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: Drive: The Surprising Truth about What Motivates Us

Instinctually, many of us may think that motivation at work is driven by money. Or maybe power. Or, in the case of some of us (ah hem) the mission of the organization for which we are working.

Daniel Pink, a smarty-pants lawyer-turned-motivation-researcher has spent four decades researching the idea of motivation. In his book, Drive: The Surprising Truth About What Motivates Us, he shares his findings about motivation which boils down to three main factors:

  • The ability to direct our own lives, which he calls “autonomy”
  • The ability, freedom, and space to learn and create new things, which he calls “purpose”
  • The ability to do better by ourselves and our world, which he calls “mastery”

So, what does this mean for you and the teams you manage? Mainly, I think it means making space for you and your teams to engage in your work in those three ways. How can you help your team members to build their autonomy, purpose, and mastery?

This book, and the third factor in the list above, inspired me to integrate one super simple practice into my every-day management style. When I delegate tasks or make an ask of my team, I gave them a compelling “why” that is linked to the bigger picture of our work–why what we were doing was going to make the world better.

Now, let’s say that I was asking my team to do something mundane, like, say submit their milage report. How in the world would I be able to link that to saving the world? I admit that at the start of my practice, I had difficulty linking tasks like this to our mission. With practice, I became a pro. So, for this example, I would tell my team that by submitting their milage reports we could assure our donors and funders that we were responsible stewards of their donation, that we actually were doing consistent and meaningful work in the community, and that our timely report submission was a sign of our respect for them.

Pink fights against theories that folks are motivated “extrinsically” with  short-term incentive plans and pay-for-performance schemes and the traditional carrot-stick motivation and punishment.  Pink writes that those extrinsic motivators “can deliver a short-term boost — just as a jolt of caffeine can keep you cranking for a few more hours. But the effect wears off — and, worse, can reduce a person’s longer-term motivation to continue the project.” That reduction in long-term motivation is partially due to the waining intrinsic motivation BECAUSE OF the extrinsic motivator–it is a vicious cycle once extrinsic motivators are introduced.

I found two of Pink’s illustrative examples particularly compelling. Swedish blood banks decided to change things up and pay people to donate blood. They anticipated that their blood bank would be filled to the brim. In fact, they saw blood donations plummet. Why? Well, you may have guessed…turns out we are motivated to donate blood out of the goodness of our hearts and not for literal blood money. The good Swedes are motivated intrinsically, not extrinsically. The second example that I found compelling was about Encarta. Remember Encarta? It was a pet project of Microsoft’s Bill Gates. It was a 1990’s CD-based encyclopedia that Microsoft paid big bucks to develop. Microsoft eventually threw in the towel and admitted defeat. While Microsoft never publicly stated it, it was presumed that their defeat was at the hands of Wikipedia–an online encyclopedia with content that is generated for free by people like you and me out of a desire to share knowledge. Those who contribute to Wikipedia are those who are motivated, again, intrinsically and not with the traditional carrot.

This book is most applicable to those who are managing people and teams. However, I think it is also tremendously useful to teachers and parents as they consider how to build motivation in children. I also find it particularly useful to consider as I develop trainings that are meant to change behaviors over the long term.

With this new knowledge, that we can and should build intrinsic motivation of our teams, I pose the question: How do you help to promote building purpose, mastery, and autonomy in your teams?

You can read the book, which I highly recommend. But, if you only have 18 minutes and 36 seconds, here is his TED Talk that describes some of the highlights of his theories.

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!

Book Report: With Charity for All: The Terrible Truth of Charitable Failure

Ken Stern, a former CEO of NPR, chronicles ways in which non-profits are financial nightmares…from overpaying CEOs, to failing to deliver on programatic promises, and finagling suspect non-profit tax breaks.

He posits that the non-profit machine keeps churning because donors do not do their homework. We donate to a charity when a friend is fundraising on Facebook. We buy the wrapping paper because out nephews are hawking it and don’t give a thought to the beneficiary. And, oh yes, I will gladly buy those Girl Scout cookies (I will gladly support girls empowerment with inclusion of LGBT kids!)!

He also writes about non-profits that have detriment effects–like D.A.R.E. Did you know that kids who went through a D.A.R.E. program are MORE likely to try drugs? There are even more organizations who can’t prove the effect of their work; maybe they have a positive effect, maybe not. In an ideal world, every non-profit will have a skilled monitoring and evaluation team working to ensure that programs are on track. Sometimes, for small organizations, that isn’t quite feasible. When I was a Peace Corps volunteer, I worked at a very small organization with just three of us working full time. We kept track of some key data and could certainly show an effect of some of our work. Could our M&E systems have been more robust? Sure–but that would have required another person on staff!

He makes the point that non-profits are often judged on their ratio of programmatic spending to overhead. Big overhead = bad. Oh, how I wish that donors would see a big picture. Non profit employees often earn less than for-profit counterparts and are still expected to have the same level of investment in terms of their education and professional development. The lowly non-profit workers are often strapped with debt, living with roommates until 35, and eating Ramen for far longer than anyone should. Interested in learning more about this aspect of the book and indulging in my tangent? Watch this great TED Talk by Dan Pallotta.

So, what are we to do?

Stern suggests greater government oversight, a requirement for non-profits to reapply for their government non-profit status, and for non-profits to invest more time and energy into measuring the results of their work. But, for donors, some of the onus is on us to dig deeper into organizations we wish to support–he urges us to look beyond HOW the money we donate is spent to the RESULTS of that spending. Certainly good advice! If you need some help deciding or don’t wish to do the research yourself, GiveWell.org is a great resource for reviewing charities you are considering.

I am also asked frequently what organizations I donate to– sometimes knowing someone in the industry is helpful. I have an eye on the budgets of the some of the places where I work and being in the field helps to know which organizations have an ethos that aligns with my own (like Partners in Health) and which ones do not (like World Vision). If my ethos and values align with yours, I’d be happy to chat!

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.

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!

Book Report: Why are all the Black Kids Sitting Together in the Cafeteria

Let’s talk about race. Let’s talk about race as a public health issue.

Right now, let’s talk about it via the 1997 book Why are all the Black Kits Sitting Together in the Cafeteria.

My interest in social justice extends to and includes an interest in race and racism. So, when this book was recommended to me, I picked it up right away.

It’s been 20+ years since this book was written and, aside from the absence of technology in the cafeteria, it reads as if it could have been written yesterday.

The author, Beverly Daniel Tatum, recently published an updated version which I am eager to read (anyone out there read it already?).

Tatum initially wrote the book with an eye towards helping parents and teachers as they grapple with race and identity in their children and students. She wanted to arm the adults with the information and guidance that they’d need to help the kids disrupt racism.

With that audience in mind, Tatum walks the readers through the development of identity from pre-school through adulthood. And this nerd is grateful that her assertions are backed up with research (if you’ve read this blog, you know that I hate baseless claims that make their ways into books!).

Tatum outlines the exposure we have to language, imagery, and behavior that teaches prejudice and contributes to the racism that swirls around all of us. Her argument, which I whole heartedly agree with, is that we have to break down the systemic racism and the obvious differences in housing, schooling, opportunities that are afforded based on our race.

The book is a call to action to have these tough conversations with people like you and people who are different than you. And with this book in your back pocket, you will be ready for these spontaneous conversations that come up.

If you’d like the Cliff Notes version, Dr. Tatum gave a talk at TedEx in 2017. It is worth a watch!

Book Report: The One-Minute Manager

The One-Minute Manager, by Kenneth Blanchard and Spencer Johnson, is a quick ready. It comes in at just 112 pages. So, that is one argument for why you should read it, I suppose; you can learn something useful in just one sitting.

My argument against reading it is the same argument against reading a lot of these management books. There is no evidence to back up what they claim you should be doing to be a good manager. This (like The 5 Dysfunction of a Team) are written as a story with key management lessons sprinkled throughout. I am not a fan of that writing or learning style.

The story emphasizes the importance of asking the right questions, holding staff to a high standard, accountability, and offering praise when it’s appropriate. Common knowledge? Probably.

The book has some nice, neat, easily packaged take aways.

The One Minute Manager establishes One Minute Goals. Those are goals that should take no more than one minute to read. Write up goals for your team and individual employees on a regular basis to help manage their work flow, manage the team’s and your expectations, and help to keep everyone on task. They suggest having just a few short-term goals at one time; those goals are constantly updated.

The One Minute Manager also looks for things to praise. I do like the notion of keeping an eye out for the positive, especially in the busiest times at work! Of course, praise can help build motivation and reinforce what a person is doing.

Finally, the One Minute Manager reprimands in One Minute. It is a two step process. First, tell the person that what he or she did wrong, how you feel about it, and then let that simmer. Then, step two, tell the person how how much you value them and tell them your sense of their capabilities. The idea behind this one is that if you reprimand immediately after the reprimand-worthy event and reprimand often then a culture of feedback is built and employees get back on track quickly.

So, overall, do I recommend this book? Well, now that you have this handy summary, you essentially have the main take-aways minus the silly story. You’re welcome.

Book Report: Strength in What Remains

I am suggesting a book where you should just stop reading this post, march down to your library, and check out Strength in What Remains by Tracey Kidder.

There is a story in this book I often retell. I recount the story when colleagues are unsure of what the community involvement should be in a project. I also tell it when communities have little faith in themselves and wait or depend on outside money or influence to solve all of their problems.

Here is the story. Deo, the subject of the book, is working in his home community in Brundi after getting his medical degree from Harvard.

The community is isolated and rural. They do not have a road that connects them to the bigger town nearby. They want a road so that they can participate more fully in the economy, get to the larger hospital, and all of the other reasons that any rural community wants a road.

They found a Belgian company that was willing to build their road. They found money to pay for it. The company of course was going to charge them an arm and a leg, $50,000 to be exact, just to make it passable, and they would take forever to get it done (when you are in a complicated labor and need to get to the hospital, any wait for a road will seem like forever).

A woman with a baby crying on her back said to [Deo], ‘You will not pay a penny for this road. We become so much sick because we are poor, but we are not poor because we are lazy. We will work on this road with our own hands.’

So, what did Deo do? He went to the women. He went to the women who were seen as leaders in the community. He asked them if they thought they could get everyone together to build the road. If they did it themselves they would save that arm and that leg and be able to use the extra money to get people to the hospital (the primary purpose of the road!).

The next day a hundred sixty-six people showed up with pickaxes, hoes, machetes and other tools. One of the volunteers was a woman who came to work with a sick child. I asked the mother why she came to work with a child that sick. And she said to me, ‘I’ve already lost three children, and I know this one is next, whether I stay at home or come to work here. So it’s better for me to join others and make my contribution, which hopefully will help to save someone else’s child, who will be sick but alive when you build your clinic.’

A six-kilometer road in rural Africa, built by every single person in a community.

So. This story has a simple lesson in it. Get your people together. Build the damn road.

And if you want extra inspiration–this short video highlights Village Health Works, Deo’s organization in Brundi!

Book Report: Adventures of a Female Medical Detective

The Adventures of a Female Medical Detective, by Mary Guinan, is a wonderful, complimentary read to House On Fire (which I also wrote a review about).

Early in her career, Dr. Mary Guinan worked as a doctor and epidemiologist for the World Health Organization during the small pox eradication efforts in India and Pakistan. Her efforts involved interviewing patients and contacts of patients, pleading with local leaders to allow work to happen in their communities, and tracking down every case of small pox in the most remote corners of India. She tells a charming story about trying to get her budget for her elephant-feed approved. Indeed, a wealthy Indian man turned up with an elephant and an elephant-driver to expedite her work as he (the elephant, not the man) could easily cross rivers and slug all of their equipment.

Her career progressed and over time she cared for patients living with HIV, worked in a Pakistani refugee camp, and became the go-to for all questions and concerns related to herpes. My favorite antidote from the book is when  “Dr. Condom”, as she was known, was asked in 1978 about the risk of getting HIV from a toilet seat, she responded: “The only way I know of that you can get AIDS from a toilet seat is if you sit down on it before someone else gets up.” She was on fire.

I enjoyed this book, I did. I wish that there were more details in it and that it was written with an assumption that the reader would like to hear more about decision-making processes and, frankly, details of her life. She is a remarkable person by all accounts—becoming a doctor when only 10% in the field were women, winning the jackpot to become one of the 45 to land a spot in the CDCs Epidemic Intelligence Service , rejection after rejection for her applications to study chemistry because she’s a woman– and yet, when it comes to her life and her ability to overcome adversity, the book fell flat. Many of the chapters left me wanting more, to learn more, or to even be able to relate to her more and see her as an example.

Is it worth a read? Yes, especially since it is short, funny, and entertaining. Well, at least as entertaining as a book about an epidemiologist can be.