Notes from the other side of hell

You might have been wondering why we were quiet for a good chunk of 2014. Short answer: the beginning of 2014 was not good to the Badass Public Health duo. Here’s a little of what happened and what I learned. Next time we’ll hear from Briana about how she survived and thrived during tough times, while dealing with a schedule from hell.

 

“When you’re going through hell, keep going.” – Winston Churchill

The title may sound a bit dramatic or dark in a Black Sabbath kind of way, but sometimes we have to get dark to get right.

The last year of my life has been difficult. The last few months have been unbelievable. Within 5 weeks, one of my dearest friends and role models died, my house was burglarized, and my big brother died suddenly. I am still healing from the end of my 10+ year relationship, and figuring out how to live the life of a single working mom and share custody of my children. It has been the hardest year of my 38 years. I hope I never have a harder one, but figure I just might because life is unpredictable and I know better than to think I’m in control.

Life is suffering. But it is also beautiful and magical. In every moment you can choose to see the pain and darkness or you can see the light and the beauty.

I have had to keep making the choice to see the light, to feel grateful. Even in the moments of despair and extreme stress and confusion. I’m not going to bullshit you. I didn’t always succeed. Sometimes I self-medicated to make it through, whether that was a few beers or binge-watching Girls.

I am not a religious person. I’m an atheist; but I sure see the power and purpose of faith in human life. I wish I believed in a divine power, to help make sense of the incomprehensible. But my logic won’t let me. Whether that’s good or bad, I’ll leave to the philosophers and theologians.

The one thing that has kept me going has been utter belief in myself to survive and even thrive in these difficult circumstances.

So that’s what I want to tell you all. When life is full of pain or confusion, just keep moving forward. Do what needs doing right now. Focus on the present moment and the task at hand. Know with all your heart that you will make it through. Sure, you are going to be sad, afraid, stressed out, and lonely at times; but you will survive.

Badasses know that every single thing that comes their way is survivable. Even the most ugly or traumatic. You have it all inside of you. Everything you need you already have. *

“When we meet real tragedy in life we can react in two ways – either by losing hope and falling into self-destructive habits or by using the challenges to find our inner strength.” – Tenzin Gyatso, the 14th Dalai Lama

 

*I recommend that any badass or wanna-be badass study Buddhism. What I have learned and put into practice has saved my life (and my sanity) on more than one occasion. Lama Surya Das is one of my favorite Buddhist teachers. He has written several great books. Awakening the Buddha Within: Tibetan Wisdom for the Western World is my favorite.

 

Nobody cares you did it

“The way to get things done is not to mind who gets the credit.”

Benjamin Jowett (1817-1893) English Clergyman, Educator & Classicist. Quoted in John Gross, The Oxford Book of Aphorisms

If you are in this work for the glory or money, you better pack it up. I mean, you and I might be able to name some public health heroes; but I bet most people never heard of them. Unless they invented something awesome like a vaccine. And even then, it’s probably just you and me. There is no glory in public health. There are barely any “thank you’s” or certificates of recognition suitable for framing.

I get frustrated pissed off by the people who barely lift a finger to do the hard work of good public health, and yet want to be the first to get any credit or accolades. These are the people who only do what is exactly in their job descriptions, and only if everyone is going to know they did it. They rarely, if ever, help out a colleague. Sometimes they even act like serving the public is too much to ask of them. I think you know at least one person who fits that description. Hopefully it isn’t you. Of course it isn’t. Those people don’t read this blog. They are too busy reading Perez Hilton or TMZ.

So my point?

It ain’t about you. It’s about the work. It’s about the people.

We public health folks need to stop being territorial about data, about clients, about programs, about ideas. Silos and ivory towers are holding us back. We could solve some big problems if we would just forget about credit and ownership. And really, so much of what we make and gather doesn’t belong to us anyway. It’s not mine or yours, it’s ours. It’s funded by the public, for the public.

Remember them?

Many of us serve our funders, not the public. That shit has got to stop. Like last Tuesday.  Even the federal government talks about coordination and collaboration, but often doesn’t provide any real support or funding to go along with the initiatives. So no wonder they fail. We are also rewarded for what we do that can be counted (clients, tests, screenings, units, etc.). So who wants to do work that they can’t get paid to do? Not too many people. And not too many managers and Executive Directors can justify employees working on things that don’t get reimbursed or fall out of grant requirements. It’s bullshit, but it’s how it works. If nobody can pay for it, it rarely gets done. I don’t know how to fix that, but we should at least try.

If we change the system to look at macro-level outcomes, maybe we can get our heads out of this us v. them head space that serves no one. Once we measure progress at organizational, city-wide or some other system-level, I think we might see if we are actually doing anything worthwhile. We are so focused on protecting our own little tree that we can’t see the whole damn forest is burning around us.

So here’s my proposal: forget your job title, your job description, and your targets;  and just focus on the mission. What exactly are you hoping to accomplish? Answer that question and then make it happen. You will probably need to work with other people to get there; and along the way you’ll probably help them with their missions too. This is why superheroes hang out in gangs like the Justice League – way easier to save the world with a super friend or two.

I call Wonder Woman! Which superhero are you going to be?

My super hero buddies and me, 2012

 

 

Bold to Ship

Around the halls of Badass Public Health we have a saying:

Bold to Ship

Now this may seem familiar (but slightly wrong) if you know the awesome work of Seth Godin (one of our badass heroes). His call to action, Build to Ship was the foundation from which we derived Bold to Ship (by an auto-correct accident, as all brilliant slogans are made). Build to Ship means to make art (work) and to give it away to the world to enjoy, use, build upon, etc. Don’t get mired in perfectionism or fear of failure or designing by committee. It’s about creating and sharing. Make some art and then get it out there, so you can start making more art. And maybe, just maybe change the world. (You should go read Linchpin yourself because I hardly do Godin’s ideas justice here. Really, go!)

Now you might be thinking: I don’t make art, I write grants or manage a program or teach people to eat apples instead of Twinkies.

Guess what, friend? That is totally art, when it’s art and not work. Don’t go looking at me like I’m talking crazy. Think about it. What is the difference between work and art? Art comes from the deepest parts of the artist. It’s original, even if derivative. Art is a gift to the world. Work is shit you do to get a paycheck or to accomplish a task. Two totally different things.

If all you’re doing is your job, then you should probably go work for some corporation. Starbucks and Target have lots of jobs. But in the world of public health and social justice, we need artists. Artists know how to do more with less. Artists recycle the old to make the innovative. Artists ignore the rules. Artists build community. Artists harness creativity.  Artists don’t rest on their laurels. They treat their last like their first and their first like their last.

 

Artists save the world. Employees don’t.

Bold to Ship is a way of being. It’s the badass version of Build to Ship. It’s taking a damn risk already. It’s being human. It’s owning your mistakes. It’s not being a wimp.  It’s being BOLD. But being bold with a purpose, to make your art for the world.

Don’t think that all this is about swagger.  Swagger has its place. But you shouldn’t be all swagger and no substance. That’s just sad. It takes no courage or inner strength to swagger through the world, but it takes a great deal of courage to own a mistake or to put yourself fully into your art (work). That’s where the BOLD comes in.

Anybody can make stuff.  But only you can make your art. The world needs more artists.

Don’t be a wimp.

You have a choice, friends.

You can be a good worker bee, checking your boxes, doing your time, fulfilling all requirements

OR

You can take a damn risk, already. Do something more. Do something different. Do something bold.

Briana already schooled us on why risks are good. Now I’m going to talk about taking the risk of aiming for the head of the table (or the room). In other words, some times you need to take the risk of (maybe) being too big for your britches.

“Reject the tyranny of picked. Pick yourself.” 
― Seth GodinPoke the Box

But first here’s a story.

Picture it, Philadelphia November 2013….

I received an email from a national coalition of organizations (of which my organization/employer is a member) calling for nominations for the at-large seats on the convening group (of said national organization). Over the last couple of years I have been looking for ways to increase my impact on the public health world (part of the reason this blog exists) and have begun to work on my leadership skills. So this opportunity seemed like a step in the right direction.

A CRAZY step. First of all, I’m shy and an introvert. Don’t look so surprised. Sure I can write some blog posts, but actually talk to real people, people I admire and quite frankly, intimidate me?!  Holy hell, that’s a lot to ask of me. And then to think that I could be ONE OF THEM?! Crazy to the extreme. Or maybe crazy like a fox.

But then, a little voice popped into my head, maybe one that sounded an awful lot like Seth Godin, “Why can’t you be one of them? Don’t let your resistance (fear of change or standing out) rob you of the chance to be something you really want to be. Stop being a wimp. Are you more afraid of never trying or actually getting the chance to do something big?

I was more afraid of the chance to be one of the people who do big things than I was of failure. And that’s just stupid. Not badass at all. So I nominated myself. (Luckily the nomination process only required me to send an email that read: ‘I would like to be a nominee for the convening group’. Otherwise, I don’t know if I would have had the chutzpah to actually do it.)

I was pretty sure that I hadn’t a chance, because nobody has ever heard of me, not compared to the other nominees. Those people were “real experts”.  I asked my boss to cast the votes for our organizations because I felt stupid voting for myself.

Then one day in December Briana walks in my office (or maybe she yelled down the hall) to tell me that I got elected. And then I almost threw up. And then I felt so proud and happy. And then I was confused. How could I get elected? Maybe only two people voted and my boss was one of the two people. So I asked her and she said she never got around to voting. So that means that people who don’t know me in real life voted for me. So maybe they know my work. And that thought thrilled me. And terrified me.  Because now I have to do the work. I have to live up to expectations. I have to prove I belong.

Back to the present day….

Last week I attended my first meeting (via conference call) as a member of the convening group.  I was scared of being put on the spot or that I would find some way to embarrass myself. But mostly, I was terrified that they would find me out as an impostor who somehow tricked her way into the group. Apparently this impostor syndrome is common in successful women (well, really everyone except you).  But guess, what guys? I didn’t fart on the conference call, thinking I was on mute. (I didn’t fart at all. I was too nervous to fart.) I didn’t say anything stupid or forget my name. I survived it and now I’m not so scared anymore. Now, I think I can actually be in the same room as the other members and actually feel like I belong. Well, I’m not there yet, but I’ll get there.

You might feel like an impostor too. But you know what? You don’t have to be afraid of getting found out. People already know you and the work you do. I bet they like it, and like you too. I bet there’s an opportunity for you to throw your hat into the proverbial ring.  Don’t be more afraid of your success than your failure. Don’t waste your talents sitting in the audience. Get up there and lead, sister (or brother). Don’t be a wimp.

I’ll be sure to let you know how my adventures in ‘being one of the cool kids’ goes. No doubt there will be lessons learned worth sharing.

I’m also pretty sure someday I’ll forget to push ‘mute’ on a conference call and really make an ass out of myself. You guys will be the first to know. Pinkie swear.

What would Roscoe do?

Everything I ever needed to know about being badass I learned from Roscoe. No not that Roscoe. (Although….)

This Roscoe:

Roscoe, role model for us all.

Now you might look at Roscoe and just see a turkey, a butt of a joke or even a main course. But when I look at Roscoe I see a role model.

Roscoe the turkey (may he rest in peace) was beloved by hundreds, if not thousands of the residents and visitors of Lansdowne during our short couple of years together. Roscoe not only has a Facebook page with 975 likes, but the Animal Friends of Lansdowne sells bumper stickers in his honor. Why did people love a creature who caused traffic jams, pooped all over town, and made noise at all times of day ? Because Roscoe was ours. We knew what to expect from him, because he was always Roscoe.

Roscoe was a turkey, through and through. He didn’t try to be a crow or a bald eagle, those scoundrels. He was himself. If being unapologetically yourself isn’t badass, I don’t know what is.

So there’s the lesson for us all. In order to do good work and leave an impact on the world:

Be yourself.

Strut your stuff.

Take up space.

Command respect.

Be like Roscoe.

Don’t be a Jive Turkey.

Where the people are

Recently I watched the Frontline documentary on AIDS in Black America and I had a moment of insight (Aha!) that I thought I would share.

In the documentary,  a social worker who runs a needle exchange program in Atlanta talks about why he thinks people respond positively to his HIV testing and harm reduction program. He says what we have all heard a million times (and I’m paraphrasing), “we meet them where they are”. Now he didn’t mean that he uses some slang and sex-positive jargon. No, he meant that he goes to the neighborhoods where people are using, coping and surviving. His program gives out food, clean syringes, rapid HIV tests, support and links to other resources. But it’s a bare bones operation. A minivan with a notebook paper sign taped to the window reading  “HIV testing”. It’s hotdogs and water bottles. It’s actually on the street, not a storefront. He doesn’t try to get people to stop using drugs, he just helps them be safer about it.

I’m getting to my point, please be patient.

And before we go there, let’s go back to my former post about connection, a.k.a. “be a human”. If you will recall (or just take five minutes and read it, I’ll wait here for you) the main point of that post was to remember that we all are human beings just trying to make it through the day. The key to making connection with the people we work with (and for) is to be ourselves. And you know what? That’s the Aha! I was talking about.

If we are going to “meet people where they are” we have to be willing to go where they are. I don’t just mean to the corner, I mean be present with people, listen to them, see them. We put a lot of stock in geography (and venues) and forget humanity. Go to where the people are and be human(e).  Care for them. Listen to their concerns and their fears. Figure out how to get them a little closer to the end goal: wellness. Don’t focus on the means to the end: treatment, testing, adherence, etc. Focus on the person in front of you and what they need. Sometimes it starts with a sandwich and leads to an HIV test which leads to talking about substance abuse treatment which leads to sobriety which leads to….

But sometimes it is just about the sandwich. And you have to be ok with that. Or else you are in the wrong line of work.

Because no matter what you want or think is best, people gonna do what people gonna do. Just like you do.  I do at least two things that I know for a fact are risky and unhealthy, but I do them anyway. And I KNOW BETTER. Knowing ain’t doing. Thinking ain’t doing. Doing is doing.

In order to make any behavior changes or even think about those changes, we need to have some basic things in our lives. Remember those needs Maslow was so concerned about? If someone is hungry or scared or cold or jonesing….they aren’t going to give two damns about an HIV test or a flu shot, but they might take that sandwich or a kind word. And it’s our job to work from there.

Even after we build some trust and share information, there will be people who will keep doing whatever it is they gonna do. That doesn’t make our work a failure. The failure is never showing up, or checking off the boxes without ever really considering the PUBLIC whose health we are supposed to be protecting and improving.

We don’t work for health departments or research institutions or non-profit organizations. We work for the public, our fellow humans. Don’t you ever forget it.

Now get out there and be human.

On belief, part 2

In my last post we explored how belief dictates behavior and how we can influence and even change beliefs by talking about values. So now, as promised, I’m going to share some wisdom I gained from the badass Dr. Paul Offit on how sometimes we just have to ignore the beliefs and stick to the facts. I know, this contradicts everything I said last time. Stick with me here.

Dr. Offit is an expert on vaccines (he even invented a rotavirus vaccine, RotaTeq). He has written books on the history and science of vaccines and why Americans have such irrational fears of them. Lucky for me, Dr. Offit is a Philly local so I got the chance to talk with him at Public Health Book Club back in October about his new book, “Do You Believe in Magic?“.  The conversation naturally turned to how public health pros can address people’s fears about vaccines and do good public health work. So here is the synthesized wisdom from that discussion in one sentence:

Don’t accept their premise.

When confronted with an anti-vaccinations argument, just stick to the facts. Don’t start down the road of engaging with them about their fears and beliefs, because it’s not a good place to be: telling people what they believe is false (or stupid). People don’t like being told they are wrong or their beliefs are stupid (even if they are). Talk about how vaccines save lives (103 million American lives).  Talk about what life was like before we had vaccines for deadly and debilitating diseases like polio, measles, hepatitis, and influenza.  Talk about how outbreaks of polio pop up in countries that haven’t seen a case in decades. Talk about the outbreaks of pertussis in the last few years that have killed American children.

Go for the saddest stuff out there, take advantage of their emotional response to make the connection that vaccines are necessary, that these diseases still exist and still kill. The emotional response is your key to their hearts and minds. It works the same way as using values to frame other health issues and behaviors. I mean, that’s the goal anyway. Some people will never change their minds no matter the evidence or heart-rending pleas. Just let them go. You have more important work to do. Do not engage with them about mercury or overloading a child’s immune system or whatever other bunk people believe now.

You have science and history on your side. They have beliefs and fear and myths. As Dr. Offit told us at book club, “Ignorance is never an advantage.”

Go get ’em, tiger!

So we were talking about vaccines here, but this same approach can be applied to any issue or health topic. Just follow the advice: don’t accept their premise.

An 1802 illustration depicts Edward Jenner vaccinating a young woman. Several former patients demonstrate the effects of the vaccine—miniature cows erupt from their bodies. (Courtesy of the National Library of Medicine)

And in case you want to geek out about vaccines or bone up for your next Facebook debate, here are my favorite vaccine resources:

The Panic Virus by Seth Mnookin. This book is extensively researched and is engrossing. You can learn all about why Americans are crazy about vaccines and what we dangers lie in the myths that pervade American culture.

A History of Vaccines – a project of the College of Physicians of Philadelphia that shares the science and history of vaccines. It’s really a great website.

Pox: An American History by Michael Willrich.  A book about the smallpox outbreak at the turn of the last century which lead to widespread panic, questionable public health practices and ethical dilemmas about public health versus individual rights. It’s a bit dry at points but worth the effort.

 

On belief

We are in the belief-changing business.

Think about it for a couple of minutes. We tell people to wear seatbelts, get a flu shot, wash their hands, wear a condom, drink water….because we have evidence that these things promote health and wellness. But people choose to follow our evidence-based advice because it fits in with their beliefs about life, health, science, God, risks, etc. If people only made health and behavior choices based on facts and rational thinking, many of us would be out of a job.  Anyone familiar with humans knows this is a ridiculous idea. So, let’s take a moment to think about belief’s role in public health. We might get a bit philosophical for a moment or two.

In order to know something we have to believe it. And in order to act on something, we have to know and believe it.

We can tell people to get a flu shot a million times, but if they don’t believe that flu shots are safe or necessary, they aren’t going to get one, even if it’s free. So how do we help them believe that flu shots are important, safe, and necessary? By appealing to their values and beliefs. We point out that by getting a flu shot they not only help themselves, but all the people they live, work and play with. There are people for whom the flu is deadly and dangerous: little kids, older people, and people with compromised immune systems. We can appeal to the values of community, fairness, and protecting the most vulnerable.

Another example is condom use. Condoms work very well to prevent the transmission of STIs and pregnancy- when used correctly and consistently. We often forget to mention that last part when we tell people to practice safer sex (but that’s a topic for another day). We also tend to ignore the fact that most people don’t like condoms and will  find reasons not to use them (and that’s not hard to do). So what’s the value-based solution? Respect: for self and your partner. Respecting your partner (and yourself) enough to protect him/her and honor their health and well-being. For long-term (committed) couples, you could use love as a value too: loving yourself and your partner enough to be honest, responsible and protective. For women, the values of self-sufficiency and independence can be quite effective. An empowered woman carries condoms and can talk to her partner about using them.

Just talking about the positive effects of a particular behavior can change the beliefs about it. So often we focus on the negative: if you don’t do X, then that horrible thing Y is going to happen to you. We should frame messages in the benefits of healthy lifestyles and preventative measures. Values help us do that.

Values + positive effects = behavior/belief change

In my next post, I’ll share some things I have learned about how to confront those pernicious myths and beliefs that impede our progress to public health utopia. Dr. Paul Offit (one of my heroes) gets the lion’s share of credit for my beliefs about belief (how meta!). More on that badass public health hero next time.

On connection

The first rule of connecting with other people, no matter who or where: Be a person.

So often in public health we get hung up on labels and demographics. We focus on the differences between people, and often lose sight of our shared humanity. For instance, we are often looking for the right person to lead a program or communicate a message,  based on demographics or look. Having a person that the intended audience can relate to is important, but that relatablility is not only dependent on demographics or skin color. Even if you find the perfect peer to lead your program, if that peer isn’t also a friendly, reliable, honest person…well, you’re screwed. Your program is likely to fail, or at least not be as effective as possible, and you are going to lose some of your street cred. And when you’re dealing with hard to reach populations your street cred is everything.

In my day-to-day life as a public health practitioner, I spend a lot of time interacting with folks who look nothing like me, didn’t come from the same socio-economic background, and are my senior by at least a decade or two. Even though there are many good reasons why we shouldn’t connect, we do (most of the time). Why? Because I’ve earned their trust by being real with them, sharing my values (their values) , protecting the safe space we share, and being reliable.

When I say “being real”, I don’t mean it as anything more or less than being authentic. If I’m having a crappy day or am tired of someone’s disruptive behavior, I tell them. I also talk about my family with them, ask about theirs. We share laughs and tease. I praise their accomplishments and mourn their losses. You know,  treat them as I would like to be treated. This takes time and trust, it’s not something that happens easily or quickly. But over time, people see that I am the person I show them; I am really this silly, geeky lady who cares about inequalities and our city. This isn’t a show. But equally important are the boundaries I have established about what I am willing to do for them, how we talk to each other, and what is appropriate behavior in our shared space.

You can’t earn trust by being the smartest person in the room. I have learned this the hard way. So many times I tried to sound like the authority or drown them in facts and data. People don’t want to hear all that. They want to know why they should care, why you care, and what we can do about it. Save the data and wonky business for your wonky nerdy friends (or me, I like that stuff). How do I share my values? I say it out loud. I also ask them what they value. We discuss big things like inequality, racism, HIV stigma, sexuality, addiction, our histories, you name it. Some people will shy away from those big -isms, but I don’t know how you can address the big public health problems without acknowledging the contexts in which they occur. Especially not in a city like Philadelphia.

We can have these honest conversations (sometimes very silly and TMI conversations) because there is a defined safe space, a circle of trust. I protect that space by modeling non-judgement, sex-positivity, and stigma-free language.  We protect each other’s confidentiality, and follow a set of ground rules. It’s not easy to foster trust when you combine 20-30 people with a variety of experiences and backgrounds, but it is a must for long-term participation and community buy-in. Sometimes it is very hard to keep my straight face or bite my tongue, but I do it (except for that one time).

And that last bit is the easy part: reliability. Do what you say you are going to do. Show up. Just by showing up, you win.

I have to end by saying, by no means am I perfect or always comfortable with every interaction. Oh no. I’m nowhere near perfect. I believe the group forgives my shortcomings because I do my best to embrace them for who they are, to really see them.

It’s either that or the free Snapples. I’m not sure.