Book Report: The Spirit Catches You and You Fall Down

Anne Fadiman’s book The Spirit Catches You and You Fall Down, chronicles the care and treatment of a Hmong child with epilepsy who is living in the United States.

At every turn, there are clashes of culture, understanding, language, norms, and even understanding of what “health” might mean. No one is right and everyone is right. No one is wrong and everyone is wrong.

Lia Lee was born in the United States. Her parents were refugees from Laos and settled in a small county in California. She was diagnosed with severe epilepsy. Her doctors and family all wanted the best for her, but they each defined “best” differently. The story is a compelling one where you will find yourself rooting for Lia and sympathizing with all of the other players in the story.

This book brings up questions of identity and cultural values. As I read it, I couldn’t help but wonder what I would have done if I was one of the players in the story. How have I , inadvertently disrespected the cultural norms of another person or group? This should be a must-read for anyone working with diverse populations or for someone working in a culture other than their own. This book never suggests that we will be perfect interpreters of other cultures, but the underlying message is one of effort. Health care providers should put in an effort to understand the lived experience of their patients and should understand their understanding of disease.

For those of you who have read the book–an update from the New York Times is here.

Book Report: Getting Things Done

Book reports–I’ll read it so you don’t have to.
 
One of the constant challenges that managers face is in balancing it all–taking time to be deliberate, creative, strategic, and visionary all while driving work forward.
 
The book Getting Things Done offers lots of tricks and tools that can help do just what the author promises.  Frankly, I found the paper-based system to be outdated in this digital world; I am far too often on-the-go, rarely work at the same desk, and don’t own a filing cabinet all of which are requirements for his paper-based system.  However, I have some great take-aways from this book that DO work for me in our digital world.
So, this post is, essentially, a Cliff Notes series of suggestions that work for me, and hopefully, will work for you!
 

First up, the weekly review: In a weekly review, you, essentially, clean up the week that just ended and plan for the week to come. I especially like this approach as I find it helps me to transition more easily into the weekend and sets me up for success for the following week.  I find that my weekends are much more enjoyable and relaxing when I know that I have tied up loose ends from my workweek. This article offers a fantastic list of what you can include in your weekly review. Fans of Marie Kondo and Gretchen Rubin will appreciate how the process also includes a cleaning up of one’s physical work space, too. I typically look back at my calendar to see what meetings I was in and make sure that I have either completed the tasks that were assigned to me during the meeting or do any follow up that may need to happen such as asking for meeting notes, scheduling the next meeting, and so on. I also look to the week ahead and make sure that I have either provided or requested agendas for all of the meetings on my calendar. Great tip–if there is not an agenda consider carefully if it is worth your time! 

As a minimum, on Fridays, I try to use at least thirty minutes to review my calendar for the upcoming week, prioritize my to-do list, and use the Getting Things Done trigger list to help spark my memory of things that may be in the back of my mind or loops that may need to be closed. I don’t have a perfect system but this helps to make sure that I stay on top of my activities. Plus, I find that by using the Trigger List that I end up clearing my mind of all of these little things that I’d subconsciously been keeping track of.  I would love to hear your suggestions about how you optimize your time and make sure that we honor our commitments.  

 
What tricks have you learned and developed over the course of your career?
What works best for you?
Let’s hear from you in the comments so that we can all benefit from your practices! 
 
Do you have a team member who could use some help in getting and staying organized? Perhaps this review could do the trick!

What it Takes to be a Good Leader

I’d like to share some  ideas about what it takes to be a good leader.

Take a listen to this talk by Roselinde Torres.

She distills the best qualities of leaders into three elements:
1. The ability to see changes that may be on the horizon and prepare for them
2. Networking skills that bring various perspectives to the work
3. The willingness to take some risks and abandon practices that may have been successful in the past but no longer serve the team

The reflection questions below may give you insight into your own practices and habits (and maybe encourage a change or two!):

  • What are your skill levels as they pertain to those three qualities?
  • Take a moment to think about, as she suggests, how you spend your time–do you allow yourself the opportunities to develop in these three ways?
  • Are you cultivating your team to be leaders?

What do you think about her distillation of leadership qualities? I would add skills around trusting and transparent communication to her very valuable list. To me, trusting and transparent communication is critical to giving and receiving feedback and to ensuring that your team is helping you to see what is on the horizon.

Have you considered watching TED talks like this one with your own teams? I have always appreciated leaders and managers who ensure that I keep learning and developing. Plus, they are short enough to fit into team meetings or over a lunch break. How do you help to foster growth and development in your team and in yourself?

The Story of Us

Since the 2016 Presidential elections, I’ve been reading more and more of the work of Marshall Ganz (and wish that I had an earlier introduction to his body of work!).

Ganz worked for United Farm Workers for sixteen years before becoming a trainer and organizer for political campaigns, unions, and nonprofits. He is largely credited for the success of the Obama grassroots campaign. 

Why am I writing about him now? 

Well, let me draw your attention to this article: Leading Change: Leadership, Organization, and Social-Movements and in particular, the section on telling stories. I try to help health care workers see themselves as agents of change. In trainings, I aim to include elements that work to build motivation and build a sense of unity between health care workers and their community and patients.

Whenever I am working to develop a curriculum or health care worker training, I like to ask three simple questions:

  • What should the participants know?
  • What should the participants be able to do?
  • How should the participants to feel about whatever they are doing/learning?

This is, of course, a re-visioning of the standard “know-do-understand” model of curriculum development. There are times when we need to ensure that health care workers are not perpetuating stereotypes or messaging treatment options in ways that may be alienating to patients.  By helping to frame the story of health care, we can also help to ensure that patients receive the best possible care.

How do you incorporate storytelling into your work?

Surprising Habits of Original Thinkers

I’ve often witnessed an amazing power in collaboration around brainstorming and great ideas; it is amazing when it happens and has led to some of the best work in which I’ve participated.  At times, though, managers will need to nudge their teams along when it comes to brainstorming. We’ve all been in a position where we don’t want to be the one to share the dumb idea or to be the one to suggest something that has been tried before.

This talk by Adam Grant about the Surprising Habits of Original Thinkers and the accompanying discussion guide may help you to appreciate how your team may process their ideas, come up with creative ideas, and communicate about those ideas.

In global health, we strive to be innovative and come up with creative approaches to solving complex health issues.  It is a task with significant weight–truly lives are on the line.

Might you be up for leading your team in a discussion about creativity and original thinking?  Hopefully we can help to support the creativity of our teams and help to grow comfort in thinking about the same old problems in new sorts of ways.

PS: The Lean In website has lots of great resources that you can use. I am a fan of the discussion guides that can be used to guide our teams through difficult conversations or to help set team norms.

 

Everyday Leadership

This week, I have been thinking a lot about the role of a manger and how complex it can be between driving a project or program forward, supporting our teams, helping our teams grow and develop, and strategizing about the future.

At times, our own growth and development can get lost in the mix. For me, I have had a wonderfully fulfilling time focusing on my career. My development has certainly not made it to the top of my to-do list. So, today, in some ways, I am letting us all off the hook.  There are many moments where we can seize the moment to be a good leader without planning or forethought. There are leadership moments at every turn.

Take a few minutes to watch this Everyday Leadership talk by Drew Dudley where he describes the everyday leadership as “lollipop moments”.

His call to action for us today is…”that we need to get over our fear of how extraordinarily powerful we can be in each other’s lives. We need to get over it so we can move beyond it, and our little brothers and sisters and one day our kids — or our kids right now — can watch and start to value the impact we can have on each other’s lives, more than money and power and titles and influence. We need to redefine leadership as being about lollipop moments –how many of them we create, how many we acknowledge, how many of them we pay forward and how many we say thank you for. Because we’ve made leadership about changing the world, and there is no world. There’s only six billion understandings of it.

Let’s start our day by thinking about someone who has made an impact in our lives—who should you acknowledge and thank today? How are you going to pay forward the impact that person had on you?  How can you make your team feel like they have an “everyday leadership” role on your team and in our work?

Enjoy the everyday leadership in your day!


Want to watch this with your team? Awesome!

Here are some discussion questions that might help to spark a conversation!

  1. What is a lollipop moment?
  2. What does Drew Dudley mean when he says, “As long as we make leadership something bigger than us, as long as we keep leadership something beyond us, as long as we make it about changing the world, we give ourselves an excuse not to expect it every day from ourselves and from each other”?
  3. How can lollipop moments can change our understanding of leadership?
  4. Who has shaped you are in a positive way? What specific things has that person done to help you?
  5. What are some big moments or milestones in your career? Who were important in making those moments happen?
  6.  Who helped you reach those accomplishments?
  7. Who is someone you never thanked for something they did for you?
  8. How can we have more lollipop moments as a team?

Book Report: The Invisible Cure

I read The Invisible Cure, by Helen Epstein, at least ten years ago when I was on a particularly fevered quest to learn as much as I could about HIV. I was so impressed by her work that I later went to a talk that she gave about her work.

Epstein moved to Uganda in 1993 to work on an HIV vaccine. She worked across sectors, with politicians, activists, researchers, doctors, economists, and so on.

She challenged the prevailing orthodoxy and the struggled to understand how politics and greed can infect and corrupt even the most honorably motivated humanitarian projects. For me, I am always impressed by stories, like those told in The Invisible Cure, about the power and potential of grassroots community organizing as the most effective solution to community problems. She offers insight into the thoughts of the Ugandans with whom she is working:

“As a woman living with HIV,” says Beatrice Were of Uganda, “I am often asked whether there will ever be a cure for HIV/AIDS, and my answer is that there is already a cure. It lies in the strength of women, families and communities who support and empower each other to break the silence around AIDS and take control of their sexual lives.”

The story that is told is one that focuses on the Ugandan solution to the Ugandan Problem. The story takes place in the Bush era (so prepared to be fired up about major failings due to political ideologies!) and focuses on the successful reduction of new infections that stem from, Epstein argues, not the billions of dollars from the West, but from the “collective efficacy” of a “shared calamity,” where people helped each other and talked openly about sex, sexuality, and HIV. The reduction of HIV incidence in Uganda focuses on the “B” of the old ABC prevention methods (abstinence, be faithful, condomize). The “A” was problematic as a huge portion of infections were happening in marriages. The “C” was problematic because there simply were not enough condoms to go around at that time. So, Uganda focused on the “B”. President Yoweri Museveni called for “Zero Grazing” as a means of limiting the numbers of concurrent partners that Ugandans (and other groups, too) had. And it worked. Dramatically. Before there were millions in funding for HIV prevention.

In reflecting on the ten years that have lapsed since I read this book…all I can think is “thank goodness”! Thank goodness that we have more in our HIV toolkit than A, B and C. Thank goodness treatment is now much more widely available. Thank goodness we have gotten from a place of encouraging “Zero Grazing” as national policy to a place where we are aiming for 90% of those taking drugs to be virologically suppressed—an HIV prevention tactic I was longing for in the 90s and early 2000s.

Of course, the dark lessons, of the bumbling western influence into the affairs of other countries continues.  “Everyone seems to know what Africa needs, but sometimes I think our minds are not really on it,” she writes. “Most of us see only Africa’s contours, and we use them to map out problems of our own. Africa is a career move, an adventure, an experiment. It fades into an idea. We aren’t really looking.”

Those lessons around the neo-colonization that is funding, aid, and imperialism are still ever present. While times have changed, I still recommend this book for you public health junkies out there. It offers a compelling look back and lessons around the importance of community involvement, questioning what we think we know, and challenging the status quo.

The Power of Empathy

We work in a climate of ever evolving innovation, best practices, and clinical knowledge.  It is charged time, indeed, to work in global health. All of that change, even positive change, however, can also usher in a sense of being untethered or a perception that change happens on a whim among our teams.

I recently read this article, The Power of Empathy Within Organizational Change.  In this article, the author explores how empathy, the ability to understand and share the feelings of another, is a necessary component of change management.

When change is coming, we often prepare our teams in terms of the changes in work-streams, new organizational structures, new funding codes and the like.  How often do we take an empathetic, rather than strictly practical, approach to managing change among our teams?

What if you took a proactive approach and talk about empathy within your team? Perhaps you can share and discuss this short video by the great Brené Brown as a starting point:

Consider the following questions to spark conversation with your team:

  • Brené Brown talks about four key practices related to empathy, perspective-taking, staying out of judgement, recognizing emotions in others, and communicating about them. How do we, as a team, undertake those practices? How might we work to improve our practice of empathy?
  • When is it easiest for us, as a team, to practice empathy? When is it most challenging?
  • What does Brown mean by “empathy is feeling with people”?
  • Have you ever had someone approach a problem with “at least…”? How did that make you feel?

As you consider an upcoming change, for example, a new hire or new funder, consider taking an empathetic approach to how you message and manage the change. Your team may be richer because of it.

Book Report: Just Mercy

I first heard about Bryan Stevenson’s work when I was working at the Kasungu District Prison in Malawi. I discovered his TED Talk and promptly shared it widely. As I am sharing it with you, now…

I watched that talk while working in the Kasungu District prisons and was immediately humbled by the enormity of his work. I became more familiar with him while working at Partners In Health as he is one of the PIH board members. I didn’t get around to reading his book, Just Mercy, until several years later. What was I waiting for?!

That should ring as not only an endorsement but a call to action…march down to your library and check it out! You won’t regret it.

Mr. Stevenson represents those on death row, who are overwhelmingly African American. In the book, he shares the arc of his life and tells the compelling story of how he started the Equal Justice Initiative. Equal Justice Initiative “is committed to ending mass incarceration and excessive punishment in the United States, to challenging racial and economic injustice, and to protecting basic human rights for the most vulnerable people in American society”. Bryan Stevenson fights racism and injustice as a part of his minute-to-minute work.

The story is important. In fact, I wish that we could have a national book club so that we could collectively examine our values and priorities. Stevenson writes, “presumptions of guilt, poverty, racial bias, and a host of other social, structural, and political dynamics have created a system that is defined by error, a system in which thousands of innocent people now suffer in prison.” He recounts the stories of a few of his cases–children tried as adults, people sentenced to death row with scant evidence that they were even at the scene of the crime. The stories made me want to celebrate those who made it OFF of death row, lay at the feet of Mr. Stevenson, and, of course, call my Senators (they are on speed dial lately!). Of course. Mr. Stevenson and his team are vigilant in their commitment to this work and, yet, they are only able to work with a fraction of the people who need his activism, representation, and his ardent belief that wrongs can be righted.

Read this book. I promise you won’t regret it.

I’ll end this with a line from Mr. Stevenson’s TED Talk, one that always moves me and inspires me. I hope it evokes the same feelings in you…

 “We need to find ways to embrace these challenges, these problems, the suffering. Because ultimately, our humanity depends on everyone’s humanity. I’ve learned very simple things doing the work that I do. It’s just taught me very simple things. I’ve come to understand and to believe that each of us is more than the worst thing we’ve ever done. I believe that for every person on the planet. I think if somebody tells a lie, they’re not just a liar. I think if somebody takes something that doesn’t belong to them, they’re not just a thief. I think even if you kill someone, you’re not just a killer. And because of that there’s this basic human dignity that must be respected by law. I also believe that in many parts of this country, and certainly in many parts of this globe, that the opposite of poverty is not wealth. I don’t believe that. I actually think, in too many places, the opposite of poverty is justice. “

PS: A movie about Bryan Stevenson just came out–Have you seen it yet? I can’t wait!

Why Your Doctor Should Care About Social Justice

It seems we’ve all been thinking deeply about race and racism in the United States. My interest in public health stems from a desire to work towards equity and justice.

One of my favorite TEDTalks is by Mary Bassett: Why Your Doctor Should Care About Social Justice.  Dr Bassett is the Health Commissioner for NYC and a long time health activist.

As you may know, I worked for several years at Partners In Health (and am working there on the COVID response now) and so appreciated her nod to the work of Paul Farmer when she says:

“But I knew that epidemics emerge along the fissures of our society, reflecting not only biology, but more importantly patterns of marginalization, exclusion, discrimination related to race, gender, sexuality, class and more. It was true of AIDS. It was true just recently of Ebola. Medical anthropologists such as Paul Farmer, who worked on AIDS in Haiti, call this structural violence: structural because inequities are embedded in the political and economic organization of our social world, often in ways that are invisible to those with privilege and power; and violence because its impact — premature deaths, suffering, illness — is violent. We do little for our patients if we fail to recognize these social injustices. Sounding the alarm is the first step towards doing public health right, and it’s how we may rally support to break through and create real change together.”

She ends her talk with this statement:
“Our role as health professionals is not just to treat our patients but to sound the alarm and advocate for change. Rightfully or not, our societal position gives our voices great credibility, and we shouldn’t waste that.”

Videos like this can be great ways to spark ideas among your team members. What if you showed this video to your team and had a conversation about it?

Here are a few questions that may help to spark conversation:
  • What do you think your individual role is in addressing the social issues that accompany illness?
  • What do you think our collective role is in addressing the social issues that patients experience?
  • Have we pushed the envelope far enough as an organization to ensure that we are using our positions of power to advocate for patients and families?