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?

Letter from a Birmingham Jail

I am largely motivated to “do” public health because of the social justice elements that underpin the work.  I credit my time at the Community for Creative Non-Violence homeless shelter for teaching me important lessons in fairness, right and wrong, and my role is in this movement as a white, privileged woman.

I re-read Martin Luther King’s Letter from a Birmingham a Jail as a tool for my own reflection as we confront racism in this country.  I reflected on how, in many ways, the work of public health intends (or should intend) to continue on the legacy of MLK.

I am particularly moved by this line: “Moreover, I am cognizant of the interrelatedness of all communities and states. I cannot sit idly by in Atlanta and not be concerned about what happens in BirminghamInjustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly. Never again can we afford to live with the narrow, provincial “outside agitator” idea. Anyone who lives inside the United States can never be considered an outsider anywhere within its bounds.”

How are you agitating from the inside?

Authentic Leadership

I keep a running list of topics that I want to write about and reflect about for this blog. According to my plan, I was going to write about the book Lean In today.  But, with all of the controversy circling about Facebook and Sheryl Sandburg, the author of Lean In, I just didn’t want to.  I have been thinking a lot about authenticity in the workplace and so, perhaps, my schedule was the best prompt to put some of my thoughts into words.

Authentic leadership is still being researched and formulated into a practice base–which to me seems, well, inauthentic. Authentic leadership is about building relationships based on honesty and ethics.  Are we still in a place in our humanity that we need to build an evidence base around the benefits of honesty and ethics at work? Apparently so.

I have always been drawn to work at mission-focused and -driven organizations.  Perhaps such organizations cultivate natural, authentic leaders. Perhaps that shows my bias, too, towards thinking that achieving a lofty mission while doing right by people is more important than the bottom line, profit, or reputation.

Why do we have to pit profit or self-interest against doing right by people, ethics, and authenticity?  I have had the good fortune of working with and for truly authentic leaders and certainly hope that I emulate and model that style. My question today is how we can teach it and cultivate future leaders who put ethics first? Any ideas?

Love as a Force for Social Justice

Poverty. Death. Illness. Repression. Injustice.  These are the issues of global health. It is what we confront, among a laundry list of others, as a part of our daily work and as a part of our mission.

Behind all of that is such beauty and joy and resilience…it is breathtaking at times!  I remember being at a hospital in Sierra Leone during the Ebola epidemic. A child who was orphaned due to Ebola had been admitted. She had been found after being alone for god knows how long.  She had illness on top of illness; she was skin and bones.

Everything about what happened next, though, was a story of community and care. I saw a nurse at the hospital draw his own blood to donate to her. Two women unofficially adopted her and ensured that she was fed, diapered, clothed.  She steadily made progress that some would call miraculous.  And right before I left, the sign of her true recovery was that she led the ward, providers, visitors, and patients alike, in a jubilant dance party!

The love behind each and every action in this story is motivating. From the community health worker who found her and overcame his fear to bring her to the hospital. To the hospital workers who stayed in their roles when so many others fled out of fear.  To the nurse who donated his blood. To the women who gave of their time and resources.

The great Ann Firth Murray at Stamford University is renowned for her work in global health, in particular, she was the founder of the Global Fund for Women.  In her long career, she has born witness to tremendous suffering and injustice.  She developed a course called Love as a Force for Social Justice as a means of investigating how love can be a tool that can be used towards the elimination of violence (elimination of violence against women is a critical element of her body of work).  I highly recommend it as a morale boost and an anti-burn-out tool.  You can read an interview with her about the course here.

In the course, she explores several nonviolent movements, from Gandhi’s Salt March to the Dakota Access Pipeline protests, in order to demonstrate how love and commitment can be transformational. She also brings in neuroscience, biology, and psychology to make her points (the science-minded side of me was pleased to see that!).

In our work, we often talk about human rights, empathy, accompaniment, commitment, humility….but we rarely talk about love as a force for change.  It’s seen as weak, at worst, and perhaps out of place at best.

Martin Luther King, Jr, once not-so-famously said that “justice is love in calculation. Justice is love working against anything that stands against love. Standing beside love is always justice.”  Cornel West said, more famously, “justice is what love looks like in public”.So, with love being so foundational to so many social movements and so intrinsically tied with justice, maybe it is time for a small change that would allow a tsunami of changes to come.

OPTIMIZE project

I am thrilled to announce that training materials for health care workers on the introduction of DTG for the treatment of HIV are now online!

The OPTIMIZE project is a global consortium dedicated to rapidly improving treatment outcomes for people living with HIV by optimizing ARV drugs and formulations and accelerating their introduction in low- and middle-income countries.  I was proud to contribute to the impressive work of the consortium by writing the training materials for health care workers.

In recent years, there has been a powerful movement to test folks for HIV and immediately treat all who have a positive test. This is a shift from pervious recommendations of treating those who have low CD4 counts or who are pregnant, for example.  This is huge! It is a huge move towards equity and justice in health care.

Of course, there are challenges to a shift like this. One of the challenges that OPTIMIZE is addressing is around complicated treatment guidelines that include several different drug formulation for multiple populations. The introduction of DTG helps to simplify the treatments overall, harmonize treatment across populations, simplify the supply chain, and save money.

There have been several pivotal moments in the fight against AIDS and this one, an effort to get 90% of those living with HIV on treatment, is one of them! And DTG is a tool that will help achieve the goal.

As always, I am open to new contracts and to working together. Please let me know how I can help you to build effective, exciting, and practice-based trainings.

Book Report: Blink: The Power of Thinking Without Thinking

Blink is Malcolm Gladwell’s second book.  It was a provocative read in many ways.

It comes down to a nutshell. Blink is about split-second decision making and how decisions made quickly are often just as sound if not more so than decisions made after great deliberation. Gladwell calls this “thin-slicing”.

It’s why speed dating works. It’s also why racial profiling and stereotypes exist.

Gladwell is a journalist by trade so his writing takes a speedy clip. This book is filled with captivating examples from a wide-range of disciplines from the arts to marriage counseling.

So, what is the take away for global health work or trainings?

Let’s take “priming” for example.  In the book, Gladwell describes a study where participants are asked to play a game of Trivial Pursuit.  For several minutes beforehand, one group was asked to imagine what it would be like to be a university professor.  And another group was asked to spend several minutes imagining that they were soccer hooligans.  When they played the game, those who imagined themselves as the professors fared considerably better. Gladwell states that the only difference between the groups is that the professor group imagined themselves as smart.  What if we primed healthcare workers to think about the lives of their patients before taking a training? What if they could imagine that person engaging in an active, happy life? Would that be a motivator to help them return to that life?

Gladwell writes about how racism and stereotypes can often be based on this same “thin slicing”.  Take a look at the Project Implicit site from Harvard.  It doesn’t look legitimate, but give it a try.  The tests ask you, the user, to make snap judgements of pictures and phrases. You’ll be asked to pair words and phrases together.  The scoring can help to uncover biases that the test taker might not be aware of; implicit bias may exist without heartfelt bigotry.

Global health work is fought with issues around race, racism, sexism, paternalism, colonialism, and so many other -isms. What if as a global health community, we made efforts to examine our biases, implicit or otherwise, and framed our work around true equality. It could save lives.

Nonviolent communication

Words are powerful.

We’ve all found ourselves in situations where we want to be heard. And we’ve all been in situations where we could have done a better job of listening.

I worked with someone with whom communication was challenging, to say the least. I tried all sorts of strategies, I took courses, read books to try to over come those challenges…all to no avail.  It left me feeling pretty hopeless, actually.  I am typically a person who oozes positivity and enthusiasm. This took me for a loop and left me feeling frustrated, ashamed at my own shortcomings, and dejected, frankly.

I didn’t want to let the relationship end without learning something or trying to improve upon my own communication skills.  I decided to read this book and take a  course with the Center for Nonviolent Communication in the foundations of compassionate communication or non-violent communication (NVC).

The practice of NVC has it’s roots in the civil rights movements of the 1960s.  Many of the social justice movements I’ve been involved with have been founded in theories of non-violence. NVC is a tool that can be used towards the social justice end.  The rationale and sentiment behind it seemed like it would naturally jive with my sensibilities.   

As a basic premise, NVC supposes that all human have a set of basic needs that go way beyond just the physical needs to include needs such as love, understanding, compassion, purpose, and so on.  If we can identify our own needs that motivate our behaviors, which might not be evident at first blush, then we may be able to recognize how to fulfill that need or identify how it is currently being filled.  The trick is to do so in a way that carries no judgement or evaluation but that is based on a series of observations and feelings associated with those observations.

Likewise, if we can communicate in such a way as to discover the needs that motivate behaviors in others, we can connect more deeply and in ways that satisfy both parties.  Typically, it is the strategy to fulfill our needs that conflicts with other people, but not the need itself.  By unpacking what the needs may be, with empathy and non-judgement, there is hope for a mutually agreeable strategy to appear and unfold.

That’s it in a nutshell.

Except that it is much harder to do in practice than it may sound.  It takes commitment, time, and a vulnerability that I am not accustomed to, especially in the workplace, even my social-justice-minded workplaces.   I struggled a bit with this method not being based in research and there are several suggested ways of communicating that seem clunky or unnatural.  That aside…I am eager to learn more and use some of what I learned to improve my skills.

What tools do you bring to the workplace to ensure clear and honest communication?

Book Report: Pathologies of Power

I read it so you don’t have to.

Pathologies of Power outlines what Partners In Health means when it talks about striving to create a “preferential option for the poor in healthcare.”
For many years, PIH shared Pathologies of Power Chapter 5 with new employees as it calls upon public health practitioners to be community-based, patient-centered and open towards others: to “observe, judge, act.”
Dr. Farmer borrows the social justice framework from liberation theology to emphasize our collective responsibility to fight alongside community partners for liberation from social, political, and economic oppression/structural violence.
What do you think of this approach?
Is it still relevant?
Is it problematic to use this framing?