Posted on the journey

Hope where we forgot to expect it

2011-09-24T12:40:00.001-05:00

Dr. Jeffery Brenner, of "hotspotters" fame lights up the room at The White House meeting Tuesday with laser-sharp data about the illogical waste in the health system of Camden New Jersey (and pretty much everywhere). Katherine Gottlieb of the South Central Foundation (Nuka) in Alaska had just finished laying out that stunning model. Bobby Baker and Teresa Cutts opened the hopeful trifecta explaining the "Methodist Memphis Model of hundreds of community partners."

At least 100 people--more than 20 of which were CEO's of major health systems--crowded the room. I'll post links to the extraordinary power points and summaries of the meeting when they are ready.

I had the privilege of giving opening comments in place of Gary Shorb, Methodist Healthcare CEO, whose mother had emergency surgery. Here are my comments:

We come to this White House aware of our many roles: we are citizens, believers, administrators, healers, sons of mothers, sisters, neighbors and, yes, even policy wonks. We will speak out of that complexity in different ways as together we try to catch a vision of what is practically possible and how we can help each other make the possible come quickly.

Why are we here? This is a mean and bitter time in public places; the poor and the sick resented by the powerful for making inconvenient claims of mercy. So it is curious that this Tuesday morning this small group of faith and community based hospitals meet with government partners at the White House to do some opportunity solving. The focus is on how to weave the extraordinary 21st century technologies with the tenacious capacities of the love-based, justice-seeking institutions still accountable to faith or community.

This is no time for happy talk, as health organizations and government face uncertainties too numerous to list. We usually forget that the most disruptive uncertainties are good news, not bad, including the most obvious; successful policies and partnerships have resulted in most of us living inconveniently long.

Technologies today let physicians see blockages in arteries in real time 3-D allowing robotic surgeries quite recently unimaginable. Every specialty rides a wave of technical innovation that propels it almost faster than can be described. The disruption comes because the technologies that change the possibilities also change the relationships between specialized roles rooted in the previous technologies, back when nothing was digital, everything on film or paper. This kind of positive disruption dominates the attention of Washington because it changes who gets paid by whom.

Let's be clear what we are not doing: we are not pleading for our burden to be less; we want to be accountable for the effectiveness of our close working partnership with government so that together we bear the fruit we are intended to bear in health (Rev Dr Don Stiger of Brooklyn Lutheran not pleading...).

In Memphis, Methodist LeBonheur Healthcare reports $156 million dollars of "community benefit" including $104 million of the actual cost of charity care and another $21 million of cost for patients only partly covered by government. A similar amount goes to pay for training health professionals in partnership with publicly funded Universities in Memphis. We do not wish the amount to be less; we want it to be more effective.

All of the hospitals here today far exceed the level required by government. We are not trying to get around the system, we want to know how to form more powerful alignment between public, private and faith driven partners to generate more health.

Most of us are committed to do this in very tough communities, each of which we think is tougher than anyone else's. Memphis is a vortex of snarly, intractable challenges of race, class and ill health. But it is not any tougher than Jacksonville, Alaska, East LA or Brooklyn. And, truth be told, we love Memphis; we are here on purpose; and we want it healthier. Just as you do your community. So we are not here to complain; we want to learn with other partners who can help us be the institutions our communities need.

The most profoundly positive disruption of all may be the new relationship possible between hospitals and neighborhoods, especially illuminated by the bright light of 21st century science. Most diagnoses are no longer death sentences; not even AIDS, cancer or CHF. We live with conditions that would have killed us only recently, but we live in greater dependence on a web of partners. We obviously still need healthcare: insurance, pharmaceuticals, physician, other providers and, from time to time, hospitals. But now the journey of life includes family, congregation, social services and a host of wellness-enhancing helpers including community health workers. These are brains on the ground, not just boots on the ground. Our communities are filled with answers and assets, which we can work with, if we become teachable by those we previously only saw as liabilities and needs.

In a time filled with swagger and spit, venom and vanity you will find this room filled with the cool breeze of humility and the refreshing tone of adults trying to act like adults (two of them, Joshua Dubois of the White House and Fred Smith of Wesley Seminary pictured). The result is not predesigned to be revealed at the end of the meeting. Nothing will happen today that we ourselves do not create. It will come out of our conversation with each other about how we could be together to help us do the right thing in our own community, informed transparently by others trying to do similar work. That would help us in Memphis, so we hope for some ongoing relationship, especially in the practical spirit embodied in the Partnership office's work.

The quality of teachableness is what links three innovative health models held up like a lens: the way that Nuka in Alaska has built a highly efficient, broadly comprehensive system by listening with unfeigned respect to their native American members receiving their services; the radically useful intelligence Dr. Jeff Brenner discovered by following his most expensive patients home to the apartment buildings where they taught him the reality of their lives; the 376 covenant congregations of Memphis who are shifting outcomes data the hospital previously found inscrutable and intractable. These are disruptive models that decenter the hospital and drag the accountants outside the lines of their spreadsheets.

In a cynical time of diminished expectations from nearly everybody, hope simmers and bubbles as we ask, "How do we bring these disruptions to full bloom?" Innovation. Community scale. Faithful. Bold. Today.

////

- Posted on the journey

Reversing History

2011-09-19T07:18:00.001-05:00

Most weeks going to the White House for an all day meeting would be pretty much the biggest part of the week. This week it is at least arguable that being part of a plenary panel for 1,500 wonks 10 miles North of 1600 Pennsylvania Avenue may be more significant. The panel kicks off the annual meeting of the Agency for Healthcare Research and Quality, a federal unit which sets much of the agenda about what and how the government measures what matters in health organizations. This year the focus is on how innovation and collaboration in healthcare can change disparities, access and quality of care.(ahrq.capconcorp/ahrq)

Not very long ago Memphis would be the negative case study because we get all three of those wrong so often. In recent years our quality inside the walls has gotten pretty respectable. But our patients don't live inside our walls; they live outside most of the time. And when they step one foot onto the sidewalk they can be back, not ten or fifteen, but 150 years, when race and class created vast differences in life expectancy and unnecessary suffering. Unraveling the mystery of why could take the full-time career of all 1,500 of my fellow-wonks.

Hospitals were rarely equitable in their healing effect on the community, since they were largely created out of the power and largess of the dominant political and philanthropic culture, which in Memphis was largely white. Employment, privileges to practice and basic access where unequal, even among the faith-based hospitals like Methodist Healthcare. We have worked very, very hard to reverse that history, but it does not help to deny it. (The picture is of Nelson Mandela's sleeping mat in his cell on Roben Island.)

The hope of healthcare is to for the powerful instituions to become teachable, not just by battalions of wonks and researchers, but by the mothers, brothers and neighbors who know the other part of what we need to understand about life in our tough city. They may not know the detailed etiology of diabetes, but they know about the lives in which that disease must be lived. The most powerful gain from our covenant with 376 congregations is to bring the hospital into an appropriate relationship where we can be taught and guided by them. Not all are "minority" (should be called majority in Memphis). But the blend of cultures and class is rich in wisdom and practical tactical insight. We all become teachable so that the blend of intelligence comes alive.

Not many data wonks will thrill at the previous paragraph. What measures and metrics? Gathered with what assurance of objective credibility? Translated exactly how across the different cultures? With what clinical processes administered by what credentialed individuals taught by who? Albert Einstein said that " if we knew what we were doing, we wouldn't call it research." I'm with Albert on this. But all the research questions must be pursued and answered and tested. That is how these organizations move, change and, eventually, change the bitter history into something that looks more like what God had in mind.

- Posted on the journey

White House 2: DNA

2011-09-18T12:54:00.001-05:00

The US News and World Report recognized our little hospital system in Memphis as the best in the region for the second year in a row, a fact which makes us very proud. The list of specialties in which we excel runs down the side of our largest hospital for four stories, as you can see. But if you look closely, "improving the health of the community" is not on the list. And it would not be on the list of any of the other hospitals the magazine honors. It is simply not something that anyone expects a hospital to be good at, much less excellent. But back a hundred years ago when our (and most every other) faith-based hospital was founded it was assumed that a great hospital would in fact, inevitably lead to a healthier community. It turns out to be harder than that.

The idea was that government would take care of public health prevention and surveillance (watch the movie Contagion, if you are wondering whether you need that....). And faith and non-profit agencies would get tax breaks to provide charity care. Nobody imagined it was possible to make a profit running a hospital and even it it was possible, it was a bad idea to try. Until this past year it was childishly easy to pretty much make up numbers proving that the tax waiver was justified, so gradually there emerged a whole category of hospitals that should be called Not-Not-For-Profits but Senator Grassly largely closed that loophole. Last month the State of Illinois, not known for its virtuous government, took away the tax break for a number of hospitals that were simply beyond the pale.

But nobody quite knows what to ask of the hospitals in terms of their role in generating the health of the community. The hospitals don't really know what to ask of themselves beyond taking care of a lot of people who can't pay. Should they also be expected to be a creative partner in advancing community health? How exactly would they do that and how would anyone know if they were good at it?

On Tuesday The White House and Department of Health and Human Services will convene a small group of health organizations to explore how communities are crafting partnership and programs that work for the good of the whole. The meeting is organized by Mara Vanderslice, Director of the federal Center for Faith Based and Community Initiatives (hhs.gov/partnerships/). The Center has a long bipartisan history, officially created by President W Bush and tweaked under President Obama. But the faith-government partnership has been gathering steam since Carter, Bush 1.0 and Clinton. Once could argue it has been in and out of fashion for 250 years, an acknowledged part of how America works since de Tocqueville wrote in 1835 (pictured).

The current meeting has blended DNA, part of which traces to the Interfaith Health Program at Emory (ihpnet.org) and its long work with the Centers for Disease Control and Prevention. They jointly hosted a meeting at The Carter Center on the role of the "strong partners" years ago. It was curious about the role that faith-based hospitals (and the foundations that were sometimes created when they were sold) could more systematically contribute to the health of the public--not just their patients. That was the first time the phrase "religious health assets" was coined. And the meeting noted that "If you follow good science to the root causes of disease and injury, you will find more than a long list of individuals awaiting admission: you will find yourself struggling in a community with social incoherence." ("Playing to Our Strengths," Carter Center 1995)

The idea of religious health assets was later elaborated and deepened by the scholars of southern Africa, especially the late Steve DeGruchy (pictured) and Jim Cochrane, then the World Health Organization, especially Canon Ted Karpf and then hundreds of others, even in Memphis.

The other streams of DNA of the current discussions trace through the many particular histories of the hospital systems and the different way that science, faith and human communities combine and morph along their journey. Neither personal or organizational DNA is destiny, however. Genes are triggered by environment and in this case leadership, community and family. Sometimes a gene can be recessive for generations and then find its time has come. I think that's what happening Tuesday. The small set of hospitals coming to the White House Tuesday have in common the fact that are not afraid of the flux and tumult of our time, they are expressing their deep DNA. They are strong and while challenged, led by people who want their systems to fulfill the promise their founders--and their governmental partners--intended.

To do that the hospitals will need to learn from each other and government experts, as both also learn from the communities about what works and what is possible. That won't all happen in six hours, even at the White House. But in this mean and bitter time in Washington, it signals that it is a bit too early to give up hope that we can be the people our communities need us to be.

- Posted on the journey

White House 1

2011-09-17T12:23:00.001-05:00

On Tuesday morning about 20 health organizations, mostly large hospitals like Methodist Healthcare, will meet at The White House for a day of opportunity solving. We will not be coming to complain that we are facing harder challenges than any generation since humans figured out how to walk on two feet. It is a group of grown-ups trying to do what grown-ups are supposed to do--work together in the interest of those that depend on us to do the right thing.

These are tough times in more ways than can be listed in a blog. Government and health organizations facing radical changes driven by technology and global interconnectedness that has bound us together in ways we don't even know how to manage. We are swimming--almost drowning--in more information that we we can make any sense of. That's the new normal. But this is not entirely new, which is why I began with the picture of one of the bronze carvings on the front door of Grace Cathedral in San Francisco.

It is also still normal that adults try to make decisions to work with what we have to give hope a chance. When you fill up a room of 15 or 20 faith and community-based healthcare organizations and federal experts, you have a LOT to work with. Even one of the more modest systems--our own in Memphis--has 10,000 employees providing care to 64,000 inpatients and another quarter million outpatients every year. About 8% of our total revenue covers those who pay nothing, with another 2% only partly covered by the government and we still give another 2% to our University partners to train medical professionals. We absorb that $156 million and still have an A+ bond rating. It is quite a feat of skilled--faithful--management, but we and others like us do that. It is not a small point to note that these faith-based institutions accomplish this in very tight relationship to the federal, state, county and local governments beginning with the very large portion of our payments that come from Medicare or Medicaid, not mention the grace in not having to pay taxes. That's what we were designed by an earlier generation of grown ups to do and it works pretty well.

We are meeting at the White House because we think it could work even better.

Warren Buffet knows you make you most profitable investments when the market is paralyzed by fear. The most significant social investments are also made in times when things seem to be falling apart. You can make different connections and alignments precisely because the pieces are apart. When the ground shifts, new things are possible.

The picture is of the rock bent into gorgeous new shapes just north of San Francisco, which sits above the fault line. The earthquake shaking health organizations these days is the fundamental shift in science that has shaken our wall to the point they are almost irrelevant. The wall has collapsed between the old idea of public health (prevention, surveillance) and healthCARE (treatment, disease management). We all tend to live inconveniently and expensively long, precisely because of earlier success in both public health and the treatment organizations (hospitals).

Our common challenges are conditions we can live with over time, sometimes shockingly long periods of time even with AIDS, diabetes and many cancers that only recently were death sentences only demanding lament (hence the picture of the poignant AIDS Interfaith Chapel inside Grace Cathedral).

These high-capacity organizations built in one paradigm now have to re-organize ourselves around these new opportunities to extend the promise of 21st century science to our communities. That's really what is happening on Tuesday; not pleading, but planning how to be together in a new way so that all the assets are aligned to serve what is now possible.

That sounds so naive, doesn't it? But it is the cold truth that many billions of dollars of health assets will be in the room that are owned by and accountable to faith or community. Their adult leaders are paid pretty well to make sure those assets provide a maximum return on the investment measure in the health of the communities that have trusted them with such extraordinary possibilities.

From time to time it is still normal for adults to do the right thing. The United Nations was formed in the aftermath of the catastrophic events of World War Two, partly as a result of fervent prayers offered up and still remembered in Grace Cathedral (marked by this wall just inside the front door). Adults to that kind of thing. And they still can.

Tuesday's work is far less ambitious for we already have all the institutions we need. We just have see new ways to learn from each other and work with each other. We don't have to invent water, just rearrange the plumbing so that health--and maybe a bit of justice--can flow down as it is intended to do.

- Posted on the journey

Dust and mist

2011-09-08T14:02:00.001-05:00

Beneath hot blue sky,
baked green canvas,
shimmering air and
flowers laid
on polished copper
held above the open grave
by dull grey metal and webbing
they knelt by mounded dirt.

Jeff, then Sally,
Brother, Sister,
then John, Lauren
(son, daughter)

let the grey dust of Melinda
through their fingers
into the light
stealing sideways
under the tent
(as it sometimes does
through clouds after
a Delta storm).

Melinda drifted in
the last emptiness
between Jean and
Mike below
waiting.

The grave breathed in.
And then, as gentle as a
memory of a smile
nearly lost,
out.

Free as steam rising
from coffee on a cold day
sister dust
lifted as dry promise
into the beam
a last and only time
to wrap
over and around the family
entirely blessed
before the preacher said a word.

- Posted on the journey

All of us praying for all of us

2011-08-27T18:06:00.001-05:00

Two gatherings in two days, both shaped by prayer. The top 500 or so leaders of Methodist LeBonheur Healthcare meet every quarter to look at mission-critical information. On Wednesday our time was built around Jim Conway, the remarkable long term leader of Dana Farber Cancer Institute in Boston (which I'll blog about another day). We always open with a invocation sometimes by me and more frequently by one of the chaplains in our division. Many think of the invocation sort of like the flashing lights telling you the real meeting is about to happen. This time the prayer flashed and illuminated the whole place as Rev. Steve Miller seized the full authority of his ordination which is multiplied by many years of integrity and prayed:

O Lord our God, how majestic is your name in all the earth!
As we gather this morning, we do so asking You to remind us of the calling and purpose You have placed upon our lives.

So remind us once again that there is no “Good to Great”, without a moral foundation, that we have no future direction, without a current guiding principle. Remind us that the “Power Of One” lives and resonates within each of us.

Remind us that our work is not only the care for the broken and diseased body, but to soothe the chaotic and fearful soul, and quiet the disrupted spirit anticipating a surgery or procedure.
Help us to genuinely care for Your people. Grant us the empathy to walk with them, hand in hand, and navigate this institution we call Methodist LeBonheur Healthcare.

Remind us that with all of our advances in medical technology, pharmacology, surgical procedures, state of the art equipment, our bedside nursing and even our status as a teaching hospital, that we will never achieve our fullest potential to heal, our greatest medical outcomes, or outstanding patient satisfaction, without compassionate care to our patients, families, and onto each other.

Lest we forget, remind us that when the patient is sick, the whole family is sick, remind us that we are the visitors in their lives, that’s why we wear the name badges, they already know one another. We are strangers giving them diagnosis they don’t understand, prescriptions, they can’t pronounce, and sometimes prognosis they can’t comprehend. We are the visitors, not them.

So change us Lord. Change our perceptions, and remind us that one day disease can overtake our bodies, that we will age and be in need of care, that we will be the patients, the one waiting with baited breath for a word from our physician, we will be the one waiting for a nurse to bring medicationfor our pain, we will be the one waiting for results from our x-ray and labs, We will be the one praying for transparency and honesty from staff, so that we can make difficult decisions for ourselves and members of our family.

Change us because we might find ourselves in an institution where our status as a healthcare worker won’t provide us any special professional privilege, our knowledge of medicine and the human body won’t entitle us to any special treatment, our hospital ID won’t grant us any special access. Change us we pray.

Now help us Lord to always do the right thing, no matter what the cost. Live out our lives individually and collectively without regret, having treated every patient, every family member, every visitor, and every co-worker the way we want to be treated with dignity and respect, with neighborly compassion and care, for we are but the servants of the Most High God. Amen.

When he finished the room had been reduced to stunned silence knowing that something holy had happened to us all.

Later the next evening, a couple dozen gathered in the Innovation Studio of the Center of Excellence to talk, pray and break the Ramadan fast at the invitation of me and Dr. Alim Khandekar, one of our long time surgeons. He and the other Muslim physicians has last eaten about 5am, worked all day, broken for prayers, then joined us to talk about how spirituality guides their healing work. One of them did the call to prayer about 8pm and we ate. And we did talk intensely about our various pathways that have brought us into healing work, how it shaped our presence with those who are ill and dying. We talked about how the Muslim physician from Pakistan has learned how to pray with the Memphis protestant at the most sacred moment in their journey. And we talked about how we can come alongside each other on the next steps of our walk of faith and healing.

Prayer. What a mystery it is that we are made to imagine that short-lived, shorter tempered humans can find our way to the boundary of the holy and speak appropriately, even, dare I say it, usefully? It is as unlikely as finding a planet made of diamond. That also happened on Thursday, the third most astonishing thing of the two days. (http://www.washingtonpost.com/blogs/blogpost/post/diamond-planet-discovered-by-astronomers/2011/08/26/gIQAAXIRgJ_blog.html)

Apparently God can make pretty much anything God choses to imagine. So
what if all of us prayed for all of us? We would never know which prayers worked. And perhaps they all would.

- Posted on the journey

Living against the grain of fear

2011-08-14T13:50:00.001-05:00

(Methodist Healthcare celebrated our "Living Awards" this past Thursday evening with quite a big show at the Peabody Hotel with nearly 500 important people attending, all in the name of faith and health. The highlight of the evening was the honors given to the Church Health Center and Dr. Bob Waller. Here are the comments I gave earlier in the evening.)

Faith and Health at Methodist healthcare embeds an ambitious strategy of aligning a strong faith-based hospital with equally strong community assets--historically, the Church Health Center and more recently, Christ Community Health Services--all surrounded by and connected to a cloud of hundreds of congregations (362 as of this morning) all focused on justice and mercy at community scale. That’s quite a sentence, but it is exactly what is happening. The only way these powerful assets come into alignment is through the shared vision and blended intelligence of those in leadership roles within all those organizations, many of whom are laypeople serious about their faith and deeply committed to the vitality of the city they love. This room if full of people like that which is why you sense such deep power moving in and through us.

Methodist Hospital is a pretty good hospital hungry to be great. While US News says we are the best in Memphis, we are tantalized and on many days humbled by what remains before us. The region we serve continues to face profound –some less hopeful than us even say intractable—health challenges driven by long patterns of gross inequity and poverty. And, as Faulkner said, the problem with history is that it is not in the past. You can see the past in our emergency rooms every day if you understand anything about the health problems of the people we serve. This is to say that our eyes are wide open to the reality of our challenges.We do not blink and will not turn away. We believe we are called to be the hospital—and health partner—that our region needs. We think we can indeed be great not just in the eyes of some national magazine, but in the hearts and minds of those who need us most.

It is easy to be confused about what is happening at the Living Awards, especially if we think we are here to honor these remarkable people for what they have done in the past. They have all received plenty of awards for that and do not need ours to add to the bookshelf. Tonight is about the future and the possibilities these lives inspire us to envision. We are looking not at, but through these lives, “as through a glass darkly” in the words of the Apostle Paul. What we are looking for is inspiration. What if? What if? What if, these exemplary physicians were the norm? What could they lead us to be? What if Dr. Waller was not such a solitary model of statesmanlike vision? What if there were a thousand of him, too many to pick out which one to honor? What if the extraordinary creative engine of compassion, the Church Health Center, was typical of faith-based programs, instead of unique?

In time of great fear and uncertainty, the world wonders where the grown-ups have gone. The credit rating agencies are really downgrading the maturity of the leaders we have chosen and thus, quite directly, us. The rating agencies, like everybody, aren’t looking for geniuses, but grown-ups. In this time, nothing is more important than to look at real lives who inspire us with the confidence that maybe we, too, could be the people and organizations our city needs.

Tonight, look not to the past. Join me in looking toward the future. Perhaps we can move from “what if” to why not: why not us, why not now.

Why not?

- Posted on the journey

Norwegian Prayers

2011-07-24T20:58:00.001-05:00

I have a Norwegian name and maybe 1/16th of my blood comes from the fierce, noble people who carved a distinctive culture of rock tough land and a cold ocean. I treasure my Norwegian friends that share in the hopes of building a global network of faith-based health institutions.

So I am also proud of a King who can cry for his people as did Harald V this weekend. Every single one of the 4 million Norwegians know at least one of the 92 young and civil servants who will be buried in the next couple days. The people are so tightly bound that most are an extended part of the many extended families who will weep for a long time.

In recent decades Norway has come to be thought of as a gentle wealthy country, so fair-minded as to be confused for neutral, sort of like Switzerland. But their oil wealth is quite recent and like the smart farmers and fisherman they have been for millennia, most of that wealth is in the bank or invested in education and health so that it will bear dividends needed when the oil runs out. And they are not gentle, but fiercely tenacious to what they have always been willing to fight for--their independence and free voice. Their "boys in the woods" tied down hundreds of thousands of Nazi troops in World War Two, keeping Britain from invasion until the Americans decided to show up and join the fight. They were among the first to lend their young men to fight in the frozen mountains of Afghanistan against Bin Laden.

Now they will weep a waterfall of tears for every single one of them and all of us who have come to love and respect them. But Norwegian sorrow will not spill like acid on the sacred documents of their democracy. They will remain recognizably Norwegian. They will love their free and open society and thus protect it against anyone whether it be a crazed evangelical from among themselves, a distant muslim or meddling American (like the Bush era puff who accused them of not being tough on terrorism). They will teach us what it looks like to defend democracy even when the attack comes from within.

Because of who they are, the lament for family and friends will be deep and slow. But so, too, will be their proud refusal to give in to fear, to turn away from the world and into themselves. Our Norwegian friends at Diakonhjemmet Hospital are convening a meeting of global and interfaith healthcare leaders on the Mount of Olives in East Jerusalem in November (Methodist Healthcare is proud to co-sponsor, with Augusta Victoria Hospital as the host)(http://www.faithbasedhealthcare.net/ejc2011/). This is the 120th anniversary of the founding of Diakonhjemmet Hospital, but they thought it would be better to focus elsewhere because it might support a global movement to do so, which is about as typically Norwegian as it gets.

The Norwegian church remains the soul of the people in a way that is hard for Americans to understand, since on most Sundays most Norwegians are off walking or skiing in nature. But the Oslo Cathedral filled to lament and strengthen resolve almost before the dust settled on the rubble a couple hundred yards away. And some of those prayers were instantly and instinctively to preserve the powerful humanistic values Norway represents, including openness to cultures and faiths from around the world. God so loved the (whole) world, pray the Norwegians, and they mean the whole thing. May we pray with them.

- Posted on the journey

Seeing with our own eyes.

2011-07-23T09:53:00.001-05:00

Sometimes it helps to see through another's eyes. This guide is holding up a print of a Georgia O'Keefe painting of those red dirt hills behind her. I'll never walk by a pile of dirt again without wondering what it might look like in different light, through different eyes. It helps.

That was sort of my job with a very smart group of Coloradans gathered at Ghost Ranch this week. I'm not Georgia O'Keefe, but I do see things differently, especially where faith and the health of the public come into focus. Mark Earnest and I unpacked the intersection of the "social determinants of health" and what faith has to do with it, which turned on some new lights of possibility. There is a gathering wave of solid science linking social factors, especially inequality and poverty, to long term health status. During the time when the sixties generation has been doing this and that to entertain ourselves the United States has become a dramatically more stratified society, with a lot less mobility among the strata. I have no idea how my generation let that happen on our watch, but it did. The result is a striking, even shocking, rate of violence, obesity, widening of graduation rates, decline in voting and other things you just would not think would be so directly correlated. But they are.

So what does any of that have to do with faith? For the most part religion in the USA has been and is complicit with those trends. Sometimes it has been actively so. I'm thinking of the ugly and cynical wedding that you'd expect among cousins living up the ideological mountain holler. You can observe this on most any religious or Murdoch TV station. That stuff is so obvious that is will wash away with the first rain burst of rationality.

The more dangerous complicity is passive and mindless; when we have stayed content to do pastoral care and one-on-one kindness decade after decade. Those things are always right, but almost never adequate even for that one person, much less the next hundred or thousand just like them. This is visible in many substantive and worthy models of faith and health--notably Faith Community Nursing. This terrifically smart model holds great subversive promise, but is currently measured and valued by its capacity to provide caring, not social transformation. We have to hold that model--and all of our models--accountable to the powerful new insights provided by the social determinants of health. For the most part, the scientists doing that body of work don't think about faith communities at all as having anything to do with those determinants. But I do.

It is right to worry about the mean chaos alive in the US today. I write this as The Deal goes down in DC; and as the blood goes down in Norway--cold shocks to any hope. But there is some serious science blowing the other way, that helps us see the way toward healing of the body politic, the public. It takes time for that flow to carve new patterns in the social stone, find new channels for the hopeful river to flow.

In the South Western Desert, you just can't miss the astonishing changes wrought over time; and how much time those changes take--oceans up and down, volcanos and then millennia of wind and rain. This cautions and encourages me as I am so impatient for changes that should have already happened (universal health coverage). And then I see such clear evidence of the reality-based science and public will eroding the old rock-like resistance. It might take a couple decades instead of the months I would want. But you can feel the wind.

Meanwhile the powerful work on the ground is happening around rooms such as this one where people are seeing their own power and doing so with their own eyes. People from public and faith-based hospitals, a handful of faith community nurses, some semi-retired clergy and docs, a smart young anthropologist working on AIDS, a psychologist my age helping organize the early steps toward universal coverage in Colorado, another bringing PICO's powerful community organizing methodology underneath a clergy action network and,

most astonishingly, a social worker who attends an evangelical church building community collaboration around... meth addicts. Sometimes hope on the ground is far more wild than the hope we were expecting. I dare you to feel hopeless in this group. I know that I can't imagine giving up until they do. Delusional to hope? Or delusional to quit? I'm staying in and hope my life can be one small burst of wind carving the next curve of the rock ready to catch the light of the new sun.

- Posted on the journey

Ghosts and Memories of the Future

2011-07-20T19:50:00.003-05:00

God paints and appreciates it when people notice. Light and land, water and wind in constant playful change. Georgia O'Keefe lived here on Ghost Ranch and noticed better than most. I'm pretty sure God gave humanity another hundred years just because of her respectful attentiveness alone.

Since 1955 this magical land has been under the stewardship of the Presbyterian Church, which offers it up as a venue for seeking and seeing for several thousand people year. I'm here this week with 18 Colorado people convened by Chris Adams(engagedpublic.com) and Mark Earnest (MD, PHD, University of Colorado) to explore how people of faith can extend and nurture the common good in the context of health reform. That work begins with noticing what God has been doing in creating the habits of the heart and potentials in human connection.

Meanwhile health reform crackles like a wildfire in DC, a metaphor that has come power here literally within view of the smoke over the ridge to the south. The picture is of O'Keefe's beloved Perdenale, but I suspect she would have loved the rain falling on either side of it today, hoping it will be enough to break the drought and dampened the fires. I wish it would rain in Washington, too, and give our land a chance to heal.

While this is the land of the endless sky and humbling rock formations, there are smaller miracles everywhere to notice. It a photographers rule to never shoot pictures in the middle of the day. But here the light is never so bad justify not paying attention. Mary Oliver said that the most basic task of a human is to pay attention, which does imply that it costs something to notice. Attentiveness is not free. You have to stop whatever else you might do, offer up just a bit of time, stand still and watch.

As I came closer, I noticed more and more and more; almost bursting out laughing to find not one, but two bees doing whatever they do in the middle of the flower covered up with pollen. I suspect it will result in more bees and more flowers,too. Life abounds.

Of course, I am talking about the miracles among us, the strange and wonderful way that even while fires of stupidity rage in Washington, people care for each other. They notice. They care. They create patterns of caring, some of which turn into committees, some of which turn into projects, some of which turn into shelters, clinics, even the random hospital now and then. Sometimes we even organize volunteer fire departments who drop everything they are doing in their little lives and rush together when the common good is at risk.

A volunteer fire department doesn't just show up like a swarm of well-intentioned people. Somebody organizes them and they buy equipment they think they might need. The show up for training, not just fires. And they build commitments among themselves so they know they can count on each other to be there and be competent. And then one day a neighbor's home catches fire. Then the whole community can see what their volunteer fire department neighbors has been doing--they've been preparing for just this moment. Months of mundane labor and a few hours courageous drama. Most of what a congregation does about health is similarly mundane, made up mostly of committees and checking blood pressure, maybe a health message during worship now and then. No big deal. But every now and then....

The last picture is of a cliff formation O'Keefe painted many times. I like the eroding gully at its base which signals that God is still painting, still creating new possibilities. Pay attention......

- Posted on the journey

Jesus and the tummy-tucking christians

2011-07-10T22:12:00.002-05:00

Why didn't Jesus go to church? I know one of the reasons is that he was Jewish; but I can't think of a single time he went to synagogue either, except to pick an argument with the puffed-up religious leaders of his day. When he needed to get to close to God and his own soul, he got as far from religion as he could get, heading out to the desert or across a stormy lake. Or he went for a long walk into forbidden territory (Samaria) and talked to forbidden people. Much of his testament is a long, long list of conversations with people up trees and standing lonely by wells with some so totally crazy they needed demons to be cast out. And he was famous for his parties. But pretty much the only reason he went to "church" was to throw money-counting tables upside down, or to scare the heck out of his home folks by claiming God sent him. He sure didn't sit down in a pew and sing.

For that matter, he didn't show much respect for any religious trappings, which made him an easy and constant target for the healing he did on the Sabbath in very direct opposition to the rules.

This is all so obvious. But it is hidden from us because we usually have heard these outrageous stories of this first century messianic itinerant carpenter inside....church. Hearing of this wild and unconstrained savior in such tame surrounds wraps the story in bubble wrap so we can hardly feel the hard, sharp edges even when we try to grab hold.

This is on my mind because I visited a church that shall not be named today. I was going because of a special event that promised to blend blues and hard-talking about following Jesus. I could use some of that, so I showed up. Deadly predictable, faux challenging, achingly polite and ancient. Jesus would have headed to the desert at a fast jog and stayed there until he ran out of locus and honey. There is a story of the devil tempting him to jump off a high tower to test God and prove divinity. I think Jesus would have jumped off the nearest steeple just to get all the niceness out of his mind.

How it is possible that this wild, bold man has devolved into the mascot for what has long passed away into harmlessness?

It isn't just the churches that have wrapped Jesus in blandness. It's us--me.

Today there was a most curious article in the Memphis paper about a gorgeous young woman, 23, who was having her tummy tucked and other parts touched up. I think that must happen a lot, but not usually for beautiful young women. What is most bizarre is that she did this to help her career as a...songwriter and singer. My life has a soundtrack largely written by smart southern women (Indigo Girls, Patty Griffin, Michelle Malone, Emmy Lou Harris, Lucinda Williams, Bonnie Raitte, Jewell (Okay, she's from Alaska....)). The whole point is that they tell the truth so vividly that even I can hear it. So it was a shock to think of a smart southern song writer getting her tummy tucked. Who can I trust?

But is it any less shocking to think of people who know a very great deal about Jesus forgetting what a wild man he was/is? We preachers, deacons and evangelists have self-administered theological tummy tucks for decades just to keep up appearances and hide the deeply annoying prophet/God who broke every rule he came across on his way to the Cross.

- Posted on the journey

Equality and Pursuit of Happiness

2011-07-04T14:05:00.000-05:00

Two years ago two British public health researchers have written the definitive book about the United States, which I got around to reading this weekend, 235 years after we we threw them out. In "The Spirit Level" Richard Wilkinson and Kate Pickett explore the mystery about why equality makes societies stronger in almost every way and why inequality makes any society weaker.Only in recent years has reliable data been available to allow comparison across many nations for a wide range of health and social issues, as well as detailed measures of the distribution of wealth between and within nations. The subject is relevant on July 4th because they cast an especially clear eye at the United States, and the wide differences between our various states.

The big idea is that once a society has passed a certain level of economic well being (think Portugal or Greece) additional average wealth doesn't make as much difference to the quality of life that you'd think. Once you have generally available clean water, safe food, decent housing and basic medical care other factors have a lot more to do with happiness and well being. The most reliable way of predicting the health of a society--or a particular state in our Union--is the degree of inequality between the citizens.It makes sense that poor people would have lower health. But why would relatively rich people in an unequal society also have worse health than their counterparts in a more equal society? People in Greece spend about half of what people in the US do on health but they tend to live about 1.2 years longer. Why? And why would I raise the issue on July 4th?

You'll have to read the book to fully grasp their answer to the question (The Spirit Level, Bloomsbury Press, 2009). But just look around to answer the second. In my lifetime the semi-United States have witnessed huge growth in our economy, but nearly all of the benefit has gone to the rich, creating a vast and deepening divide between them and the large number left behind. The United States today is a very, very different pattern of citizens with quite different prospects. I write as one of the accidental winners. A public school kid born to a teacher and civil engineer, I went to Wake Forest back when it was for middle class kids who couldn't afford Duke (or get into UNC!). When my parents passed away, they left each of us five kids about $15,000, which is to say we were born to honorable work, not wealth. I've traveled to many countries for this and that reason, so I know to be grateful for where and when I was raised.

But that nation is largely in the past, as Wilkinson and Pickett gracefully point out. And we face growing sense of conflict among ourselves, constrained by real limits to our growth and real competition for our privileged status. The fundamental structural inequality taking root in the United States is showing up in predictable rates of disease, violence, anxiety, depression. In short anything related to social phenomenon is acerbated by patterns of inequality.If you doubt this, let me invite you to spend a day in our emergency room, or at The Church Health Center or one of the Christ Community Health Clinics where reality is not ingnored.

While these are big patterns, they are not inevitable or irreversable. For instance, the authors chart the large differences between nations and states in terms of whether people trust each or not. In Norway over 80% of respondents say they could trust pretty much everybody in the country. They noticed, as I have, that it is common for coffee shops to leave blankets outside on chairs so that customers can linger in the cool over coffee. I've seen people leave their babies in strollers outside the window of coffee shops. It would not cross their minds that anyone should think this odd, dangerous or foolish. What could happen? Ask anyone in Mississippi, the state with greatest inequality and lowest trust (17%!)(page 52-3). Does inequality produce lack of trust; or does lack of trust produce inequality? The causal arrow goes both ways, but the result is polytoxic producing generational patterns of problems including a chasm between those trying to fix the problems in government and also in private healthcare such as my own Methodist LeBonheur Healthcare. Inequality produces distance, which produces ignorance, which produces misunderstanding and more distrust and lack of collaboration and and and and. People don't trust their doctors, much less the abstractions called "executives" of huge organizations like hospitals.

There is much to learn here from our British friends, but the most basic is that we cannot expect to merely grow our way out of inequality. And that is simply not possible, especially as we must all make our choices in the context of increasingly clear environmental limits. "Modern societies will depend increasingly on being creative, adaptable, inventive, well-informed and flexible communities, able to respond generously to each other and to needs wherever they arise. Those are characteristics not of societies in hock to the rich, in which people are driven by status insecurities, but of populations used to working together and respecting each other as equals."(p263) Sounds like America to me, at least what it was. And could be again.

This has very practical implications for our work in Memphis where we have built a "web of trust" among 357 congregations to care for members and neighbors and advance the health of the whole community. Inclusion, invitation, generosity, transparency, flexibility, connectivity--all among people dealing constantly with gross evidence of inequality on some of the toughest soil in world.To give health a chance, build trust.

I appreciate the Brits for reminding us of what is worth fighting for as we go back to work tomorrow. Check out their website: www.equalitytrust.org.uk

The opposite of old, dumb, scared and mean

2011-06-25T18:15:00.001-05:00

There are many things in the world to be afraid of. Tornadoes and floods deserve a thought, especially this year. Hurricanes, always. But the big damage is done by groups of people that are old, dumb, scared and mean, especially when all those objectives describe how they think about the future. Like a tornado, there is no arguing with them, just beware their random damage. But like a flood, their swath is predictable; you can usually stay out of the way. And keep on eye on the levees, especially behind the levees where dumbness tends to find a way under. I’m thinking of the silly foci of the anti-Muslim crowds in neighborhoods all over the world. This is the same bunch that wants to change the very structure of our civil society to protect us against people nobody should be afraid of at all. They are a civic sand-boil, not a levee break. But they are useful in reminding us of what the future is not about.

What is the future about and how can we get there? Well, you could look through young lives that are the opposite of old, dumb, scared and mean. The (first!) Summer Youth Conference on UNITY and HOPE, attracted youth and adults (who are fit to be with youth!) in a feast of smart discussion and action, all about the world that should comes next. The future isn't exactly dazzling when it first becomes visible. The line up deserved 2,000 people and we had a cozier group of about 150. But then again, the Dalai Lama didn't fill up the place either (Memphis is a tough town). But the future is on the way. You can see it.

The gentle and gentle sprout of hopefulness was watered by some very big global names, such as as Nobel Peace Prize Nominee Dato’ J. Jegathesan of Malaysia. Most of us in Memphis haven’t heard of him, which is because isn’t from around here and isn’t afraid of the things we’ve been taught to worry about. He—like most of your youth—is interested in what should come next and how we lend our lives to making it so.

The whole gathering idea of Dr. Sunny Anand, the globally renowed intensivist at LeBonheur. He spends most of his time seizing the next few days of life from the jaws of young tragedy, one moment and one life at a time. Thank God. But he is a citizen of the future, focusing hope and imagination on those who we will depend on soon—and finding a way to gather them together to help us all find our way. Those coming together bring their faith, not just of different traditions, but also different futures. I’m glad my Jesus faith is there, but also that of others illuminated by other lights.

It is a bit audacious to think that my generation of grown-ups has much to teach the rising one. We’ve spent most of our time fiddling with new gadgets while a few of us invented some great music. But we pretty much failed to turn the course of things that matter; looking around the world today looks old, scared, dumb and mean, just with iphones. . But few of us can still rock, including the Kings of the Delta led by Greg Lacky of Arkansas (It takes some guts to call yourselves kings of the delta in Memphis!) So maybe we can at least talk with the rising ones.

And maybe together, teach other the things that make for peace and hope.

It's not done! (the future or the conference about it) It rolls on Sunday morning at 9am at Cannon Center in downtown Memphis through about 4pm. Check out the website at http://www.unityandhopememphis.org/

- Posted on the journey

Essence, Hope, Generosity (amazing)

2011-06-16T20:49:00.001-05:00

You would not expect the Mississippi Annual Conference of the United Methodist Church to be a life-enhancing experience. Unless you knew anything about what is going on here. Mississippi is dead last in almost any health statistic in the any book, although they swear they have edged up ahead of West Virginia in a few categories. And it is true here as in most places that United Methodist clergy have been about 20% heavier than their lay members of the same age (not easy to do in the South!). Not encouraging for health folks.

So it is, well, amazing, that this is the Conference that has become best example of Wesleyan tradition in integrated health and faith since Wesley got on a horse. And the most visible signal of what is working is the Amazing Pace program, which builds a very smart and comprehensive wellness emphasis focused on the simplest of all things, walking.

Hundreds of Mississippi clergy wear their uploadable pedometers religiously, to use exactly the right word. In the past several years they have walked just over 2 million miles(including a couple around the state capitol early saturday morning). It is not a coincidence that the clergy health insurance plan has not had to have a rate increase in those four years and even returned a million dollars from their reserve fund into the pension fund -- because the hard claim data indicated that fundamental usage patterns had changed. This has happened in the years of recovering from the still-lingering trauma of Katrina when you would expect the opposite.

Some would think it would take all kinds of draconian threats, humiliation and massive incentives to achieve changes like that. And there are some minor incentives that will actually return some cash to participants if they meet the goals of 10,000 steps each month. But the main incentive is visible, verifiable improvement in health, energy and sense of possibility that is visible in the lives of each other. Oh, and, being religion, competition. The program tracks and makes visible who is walking how far in terms of individuals, but also teams from Districts. It is considerably more fiercely watched than church basketball (which makes rugby seem civilized). People encourage each other and not just the svelte and fit. Many of the leaders are traditionally shaped, but getting fitter and fitter.

We see this because Methodist Healthcare offers free health screening, which we've done for a couple decades. In the past few years we've been delighted to lend our support to the Amazing Pace (including sponsoring that walk in what feels like the middle of the night!). Our volunteers, almost all retired employees, do blood work and then counseling for a bit over 300 people each year. They tell the truth, inform and encourage people to take their own lives in the right direction. And many do. Year after year after year. Amazing.

All this health stuff is like a positive whirlwind that translates quite directly into energy that is felt on the floor of Conference itself. It helps that Bishop Hope Morgan Ward is the embodiment of all things alive and well in the Church--and that she is such a gracious messenger for Life. So the hundreds of pedometers carried by clergy on the move resonate with the Word from leaders.

So the songs of hope, grace and possibility all make sense; the prayers for healing are seen to be in the process of being answered. It is not delusional to hope--just look around. The Spirit moves and moves and moves.

It is still Mississippi so much of the mean and savage past remains visible, too. Faulkner noted that the problem with history is that it is not in the past. Race, gender, sex, privilege and power are all remain fiercely contested. The Bishop is regularly flogged because she gave the microphone to a lesbian couple two years ago. But just a few booths down from the Methodist Healthcare health fair is DREAM: "daring to reconcile and embrace all in Mississippi"(blogging at www.dreams.word press.com).

Steps and then more steps. You show up and start walking. Things happen you had given up hoping for.

I've been thinking again about Nathan Wolfe's observation that viruses live because they are able to "generate novelty." And the way they do that is to share their DNA in wildly unpredictable ways. They are generous with their essence, so things happen that would never be possible if change depended on each individual virus tweaking and scheming.

Human communities that learn to be generous with their essence generate novelty that allows life to find a way. Lee Burdine is the brain and spirit behind Amazing Pace. He is quick to deflect credit and he is correct in seeing the amazing changes involving many people who are generously contributing to the emergence of novelty. But he is generous with his essence, gracious and tenacious in the Mississippi way I have to respect. Not one, but ten thousand steps at a time. Amazing.

- Posted on the journey `

Murder of crows, hilarity of geese

2011-06-07T16:56:00.001-05:00

Paducah is full of surprises, such as a full scale giraffe where you would not expect it. And, for that matter, a whole arts district (and a gorgeous coffee house named "etcetera"). Here for the Annual Conference of the Memphis District (no, nobody knows why Paducah is part of it). Reflecting on the curiosity of hundreds of clergy in one spot, John Kilzer informed me that a group of crows is called a "murder of crows" (look it up) and a similar group of geese can be called a "hilarity of geese."

I'm not sure what a gaggle of clergy should be called, but nothing so bland as conference. Some are worse than crows and funnier than geese, but most are simply people who year after year after year show up in people's lives with integrity, humility, care and then do the very best they can with what they've got. And then suddenly before
they notice, they've done it for 30 years. The best are surprised and regard the suddenly passed decades with some humor, but could fill it with a million stories of what matters most.

When you look closer, the colors and patterns of integrity are subtle and dazzling at the same time.

In Bishop Dick Wills "state of the church" this morning he said that if you didn't want to follow Jesus, just stay in church. But don't bar the gates for those following Jesus outside in ministry. He begged us not to take the church so seriously, while taking Jesus far more so.

He played the video from "playing for change" and the original stunner of a video beginning with Roger playing "stand by me." (http://playingforchange.com/episodes/2/Stand_By_Me) If you haven't seen it, do it now and forget the rest of the blog.

Wayne Merrit used to say that "you shall know the truth and truth shall make you odd. "It is not easy to follow the odd savior Jesus, for it will surely make you odd, too. It is sure a lot harder to do so inside the walls of the institution which tries to keep him safe from all he said. This is probably one of the clues to why it is generally healthy to be in a congregation, but potentially lethal to lead one, or lead four hundred like a Bishop tries to do. And a clue about what health looks like. More like the arts of resistance, than "compliance" (a hospital's favorite word for good patients).

- Posted on the journey

Innovation Invocation

2011-05-25T22:23:00.002-05:00

Every quarter the top 500 leaders of Methodist Healthcare gather to see how we are doing and where we are going. We call this the "quarterly business review," but it is really a mission review. Today we gathered in 8 locations linked by video broadcast from the Innovation Studio in the Center of Excellence. We were sobered by the stunning images of the wrecked hospital in Joplin, so I opened with the following prayer.

God of every past, you have drawn 10,000 of us together from Arkansas and Mississippi and every part of Memphis, but also Pakistan, Scotland, India, Africa and every part of the United States. What a wondrous thing you have woven from so many different pasts!

We see the shattered hospital in Joplin and ache at what people just like us are struggling with at this very minute. Give them strength beyond their own strength to do their labor. We cannot know what the day will ask of us. But whether we are asked for courage or quiet diligence, we thank you for bringing us into others' lives as agents of your healing.

God of what comes next, give us the spirit of curiosity about you have not yet revealed, not yet done. As we are accountable to the past, let us be accountable to the future, too. So we offer up our best without pride as the seed of something better. Revealing God, honor our earnest search for innovation so that your love and justice might flow into the lives of the patients and families and neighbors you have given us to serve. Break down our fear, break loose our imagination and break through our satisfaction with "good enough." Fulfill Ezekiel's prayer that you replace a heart of stone, with a heart of flesh. And now tune our hearts to each other as we listen for the common heartbeat of a common mission.

We know you are already saying yes, even as we offer up our prayers. So with confidence we say Amen.

- Posted on the journey

God's Economy

2011-05-18T22:58:00.001-05:00

There are no weeds in the economy of God. There are, however, a lot of things we don't know how to work with. So, fifty of us met in Simsbury, Connecticut (which has this week nearly as much water falling from the sky as Memphis). We were "converged" by Criterion Ventures, led by Joy Anderson, one of the most creative people in whole world (top 100, according to Fast Company Magazine). In her presence, everybody gets about ten notches more creative, too.

Patrick Duggan helped us move to understand the "church as an economic being" with some asking, "where is the cash stuffed away in all the nooks and crannies of denominational structure?" Others asked baldly, "what is the value proposition of the local church?" Others, also practically, "how do we find a workable business model for seminaries," and "how do we find and form the next generation of leaders who can lead these spiritual/economic beings?" Andy McCarrol and I came curious about whether there were new models that might help us expand our Memphis congregational health strategies to scale.

There is no shortage of anxiety in the church today, but I share little of it. Church structures are certain to dramatically shed structure and form like our auto companies have done in humbling fashion. But humility is appropriate after decades of serving as the complicit center for a culture that is among the most wasteful in the history of the species. Does anybody think the church deserve a reward for our performance any more than Chrysler?

So we'll have fewer full time "learned" clergy, a lot fewer seminaries and way less gothic boxes on corners. No big loss to the Kingdom of God. The astonishing thing is that we (I am an ordained part of it) have billions of dollars of liquid and material assets that are fungible enough to realign in service of what God might have in mind next.

We still have thousands of people laying their life on the line through churches doing all sorts of useful things. Some are young and crackling smart like Tom Daniel of Atlanta, or Tim Soerens of the Parish Collective in Seattle, Dan Senter of California and Cynthia Rasmussen in Rochester. How much more talent does God need?

And there are plenty of the "older young"--people in the 50's-70's who have seasoned talent and staying power: Jim Bennett of Church of the Savior, Steve Monti in North Carolina, and on and on. And some way smart veteran denominational mechanics: Phyllis Anderson, Greg Black of the UCC, Woody Bedell, who knows all there is to know about clergy health. How much talent does God need?

So too at the root. Last Thursday I witnessed the miracle of another class graduating from our CHN training, filled with power and encouraged by the practical knowledge. Every seven weeks another 60 or 100 goes through another flight of learning. How much talent does God need to get going?

There is startling number of faithful people who know how money works, and how to get it into the service of real change. The Investors' Circle, Village Capital, Praxis, Imago Dei Fund, OikoCredit, Equilibrium Capital Group, e3bank--and the whole wild ecology of others found at SOCAP. How much money does God need?

This morning I walked through the drizzle to an abandoned field behind the hotel. Some pine trees were quietly starting over in their busy and awkward way. And down at the root of what I thought were just weeds are gorgeous little red flowers. How much beauty do we need?

When we release our fears just a second, we notice assets and human capacities sufficient not just for the day, but for all that may be required of us. If God has enough (which seems to be the case) perhaps we do, too.

Surely, we have at least enough to take the next right steps on the path. What we could use more of is clarity of vision. That deserves some prayer, discernment, deep dialogue and, maybe even silence. What exactly do we need to do next?

The question has an edge when we know we have enough to start.

- Posted on the journey

Quiet, massive. The Mississippi

2011-05-07T18:43:00.001-05:00

The Mississippi flows across the land and carves it path this way and that. The picture is from Reelfoot museum, mapping in different colors the many different courses across the years.For the last hundred years or so it has been contained within earthworks that among the largest humanly constructions on the planet. For the most part they look like they will hold the river in once again, except the lowest-lying neighborhoods where the poor live. There are a lot of poor in Memphis, so this is not a small number who will lose--once again--everything.

What is surprising to me--and might be surprising to those reading from a distance about the raging river and it wrath-- is that massive flow is actually quiet. It is hard to imagine tens of millions of gallons of muddy water moving in silence. It boils and rolls, carrying trees and clutter from upriver. But it doesn't seem wrathful, or particularly emotional.

It just does what rivers do, dangerous only to humans who take it personally and fail to respect its ways.

- Posted on the journey

Be a whirlwind of love

2011-05-02T12:59:00.000-05:00

It is still raining out my window as it is up and down the Mississippi. There is justified awe and fear of the power of that great river, which channels the flow from 31 states. A very great deal of that brown water goes past beneath the Memphis bluffs and it is rising to levels not seen since 1937. One of my sunday school class members told yesterday of that great flood which covered much of eastern Arkansas. He was 17 at the time and remembers his high school closing so that it could be converted to emergency shelter for people driven off their land by the water.

On saturday I road in a fundraising bike ride for diabetes (the tour de cure). The 35 mile route wound from riverfront splendour though industrial grit and then in neighborhoods on the edge. Their homes were financially "under water" with lots of foreclosure signs block after block. And now non-metaphorical water rising up the walls of the mobile homes in the bottoms, heading for the streets nearby. Humans are vulnerable people, needing each other to make it in ways and means that we don't expect.

The radio and TV shows know they can draw a crowd with bombast and mean-spirited silliness about individual responsibility replacing government. But in real life where it rains, floods and ever now now and then swirls with F5 tornado force, it takes all kinds of responsiblity--personal, social, faithful and government.

Collins Dillard is an artist of abnormal sense and sensitivity. The picture is a poster he did for our little United Methodist Church, St. John's, to tell us how to send money where it will help somebody immediately and efficiently. The United Methodist Committee On Relief (UMCOR) has a stellar record moving fast and smart with compassion and competence. Just google UMCOR Advance 30021326. Send money. And prayers of gratitude that we are made to connect.

The other pictures are of a kind of sculpture Collins did that went along with the poster. The bent wire spirals up out of a stone toward a heart. We were encouraged to come, pray, place a paper heart at the base signalling the prayer and the intention to help.

Do it.

Gary

(Thank you Collins, for quietly reminding us that art gives us the coherence to find our toward each other.)

Predicaments of trees and turtles

2011-04-27T07:49:00.001-05:00

A week of profound passages: Heather Ion convened sparkling minds exploring "the epidemic of health," KD's 90th, my 60th and Jesus rose again, too. Too much to think about, so I am mulling on the predicament of trees (in real forests) and turtles (crossing actual roads). The tree first.

Walking down the gravel road alongside Fighting Town Creek, we passed under a young oak bent a perfect arch. One of the pines killed by the bark beetles a couple years ago fell in the heavy spring storm, tangled with the oak, weighing it low, caught.

I thought all day about the improbable things that happen to real trees, so unlike the pictures we paint. In real forests (and neighborhoods) anything physically possible just might happen no matter what the predictions based on averages might expect. I was intrigued by the tangle off the ground that held the bent tree captive to the fallen on and even walked back later near dusk to find the predicament more improbable than I thought. The pine didn't just topple over, it snapped in the wind, caught its upper branches in the young strong oak, which bent but held the severed trunk a foot off the ground like a grey ghost might hold a troubled mind. The things that happen to trees ... and people.

Nathan Wolfe, a virologist Jonas Salk would have liked a lot, joined Heather's exploration of viral metaphor by phone. Nathan is named by Time Magazine this week as one of the 100 most influential people in the world (and on a much shorter list of influences on my daughter). Sparked by Heather Ion, he noted that virus are instructive for humans in how they "generate novelty" by combining and recombining genetic information constantly and promiscuously. Novelties (innovations) are tested against reality--also constantly--and those that work better stick long enough to generate more novelty. That's how viral life works, with some clues for us mammals.

I'll wait for a fuller posting on this until Heather has a chance to edit the transcripts. But you can see why it matters in the real neighborhood where you live.

Humans mash ideas together constantly, too, because we face not just threats but opportunities. As technology and knowlege move, it turns out that reality holds more possibilities for life than we had known. We are not contained by what has been possible yesterday, or even this morning. We can generate novelty, too. Indeed, the lives of all we love depend on the adaptive innovations that come from how our lives combine with others'.

Less than a month ago I was measuring my steps against geological phenomenon, noticing that I lived barely longer than one of Nathan's virus. Better generate novelty fast, for life is quickly passed on to others. The thoughtful community philanthropist behind our "epidemic" meeting passed on just last night. But Richard Cornuelle knew his ideas had combined with those of Jonas Salk (who passed on a handful of years ago himself). Lives are good when they leave a vital process more alive.

In the meantime, notice that turtles (and people) have predicaments that can be helped now and in very straightforward ways.

This is the patch of clutter where I moved a box turtle from his precarious rest two thirds of the way across a gravel road. Safe in his armored skin, he probably thought this an unnecessary novelty. But he didn't know about cars and I did, so I moved him unasked. He did not tarry to thank me and was long gone when I walked past again 45 minutes later. I thought of Loren Eisley's "star-thrower", walking the beach at dawn chucking stranded starfish back in the surf. Turtles are less poetic, but probably a lot more alive.

In Rock Hill to celebrate KD's 90th, I noticed an off-brand Baptist church announcing "Jesus stripped, shamed, tortured, killed...for you!!!" (Happy Easter). The ultimate Vital Novelty lost amid the violence. What wondrous life is this, asked the song, more helpfully astonished at the combination of divine and human. I wonder what it would look like if we believed it?

I thought of Bobby Baker, his Navigators and Liaisons intervening in the lives of hundreds of people (mostly moving slowly as turtles) every month getting them to where they need to be to have a better shot at health. Many of those lives are as unlikely as the tangled tree and many just as obviously exposed as the turtle in the road. Their hope is the novelty of competent compassion--hundreds of mundane but creative acts of vitality done quietly and a system that puts people in positions for life giving novelty.

- Posted on the journey

Ready... aim, aim, aim...

2011-04-18T20:10:00.002-05:00

Boston is a city of revolutions past--and maybe future. Sometimes revolutions are simply things that just need to happen and are overdue. This is certainly the case with the "triple aim."

Among health wonks nothing is more obviously righteous as "the triple aim"-- lowering cost, improving quality and improving population health. Originally advanced by the Institute for Healthcare Improvement under Dr. Don Berwick, the triple aim is embedded at the very root of the current federal health care reform legislation. It also pops up at state levels such as Oregon (http://www.oregon.gov/OHA/action-plan/).

Just beyond the water over yonder is Bunker Hill; to the left behind the glass towers, Boston Commons. A more wonkish revolution is under way now, which is why a group from Memphis was here for a couple days. We were drinking deeply of the IHI / triple aim cup along with a hundred or more other folks from around the country. Representing both major hospitals in Memphis, the Med and The Church Health Center we listened to how these goals were being reached at large scale in upper Wisconsin and Oregon.

Of course the new triple aim is a footnote to the original one in Micah 6: "you know what the Lord requires already (some 2,600 years ago): do justice, love mercy and walk humbly." If we had done that, we would not need the new triple aim. The new triple aim is related to Micah a bit like the plumbing is related to Amos' prophecy that justice will role down like mighty river. Don't take plumbing lightly. Just because it depends on gravity, doesn't mean it is easy or obvious to get it to work. Same with health care.

We learned about CareOregon, a managed care organization for the poor that actually manages and actually cares. With tenacious decency, they use data like a righteous sword to carve waste and silliness from the lives of their members and providers. The result is dramatically more efficient services that are proactive, comprehensive, quick and responsive to what people really need. It passes for brilliance these days to notice that the most expensive patients needing the most medical services can be predicted by asking simple questions about substance use and family problems. And it passes for innovation when you do something non-medical about non-medical issues. Micah knew that would help, but did not need the cost savings to justify it.

Rebecca Ramsey, of CareOregon, shared how the basic revolutionary idea came from the SouthCentral Foundation in Alaska, which has built a large health services network on the highly participatory wisdom of the Native people. They (the people!) turn out to be pretty smart about the way people's health is connected to their families, community, decency and ... spirituality. The Native spirituality got left out of the story but the moral commitment to decency sure didn't. The key is that the embrace of those with the most complex conditions (almost often involving the snarly mix of substances, interpersonal violence and mental issues) is way cheaper than pretending the complexity isn't there. Mercy is cheaper; justice even more so.

These lessons are crucial for Memphis where we sit on a never-ending well of wicked disparities and poverty. We could be tempted to think we can't face the inherent complexity of multi-generational cascade of race and class. "We'll just do what we can; we can't afford world peace." Actually, IHI, Oregon and Wisconsin seem to say that world peace--taking it all on--is cheaper and more managing than trying to operate a hospital blind to the quiet violence of our patients' lives. We are way off the national curve for unneeded hospitalization that can be effectively managed only by getting involved in the complexity of those who have no real alternative. We are even further off the curve for expensive and futile care at the last months of life; that can be managed not by harshness, but by the gentle-kindness Micah aimed at. We're in a world war; why not work on world peace?

In the meantime, we can at least do a lot better. Micah thought he was only asking for what was obvious and doable: "you already know what God asks.....". IHI lives on the wonk-ish side, finding a buzz from the data and flowcharts. But they are talking about the same mercy, same justice and, ironically, the same humble seeking for what is possible on this earth.

- Posted on the journey

Adults behaving badly

2011-04-09T18:42:00.001-05:00

In what appeared to be one its last actions before closing down in the fact of stampeding Vandals, the White House Office on Partnerships posted an article about "the Memphis Model" on its website. The Vandals thundered past to no affect, but may return at the walls next week, so you might go quickly to http://www.hhs.gov/fbci/resources/newsletter/040711.html#feature
to read the brief piece by Mara Vanderslice.

You've read the basics here before: hundreds of congregations connected to the big three faith-based treatment systems (Methodist LeBonheur Healthcare, Church Health Center and Christ Community Health Services) and pretty much anyone in town that wants to partner.

This would seem to be a fragile model for such wild oscillations in public policy. I could fill pages with simply lists of fundamental variables affecting the choices of all institutions involved. Given our 330 covenant congregations and these 3 key partners, there are at least 333 long lists of unknowns with big upsides and downsides that raise uncertainty to the 333rd power.

So we do the best we can on most days to consider the limits of what is possible to imagine and try to move that way with whoever we can do so that day. We try to respect each other and expect the best of all involved, and we are usually right. It is not pretty, but real.

However, we are not naive. We do not expect all the adults to behave well or to be able to keep to their best intentions, sometimes not even to keep their promises. In other words, it fits the times in DC and Memphis.

We muddle, which is what is possible for humans to do in complex and uncertain times. But we muddle while talking constantly to each other, making every incremental good choice we possibly can. It is not all that might be possible in the abstract, but all that are possible on this small and wild planet.

Sometimes the stars offer up an opportunity to move in big leaps. We are considering trying to become a model city for application of the Institute for Healthcare Improvement "triple aim." But that model seems to think that we could and should get all the powerful and smart people to agree, first, then act. The "memphis model" that appeals to the White House is more untidy and yet more ambitious. The heart of the Memphis model is to take advantage of every opportunity to bend the arc of justice in the right direction. It might work. And it might not. We continuously improve our aim and never give up.

In a week when we are told to be grateful our government employees are even going to be allowed to come to work, that seems pretty good.

- Posted on the journey

Shalomalization

2011-04-08T19:30:00.001-05:00

Talking won't end disparities, but learning might. It depends on who is learning (and to a lesser extent, who is teaching).

Monday was April 4th, a sacred day in Memphis where Dr. King was murdered 43 years ago just down the street from the Center of Excellence on Faith and Health. In recent years we have joined with other organizations in town in a broad array of events, preaching, worship, lectures, march(es) and odds and ends. We shared a logo and a theme: "we are the beloved community."

Our patients and employees look like Memphis in terms of race so we aren't dumb about the subject. We are a very large organization serving hundreds of thousands of patients a year through the efforts of 10,000 Associates and a couple thousand affiliated physicians. Dr. King died before many of our staff were born yet the scandal lingers in the continued dramatic differences in the health of Black, White and Brown. Why? And what can we do?

So this year Methodist Healthcare decided to honor Dr. King by doing the labor of learning, seeking discernment about what our unfinished work is in removing disparities in the patients, families and neighborhoods we can influence.

We met in the Innovation Studio, seeing this as a most profound work of innovation. Led by Dr. Joyce Essien, Dr. Fred Smith and Dr. Elizabeth Williams we talked of the pain (and privilege) that are the lenses through which we are learning. We borrowed the IHP "4 frames" to keep our imagination from collapsing into simple "train everybody" reflex. Structure?How are we structured for disparities? And how could we lay down structures for equity? How might we use our symbolic role in Memphis? (The committee is called "equity" not "disparities," for starters.)(And we met on April 4th....). What does power have to do with it and us. How could we use our power? We will meet again, but the organization seems to be at a true learning moment, tuned to hear what is possible. And then do it.

That evening most of us went to the April 4th Foundation Gala, a very Memphis thing that always crackles with gritty power of history and hope. This year Dr. Jeremiah Wright keynoted and chose the power of cool analysis rather than the fire and thunder he is known for. He reminded us of the "dangerous King" who wanted the Movement to help put out the "house on fire." He channelled King's clarity about the three demons of America--race, militarism and materialism. The history we gathered to honor was still around us; and still ahead of us.

I was just a high school kid in the Baltimore burbs when King fell. And nobody in my family felt much sorrow as we lived in the soft racism of the unaffected. A few years later when the triple demons of America finally caught my attention, I dropped out of ROTC, sought simplicity and began to see race. I thought I would have to dump Jesus, too, since my old god seemed so complicit (he was!). Richard McBride, a Wake Forest chaplain, gave me books of Berigan and King, telling me that I needed to see the Church was bigger than my tame little god.

King blew a hole in my soul that let me out into the real world--the one God so loves; the one God has still not given up on. Everything else in my life has been a footnote to that.

Thursday night was a normal night in the hospital, which is to say that the place is electric with learning. In the Innovation Studio 85 people were learning the art of spiritual accompaniment--how to truly be present amid the illness of another. (Chaplain Jonathan Watkins had them shout "It's not about me!") (We should to that at executive meetings, I thought.) Down the hall in the Medical Arts Auditorium another ninety were learning the practical arts of caring for those living in dementia, led by Dr. Teresa Cutts and Chaplain Belisle, but illuminated by the experience of nearly everyone present. Another 40 people were attending via video-conference from our Germantown campus.

Although the 330 CHN congregations are hugely ecumenical and multi-hued, for the most part Thursday night feels like Black Church. It is. These are the ones whose brothers die too young and whose mothers will die much younger than mine. So the night closes in shared prayer filled with pathos and power.

This goes on week after week after week, pretty much all year round as the congregations open themselves to knowledge respectfully offered up in the hopes it is smart enough for their tough streets.

Nobody was just talking this week, not the equity committee, not Jeremiah and, for sure, Thursday night. Fred talks about education as the work of "shalomalization." That's what all this felt like to this white guy, grateful to be carried on the movement.

Can we learn the ways of shalom? Enough to do it, know it, let it fill and move us? Jesus cried at the question as he pondered his town. I'm a bit more optimistic. Yes, I am.

- Posted on the journey

Grand

2011-03-28T18:33:00.001-05:00

My pedometer said it was 32,000 steps from the rim to the river where the base rock is 1.8 billion years old, give or take a hundred million. (It was less than 8 miles, but nearly a mile down, so I took little steps.) But every little shuffle was about 56,000 years of geology. So my first twitch down the trail passed democracy; the first lift of the knee marked all the time since Jesus, never mind Wesley, all the fruits of scientific method, the Indigo Girls and the Web.

I was silenced by the distant witness of petroglyphs that had improbably survived just a scramble up from the trail. But before my first foot touched the icy mud, I had passed them and all of recorded human history; and then all trace of humanity before the first switchback.

From then on, nothing but the raw creativity of time, wind, water and microbes. Entire oceans filled up, drained and up again. My favorite formation is the "great unconformity" where two geologic layers coincide impossibly because 1.25 billion years in between washed away without a trace. Think about it.

It is no small presumption to think we can comprehend the question posed by such a testament, much less an answer. But you would have to be dumb as a canyon full of rocks not to notice that life found a way. Infinitely serious creativity produces mule deer with ridiculous ears (they turn out to be really helpful in cooling), purple cactus (God only knows why) and trees that can grow in the most absurdly precarious places. God or time, some ask. God in time, I think.

And why we humans? Our sole capacity worth the evolutionary risk may be our capacity for awe, wonder, gratitude and sometimes, even kindness.

There is no litter in the canyon until you get back within a hundred feet of the rim and the 5 million people who come here. People at the bottom talk of "micro trash" and carefully scan their campsite before leaving. So I was so shocked when I neared the rim to see a plastic water bottle in the muddle trail that I stopped, carefully thought through how to get myself and my pack bent over far enough to reach it without spending the afternoon in that position. I figured it out, picked it up, poured out its purified water on a grateful pine, crushed the plastic into my pocket and walked on.

Only 1% ever go that far into the chasm, which might be about the same percentage of those attending church who ever give themselves to the vulnerability of the Spirit and its Question. Meanwhile, as Larry Pray suggests, walk softly.
Give way to those making their way up the path.
Thank the ones maintaining the trail.
Take on part of the load before giving advice.
Pay attention.
And pay with the currency of gratitude.

(And thanks to Karen and the kids for sending me, to Jeff for accompaniment and to John and John for trail guidance.)
- Posted on the journey

Audible Sigh

2011-03-24T22:28:00.001-05:00

Bill Mallonee and Muriah Rose have played to a lot larger audiences than the one last night, but I'd be surprised if there have been any more tuned in to every whisper. They were the first artists to play in the Innovation Studio, consecrating the space with true, clear music that pealed back the cover of life. "Rural Route," looked -- and felt -- through the eyes of a friend who delivers mail in Indiana with lots of time for reflection. "Bakersfield" reached into the inner spaces of a man driven by the dust storms of the depression (a Tsunami of dust, Bill noted). "Friendly Fire" went into the free fire zone of a Vietnam Vet's return and then turned the lens slightly so that it reflected the spaces in between man and woman (Bill warned us). "Audible Sigh," of course (the last album of Bill's earlier band, Vigilantes of Love). This isn't "church music" any more than John the Baptist was just just a philosopher. Bill invites us to see through the dust and ghosts and spaces that look empty, but aren't. It can be scary, but we don't go alone.

The Innovation Studio is designed for just this labor of looking beyond, which is why we need all the art we can get. For one thing, you can actually hear yourself think. And we could hear Bill and Rose think, too, not something that happens much in the usual bar or church gig.

Earlier in the day a group of mostly retired physicians gathered here to honor Dr. Ralph Hamilton, who gave the first gift to build the whole Center of Excellence. They had each in their way pushed far beyond the obvious to find the possible healing in the lives of their patients. The previous day we spent an afternoon looking through the lens of those who take their own lives. Rick Kirchoff notes that "healing is a community venture." Indeed.

Art, science and spirit move toward what looks empty, believing that is where are most likely to find life raw, vital and new. None of the three -- art, science or spirit -- is tame or predictable because you just don't know what's out there until you open yourself to it. You don't "have" science, faith or talent. It has you and won't let go until just can't go another note. Bill has released 39 CD's so far, which he described as evidence of obsessive compulsion more than a career. Life won't let go.

In one of our more grandiose moments at Oakhurst Baptist, we once said that God only calls us to great things. Almost as soon as we heard it, we knew it was a trap. In real life, we never know if our day's labor is big or little until years later. It usually takes me about 5 years to figure out if I wasted my time on a project, a meeting, a conversation an audience. The IHP is 19, ARHAP 9, CHN 4 and the Center of Excellence just a few weeks old. But then sometimes it is clear right away, as last night.

Bill and Rose drove on to Independence, Missouri today, winding their way back to New Mexico. Do your heart, spirit and mind a favor and find out when they are coming near you. Better yet, reach out and bring them in.

- Posted on the journey

Grown ups and government

2011-03-20T21:50:00.001-05:00

Last thursday a handful of us from Memphis met with about 20 leaders and staff of the government in the conference room of the Secretary of Health and Human Services. The Hubert Humphrey Building is one of the remarkably ugly in the whole city, except for the gorgeous quote from .... Hubert Humphrey right inside the front door: "the moral test of Government is how that Government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped."

It takes a real grown up to do that kind of work and the folks here do the nitty grit labor involved 24/7/365 year after year after year. Not easy for DC these days is wall to wall weird and mean. This may be why a way of thinking about community health born in Memphis makes more sense than you might think. Nobody in Memphis is EVER surprised by the weird and mean. And we don't need or expect the course of human events to be pretty and clean. We just keep trying to focus on what we actually have to work with and then try to connect the moving parts as best we can.

That might sound a bit casual, but it is not. It does take the patient, tenacious grown-up labor of paying attention to what is possible and then trying to do it. And just what is possible? That is constantly coming in to view by working on what you already know is possible. The path is made by walking, not alone, but with a broad cast of others trying to act out of their best selves. It is not pretty on most days, but it is real.

Rev. Dr. Cynthia Davis is one of our exemplar pastors who spoke about what happens at the congregation level. It was so inspiring that it sounded almost magical. It isn't magic at all, of course. Enormous hours invested in building the strengths of spirit, mind and body called the Church so that when somebody needs some part of it, it can be the channel for God's love to flow toward healing, if healing is possible at all.

Bill Foege said that "tenacity doesn't always work. But it is the only thing that works."

We were meeting Thursday literally next door to the "situation room" where HHS people were tuned in like lasers to the fragile and horrific events taking place in Japan. Filled with all the apparatus you'd expect in a high-tech nerve center, the human beings were tuning to what was possible to do amid a situation that was impossible to expect. And they were doing it as best they could, (for which we should be grateful enough to pay our taxes without acting like spoiled four year olds all the time.).

On most days our work is dramatically undramatic. Jimmy Carter once called it "the mundane revolution." Doing what might help one thing after another 24/7/365 year after year.

- Posted on the journey

Billions of exceptions

2011-03-13T20:28:00.001-05:00

Mindy Smith sings wistfully, "Tennessee may not be what everybody needs, but it's good enough for me." I feel the same way about our little nearby star, which shines on all that matters on the planet I like to live on with those I love. Last night I had the opportunity to compare it to a few countless billions of other stars at the South Africa Large Telescope complex in the high dry air of Sutherland. If one is ever to be humble, this is the place to get in touch with scale and time.

The star among the many stars is the Southern Very Large Telescope (SALT), the largest the Southern Hemisphere at 11 meters. Open only 5 years, it is a time machine reaching into the aching spaces of what is there to know. And there is a lot. For instance, they've learned about binary stars. About half of what you look at in the dark are not one, but two or more oddly dancing ensembles of bizarre varieties. SALT has found one called a "catastrophic binary" in which a dense small star sucks the volatile gasses off the its companion until it eventually becomes unstable and explodes into a supernova. Perhaps you can think of institutional relationships like that? (pictures at www.star.ac.za)

Thirteen other sophisticated telescopes owned by universities from around the world clutter the 6,000 high plateau. I was hoping Mindy Smith would help me ease into this, but there is simply no gentle way to say that Vanderbilt's tool is called the Kilodegree Extremely Little Telescope.

The South Africans claim my Tennessee colleagues are aware this, but I am sure I am among the few others in the state to know that. It turns out the little sucker does work well at its very specific task of finding other planets. We may need that one day.

Jim, his son Tebo and I spent some astonished hours squinting through a mere 13 inch scope which was motorized to point at nearly anything you'd think to look at. (Imagine what Galileo could have figured out if he had this thing we can buy in a catalog instead of his crude Dutch optic). I saw a globular cluster, which looks to the eye as one fuzzy star, but is actually a cloud of them too dense to count. And the Small Magellan filled with bright young stars emerging in a cloud of galactic dust. My favorite is the "jewell box, a handful of differently colored gem-like suns just below the bottom of the Southern Cross. Oh, my.

SALT sees through an array of 91 mirrors that align to form a perfect 11 meter wide reflective disc. It can stare for hours at the same thing 13 billion light years out of our neighborhood and then an astronomer can peer into that data for months to figure out what it means. There are many arts and wonders to making that happen, but I noticed that they have to constantly fiddle, tweak and tinker with the alignment in order to see anything.

As the edges of the universe constantly expands, so does our ignorance, as new and impossible to imagine things keep happening. So we are constantly chasing after the universe with better tools. At the moment scientists are deciding to build a vast radio telescope array that would cover miles of either here in the Karoo or the Australian Outback. Who knows what we'll realize we don't know.

The Karoo raises people kind to their own kind, for nobody can live in this dry rocky terrain without generous friends. But the land tempts toward hardness on the others who may compete for the green and trickle of water. Surely, if we ever could get our eyes in alignment, we could see that our neighborhood is impossibly cold, that there is nobody on our tiny spot who is not us and that we must be kind or die.

I read Lauren's newest play, "Silent Sky" in Sutherland. It is about Henrietta Leavitt, the woman who figured out how to figure out where we are in the universe partly by studying the pulsing Cepheids in my favorite Small Magellanic Cloud. It is all about connections and knowing of the kind that Sutherland is all about.

Henrietta closes the play looking up.

"Vast. Black. Lonely, except for billions upon billions of exceptions. And there is a reason we measure it in light."

Silent Sky opens April 8th at South Coast Rep Theater in Orange County, California, hardly another 100th of a light second away from Memphis.

- Posted on the journey

Mind Fields are the hope of the world

2011-03-11T02:36:00.001-06:00

This woman with the bright eyes on the front row is Dr. Marion Jacobs, the Dean of the School of Health Sciences of the University of Cape Town. We were pausing for the photo op after discussing the signing of the memorandum of collaboration between the public health and family medicine department (The Department head, Leslie London is next to her) and Methodist LeBonheur Healthcare's center of Excellence in Faith and Health. This gives the African Religious Health Assets Programme a strong new home and Memphis a strong partner.

The intellectual work involves the complex and nuanced relationship between medical science institutions and the even-more complex dynamics of community. The heart of the Memphis work is intentionally changing that relationship with new pathways of trust so that people can move to where they need help at the right time. South Africans know a very great deal about historic patterns of race and poverty and thus have a rich emerging body of thought and practice about building systems of health. We both live every day amid the aching irony of the blinding evolutionary speed of medical technology and the inexplicably slow changes that matter most to most peoples' journey through life. We work together, chewing on data, developing practice smart enough to make a difference at a scale that matters. (other smart and smiling people include from the right Dr. Jill Oliver, me, Dr. Lucy Gilson, Dr. Jim Cochrane, Dr. Teresa Cutts, Almost-Dr. Sepetla Molapo and Dr. Liz Thomas).

And what is also happening is the emergence of what Ian McCallum describes as a "mind field" in his new book, Ecological Intelligence. Across the miles we think alike and also hope alike. "It is therefore, more than anything, an attitude: one that is open to choosing the hard path, the one that E O Wilson calls the path of 'volitional evolution.' This is the difficult path of those who have decided to do something about their heredity and their fate and who are committed to playing their part faithfully." (p.152)

This sounds somber, but the smiles are frequent in this kind of choosing. We laugh more than sigh; say "ah ha!" more than "oh no!" And in the process the data gets clarified, the theory smarter, the practices more effective.

This is Dr. Liz Thomas a longterm core leader of ARHAP thinking hard (she does that a lot). The drawing behind her is, believe it or not, a kind of map for the complex mind fields of faith and health that now span hundreds of partners scattered around the world.

Thinking is a kind of doing. And doing is a kind of thinking. If we are going to bend the curve of the gross and deadly patterns of disease and injury, we are going to need to think and do a lot; and choose partners that are built for high seas and the long walk toward freedom.

- Posted on the journey

Entrance, led by a bear

2011-03-07T00:02:00.001-06:00

I am writing this from CapeTown, South Africa early on Monday morning, but still thinking about something that happened Saturday evening in Atlanta. Technically, that qualifies for "last night" because off the time zone shift. Lauren's new play, "Exit, pursued by a bear," opened at Synchronisity Theater. I shifted time zones, but Lauren managed to shift a whole audience through seven mind-zones.

First and most obvious: you need to go see this thing. You can't describe a play any more than you can describe a song. It's art; you gotta be there.

I saw it being read by a group of actors sitting in folding chairs in a bright room when it was under development at Emory a few months ago. And even at that stage it was mesmerizingly smart and sharp. The play weaves around the story of Nan Carter, a woman in a bad North Georgia marriage trying to get out with the help of some friends who are nearly equally trapped in their lives. Nan quotes Jimmy Carter a lot (who she wishes had been her dad). The structure of the play-- a tragic comedy--is borrowed from Shakespeare, but she managed to get the Discovery Channel in there, and more than you'd think you'd want to know about...bears.

I suppose that all art matters. But art with words performed by human beings in the presence of other attentive human beings really, really matters.It help us see through the clutter, weirdness and wildness of life to find our way. I was in Nashville Thursday, Kansas Saturday and Cape Town today, in each place talking with people who really care about our very weird world. I can tell you that people at least over that 9,000 miles of the globe have a pretty good grip on a LOT of facts. But facts need a narrative, and narratives need a heart for the world.

Art helps science find the narrative of life. And, of course, science keeps story tethered to reality. "Exit, pursued by a bear" is an artistic stage direction from Shakespeare. Clever. But the plot turns on the scientific fact that Nan knew something about bears that her husband did not.

Facts matter. It matters that our planet can't work with more than 350 participles per million of carbon in the air. We have to know that fact so that we can be appropriately afraid that we're already over that number. We should be afraid of that, instead of the goofy fears about Muslims nurtured even in the heartland of Kansas. But facts and fear do not lead us out of our quandary or into the world we hope for. Only a true story--truer than our current facts--can do that. Art matters.

Makes me think the world has a shot. Thanks, Lauren.

Full Run: March 3 - 27, 2011
Thursday thru Saturday at 8:00 p.m.
Sunday at 7:00 p.m.
Venue: 7 Stages Mainstage Theatre, 1105 Euclid Ave. N.E. in Little Five Points.

- Posted on the journey

Straight, No Chaser

2011-03-04T22:37:00.001-06:00

Bill Mallonee (appearing with his wife Muriah Rose) will be the first singer-songwriter in the new Center of Excellence in Faith and Health, Wednesday March 23rd.

I heard Bill at Eddie's Attic in Decatur, Georgia a few months ago and was simply blown away by the powerful, almost painful integrity of the music. I didn't know then that he was so frequently--and surprisingly-- welcomed at seminaries helping to illuminate what the arts have to do with practicing faith. He'll be in Memphis after a wild schedule that takes him through a number of performance venues, but also to Union, Princeton and Wesley Seminaries.

If you haven't heard of him, well, go his website and download his latest WPA album and see if it doesn't light up some places in your spirit you didn't know were there.

And in the meantime, read over the lyrics to "straight, no chaser"--the tune on his WPA album that made a fan out of me. (http://volsounds.com/)

We're sponsoring this with John Kilzer and his Theology and Arts program of Memphis Theological Seminary. The Center of Excellence only holds 95 people as a music venue, so email Ruthie Hayes to protect your seat hayesru@methodisthealth.org

$10 suggested donation.

Straight, No Chaser - music/lyrics: bill mallonee

Trails that led to the mountain top
too late to turn back, too late to late to stop

Friends all left with logs in their eyes

Clapped their hands at my demise

And that’s how the righteous apply

the justice of God with a cold clear eye

Ain’t no one in here without a taint

In every sinner there lies the perfect saint

chorus:

Lay down your sorrows…

They’ll still be there tomorrow…

For you to pick up again

Lay down your fears and doubts…

Give of your heart from the inside out

And all those sad mistakes?

They’ll still be there…when you awake

———————————————————-

A million knocks on unopened doors

A million questions there’s no answers for

Usually the last to know the score

Got these splinters in my knuckles

Sun going down and the city arises…

Shake of the dust and the compromises

Down here kid, you know it never really ends

You gotta learn to dream in color again

(repeat chorus)

I swam the river way past the shallows

I found a thousand dreams there…hangin’ on the gallows

And the shadows they cast on the tender blades of Spring

Gave me…this song to sing

So, sing of the kisses…sing of the failures

Sing of the grief, kid…straight, no chaser

Sing of all that’s poisioned your well

Sing of all you had to sell

(repeat chorus)

- Posted on the journey

Movement Grunt

2011-03-04T22:10:00.001-06:00

Vanderbilt University, like my own Emory, is privileged. It has been for many, many years. It attracts those among the best and brightest, who are able to see the world whole partly because many live sort of on top of it. Sometimes that is useful. Yesterday about 150 from the academy and surrounding places gathered around the question "is there a balm in Gilead?" It was a way for the Cal Turner Center for Moral Leadership to approach the question of how people of influence and initiative should use those assets to advance the health of other people, especially the poor.

It is very good news that that many people of all sorts and types would show up on a gorgeous Tennessee morning to talk about that. Dr. Scott Morris kicked things into motion, as he always does, with passionate and smart stories of his ministry (and his new book, which you should have read by now)("healthcare you can live with" on Amazon and just about everywhere else).

And Governor Haslam showed up to close it out. In between there was a lot of very smart discussion. But my favorite insight was an accident; kind of a blurt, really. We were all asked to raise our hand to show our primary identity. As usual the question stumped me, so I raised mine about six times. Healthcare provider? Academic? Minister? Theologian? Activist? Consumer? Not doctor, nurse, chaplain, counsellor or anything actually useful, of course. But as I was pondering my identity a voice from the back called out "congregational grunt." That's what I should be, I thought!

Maybe a "movement grunt" would be more useful, but I think we meant the same thing. A movement is not something that we have or use. It is the thing that has us; that uses us. And it gives us life in the process as we find ours in the larger life of the world God so loved. And still does.

Amid the infinite complexities of the issues that shape the health of our communities, we are tempted to spend time spinning fantasies of overarching solutions that would make things right. We imagine Counsels, Committees and Memorandum that would bind together Science, Ethics, Power and Rationality. These are works that tempt us away from the real work of imagination. In the end they tempt us to despair.

I think we are in a Bonhoeffer moment these days that calls for something more humble and, yet, radical. Faced with the catastrophic collapse of all that was good in Germany, the young theologian formed a small group of people that prayed, and read the Bible in big chunks, studied and prayed some more. He fell in love and he wrote some (I wish he had written more.) And he gave himself to a failed violent plot to kill Hitler, dying young in the process. He did what he could with who he was and what he had and what he knew. And he did so, not a heroic loner, but a member of a congregation. He was, in a sense, an extremely well-known congregational grunt.

I do not know whether all of our very best will do any better than Bonhoeffer's efforts. We live amid terrible times when we hardly notice the mentally ill wandering unattended under the bridges, sleeping on the steps of our downtown churches. We have forgotten to be sickened by the amputation epidemic filling our streets with people on little scooters marking the motorization of uncontrolled diabetes. We are now hardened people forgetting to gasp at the casual structural violence with which we are complicit.

I don't want to be that way. I want to feel the shock of being drawn by a movement of spirit to lend my mind and my body to bend the curve toward hope. I want to be a movement grunt.

Let it be.

- Posted on the journey

Consecrating a hope, not just a space

2011-02-23T18:22:00.001-06:00

On Monday and Tuesday we experienced a most remarkable flow of blessing as the Center of Excellence in Faith and Health was blessed, celebrated and consecrated. Bishop William Young leading in prayer, Dr. Ralph and Barbara Hamilton lending their support, Rev. Steve Miller blessing the hands of clergy (even me!).

Here are my comments; others to follow:

I must give a personal word of thanks to the many present who have made this space sacred by their creative gifts of every possible kind. And to the most remarkable staff of our division who do the daily work of caring, teaching, prayer and research--wrestling with ideas and data until they turn into smart program. I am an ordained guy from Atlanta who writes books. I would be easily ignored in a busy hospital, if were not for the sparkling quality of their work. That is the true credibility on which this Center rests.

When we started this journey several years ago, I imagined someone asking me “so, where’s the excellence?” I wanted to be able to say, “go look to the family and ask them. It should be present in their lives.” The families helped us get the design right along the way. The family care center is testimony to their guidance, especially the learning spaces so crucial to helping the families with knowledge when they need it. It is important to say that the space makes possible the participation of volunteers who come from our 329 covenant congregations. And the volunteers learn as they serve, enhancing the capacity of those congregations to be places of caring and healing far beyond our walls.

This is the virtuous circle which carries us: more partners, more aligning of strengths and more blending of intelligences. This enables us to do things together that no other hospital or community can aspire to do.

This special room is all about innovation, so let me say a word about that. A lot of what passes for innovation in healthcare is expensive bangles and beads. Innovation is about doing different things, not trying harder at old things.

Nothing could be more obviously needed or difficult to do than changing the relationship between the hospital and the community. This is social innovation, cheaper, but harder than plugging -- or unplugging -- another medical device. Any innovation, technical or social, rests on a blend of imagination, intelligence and evidence. The blender for the Memphis Model is the Innovation Studio at the heart of the Center of Excellence in Faith and Health right near the front door of Methodist University Hospital. This is where the 329 congregations are trained in the arts of connection and caring; here the real-time analysis of many forms of data, here technology connects us with experts working the same challenges in Cape Town, Tubingen, Oslo, or Vellore. This kind of innovation isn't free, but infinitely cheaper than doing the wrong thing or missing big opportunities to do the right thing.

And where is the faith? The whole story is faith: blending our faith-based hospital, with faith-based primary ministries like Church Health Center and Christ Community Health Services. But the true health system is the hundreds of congregations that surround our medical sites with caring, comfort and healing. These are the primary partners led by clergy who have already been generous with their intelligence and lending us their most precious gift, their trust.

Joycelyn Elders once said this kind of work is like dancing with a bear: you don’t sit down when you get tired, but when the bear gets tired. The bear is not tired. But together, we dare believe that we can bend the curve of brutal health data that maps the patterns of death in Memphis today.

So we today consecrate not just a space, but the hope the space serves. Every bit of carpet, fabric and art sings out the word of life, as does the light that washes the space. This is God’s imagination at work, I believe, imagining a community beloved and whole and healthy.

May God protect and empower us as we move.

- Posted on the journey

"The Memphis Model" ("use what you got, baby")

2011-02-12T16:57:00.001-06:00

Rev. Bobby Baker works for me. But I am just smart enough follow him. He has evoked the Congregational Health Network, now 314 strong, that is the most unusual part of what is coming to be known nationally as "the Memphis Model." This week we inaugurated the "innovation studio" in The Center of Excellence in Faith and Health by hosting a working delegation of leaders from federal health and human service agencies, including Mara Vanderslice, the acting director of the office on Faith Based and Neighborhood Initiatives. They wanted to understand how this very novel model of collaboration emerged where you would least expect it. So we played Memphis Minnie as the sound track: "use what you got, baby," she counseled.

It is, as Mara noted, a victory all by itself to see a covenantal relationship among hundreds of congregations working to advance the health of the community. But the Memphis model includes many other partners, especially Church Health Center, Christ Community Health Services, the county health system and other collaboratives (notably Healthy Memphis Common Table). We all have different (sometimes opposite!) ways of doing business and staying alive. We work in an environment of conflicting, even perverse, disincentives and weirdness. But in Memphis we do find a way to help each other express our best selves on most days.

We are known for mapping our assets as taught by the South Africans. They also taught us to focus on what we've got. As Steve DeGruchy said, "you can't build a community out of what it doesn't have." Still a work in progress held together by leaders trying to do the right thing, this work of aligning our assets is bending the curve. Or, maybe even more; perhaps the arc of history is bending toward justice, as Dr. King prophesied.

This is a time when the country needs models built for the real world of mud and muddle like Memphis. All of gathered this week with a deep sense of urgency as we work in a mean spirited political atmosphere where health reform is frayed and undermined even before it is barely under way. We need to move fast and bold.

Just days before I was in Miami at the annual governance meeting of Premier network of non-profit hospitals. The theme was all about "leading transformation through the power of collaboration." Premier is essentially a buying club for hospitals so that they can achieve bulk savings. But it has grown into a learning network of real significance. I attended an early morning briefing by Kirk Hanson about the ethics challenges of reform. Notably, it took Kirk nearly all his time to list the many wild drivers of change in hospital-land these days that are spinning off ethical issues like feathers flying from a truck load of chickens. But he barely got to the big ones, such as what hospitals really should be accountable in terms of creating healthy communities. And he didn't quite get to the fundamental uncertainties such as global economics. Oh, and climate change.

The name of this blog is "leading causes of life." It is about a simple ethic: if it looks like life, go that way; and if it looks like death, go the other way. And make sure you grab the hands of whoever is heading toward life, too.

I thought of Bill McKibben, in his stark book "Eaarth," about catastrophic climate change, but counseling us to not despair in the face of destabilizing realities. How to live? Come together acting in hope, intelligence and sacrifice beginning in your own neighborhood, city and region. Act like grown-ups, in other words, working with other grown-ups to create social levees adequate to the floods we face. The waters rise, drive and fly in the winds of change. So we turn to each other and do the right thing, whatever that means with whatever you have influence over or leadership for a huge hospital, a health clinic, a congregation or just your own home.

That's the Memphis Model. You can see it happening....live.

- Posted on the journey

Not Here by Chance

2011-01-31T20:13:00.001-06:00

This is the covenant that guides the wildly vital life of Oakhurst Baptist Church in Decatur, Georgia. (You can read it at www.oakhurstbaptist.org) Written in 1977 by a number of mostly laypeople some of whom are still finding their life on the corner where the "covenant stone" now rests. Karen and I joined only a year after it was written and born and raised both daughters in its light. The covenant continues to be living body of thought for sons, daughters, rising and setting stars, recovering and revolutionizing people ever since. It was amended in 1997 to broaden Galatians 3:28 to exclude distinctions in sexual orientation and mental ability. God only knows what other distinctions will be excluded next, but I would note that my golden retriever, Jessie, once walked the aisle on a snowy day to join and was accepted. ( I believe that even the Apostle Paul would have recognized Jessie's faithful heart.)

The covenant invites, not contains, reminding me of the the way the banks of a delta river guide, more than hold, the vital flow. And like a river, you can never visit the same Oakhurst twice.

John Shippee offered up the prayers of the world this day (those prayers being pretty much the only constant in the order of service for the past 30 years). John's language is usually the superabundant eruption of Old Faithful. But today--on his 67th birthday-- all of us could hear that the cancer is back. He asked for our grace as he read his prayer. I can't remember a single syllable, but I am sure God took good notes and got to work on them. But you could feel the depth, ache and reach as he prayed, not for himself, but for the green and glorious, bloody and lonely world.

Curt Armstrong, the leader of the local l'arche community, spoke to the last line we pledged, "with God's help and the help of my sisters and brothers in this fellowship, I make this covenant." Echoing Jean Vanier, he distinguished between productive and fruitful fellowships and the way that our blended vulnerabilities lead us to healing as they pull us toward relationships. Incompleteness is a grace, when experienced in fellowship. So is the ache of never-to-be-completedness.

I thought of other days when we stood by the stone and read the covenant.
One sunday I even preached and said that the test of a covenant is that it would not be fulfilled in ones life, but would be found valuable enough to be picked up when we laid our lives down. I had no idea what I was talking about, of course, assuming I would always have time. Now I see that my very best thoughts and visions call me far beyond my little self for I will not see them complete.

The Congregational Health Network also has a "covenant" that calls us beyond ourselves to the beloved dream of a Memphis that looks more like what God had in mind when he made the river flow just beneath the bluffs and across the rich delta. This is a baby covenant, alive only three years and living among only the first 311 congregations. What will it be in 2045 when it will be 34 years old like Oakhurst's is this day? Will it still stir the heart of young and old and call out prayers by the sick on behalf of the well? Will it still feel young, wild and possible only with God's help and the help of the sisters and brothers in the fellowship?

May it be, Lord, please may it be.

- Posted on the journey

Enough to go around

2011-01-27T20:34:00.001-06:00

So, I was planning all this week to post a very cool and thoughtful reflection about presenting a seminar at the World Bank about Memphis' experience as developing community and, of course, how our mapping, aligning and animation of religious health assets is showing such promise. Would that not have been very impressive? Well, it turns out that Washington DC needs a bit of development. About 15 minutes from landing in the heavy snow our plane headed back up above the clouds because the ground radar was broken. Flying cowboy that he was, he insisted that he didn't mind landing into that twisty little runway by the Potomac in the driving snow, but they wouldn't let him try it without ground radar. Kudos to whoever decided that!

So instead of a picture of me at the World Bank, I give you a picture of the little train that shuttles back and forth in the Detroit airport, which is where they send you, apparently, when you have tried and failed to land in DC.

Delta handled the deluge of frustrated passengers with calm competence. And the hundreds of frustrated passengers were pretty calm themselves, actually. I did think some of those in the 'privileged" line would pop a gut when two people in wheelchairs turned out to be even more privileged than they.

I found my way back to Memphis on an early morning flight in time reflecting on how it was that there are people in Detroit standing by, prepared and ready for such a deluge in the middle of the night. Where do they keep all the stuff that turns out to be needed on sudden notice? What would all those people have done with their time, if we had not dropped from the sky?

And I thought about the fact that even in our tightened times, there is slack in the system when needed. And there is actually slack in other systems, too. About 10% of our patients at Methodist pay nothing these days and yet we find a way to cover it and keep going, still making money ourselves. There is enough to go around.

The last picture is another one from the soon-to-emerge Center of Excellence. This one is soon to be where Ruthie will sit in the reception area welcoming families, clergy, and zillions of volunteer care-givers to be trained. And a lot of other kinds of smart people ready to blend their intelligences to create the social innovations we need in Memphis. There is enough for us to work with. Way more than enough.

- Posted on the journey

Sheetrock and HTML fit for a King

2011-01-15T12:14:00.001-06:00

Things are emerging in Memphis wrapped in new sheetrock, glass and even HTML. I do love things under construction!

What? Aren't I supposed to be reflecting on Dr. King and rampaging violence? Well, we do that pretty much every day in Memphis. I can see the Lorraine Motel from my desk. So I find myself thinking about the idea of an "implicate order" emerging through the complex dance across the years. David Bohm wrote a great book about the idea that order unfolded through the mystery and wonder at the edge of "the unlimited." I like all that and am known for being dangerously comfortable with ambiguity. Sometimes I am accused of mistaking plane 'ol disorder for emergent order. Fair.

Bohm was the last thing from naive, but his language implies something less than the brutal turbulence I have come to appreciate in Memphis. Here disorder fights back, actively, and does not play fair. Blood flows.

It is dangerous to think the intractable phenomenon of even the most obvious evil--race-linked health differences--will simply unfold. We must wage health with all the focus and intelligence and energy that others wage war. Our tools are not those of violence, but need to be sharp as any sword.

That is what the Center of Excellence in Faith and Health is for, especially its "innovation studio" which will be open within a few weeks. And just in time. The CDC released one more stunning report about disparities yesterday. Another 116 pages of footnotes to the most obvious intractable story. (http://www.cdc.gov/mmwr/pdf/other/su6001.pdf )

We saw some of this in our own our North Hospital in a study focusing on heart attack and heart disease survival rates. Those findings find an echo in the study of disparate outcomes in the LeBonheur ER for hispanic children almost as dramatic at the Black elders at North. This has brought to view information we can't look away from--and need not.

We have the intellectual capacity to burrow through piles of unreflected assumptions sorting out the things we can do now from those we must drill deeper into. We have leadership capable of applying moral capital guided by good judgement to change the reality of gross disparities toward equity. We didn't create disparities in health and we can't eliminate them by ourselves. But we can think and lead, building trust and momentum in the process through transparent, non anxious systematic work, acting where the course is clear enough to do so and systematically researching where it is not. That's what grown ups are for, especially those with the faith the size of a kudzu seed.

The pursuit of equity is not confined to religious partners. Indeed, it is the most obvious intersection between public and faith at every level in any democratic country. And the imagination of faith is not confined to health disparities, partly because all scriptures are pretty realistic about how hard it is to bend the arc of human history toward what God hopes for. But. We can do better.

The Center of Excellence will open in tough times dedicated to going right at the heart of darkness. It is only one unit in a very large organization with many partners. But for the first time we will have a place designed and committed to the work of innovation that dares hope for transformation.

This signals a long term sustained creative effort that reflects our most fundamental confidence that our institution and our community is part of God's ever-constant action to create the Beloved Community. The space is nice, but our commitment and confidence rests not on our competence alone, flawed and fragmented as it is. We do not act alone, for we are moved by a God who is not done with us or our community.

Oh, and check out our new website, which we breathed fresh air yesterday-- www.methodisthealth.org/faithandhealth. I hope Dr. king would like it.

- Posted on the journey

Healthcare you can live with

2011-01-12T22:39:00.001-06:00

Scott Morris is a physician. And he is a minister. And he is a classic social entrepreneur, creating and sustaining a unique ministry for a quarter century, The Church Health Center. And he is a one great story teller.

All of these come together in his new book, "Healthcare You Can Live With." The book is built around Scott's rich reservoir of stories and the simple, but profound framework of Christian virtues and "model for healthy living." The Church Health Center builds around the same two frameworks, so it is possible to read the book as a lens through which to focus on health ministry, and just as well, to focus on one's own health.

The virtues come straight out of the third chapter of Colossians, which I think Scott understands better than Paul. At the very least, Paul would have been surprised to find how smart his simple list actually turned out to be once Scott built a large ministry on them. Clothing oneself with "compassion, kindness, humility, gentleness and patience" is, well, healthy, especially when they are bound together in "perfect unity" in love. Forgiveness and release of grievances is the hub of them all, of course, which Scott unpacks in many richly persuasive narratives. Very healthy.

Scott lays out a nice "model for healthy living" designed to help people develop "smart goals" in the various aspects of health including medical, movement, work, emotional, family and friends, nutrition and faith life. The focus is on what one can do themselves, not on scolding or simply accepting somebody else's prescription.

Policy makers will be disappointed with all the easy shots at government (You'd never guess Scott voted for a Democrat in his life by reading the book, but I have reason to believe that he has.) Academics would like more footnotes, of course. Some clergy might be hoping for someone to write them a prescription for a healthy congregation. Scott tells stories and, in effect, says to come and look at The Church Health Center. It is a very good idea to do just that (churchhealthcenter.org).

In the meantime, read the book: http://www.amazon.com/Health-Care-You-Can-Live/dp/1616262478

And choose life.

- Posted on the journey

What we are here for

2011-01-10T21:05:00.001-06:00

There is nothing new in the world when it comes to suffering, not even in Tucson. Over the horizon of our attention span yesterday dozens, perhaps hundreds, maybe thousands of equally innocent people where cut down with as little reason. Perhaps they were also caught in a rising tide of violent and cynically divisive rhetoric. Perhaps, another man armed like a warrior but fighting only internal daemons, went off like a grenade in their lives, too.

It is certain that another 25,000 children died of things like diarrhea, hunger and quiet desperation because they do not look like the people where they live who have money or guns or education. The same day the bullets flew in Tucson, our local paper published an exhaustive article about the grossly disparate rates of premature death linked to race in Memphis. No bullets, but lots of death.

There is nothing new in the world when it comes to suffering.

Or healing.

Says Larry Pray: "I do not live in Tuscon. But I know what the churches, synagogues, mosques and temples there are doing. They are gathering together. They are praying, they are reaching out, they are consoling, they are looking for ways to stem violence. They are embodying Tikun olam. That’s what they do." (http://www.larrypray.com/?p=2077)

What are we for, if not to heal? Or, as Larry spins out the vocabulary of hope: “Mend. Repair. Forgive. Strengthen. Find hope over despair. Find a way to stem the tides of violence. Heal. Tikun olam." That’s what we are for.

I am old enough to have known people doing this kind of most basic healing for some decades. They serve in the soup kitchens, come alongside the bruised and battered women and children, sit with the abandoned ones suffering mental torment and those caught in chemical tangles. They tenderly, quietly stand with those damaged by violence. Tikun olam.

This kind of healing isn't done on the internet or through the windshield. While you can send an unmanned drone to kill, you can't heal that way. "No drive-by compassion," I heard many years ago.

Healers, most astonishingly, keep doing it decade after decade. How can this be?

We are find our lives in the healing of others'. It is not a paradox; it is straight up truth of how it works on this odd and wonderful planet.

Healing is mystical, but not magical. We can show up on purpose. Prepare ourselves on purpose. Train our congregations to do healing work on purpose. We can choose words that heal on purpose. We can give our children eyes to see others kindly on purpose.

That will all happen in the morning in Minneapolis, Memphis and Mombasa. And it will happen in Tuscon even amid the tears.

- Posted on the journey

Wonders and warnings

2010-12-31T12:05:00.001-06:00

Back in Memphis after a brush with global weirding. That's a more useful phrase than global warming, as the local affects of climate instability show up as extremes of cold, heat, drought and drenching. In our case, we just caught a glancing blow of a storm that rearranged many lives this past week. Just 10 inches of snow and temperature in the teens locked us in our cabin for three days longer than these city people planned.

And amid the weirdness, great beauty for our eyes are tuned to regard as beautiful the most mundane aspects of nature. Freezing and thawing of water, snow on the trees, fire on wood. What could be less notable? But I am drawn in wonder to the play of sunset's light in the ice.

We are so comfortable in natures womb that we are surprised to learn how wondrously balanced it all is, and what a narrow range of conditions permits our living. Just a wobble this way or that, and we find ourselves near edges we had no idea were there.

About a month ago I found myself with many hours of driving alone, so I downloaded Bill McKibben's, Eaarth which riveted me in extremes of sadness and hope. Sadness as he persuaded me that the planet I grew up loving no longer exists. We have literally changed the chemistry of the air with countless effects, some of which we can actually see in all their weirdness. The hope (less convincing) is found in the human ways of coming together with what we have and can do. Bill sees hope in localism and regionalism and, via our long term connectedness, globalism. He and some Vermont students created one of the most remarkable signs of viral hope that you should visit: 350.org.

The number is the whole story--the level of carbon in the air above which our Eaarth can stabilize somewhere near our current level of warming. Above that and the chemistry of the air guarantees that we will continue to warm -- and not in the long future of our grandchildren. But visibly, quickly, in a few dozen years. I love a lot of people who are vulnerable to that.

McKibben sees hope in how we connect to each other where we actually live. I saw that this week up in our micro-neighborhood of a couple dozen cabins scattered around the steep and winding gravel roads. Eddie Geller is about 6 foot two inches of practical human decency, who made it around on his ATV to check on every last stranded family. Getting baby formula for the Brazilians up the hill, getting another woman to her chemo appointment. And then he guided us all down the icy roads to safety when it was possible to move at all.

I was worried for the safety of my family amid the ice. I was glad Eddie was in my life to help. And I am worried for my larger family amid the growing warmth. But also filled with the wonder of how we are wired to find our way, first toward each other, and then to do what wisdom makes visible.

Go to 350.org and help out.

- Posted on the journey

Can we be smarter than Walmart?

2010-12-28T13:26:00.001-06:00

I'm hoping this post does not circulate to certain foundations making major healthcare grants for consumer engagement such as one we recently applied for. So don't go forwarding this willy nilly; keep this among us humans. I think I'll even hide it beneath some nature pictures for safety.

Maybe its just being snowbound in a cabin, but I've had it with calling human beings "consumers" as if that is a promotion of some sort. The curious habit has even infected healthcare organizations who started describing the people in their care as....consumers. This is more common among those receiving stigmatized outpatient treatment, such as mental health services. The idea is that we should remember patients are active decision-makers and purchases of services, just as honorable in their own way as somebody choosing Target over Walmart.

Treating people with as much decency as Walmart seems like a low goal to aim at. Human beings in a relationship of caring and treatment are in a more complex dance of intimate exchange than Walmart understands.

Somewhere between 17-19% of economic activity in the United States currently involves health services, so there is a lot of consuming going on. But even when the activities do involve people paid to be present, the relationship is poorly understood as consumption. Larry Pray, who may be my very smartest friend, posted about his visit this week with his mother who is suffering from dementia and is in the daily care of people who are not his family. "It is the last day of my visit to the nursing home in Madison. The Memory Care unit to be exact. I am touched, once again, by the kindness of the staff who have learned how to lovingly live with confusion, how to turn caught thoughts to another topic, how to comfort, and how to laugh. Doctors are great, but here where folks actually live it is the staff-on-duty who speak of life." (http://www.larrypray.com/?p=2024)

It not just impolite or impolitic to describe such relationships as consumption; it makes everyone involved stupid and less able of playing their role. Those closest to the work of healing, the family, are reduced to functional bargains because they work for free. Physicians and nurses are similarly diminished, but paid. Hospital leaders are no more than marketers and distributors of services. Leaders of caring congregations are reduced to gullible partners, lending their skills to doing others' work without pay. I can assure you that the Le Bonheur staff in the picture care way, way beyond what money can explain.

Thinking of people only as consumers blinds us to the extent that the "health system" is constrained to only institutions and people who do things for money. All professionals, whether medical or those in "public health" are diminished to mere employees and providers of monetized exchanges.

No wonder we have trouble understanding the complex journey to and through our institutional space that is governed by many moments of discernment, trust, judgement, expectation, hope and fear. No wonder we are surprised when, for reasons of race or religion, people fail to act like we think rational consumers would do.

Health is not consumed or provided, it is the name of how we live together. We do not engage consumers, we listen to each other.

So why not call ourselves members? Why not citizens? Why not extended family, brothers and sisters?

Our electronic medical record at Methodist is the hard wiring that connects every member of the our treatment system with those in our care. It keeps track of every pill and procedure for every person involved, including many things nobody pays for, such as spiritual care. Our system is distinctive in that it also has a page allowing physicians to recommend actions to be offered up by a patients' congregation, as a natural part of the healing system. We have the capacity to help all involved in the caring process to be informed and guided by the others. Sort of like humans might do.

Even those of us most highly paid "providers" will experience our time of dependency. We hope that when we do, we will be engaged not as a consumer, but listened to even as a mother, father, sister, brother, friend.

- Posted on the journey

Waffle, Waffle, Waffle

2010-12-26T11:58:00.001-06:00

Ever since moving to Memphis five years ago an odd family tradition involving the Waffle House in Jasper, Georgia has developed. (Hence the picture.) For fifteen years we had hosted an increasingly large Christmas Eve party after church at Oakhurst Baptist. Many folks there have, let us say, complicated families, and we opened our house to those who needed a family place to land on the Eve, eat, drink and be merry. Now we try to catch the service on the way from Rock Hill to our cabin in north Georgia, but instead of having hundreds at own home, we throw our lot in with whoever happens to be in the Waffle House.

The "A-Team" is usually not covering Christmas Eve, so unusual--and always interesting-- things happen. Once we were waited on by--I swear to God--Mary. The teen-age waitress was pregnant, unmarried and obviously ready to have the Prince of Peace right there in the corner booth at any moment. Last year, we ordered (eggs, eggs, eggs and, for me, a waffle). After a bit, the eggs and hash browns showed up. Waffle?

"Oh, I'll be right back."

The coffee was refilled twice as each time I commented how good a waffle would be.

The third time she noticed all by herself that I was waffle-less. I heard her exclaim (as she shuffled out of sight).... "waffle, waffle waffle."

You would not think one would need memory tricks to remember waffles in this restaurant, but some do.

And you wouldn't think you'd need to remember what Jesus was about, either, but most of find it heard to keep track. And not just amid the ridiculous clutter of brain dead buying and selling that marks the month.

I write in the aftermath of the Waffle House, but also anointed by 10 inches of astonishing snow that has frozen us in place and riveted my attention.

Robert Farrar Capon wrote "The Astonished Heart", the title inspired by Ecclesiasticus 43:17-18 (KJV): "As birds flying he scattereth the snow, and the falling down thereof is as the lighting of grasshoppers. The eye marvelleth at the beauty of the whitness thereof, and the heart is astonished at the raining of it." (p.118)

Capon continues: "The Lover who restores the world in Christ is not the God of the philosophers or even the theologians (unless they are very astonishing theologians indeed). And that God is certainly not the god of the inner-harmony-through self-help gurus.... He runs the world from beginning to end by the radically astonishing device of romancing it into being out of nothing..... And when every last particle of creation--including you, me, the lamppost, and the church--ends up dead, gone, and at absolute zero, its heart will still leap up at the voice of the Beloved." (p122)

"Waffle, waffle, waffle," she muttered.

"Life, life, life," I try to remember.

Astonishing.

- Posted on the journey

Birth of a Good Idea

2010-12-16T00:11:00.002-06:00

The only thing that may be more uncomfortable than watching sausage made is watching an idea happen. At least one can eat the sausage and be done with it. An idea is chewed, coughed up, chewed and coughed up any number of times until the original is well beyond recognition. I know this because I have had many ideas, most of which are now just intellectual compost. And I also know that sometimes the world ends up with a good idea that justifies all the indigestion.

Tubigen, Germany has been home for really big ideas for centuries: Hegel, Nietzsche, Moltmann worked here. Up the hill from the University is the jewell-like "Tropiklinic" and German Institute for Medical Mission (www.difaem.de). We met here this week, convened by the World Council of Churches and DIFAEM as the "Strategy Group on Health and Healing." Conversations like this have happened here many times since the 1960's. And every now and then, something big emerges. I think I just saw it.

We were listening to Prof. Bernard Ugeux carefully describe his work in Eastern Congo rehabilitating young girls accused of witchcraft, thrown into the streets and shunned. It is a bitter story, even offered in his priest's hopeful voice and anthropologist's systematic detail.

Noticing the pattern, I asked psychiatrist Ehab El Kharrat whether he saw a similar framework to his work with alcohol and drug recovery in Cairo. (Ehab on the left, Bernard on the right. Dr. Vijay Aruldas in the middle). It reminded me of the journey with diabetes in Memphis.

And then the magic happened, which might have slid past if not captured on index cards by Dr. Gisela Schneider, the physician who leads DEFAEM. Within a few minutes Manoj Kurian roughed out the map on the computer, which then acquired the name "integrative programmatic framework for transformation."

Ehab, also a Presbyterian Elder, noticed a profound theological level to the pattern. And then somebody put the Holy Spirit -- "Spirit of Freedom" -- underneath. Witchcraft, drugs, diabetes--all conditions in which God moves to transform. Alleluia, indeed.

More chewing and coughing is needed. But can't you see what an astonishing advance it will be for Christian health organizations to have a distinctive framework in which to see their individual "best practices" so they add up to.....transformation? Right now we have a clutter of pretty good practices that help, sort of, to fix a lot of different medical problems that catch our attention. And we argue that faith-based organizations perform as well as anybody in delivering that clutter, which is less than inspiring.

Actually, miracles as Bernard and Ehab see, are not uncommon. We have not had a way to see the pattern of those miracles so that we can be accountable for creating a natural channel for God's healing work. And without a common framework, we have not really had a way to be attentive to the evidence of that healing.

It is well below freezing as the snow feathers down quietly the day after. But something shook this sacred ground and I can still feel it. A good idea is alive.

- Posted on the journey

Shalom from a box of parts

2010-12-13T00:26:00.003-06:00

Sometimes I feel like I live in a remix of that bar scene in Star Wars where a bizarre menagerie of life forms find themselves hanging out together. I write this from Tubigen Germany after flying from an afternoon at Horseshoe Lake, Arkansas (the cyprus is not in Tubigen).

The Horseshoe lake lunch was at the home of John and Anne Stokes with other major Memphis leaders who had been through the Life of Leaders experience a few months ago. Life of Leaders is an intense time of guided discernment for groups of 10-12 people put on by Methodist Healthcare and The Church Health Center. It includes pretty much everything medical that you'd experience at someplace like Mayo, but also a more comprehensive range of psychological, spiritual and social aspects. The point of the whole thing is to enhance the leaders capacity to lead a life of value and change-making. That has many aspects, so reflecting back on what happened since their intense time together, some shared medical journeys both profound and mundane while others found themselves drawn into a deep search for meaning.

Some of the group had attended an unveiling of a report from "the shalom project" which is an attempt to gather the energies of the evangelical christians in Memphis to fix the city (theshalomproject.org). Like Life of Leaders, the project is bold in its expansiveness, but social, not individual. But nothing at personal or social levels changes without transformational relationships. There is no escaping transformation in every aspect.

The highly privileged leaders at the lake ended up talking mostly about their relationship to the poor and how their lives would be measured by whether they advanced God's vision of justice. The Shalom Project looks hopes for broad shalom, but stressed the explicit need for old fashioned Calvinist repentance and salvation as the starting point. I helped write part of their report and I am about 400 years from Calvin.

Putting aside for a minute the specific components of needed change (personal or social), let me ask a question: How much do we have to think the same about Jesus, global warming, sex, vitamin D, Obama, hunting ducks, and eating cows in order to find the future together?

Does the future of the planet (or even little Memphis) depend on coming to agreement with each other? The question is unavoidable here in Tubigen, where we are convened by the World Council of Churches, which has 300+ denominations, not counting close working relationships with Adventists, Catholics and Pentecostals. This is a theological scene as edgy and explosive as the Star Wars bar, but for higher stakes--a real planet.

It is said that "it takes all kinds." Does it? How exactly does a leader live like that?

The clue may be that "in the beginning was the Word" which was not a creed, book, blueprint (or blog). It was more like an image, an idea, a hunch, in the mind of God of what might be possible. So it is with every beginning and every restarted effort that we will need to find our way from here. We move toward a word, an image. And that may well take all kinds, or at least a very great cloud of kinds. Ideas and experiences--including painful and failed detours that we talked about at Horseshoe Lake--can be parts of new images of what is possible.

The vision of shalom is assembled out of a box of parts like you might find in an old garage. I still have a jar of screws that my father collected decades before he passed away and passed them onto me nearly 20 years ago. I don't throw away those screws because you just don't know when you'll need just that one. And I am loathe to draw lines between useful and non-useful people. You just don't know when you'll need just that one. I would hope for something of that optimistic humility when leaders try to find the parts out of which to assemble the future. "Okay, we know the parts we need are in here somewhere......."

- Posted on the journey

Wow! Pow! Zip! Snap!

2010-12-08T21:45:00.002-06:00

Connection and community were the dominating theme of the American Healthcare Congress concluding today in Irvine, California. Lots of technology, as usual, but way more about connectional tools than imaging and interventions. Virtual office visits, smart phone reminders of check-ups, personal record health records in the "cloud" linking providers and patients. Wow! Pow! Zoom! Zip! Snap!

For all the internet metaphors that fill our conversation these days, we remain squishy, not hard-wired. Transformation is hard because humans are, well, human. We are distracted by all the other connections and appetites that tug for our attention. Physicians and nurses and everyone involved in the health journey are already busy. The new ways add work long before they free up any time and trouble.

The good news is that humans are made for connection, but with eyeballs, voice, touch, tone and gesture. Wires and machines are dead as a box of rocks until somebody connects them and makes energy move through.

Humans, however, move toward each other naturally because we are alive. We connect. We handle complexity through relationships more than protocols. We seek to know somebody who knows somebody who knows somebody who cares. We use the odd and unpredictable links to find our way: the former wife's boyfriend's buddy who works for the hospital who knows the admission person. Friends and the kindness of strangers help us find our way through and across the dangerous cold currents as across rocks in a mountain stream.

Don't read me as excusing the toxic stew of policies and practices that explode like land mines in the journey. It is the job of the grown-ups in the structure to get the predictable stones out of the healing way. But we don't have to figure it out in maddening detail like we do with machines.

Part of management is bringing order out of disorder. But another part is holding the space for disorder so that new human connections can find their own order, smarter and more adaptive than our imposed structure.

If we permit connection, humans will figure it out, especially if we permit their friends to help out, too. That is what happens a thousand times a day with congregations and friendship networks anyway.

We are making it easier and more likely in Memphis by allowing our hospital to be more receptive to the connections through congregations. It is like dropping the string in the sugar water, signaling that it is okay for the crystal to form. The crystal wants to form.

Look like you want a human connection and the human networks will form. And people will move across them more efficiently than you could program. Squishware!

Reverent Planfulness

2010-12-07T00:21:00.001-06:00

This is Adam, the first child of 162 who were moved from the old Le Bonheur hospital to the new palace of healing and care topped with a huge red heart you can see for miles. Almost every story about the new hospital cites its cost--360 million or so-- and that it included the largest fundraising campaign in Memphis history. But the financial story misses the point, as it usually does with pediatric healthcare. The point is the thoughtful overflowing attention to detailed planning, which rose to the level of reverence. I do not normally notice or write about that kind of reverence the raw and ragged creativity. I love emergence and flow and generativity.

But I must pause today in praise of plannfulness, detail, thoughtful anticipation of every possible thing that might go wrong so that Adam's ride across the street might be totally smooth. That playfulness extended for months, indeed, years. So the ride was so smooth that everyone involved could enjoy it with the celebratory delight it deserved. The air vibrated with delight and pride of a job well done--and prepared for.

It was a day to wonder about what else might be possible. What if we turned ourselves to even the more complex challenges of community disorder and chaos. From the top of Le Bonheur you can see many neighborhoods in which wicked problems twist and thrive, having their deadly way with children who will never ride like Adam. The more mundane catastrophes of poverty and social brokenness have far more fluid variables difficult to anticipate and plan for. But what if we could summon the gods of generativity to work with the gods of detail? What if??????

Surely it must be possible to imagine that after seeing the miracle beneath the big Le Bonheur heart.

- Posted on the journey

AIDS Day (Out organized, not outnumbered)

2010-12-01T09:29:00.001-06:00

The picture is of Dr. Fred Smith speaking at Monday's opening of the Interfaith Health Program office on the top floor of the amazing new building of the Rollins School of Public Health. IHP shares the space with the Center for AIDS Research, which is led by Dean Jim Curran. Sandy Thurmond, the current Director of IHP, has worked on the leading (and bleeding) edges of the AIDS movement for decades. The modern movement of faith and health is one with the grinding struggle with AIDS.

Fred commented once that evil doesn't have us outnumbered. But we have allowed it to out-organize us. There is a big difference, although the affect is exactly the same: we fail to break the pattern of disease, stigma, injustice and suffering. Everything in our faith and science says that the sufferings of AIDS is not inevitable and thus not acceptable. But we have not organized ourselves well enough and the band plays on.

Humans are not hard-wired and thus capable of rearranging our connections to let the energy and intelligence flow in new ways to do new things. That's what AIDS has demanded of us that we have only partly accomplished--so far. AIDS exploits our human weaknesses buried in our most intimate patterns of silence, domination, fear and ignorance. Religion has been mostly complicit in those deadly patterns. But none of this is locked in our DNA. And where the pattern breaks, it is because we have found our voice, new relationships, hope and knowledge. Sometimes our faith does the breaking.

There are now more than 91,000 names on the AIDS quilt and many hundreds of thousands that will never be known. We should feel appropriate shame. But lament only for a moment. For even while the grinding pace of scientific discovery is much slower than we ever imagined, we learn on. And the most important thing we learn is how we are together.

- Posted on the journey

Finding life here

2010-11-29T09:25:00.002-06:00

We were happy this week to see that Memphis has dropped out of the top ten most violent cities in the United States, letting St. Louis receive the dissing we normally absorb. Some things are moving in the right direction. However, we remain at the wrong end of nearly every list ever made of problems: obesity, diabetes, violence, stroke, disparities, foreclosures, failure to graduate and pretty much any other way of measuring pathology. Nobody in Memphis is surprised to learn of anything bad. But this is our city and we choose to live here. We work with the strengths and assets to be found to craft the future along the lines of God's hopes, not our fears.

That is a work of discovery, not recovery, for there is no "re" to go back to. There never has been a time when Memphis can be said to have been healthy. Cleaner and quieter, perhaps, at least for white people. But healthy?

Health lies in the undiscovered, not in memory.

This is why our center of excellence revolves around the "innovation studio" and why our research is driven by our curiosity about what might be possible, not what's wrong. What if we mash up this and that with the other to see if they might lead to something more like health?

We have eyes for strengths, assets and webs of trust where others just see pathology and gaps. And we are learning how to weave them in patterns that are tough enough for these tough streets. The fellow in the picture is painting this space. I assume he thinks it honors somebody for the past. But it is built for the next idea. You can see the room is curved in on itself, which gives mind to a womb safe for the gestation and generation of living ideas. We are only midwives of the future, maybe raising children of other parents, blending an extended family of odd, but hopeful members.

We can live here and even thrive, if we see the possible and work toward it.

Life thanks you

2010-11-25T10:37:00.000-06:00

The Reverend Fred Smith has been my guide and pathfinder for many years in the shared work of faith and, well, all sorts of things including health.

This morning Fred sent this kind of thanksgiving anthem to that circle of collegues. It came in while the bizzaro Macy's thing was filling the streets of New York with balloons, rental elves and such. Just as I was descending into cynicism Fred pulled me toward deep gratitude.

Fred's words:

I give thanks for
and to all of you.
for all the years
we labored together
in Faith for the Health
of all God's People.

Let's all give thanks
for all the inspiration
and soulful deliberations
that has shaped our
common vocations
together.

Life gives thanks
for those who have chosen it
and pursue living
with academic rigor
and the passion
of an evangelist
to a dying world.

From one end of the world
to the other
God gives thanks to all of you
who know
no boundaries
But are deeply woven
together in the Beloved Community

Shalom to you...

Not-waiting, honestly

2010-11-22T09:07:00.006-06:00

Last thursday the families of the patients of Methodist University Hospital made a small step in the right direction as we opened our Family Care Center. At the same moment we closed and abolished the old intensive care waiting room where thousand of people over the years spent uncomfortable traumatized hours as their loved ones were in treatment upstairs. They waited.

I'm not a trained hospital professional, but as a fairly experienced human being I appreciate the fact that nobody attending to a loved one in a time of hospitalization should just be waiting. They should either be cared for themselves -- because just getting momma to the hospital is enough to wear anybody out-- or they should have the chance to learn the things they will need to know when momma comes home. Who knows anything about a stroke and its grueling process of recovery until someone you love has one?

So the concept is simple: no more waiting and no more waiting room. Instead, a Family Care Center bathed in gentle northern light, equipped with hotel-quality furniture, abundant space, staffed 24 hours a day with people who, well, care. The families have access to a quieter and more dim space where they can get deeper sleep anytime in the cycle of the day. Every surface, fabric and square foot of carpet was chosen to speak of life, growth and peace.

We're not done, but we have made a huge lurch in the right direction. Soon the chapel for the families will be done and the volunteers will begin to flood the space like the gentle light. The education and resource center next door will be finished next month.

And the hours will still be grueling and filled with fear, anxiety and exhaustion. So when we paused to bless the space, we used a litany written by Larry Pray just for the occasion. I'll post the whole thing tomorrow, but this to start:

"Let us be honest. In such a place as this
there is a note of uncertainty,
and no small measure of fear.
And yet, beset as we are by circumstance
here we are surrounded by hope.
We know we will leave from here
not as we were,
but called to reshape and restart our lives.
We leave called to care, called to hope,
called to bless
and called again to find life."

We've all been waiting a long time for such honest not-waiting to begin.

Eden Long Gone (Thank God)

2010-11-14T16:30:00.003-06:00

In the past couple weeks I've spent about 3,500 miles in my Prius bouncing back and forth to an odd assortment of events looking forward and backward. I listened to Bill McKibben's painfully clear new book Eaarth. The new spelling makes the point the old Earth simply doesn't exist anymore given the imminent affects of carbon levels unseen in 20 million years. And then I read Sue Thistletwaite's "Dreaming of Eden", which as a bit ironic in that I was speaking at Eden Seminary. Hers is an equally searing call to lay down innocence-- leave Eden--so we can make the real choices that must be made today. They both write as lovers, seeing their world whole, deeply threatened, but not lost.

We lovers must see the rivers of crap that determine Haiti's breaking catastrophic cholera hell. And don't look away from the stagnant swamp of Memphis' gross disparities and broken systems. There is no magic, machine or pill that will get back to Eden's innocence. And so many interacting forces make hope harder. But this is the world God gave us to live in; the only one to love. So we can act in ways that are good for what we love. Or dream of innocence and be complicit as crap.

Love casts out fear, which is good news. Fear creates and sustains illusions that disable good choices, especially at social scale. This is most obvious of diseases that travel in body fluids that are hard to talk about, such as AIDS/sex and Cholera/crap. Disease loves stupid silence.

Fundamental determinants of hope emerge amid chaos, too. Nicholas Christakis is able to map the spread of such ephemeral virtues as happiness across social webs which are also relevant to mapping epidemics.( http://www.ted.com/talks/nicholas_christakis_the_hidden_influence_of_social_networks.html) This kind of network modeling is usually being engaged to map out negative phenomenon like obesity and depression. So it is of practical significance that goodness spreads through networks powered by meaning and trust. Disease hates smart trust. And we can build those networks on purpose!

For roughly 90% of the time since Jesus, the gaggle of believers that are his Body did not have anything that could really be called a hospital. But even in the first astonished days recorded in Acts, that Body expressed "diakonia"—ministries of practical care that were understood as evidence of God’s practical presence. Where hope rubs up against mortal reality social forms arise. That's how the hospital I work for came from; and where our new forms of community alignment with 280 congregations are now coming from.
Who knows if our slender webs of trust are enough and in time? Not for the 1,000 bodies already in bags in Haiti as I type. Innocence long gone. Crap.

But I do believe that God so loved the world that God send us out into it. God gives us hope, not innocence.

Never give up on who God loves.

Wild Water

2010-11-08T20:44:00.004-06:00

“There is only one stream of water. What passes through the bodies of humans, passes through the bodies of animals, insects and plants. It flushes through our sanitation systems, flows through the rivers, seeps through wetlands, rises to the heavens to become clouds, and returns to nourish us and all living things. There is no life outside this cycle, and theology has to get real about it. Talking spirit without talking water is meaningless.” –Steve de Gruchy, Water and Spirit: Theology in the time of cholera.

Steve DeGruchy lived on the turbulent waves where theology was helping those in adjacent fields do hopeful labor amid fundamental vulnerability. Steve died earlier this year in, ironically, a wild river that he should not have been in. One of those emergent fields which Steve thought useful for life, was about Religious Health Assets which is how I became one small potato in his big bubbling stew of hopeful relationships. Last week, a group of us in the International Religious Health Assets Program (IRHAP) planted a tree on the Emory campus and gave papers in his honor at the American Academy of Religion.

Steve has been much in my mind as we get ready to open our “center of excellence in faith and health” in the heart of the hospital precisely because he constantly focused our attention outside of anything with walls toward the community—the social body.

Community is not just where we heal, but the thing that does the healing. This can only make sense when spoken with a theological accent, probably one with an African lilt. Shalom, like Bophelo, is a quality of a social body that is not “sort of like a body” or one only in the mind of a poet or prophet. It is, in the more crude language of our day, a network attribute. A network is not normally thought of as sacred but it can be. Shalom/Bophelo is the work of God, for Trinitarians, the work of the Spirit. We thrive because we are made into something capable of shalom or Bophelo.

Nobody even has an accurate count of how many religious hospitals have been born in the past two centuries. But it is important to note that every single one was formed out of a web of humans bound together in hopeful meaning capable of working amid chaos. Even a cursory glance at the tangled and tumbling stories of how the institutions of healing came to emerge alongside the wild Mississippi reveals a twisty bit of chaos. A hospital that was built to care for a very white Methodist pastor by a plantation owner in the heart of the Delta now provides the preponderance of indigent care for mostly African American men and women, upon whose ancestors' backs and suffering that early wealth was built. Closely aligned academic and research institutions share the same intertwined ironies that are almost too incendiary to fully map. Today we are wrestling real relationships and caregiving from this bitter landscape partly by means of relationships that dare to bear the name of a “covenant” designed to weave a “web of trust.” We hope to do this even amid ongoing unpredictability at the heart of liquid modernity. We live on the banks of a very turbulent river that never lets us forget that history emerges from unpredictability which produces good, bad and tangled things all along the journey.

It is almost too painful to read Steve’s writings about the complex symbolism of water in which both life and death tangled and tumbled together in ways that can only be spoken of in song, poem and lament. Do not try that at home alone for any one life is too bounded and random on which to rest any hope of transformation. Surely, this is the most obvious thing in all of human history.

The testimony is not all about bleak unpredictability, for chaos has an upside. Both theology and public health wonder whether chaos actually trends toward upside or downside. Human plans are often swept away, but sometimes improved in the process.

The findings of IRHAP on the effectiveness of faith forming entities on improving health outcomes remains somewhat mysterious precisely because the impact is inseparable from the ritual spiritual practices that form, sustain and reform and express faith. Worship, prayer, practices of accompaniment, hope and lament are not advanced by stripping them of their religious essence to be explained by the more barren language of functional outcomes. Health is a by product of an essentially mysterious process of faith. At least that is what those practicing in the context of the faith forming entities say. Steve listened to them, which is why his research and analysis has been so strikingly vivid and bold. May we be so, too.

Gary

Thoughts and Prayers for the Week of March 24, 2008

2008-03-24T12:52:00.000-05:00

by Butch Odom

Thought & Prayer for Monday, March 24, 2008

Welcome to the season of Easter, where we will remain until May. Easter is the most important time in the Christian year, but it is also the most mysterious. Since death has been overcome, since death has lost its sting, let’s consider embracing life and spend this week contemplating the Leading Causes of LifeTM, by Gary Gunderson with Larry Pray.

The lectionary passages for this week are numerous, and include: Jeremiah 31:1-6; Psalm 118:1-2, 14-24; Colossians 3:1-4; Acts 10:34-43; John 20:1-18 and Matthew 28:1-10.

From John 20:1-2 – Early on the first day of the week, while it was still dark, Mary Magdalene came to the tomb and saw that the stone had been removed from the tomb. So she ran and went to Simon Peter and the other disciple, the one whom Jesus’ loved, and said to them, “They have taken the Lord out of the tomb, and we do not know where they laid him.”

Leading Cause #1 - CONNECTION: As human beings we depend on our connectedness to family, friends and even coworkers. Imagine the sense of loss Jesus’ followers felt after the crucifixion. Now Mary finds the tomb empty, making her think initially that the final connection to Jesus, his grave, has been severed. Think of the significant connections in your life. Wouldn’t you agree that those connections are life-giving?

Prayer:
Creator God, you made us a people who thrive in healthy communities. Help us heal the disconnections in our lives so that we might live more fully. AMEN.

Thought & Prayer for Tuesday, March 25, 2008

From Acts 10:34-36 – Then Peter began to speak to them: “I truly understand that God shows no partiality, but in every nation anyone who fears him and does what is right is acceptable to him. You know the message he sent the people of Israel, preaching peace by Jesus Christ-he is Lord of all.”

Leading Cause #2 – COHERENCE: We strive for lives that have a sense of meaning and purpose. Imagine the coherence the disciples felt through their work with Jesus. Now imagine how that life-giving meaning was upset when Jesus was killed as a common criminal. Today, consider those people, those connections and those beliefs which bring the most meaning into your life.

Prayer:
Faithful God, for those people, those institutions, for all that brings rich, life-giving meaning into our lives, we thank you. AMEN.

Thought & Prayer for Wednesday, March 26, 2008

From Acts 10:36-38 – [Peter is still speaking.] “You know the message [God] sent the people of Israel, preaching peace by Jesus Christ-he is Lord of all. That message spread throughout Judea, beginning in Galilee after the baptism that John announced: how God anointed Jesus of Nazareth with the Holy Spirit and with power; how he went about doing good and healing all who were oppressed by the devil, for God was with him.”

Leading Cause #3 – AGENCY: “Just Do It” was the slogan of or the name of an organization that encouraged young people to do good…to act…to do something for the greater good that was within their power or skill set, even of something simple like planting a tree or picking up trash. Agency entails this ability to get things done. Can you begin to see how these Leading Causes of LifeTM tie together? The greater the sense of connection in our lives and the more coherence we feel, then the greater our ability to act effectively. Also, the more we act, the more meaning we could add to our lives and the more opportunities for connection we could have.

Prayer:
Gracious God, it is easy for us to think globally. Give us strength to ACT locally. AMEN.

Thought & Prayer for Thursday, March 27, 2008

From Psalm 118:1-2 – O give thanks to the LORD, for he is good; his steadfast love endures forever! Let Israel say, “His steadfast love endures forever.”

Leading Cause #4 – BLESSING: “How are you doing today?” I asked Janice. “Fine and blessed,” was her reply. We give blessings to each other and we receive blessings from others. But blessing also occurs through the ages as we connect with our parents and their parents on through the years and with our children and our children’s children. Through blessing, we are connected to forever.

Prayer:
Steadfast God of the beginning, middle and end of time, stand by us in our now. Help us be a blessing to those around us, and may we be blessed today. AMEN.

Thought & Prayer for Friday, March 28, 2008

From Psalm 118:24 – This is the day that the LORD has made; let us rejoice and be glad in it.

And from Matthew 28:5-8 – But the angel said to the women, “Do not be afraid; I know that you are looking for Jesus who was crucified. He is not here; for he has been raised, as he said. Come see the place where he lay. Then go quickly and tell his disciples, ‘He has been raised from the dead, and indeed he is going ahead of you to Galilee; there you will see him.’ This is my message for you.”

Leading Cause #5 – HOPE: The final of the Leading Causes of LifeTM is real, grounded hope. Such hope comes from the interaction of all the other causes discussed previously this week. How does one have hope in the midst of deep despair, for instance, if their life is not connection and coherence-filled? If one feels powerless to act and has no sense of blessing how can they experience hope? Today, take a moment to embrace that for which you hope most.

Prayer:
Steadfast God of hope, even in our despair, we know you are by our side. Help us be better instillers of hope in those around us. AMEN.

Clinical Improvement is Life, too

2008-03-02T13:02:00.002-06:00

This week in a couple of our hospital leadership meetings we took a close and very encouraging look at some new work aimed at reducing the leading cause of death in our (and most everyones') facilities, sepsis. Although strokes and heart attacks are more familiar, sepsis kills more people. Sepsis, which is really blood poisoning, is one way the body shuts down naturally, so it can't be eliminated. But some sepsis is unnecessary and, if detected early can be beaten back. Indeed, in just one of our hospitals (Methodist North) we are now seeing 5 fewer sepsis deaths per month because of a carefully coordinated set of tools and practices. That's a lot of birthdays over a year.

When this was presented to managment, the story was all about the technology, which is not inappropriate because the early detection that is the key is driven by the dramatically new potentials our brand new fully eletronic medical record system have given us. When the vital signs are entered into the system (more and more this is done via monitoring devices that are directly wired into the system), the system screens for the pattern of early sepsis. Those symptoms may not be apparent to a nurse just standing next to the patient, but when that pattern is recognized by the system an email and text page is sent to the physician and response team so they can go intervene right away.

What I see is wires, but more precisely, wires allowing the leading causes of life to flourish. The whole response is highly social--its a team. And any time there are two or three in some relationship to each other, there will be life going on. In this case, the new level of connectedness, illuminates dramatic new levels of agency possible for the team. When you hear the team report on this powerful innovation, the voices vibrate with coherence -- this kind of life giving work is what they have organized their life around since they entered school. This is why they come to work and the source of their creative passion. It is the reason Dr. Joe Kettracide went into the odd and arcane stream of work known as medical information management. He's a physician who helped invent the technology of the electronic medical record and came to Methodist because he wanted to see one health system actually fulfill its promise. Those five birthdays a month ring every coherence bell in his body. But so it does for the nurses, the managers who figured out how to build the business case, the tech guy who plugged the computers together.

The word blessing pops up in this kind of conversation as something experienced not just by the patient, but by everyone involved. The successful innovation brings everyone into a living relationship in which they experience more life and deeper life.

The connection feeds the agency which resonates deeply with the coherence among the care team which creates a powerful sense of blessing. The result is a lot more life than we had going on. The new energy in the room was palpable. We were all more alive and capable of participating in more stuff like this. We found ourselves with more hope --riskable expectation-- that we had before. Methodist risked $100 million so far on these electronic tools, so that is not a small thing to think about.

Life was at work in this process, which can even flow across the wires, beepers, stainless steel and odd language of a hospital.

Jacqueline writes: Connection in Possum Trot

2008-02-26T11:55:00.002-06:00

I read an article written by Erin Gieschen, “Small Town, Big Heart.” Gieschen’s account is of a miracle that takes place in a tiny rural community called Possum Trot. This tiny community adopted “seventy-two of the toughest kids in the foster care system” 1 forever changing the lives of the town and the children they saved. This is a story that bears out all five leading causes of life discussed in The Leading Causes of Life written by Dr. Gary Gunderson and Dr. Larry Pray (connection, agency, coherence, hope, and blessing). However, for the sake of time and space I will only discuss how Possum Trot practice connection.

The people of Possum Trot, Texas dared to hear and respond to the language of life (connection) bringing love and promise out of loss and hopelessness. This community of 300 people brought life out of death by rising to God’s call to “defend the fatherless,” by adopting seventy-two (72) of the most unwanted children in the Foster Care System in their county.

The story starts with the death of Donna Martin’s mother, Mrs. Cartwright who was a legend of love in the town. Donna, the wife of Bishop W. C. Martin, the pastor of the town’s church, Bennett Chapel was left “shattered, angry, and empty” when her mother died. For months, she lived in agony until she prayed for God to “heal her or let her die.” Gieschen writes, “God’s answer came straight at Donna’s heart with a clarity that caught her off guard. I hear you, she understood His Spirit to say. I’ve heard your pain and complaints. But I want you to think about all those children out there who don’t have what you had in a mother. I want you to give back to them. Foster and adopt.” 2

Donna responded to this call as if to answer Dr. Gunderson’s question: “For what are we perfectly adapted?” 3 This “first Lady” of a church and mother of a special needs child enlisted her sister to go with her to attend evening adoption classes that took 120 miles round-trip to attend. It seems that she understood the answer, “We are adapted for complex social relationships. We are adapted for connection relevant to the work of transforming the communities we love.” 4

Once the Bishop started driving the sisters to class, he too caught the vision and supported it from the pulpit. He began preaching this living model of adoption. “The only way man was able to get back to God was through adoption. It’s part of the plan of salvation…. Adoption isn’t a concept just handed down yesterday. It was a God-given thing to get all of us back to him.” 5 Soon the entire church/community rose to the call and “life came out of death.” This small town of 300 people, most of who earned less than $30,000.00 per year adopted 72 foster children. Was it a miracle? After all larger cities with more economic resources have not experienced the successes of this town. What makes Possum Trot different? It is their ability to recognize, initiate, manage, and respond to highly complex social relationships. 6 As Dr. Gunderson says, connection heals. 7 He says life’s cries are louder than the cries of death. We know what elements are missing in the equation to effect adequate change in life’s circumstances. However, the question is: what words, activities, and strategies are required for discovering life’s language? Dr. Gunderson submits that life’s basic language is seen in:

• “The connection through which life comes (even in one’s isolation)
• The coherence of God’s grace against the chaos of loss
• The sense of agency that is able to harness intelligence and energy
• Inherited and transcending blessings, and
• Hope ”8

The small town of Possum Trot chose life, creating possibilities, filling emptiness, weaving together broken pieces, and moving simplicity toward festival.” 9

_________________________

1 “In Touch, Created to be Loved”, February 2008, Vol. 31 No. 2, 2008, Gieschen, Erin, “Small Town, Big Heart” pgs 12-16

2 Ibid., pg 13

3 Gunderson, Gary, Dr., Pray, Larry, Leading Causes of Life, The Center of Excellence in Faith and health Methodist LeBonheur Healthcare, Memphis, TN, 2006, page., pg 71

4 Ibid., pg 71

5 “In Touch, Created to be Loved”, February 2008, Vol. 31 No. 2, 2008, Gieschen, Erin, “Small Town, Big Heart” pg, 15

6 Ibid., pg 64

7 Ibid., pg 67

8 Ibid., pg 3

9 Ibid., pg 46

Gary Y writes: Leading Causes of Life…. A Chaplain’s perspective:

2008-02-12T11:45:00.000-06:00

LEADING CAUSES OF LIFE by Gary Gunderson with Larry Pray is a dynamic approach to redefining and clarifying our life’s purpose, plans, and meaning through relationships that provide us connection, coherence, agency, blessing, and hope. It is NOT a ‘self-help’ book that is built on superficial optimism. Gunderson and Pray challenge our thinking as to how we are interconnected and that these significant relationships are both life ‘causing’ and life transforming.- - gary yarbrough;, chaplain, director of pastoral care; SBMC

Leading Causes of Life…. A Chaplain’s perspective:

Even though (or, perhaps, I should say, because) I spend most of my time within the walls of a hospital, I resonate with the energy and optimistic outlook of Gary Gunderson. “I want to talk about life, not death,” he writes. “Two-thirds of deaths before age 65 turn out to be preventable by fairly mundane social policies and pro-health personal decisions.” Did I say that I was optimistic? As I walk the hallways of the hospital and visit with patients, family members, and staff, I am daily reminded of my own mortality. For some, that may sound rather depressing; however, I have found it to be rather liberating. That is, I provide a ‘pastoral presence’ that acknowledges the awareness of “God’s” presence in the midst of suffering, illness, dying, and death.

I can only ‘be who I am’ and ‘do what I do’ in the context of providing pastoral care for others inasmuch as I, too, remain connected and anchored to the significant relationships in my own life. Consequently, I want ‘to talk about life’ not only in the hospital setting, but also beyond the walls of the hospital that reaches into the hearts, minds, and souls of those around us.

I believe that ‘connection heals.’ Gunderson describes the encounter between Larry Pray and Dr. David Wright, M.D. at the Church Health Center in Memphis. Of this encounter, Gunderson notes: “Patients who are connected survive medical setbacks that would shatter those who are isolated and lonely.” How many times have I heard from a chronically ill patient, “I couldn’t make it without my faith, family, and friends.” (Wholeness and well-being is more than the healing of the physical body).

I believe that ‘coherence’ can hold us together ‘in the face of the most difficult and horrible circumstances.” Gunderson states: “Simply put, coherence is a sense that life makes sense….” Similarly, Viktor Frankl wrote: “A literal translation of the term ‘Logotherapy’ is ‘therapy through meaning.’ Of course, it could also be translated as ‘healing through meaning.” May I be so presumptuous as to quote a verse of scripture from the gospel of John. Jesus said: “I am come that you might have life and have it more abundantly.” ‘Abundantly,’ here meaning, ‘a full and meaningful life regardless of one’s circumstances.’ Now, that’s living!

I believe that “agency is a generative force that inevitably leads to the matter of call. It gives traction to three questions, ‘What am I to do with my life?’, ‘What have I been called to do?’ and, “Am I doing it?” I’m an ‘agent for change.’ That’s why I’m proactive and intentional about reaching out to the community to promote faith and health. I am a resource person for a steering committee that seeks to establish a free health care clinic. Fortunately, to be an agent of change no one has to work alone. I work with other ‘agents of change,’ such as ‘We Care Ministries,’ ‘Congregational Health/Parish Nursing,’ ‘the Salvation Army,’ sponsoring a child in Zambia through ‘World Vision,’ ‘United Way,’ the ‘Shelby Baptist Ministerial Association,’ and ‘the CareNet Connection.’ (and, a litany of others). I am learning about other agencies of change and how they are promoting the health care of the non-insured. These agencies of change are all interconnected as they use the multitude of available resources. Gunderson writes: “Agency is the human capacity to do.” We’ve read and heard it said that ‘faith can move mountains.’ The apostle Paul wrote: “Now, these three remain: faith, hope and love. But the greatest of these is love.” So, I have a question. If faith can move mountains, and love is greater than faith then what do you think our love for God and others can accomplish?! They both move us to action.

To be a leading cause of life, is to be a source of blessing and hope.

(Re)connecting to healthy, loving relationships with others and one’s self is important for everyone. I am reminded of my own mantra: healthy self-care isn’t selfish. This is one of the reasons that I am drawn to the concepts within Gunderson’s Leading Causes of Life.

Healthy self care isn’t selfish. Think about it. Most of us would identify with Gunderson’s introspective observation and subtle confession for writing this book, as we would perhaps admit our confession for reading it. “Who should read this book?” he asks…. Any author who thinks that they are writing for somebody else is simply out of touch. You’ll see throughout that I’m writing to satisfy my own curiosity about life: about how to be a parent, a friend, a neighbor, a Christian, an administrator; in short, a grown-up…. I am writing so that my own life can be about life. And I hope you’ll find this useful in yours, too.”

“So, when are you going to love and care for yourself, the way you're doing for others?” I felt emotionally paralyzed. Shock. Pause. “Would you repeat that?” I asked. He repeated the question. Then I asked him to write it down for me. After a lightning speed mental self-analysis and reflection, I realized that I had arrived at a critical turning point. No, I didn’t turn into a self-indulgent egoist, but I knew that I had to become intentional about nurturing my core being. After all, I’m somebody, too! That was seven years ago. I must admit that I still struggle with the balance.

A couple of weeks ago, I returned from a seminar focusing on “faith and health.” While there, I did feel rather self-indulgent and privileged; taking time away from work to re-energize, think, reflect, and let the (re)creative juices flow. The seminar is like a spiritual, mental, emotional, and physical high; a mountain top experience, if you will allow me to say so. Since my return to the ‘real world,’ I have hit the proverbial brick wall. As a hospital chaplain, I returned to a tough on-call schedule in which I became the pastoral caregiver for five families who experienced the death of their loved ones. This past weekend, I was with three more families that faced the ‘leading causes of death’ rather than life. I remember a young man trying to console a woman who had received word that her thirty-nine year old daughter had just died. He said, “God just needs her more than you do now.” To which, she responded with utmost ire and defiance, “God sure is getting needy isn’t he?”

After all that, who cares about trying to write a blog about ‘the leading causes of life?’ The deep grief, doubts, fears, anger, disbelief, and anguish that I witnessed and felt with them, caused me to seek refuge and solace for my own body and soul. The ‘leading causes of life’ would eventually emerge again... in the relationships with which I have been blessed. It just takes time.

I guess that’s the reason “leading causes of life’ is timeless. When all is said (written) and done, it’s about God’s time and our time. The ‘common denominator’ of Gunderson’s key concepts of Connection, Coherence, Agency, Blessing, and ‘informed’ Hope is relationship(s). That is, our relationship with God, others, and self.

Go and live…..

About me: Now let me take a hike in the woods, spend time with the family, play the guitar, have some ‘quiet time,’ watch the sunrise/sunset, journal, play racquetball, watch a movie, or simply sit still…. I’ll catch up with you later…. I am an ordained United Methodist minister with the North Alabama Conference presently serving as Chaplain and Director of Pastoral Care at Shelby Baptist Medical Center which is part of the Baptist Health System; Birmingham, Alabama. I am a Board Certified Chaplain with the Association of Professional Chaplains and a Clinical Member of the Association of Clinical Pastoral Education. About family: Ramona and I have been married for five years. Together, we have four children and seven grandchildren – all girls. We also support a child and her family through World Vision. Pictured below are: (1) The Big Oak in Audubon Park, New Orleans – some call it the ‘Tree of Life.’ I wonder how many Hurricanes it has endured and now continues to provide shelter, shade and hope. September, 2007. (2) MTS Doctor of Ministry Candidates ‘around the globe’ at the Jimmy Carter Presidential Center. Faith and Health Seminar; January, 2008. (3) Family Fun playing Twister; December, 2007.
-Gary W. Yarbrough (February, 2008)

Notes, in order, but unnumbered due to blogger site restrictions.
Gary Gunderson, Leading Causes of Life (Memphis, TN: The Center of Excellence in Faith and Health; Methodist LeBonheur Healthcare, 2006; p.13)
Ibid., p.67
Ibid., p. 68
Ibid, p. 89
Viktor E. Frankl, The Unheard Cry for Meaning (New York, New York: Washington Square Press, 1978, p. 19)
John 10:10
Gunderson, Leading Causes, p.107
African-American Outreach Ministry: Rev. Albert Jones, Pres. and Coordinator; Mt. Olive Missionary Baptist Church; Wilton, AL
http://www.bhsala.com/spiritualServices/parishNursing.asp
http://www.birminghamsalvationarmy.org/
http://www.worldvision.org/
http://www.uwca.org/
http://www.shelbybaptist.org
http://www.bbaonline.org/templates/System/details.asp?id=1829&PID=259689
http://www.pnhp.org/stateactions/alabama/
http://www.adph.org/Default.asp?bhcp=1
Matthew 17:19-21
I Corinthians 13:13
Deuteronomy 6:5; Matthew 5:43,44; Matthew 22:34-40
Gunderson, Leading Causes of Life, p. 5
Memphis Theological Seminary, TN (Doctor of Ministry: Specializing in Faith and Health)

Other Recommended links:
www.cartercenter.org
www.ihp.org
www.churchhealthcenter.org
www.health-ministries.org

Kevin writes: The Language of Life

2008-02-08T17:48:00.000-06:00

In the 10th chapter of John, Jesus says, “I came that they may have life, and have it abundantly”. The narratives of the gospels also provide us with wonderful stories and pictures of how Jesus brought life into the world and how he gave that life away to others. These stories of a first century life written for a 2nd century audience have the texture of antiquity.

The scientific revolution of the modern world gave us the language of science. With the industrial revolution we needed more precise ways to communicate events. Poems worked great for the ancient Greeks and stories served the early Christians well, but moderns need statistical data and precise language.

When we talk about life, however, the language of the moderns struggles. Gunderson attempts to bridge the gap between the ancient language of life and the scientific language of the moderns in his book The Leading Causes of Life. One of the causes of life, according to Gunderson, is agency. Agency is the capacity to do, but as a cause of life, it is more than just capacity. Agency represents capacity within our most important relationships and within the story that defines us. Capacity-Leadership-Opportunity, according to the Congregational Health Ministry Survey conducted by the NCC, is the fire triangle within which congregational health ministries bloom (10).

Agency is one of the foremost areas where we can quickly begin to engage the public health, science language. I will demonstrate with quotes from two different scientific articles how quickly the language of life struggles when forced into the precision of scientific language. Two main areas where we struggle with this language engagement are the areas of grant writing and conducting of scientific studies. In their article, “Health Programs in Faith-Based Organizations: Are They Effective?”, DeHaven, et al. conduct a literature review to determine the effectiveness of faith based health programs. In order to quantify their findings, they defined church involvement: “Church involvement was coded as ‘faith placed’ if health professionals used the church to test an intervention and ‘faith based’ if the program was part of the church’s health ministry. Programs were coded as ‘collaborative’ if they combined faith-placed and faith-based features” (1031). In a book edited by David Satcher there is a chapter on “Faith Based Initiatives”. In this chapter Stryahorn shows that the “research fails to show that faith based social services provide long-term, holistic service delivery solutions, evidence exists that faith based organizations can provide short-term and effective health promoting activities and interventions” (, 495). Both of these articles use the same words, but are not always describing the same things. The language of agency gets parsed almost beyond recognition. How do we measure agency? Is it possible?

Trying to measure agency forces us to put the language of life into the quantifying language of science; however, this often reminds me the student in Dickens’ novel, Hard Times. In a chapter entitled, “The murdering of the Innocents,” the boy student defines a horse as a: “Quadruped. Graminivorous. Forty teeth, namely twenty-four grinders, four eye-teeth, and twelve incisive. Sheds coat in the spring; in marshy countries, sheds hoofs, too. Hoofs hard, but requiring to be shod with iron. Age known by marks in mouth”. The description is quantifiably correct, but doesn’t capture the essence of the creature that is a horse. The language gains clarity, but looses life.

As many of our post-modern thinkers have suggested, life is difficult to define in quantitative terms. Life is narrative. Because effectiveness has to be measured so that we can receive funding and analyze our own effectiveness we must continue to struggle with language. As people of faith we are people of story. Is there some way that we can find a different way to measure that doesn’t submit the language of life the parsing scalpel of science.

I am reminded of a poem by former poet laureate Billy Collins in which he describes people trying to “get at” the “meaning” of a poem. Collins claims that, as an artist:

“I want to water ski
across the surface of a poem
waving at the author’s name on shore.

The more scientific people, however, treat the poem differently.

“But all that they want to do
is tie the poem to a chair with rope
and torture a confession out of it.
They began beating it with a hose
to find out what it really means.”

When I read some of these attempts to measure the effectiveness of bringing life, I can’t help but believe we are somewhat like the meaning-hunters in Collin’s poem or the student in Hard Times. Instead of parsing life in such a way to make it scientifically measurable, perhaps we can find a way a new way to measure. In the movie, “Smoke”, the story is told about measuring smoke. The argument, among the characters of the movie is that nobody can measure. One character, however, quoting William Raleigh contends that you could measure smoke. To prove his theory, he began with a balance scale. On this scale he weighed his cigar. Then, he lit the cigar and smoked it. He carefully placed all of the ashes on the scale. When he had finished the cigar, he placed the butt on the side with the ashes. The difference between the weight of the original cigar and the weight of the ashes and butt, he concluded, was the weight of the smoke. Measuring life may be difficult, but it is not impossible. Can we find a better way to measure the effectiveness of our life giving efforts?

Kevin

Joey writes: A Partnership between Public Health and the Faith Community?

2008-02-08T17:42:00.000-06:00

After surfing the web for different examples of congregational health ministry connections between our congregations and public health, I was pleasantly surprised when coming across an encouraging article found on the Tennessee Department of Health official website of the state of Tennessee (http://health.state.tn.us/dmhde/faith.shtml). The article, published from the office of faith based health initiatives, entitled “A Partnership between Public Health and the Faith Community: Why?” encourages the reader to “educate your congregation on the importance of caring for themselves physically as well as spiritually and mentally.”

Based on the article, Tennessee has moved from 48th to 47th in state health rankings according to the United Health Foundation (www.unitedhealthfoundation.org). Statistics show that Tennessee has one of the highest infant mortality rates in the country, and to no Tennessean’s surprise has a high number of people who smoke and suffer from heart disease, our biggest killer. Obesity was also listed as a serious lifestyle issue that has doubled since 1990.

Although the statistics were discouraging, the suggested connection between health and our congregations was encouraging. The article encourages us as Tennesseans to “help Tennessee become one of the healthiest states in the country” by educating our congregants on the importance of wholistic healthcare. The Tennessee Department of Health offers its website (www.Tennessee.gov/health) as a site for educational resources, as well as our local health departments the service of providing free educational materials on physical wholeness.

We are encouraged to consider these alarming health statistics of Tennesseans and to remember that each of these statistics represents a person who may have been a member of our own congregation before their untimely death. As a church family and congregation, we influence a wide variety of families within our communities. If we emphasize from the congregation the importance of improving our health, the article suggests, we can not only save lives but also help to improve the quality of life for Tennesseans.

A suggested five minute health message every week during our worship services or a short message placed strategically in church bulletins or newsletters will give information that can reach many people and can make a difference in the lifestyles of the readers.

I am so impressed that our state Department of Health is actually encouraging this on the official state website. Also on the same page are informational links on “How to Start and Grow A Health Ministry,” “Resources and Tools for Building a Health Ministry,” “About Faith Based Initiatives,” and “Health and Faith.” My only hope is that this intent of agency by the state is well publicized and acted upon by our congregations and those in charge of the health departments at the local level. Unfortunately, by ranking 47th in state health rankings, the assumption is that many are not yet getting the message.

One other website that was very impressive that was too good not to share, from was http://beliefnet.com. Beliefnet offers excellent features on religion, spiritually, faith, health, prayer, and the Bible wholistically. The sight is independent and not affiliated with any spiritual organization or movement. The health and healing link, was most impressive and demonstrated to be an excellent example of hope.

Joey

Myra writes: Epiphany

2008-02-08T17:41:00.000-06:00

On Sunday, January 6th, I had an epiphany. For me, this epiphany was significant because it occurred on the day that we Christians celebrate Epiphany in the liturgical sense. Bear with me as I explain what you probably already know. The Greek word “epiphany” means “appearance” or “revelation.” The season of Epiphany follows the season of Christmastide, and it commemorates the revelation of God in the birth of Jesus Christ. For many Western Christians, we remember this day as the time the Magi followed the star to Bethlehem and brought gifts to the Holy Child. We think of the star as giving light, and for this reason, some people think of an epiphany as a moment of enlightenment…or a so-called “aha” experience.

That’s what my epiphany was… a moment when the light dawned on me about the importance of making connections. The weather was mild that night and the new moon surrendered its light to the fading stars in a wintry sky. After attending a party for chaplains and counselors at the Harbor of Health in downtown Memphis, my husband and I walked to our car, satiated from the good food and fellowship. We left the lights of the Mississippi River Bridge behind us as we drove east toward our home in Cordova.

Along the way we chatted about the food and the music, and we filled in any gaps of conversations that we might have missed. That was about the time when my husband of many years blew me away with these words.

“You know that stuff about networking with pastors to help congregations?” he asked.

“Yeah,” I replied, not expecting what he would say next.

“Well, we’re already doing it,” he said.

“Sure, I know…” and I launched into a overview about the existing congregational networks organized by the hospital.

“No,” he said. “What I mean is…I’m already doing it …in my classes with my students.”

What?” Now I was really confused, so I tried to clarify. “I know you teach students who want to be certified as substance abuse counselors.” Some background…my husband Jim is a licensed professional counselor who teaches substance abuse treatment methods and theory at a local community college. At one time, he was an EAP counselor like me, but now he has a part-time private practice and has been teaching at the college for about four years.

“Yes, but did you know that several of my students are bi-vocational ministers?” he reported. “They are taking these classes because there is such a need in their congregations for substance abuse treatment. They work in neighborhoods in Memphis where some of their members are addicted to drugs and alcohol, but because they have no health insurance coverage, they can’t afford treatment. Their members are seeking help from their first line of defense…their pastors. And the pastors are responding by forming free treatment programs in their churches.”

“Oh, my goodness,” I said. “Why didn’t you tell me this sooner?”

“I don’t know,” he said. “I just haven’t thought about it until tonight when we started talking about the importance of making connections in the community.”

“Well, one of the first connections we need to make is that we need to talk more about what really matters,” I observed. This was my first epiphany…that my husband and I need to talk more about what we do every day. But the second epiphany was even more significant. “Connection”, one of the “leading causes of life,” was happening right under our noses! What a revelation! We had just uncovered a way that connection heals communities. Here was another dot on the map of assets in our community.

Then another light turned on my head. Perhaps the most amazing part of the story was that connection was happening naturally and powerfully and incarnationally… without any formal intent to evangelize or recruit or even publicize. It was happening because God has called some bi-vocational ministers to bring healing to their congregations. And before that… God called people like Jim to teach what he knows with compassion and humor and purpose. Is it any real surprise that Jim served ten years as a local United Methodist pastor and twenty years as an addictions treatment counselor before he became a professor? If God is the One who calls and connects people and agencies and communities, then healing will inevitably come from it.

One more epiphany…there are more healing works to be done. What would happen if we were more intentional about connecting our assets? Now that we know what God can do, what will we do? The National Council of Churches USA recently publicized the Congregational Health Ministry Survey. The good news is that churches are involved in health ministries. The data shows that congregations care about the health of their members and the communities they live in. But the disparity between the total number of health education programs (24,072) and direct service programs (13,033) is glaring. Apparently congregations are better at educating people about problems than doing something about them.

Direct service programs are, according to the survey, “understood to mean provision of medical care provided directly to individuals, usually by someone specifically trained to do so”(p.6 of the report). A good example of a direct service program is a free substance abuse program led by a trained pastor of his/her congregation. We have to do more than just educate congregations about problems that already exist. We have to engage congregations in making commitments to provide or sponsor training for interested pastors and lay health ministers, especially in the areas of mental wellness and substance abuse. Direct service programs are not intended to take the place of hospitals or formal treatment programs, but they are intended in fill in the gaps of service where hurting people are seeking help from the healing connections in their lives.

We need more epiphanies. We need people turned on by the revelation of what God is already doing in our communities, and by how much more we could do if we could get better connected.

Myra

Eddie writes: Reflections on the Book, Leading Causes of Life

2008-02-06T15:19:00.000-06:00

First let it be said that this book, “The Leading Causes of Life” speaks to just that, life. In society it is death that is most elevated. It is the negative aspects of society that we tend to dwell on most. Dr. Gunderson, in his book celebrates life in all its many facets. I believe we have to move to the thought pattern that Dr. Gunderson puts forth. I too had/have so often looked at our communities and seen so much negative feedback.

I thought of Proverbs 18:21 that says, “Death and life are in the power of the tongue …” It is no wonder Dr. Gunderson’s book speaks to so many. There is life in the spoken word. There is life when we speak it into existence. There are many scriptures that speak to life. It was delightful to open the book and see the scriptures and quotes relating to life.

“If we can learn life’s language, we can see it, work with it and maybe even more deeply discover our own life in the process. To walk the streets these days you’d better understand Mike’s language or you’ll be living in a hopelessly naïve bubble. But if you can’t talk about TJ’s life you’re just as naïve about what’s going on around you.” Having been around the world a bit I thought of me as fairly learned. But when I read the above paragraph I wondered how naïve am I? How much of life have I missed out on, by not knowing or hearing life’s language? I think and hope to learn to listen to life’s language.

Upon the first viewing/reading of this book I somehow became very attached to the word hope. I grew up in a time and tradition of hope. The possibilities were often clouded by societal barriers. I felt this particular statement seemed to give me power, “Hope does not escape circumstance, it transcends it.” I think that this statement gave me power because it made me think of my past. A place that, as I stated before, was often hindered by societal barriers. But it was these barriers that caused me to have hope. I struggled and achieved a greater sense of accomplishment because of a hope of getting out of the environment. Then when I read the statement on page six, “…struggle, violence and brokenness that scatter hope like dry leaves.” I thought, wow, I remembered the early struggles of my own life. I must admit the statement almost made a cry come up out of the depths of my soul. I thought of so many young lives in this community that do not have hope. Perhaps they do not hear the language of life. I particularly liked the statement that hope is the theological lodestone that attracts the most profound of every generation of every faith. It feels great to know that hope has the power to cross the boundaries and barriers that we humans erect against it.

When I first heard of hope in reference to this book I did not think of hope as being informed. But as I looked more closely at it I found this to be a fact. The hope that was instilled in me as a youth was informed. The hope was expressed but there was always the expectation that I would succeed because there was a plan in place to get there. I would be the first in the family to go to college. Then I would be the first to go out into the world. Next I would help the others to get out. The base of all this was an education. Gunderson said it quite succinctly; optimism devoid of reality can bring us both denial and despair. Informed hope is life but too often we choose the uninformed magical thinking which does lead to sadness and ultimately to despair.

I wondered about a statement on page 140. “Humans tend to live out of their expectations, not just their histories. We anticipate, expect, weigh the likelihood and then act as if that is what is unfolding”. I wondered if this might not be what we interpret as faith. In the book of Hebrews 11:1 now faith is the substance of things hoped for, the evidence of things not seen. Faith like hope is an intangible thing. According to Gunderson, hope is a “riskable” expectation. Hope then act! This sounds like, faith without works, which is dead. This seems to link back to the earlier definition of informed faith.

As a hospice chaplain for a year and a half I saw examples of both informed and uninformed hope. There were cases where caregivers and family members would hope for a miraculous recovery for a family member. The result was the unprepared death of the patient. The family members often exhibited anger at God. In other cases I witnessed families who had a well informed hope that resulted in a smooth transition for the patient and family alike. I hope that I was able to relay this to some of my former patients. I would like to end this blog with a quote from the book. “The well-lived life is not delusional, but the opposite. It is one informed by a hope for those things that matter the most: the ones to whom one is connected the most. It is grounded in a sense of possible choices that could bend the curve toward life, especially the life that would endure beyond one’s own.”

As a fresh example of hope I submit the following news article. This project could present a tremendous amount of hope for countless Africans.

“A grant of almost $43 million from the Bill & Melinda Gates Foundation will enable Heifer International to expand an anti-poverty program in Africa. The program is designed to reduce poverty among 1 million people living on rural dairy farms in three East African countries.

An important focus of the effort will be bringing more women into positions of responsibility, both on family farms and in regional chilling plants for the milk. The grant announced Friday is for parts of Kenya, Rwanda and Uganda, where 179,000 families are to receive assistance.”

For the entire article see the associated press dated January 25, 2008.

Eddie

Life in Religious Entities

2007-12-05T17:44:00.000-06:00

Perusing through the ARHAP (African Religious Health Assets Programme) Newsletters, I came across a study on two countries in Africa, Zambia and Lesotho, where religious entities played an important role in the struggle for prevention and treatment of those living with HIV/AIDS. The focus of the study was on the contribution of religion and religious entities in the struggle for health and wellbeing in countries stricken with poverty, HIV/AIDS, and public health systems that are overused.

The study involved opinions of participants from the community, professional leadership of corporations and churches. The responses were from people of diverse religious backgrounds and from every walk of life, including the unemployed. These groups participated in workshops and special exercises where they gave feedback on their perception of how religious entities contributed to the health and wellbeing of those living with HIV/AIDS.

It was found that the religious entities operated within a network of relationships where secular entities and public health facilities worked together in the struggle against HIV/AIDS. These secular entities and public health facilities were well connected and active in the struggle to help with HIV/AIDS Alliances. They used their combined resources to find monetary funds, to come up with creative ideas and strategies on how they all could work together for the cause of HIV/AIDS. It was through these relationships that connections were made between the church and the secular world to help those living with HIV/AIDS in Zambia and Lesotho. These connections helped to give the possibility of longer life for the Zambians Lesotho people. Coherency was shown when participants identified ways in which HIV/AIDS had emerged as a crucial issue in the health and wellbeing of those living in Zambia and Lesotho. It was noted that the religious entities were concerned about finding help for those living with HIV/AIDS and to help others with resources for the prevention of HIV/AIDS living in Zambia and Lesotho. The religious entities understood the importance of having life, even in the mist of poverty for those living with HIV/AIDS. I believe that coherency existed here because the religious entities, secular entities, and public health facilities had a common goal of working on the issues that HIV/AIDS bring. They worked on behalf of those with the disease; to say that they could have life despite their situation.

The study found that religious entities contributed to the health and wellbeing of those living with HIV/AIDS in six ways, with spiritual encouragement being number one of the six. Spiritual encouragement provided people with the inner strength to keep going with courage and determination. Prayer was the vehicle in which many people received blessings that kept them lifted and moving forward to fight for their lives. The spiritual encouragement empowered the people as they gained a sense of hope that things would get better and that life could be lived.

Agency was seen when the participants came to their own sense of commitment in the struggle against HIV/AIDS. They committed themselves to help organizations and entities in the community to make a better contribution to health. They committed to share information, to working in smaller programs, to coordinating activities, to be inclusive of smaller faith based organizations and to find more ways to generate income for the cause of people living with HIV/AIDS. Leadership participants committed to unlocking resources, embracing diversity, supporting each other, have a common goal and to continue to network together against HIV/AIDS.

The people of Zambia and Lesotho received compassionate care in the fight against HIV/AIDS when religious entities, secular entities and public health facilities found ways to not only connect with those living with the disease, but also with each other. It was through coherency that these entities came to a common goal that was important enough to fight for. The people received blessings through spiritual encouragement and they gain a sense of hope. Lastly, agency occurred when these entities and health facilities collaborated together and committed themselves to the cause of HIV/AIDS.

Joyce

Connect, connect, connect (what congregations do)

2007-09-24T21:47:00.000-05:00

The National Council of Churches discovered this week that people of faith care about the bodies and minds of each other and their neighbors. You wouldn’t think this would be big news, but the scale and ubiquity of the health-related programs conducted by congregations is striking. Released the same week as Hillary Rodham Clinton’s health reform proposal, it is important to understand what the thousand of churches, mosques and temples are doing and can do around health lest it become one more reason for politicians to duck the serious debate about the government can and should do.

The report has some serious limitations, most importantly because it outlines self-reported activities. It’s like judging a school by interviewing the smart kids who sit at the front and raise their hands. And, the congregations reported on the volume of activities with no way to evaluate the quality of services, accuracy of education or effectiveness of advocacy offered.

The best way to understand the report is that it shows what congregations would like to do and are beginning to do, which is encouraging, if not staggering. The NCC, not surprisingly, misunderstands why it is happening, casting the phenomenon as the trickle down of national and denominational leadership. Actually, the sheer volume of health activity shows that congregations are intimately aware of the terrible impact that an inadequate health delivery system is having on their congregants and communities. They do not—cannot—turn from the reality of a deeply broken, irrational, non-system of health that leaves people so exposed and vulnerable. So 51% of the congregations report helping to pay the medical bills of people in need. That is staggering, but those bills are even more staggering.

The data show that congregations are intimately connected to their members and available to their neighbors that results in a remarkable array of activities. The NCC suggests that denominations and public health agencies should work on increasing the capacity of congregations, but fails to mention the actual treatment providers/prescribers, which is where all the money and politics actually are. In Memphis we like to describe religious congregations (about 2,000 of them) as the true “health” system while the city’s hospitals and clinics are more appropriately called the “treatment” system. The health and treatment systems are highly disconnected, even though we know that almost 70% of our emergency room patients report having attended worship within the last month. We’re at the early stages of a serious effort to build a broad-based relationship with a critical mass of congregations (maybe 400 or so) that would share the ministry of health with Methodist Le Bonheur Healthcare. Their members and neighbors are on a journey of health that, from time to time, requires them to be our patients.

Most of the time, our patients are not in the medical system, they are in the congregational system on which their health depends in all the ways the NCC reports: 85% volunteer to visit and provide rides to services, 65% do some kind of health education focused on prevention (28%), elder care (28%), as well as end-of-life issues (24%). Direct service provision included counseling referrals (32%), screening (27%) emergency medical funding (25%) and mental health counseling (22%). Congregations don’t do any of this because of the national policy debate or because a Bishop tells them to. They are small organizations (average attendance 159) who know each other and their neighbors. Every person who gives and receives care has a name and, usually, a history. So congregational bodies can’t turn away when the cancer shows up or a child falls into a deep depression.

In New York or Washington health looks like programs aimed at what people don’t have. On the ground health looks like people helping each other to connect what they do have. You can’t build health out of what isn’t there. So we have begun to use a process to map the “religious health assets” in Memphis that was developed by friends in South Africa and Emory University along with the World Health Organization (http://www.arhap.uct.ac.za/research_who.php). In a neighborhood widely regarded as “poor”, we discovered a rich fabric of assets that includes the schools, beauty parlors, churches and mosques, clinics, parks and 23 other kinds of things (including our community hospital). Congregations are life-giving, not because of their direct services, but because of the people they connect to each other.

The report suggests that congregations naturally blend referral and provision of physical and mental health that is far, far in advance of any suggested national policy. One great example is a new bill sponsored by forward-thinking Tenn. House Rep., Gary Rowe. Inspired by what congregations in his district are already doing with almost no funding, his bill outlines how we can transform community-based mental health and substance abuse treatment by partnering with local African-American pastors to “get the message out” of understanding mental illness, decreasing stigma and offering treatment options, supervise counseling and other support services in such churches and employ and train “indigenous community navigators” to conduct outreach efforts.

Nobody will be more surprised by the scale of the health activity than the clergy themselves, who are usually most painfully aware of the vast volume of needs they can’t meet, the truly staggering scale of medical bills they can’t help with, the profound social disarray that dwarfs all their programs. But at least they look into the eyes of need and act at some real cost to themselves. This is a lot better than what is happening in Washington.

Life on the road

2007-09-05T21:03:00.000-05:00

Well, in case you're wondering how the world works these days, I'm blogging this on a live broadband signal at 78 miles an hour zipping through an illiniois cornfield. How how in the heck is that happening? But it is. So there. We're wired, linked, cross linked in real time all the time everywhere. And sometimes this even makes us connected in the way we mean it in the Leading Causes of Life. All this linking only gives life when it helps us talk to each other about what matters, for we are still powered by stories, roles, narrative. It is connection in which we find coherence, express agency, experience the web of blessing and know hope. And all of those float untethered without connection. But we should reflect a bit on what kinds of electronic connections bring life and which distract from it; which substitute for it, which accelerate its growth. It does not help to reject it like a Luddite. I remember fondly that one of the very finest South African Syrah I've ever tasted is named Luddite (I digress). We use technology for very old purposes--to be in relationship to those that matter and find many that matter in ways that were impossible to know and to have an informed coherence richly fed by knowledge easily gathered once we get the questions right. We experience an expanded reach for our agency.

And now I will go back to talking to John and Niels, sitting in the front seat on our way to Chicago.

Gary