On Saturday, June 1st, 2019 the City of Madison dedicated that wonderful new work of public art at the intersection of State Street, Library Mall and East Campus Mall. This is a heavily used crossroads, and because of the logistics of installation and signage, many of us have been walking by these new structures during the several weeks between installation and formal dedication, when they were not yet titled.
So we have been looking at the blue granite rock and wondering “What is it? Is it supposed to look like it’s floating?” And the tall lacy steel – “What is it it pointing us toward? Do you think it looks like a waterfall?” And the yellow spot. “Is it an eye? The sun? A mind on fire?” And from those who are less experienced with the abstract, “Um, I’m not sure I get it. What’s it called, anyway?”
It’s called “BOTH/AND- TOLERANCE/INNOVATION,” and at the dedication I had the chance to meet the artists David Dahlquist and Matt Niebuhr. The space is designed to echo the confluences and crossings that have happened in this spot for over a century. People have gone back and forth — to the the library, the State Capitol, adjacent places of worship, the Memorial Union, the University Club, the Historical Society, and more recently, the Chazen Museum. Just imagine what the flow of people would look like from the sky!
To help you to “get it” and find your own meaning in the space, the plaque provides the followings guidance:
“Between knowing and believing, Both/And is an acceptance of seemingly disparate thoughts coming together — it is the presence of action and reaction to ways of understanding.”
One of the artists tells me that the rock and fluid steel beams mimic what happens when a stream is disrupted by stone, there is a bubbling up, and turbulence, but a new balance is restored again downstream. The other explained that the yellow color and lighting is indeed intended to recall the sun to us, with all the other meanings welcome, of course. In fact, the work was sited with the fall (September 23) and spring (March 20) equinoxes in mind — so that the sun can shine through the sculpture and create a special beam of light at those times.
We are encouraged to contemplate the rock, the steel, and perhaps especially the space in between them from all these perspectives. I did this on the morning after the sculpture was installed, classes had ended and it was quiet. Walking from Memorial Union, the steel and rock looked like they had always been there. The steel beams lined up and came alive — they could be UW graduates in caps and gowns, a choir singing outside the church, or a group of concerned members of our community, gathering in formation to march down State Street to the Capitol.
As I got closer the imagined people fell away and the more natural images came to the fore. The Steel elements seemed like a waterfall now, and the rock seemed to be in a pool of water.
Moving closer, after taking a few pictures, the massive structure becomes human again. I see a hand — steel fingers and a blue granite opposable thumb reach toward the sky. In prayer? Offering friendship? Ready to make something new and good and true? Over the years I hope it will mean all of these things….
Perhaps, rather than different parts of one hand, the steel and stone can represent two very different people coming together. One is tall shiny and reaching, with flashes of color. The other is grounded and beautifully dark with glowing shades of red and blue. They are huddled toward each other and it seems like they are looking down. Perhaps they are two children on a playground marveling at a frog. It doesn’t have to be complicated…. Or perhaps they are two wise and different people trying together to understand the puzzles of history, to accept the gift of confluences, to create the future.
I hope this reflection helps readers to begin to answer the question “What is it?”
The other question is “What will it become?”
Of course that depends on us — the people of this city, this university and around the world – it depends on how we choose to pass through this space in the decades to come. Based on past crossings and confluences I am guessing that we will meet up at “the Rock” for a thousand different reasons. We will sit on the benches to read or rest. We will discuss the weather, current events, the stories of our lives. We will profess love to each other, and we will watch for beams of light, as has been done in different ways on this Ho Chunk land where Madison sits, for centuries. We’ll take selfies here, and inevitably BOTH/AND will become a site of interest on the college tour. Some new thing that we do not know will happen here. And BOTH/AND will become that new thing too.
What is it? What will it become?
You tell me.
….Or better yet, let’s meet at the Rock and and figure it out together with Both/And -Tolerance and Innovation. We’ll share belief and knowledge, history, and so many crossings. Beauty. Perspective. And we’ll make something new.
Earlier this week “The Monarch” was unveiled in the Hamel Browsing Library at the University of Wisconsin Memorial Union, placed there to honor the 150th anniversary of women receiving degrees from UW-Madison. What this living, woven being of metal and air will signify for us will be revealed overtime. This weekend as the Class of 2019 graduates, let the meaning making begin!
THE MONARCH. Artist: Victoria Reed. Gift of the UW-Madison Class of 2019
For me, the Monarch evokes strength, fragility, openness, and the readiness to fly. I sense the hard fought and unapologetic embrace of one’s own beauty, uniqueness, scars. I imagine resilience in the face of strong winds on what seems to be an impossibly long journey. I am reminded of how exhilarating and scary it can be to leave the places that you love. And the blessed possibility of return.
Perhaps this sculpture is speaking to me, or perhaps this incredible beauty is what I have seen in my students over the years.
Meanwhile, for all, and especially for the 2019 graduates, here is a closer look at “The Monarch.” I hope you have a chance to sit close for a while, consider the strength, marvel at the openness, see the possibilities, and contemplate flight.
This morning I started my day an hour before class, at 8:30am. It was 15 degrees below zero, but that did not stop my global health students from stopping by to talk about joining the US Peace Corps. Later in the day Peace Corps Director Carrie Hessler-Radelet visited campus to announce that UW-Madison leads the nation in Peace Corps College Rankings, which answer the question “which University has the largest number of Peace Corps volunteers serving around the world in 2014.” Seems like a good time to give a shout out to some of our recent UW-Madison graduates who are serving in the Peace Corps around the world!
Readers may know Carybeth, Allison, Kevin and Monica. There are about 100 more Badgers out there! I invite readers to post pics and info about other UW-Madison PCVs in the comments, or send them to me at dipretebrown@wisc.edu and I will add them to the body of this post.
CARYBETH REDDY majored in agricultural economics (CALS), worked for the Global Health Institute, did an international internship in Ecuador, and helped us to launch our Wisconsin Without Borders Marketplace, which works to improve health and wellbeing through economic strengthening. She is currently serving in Cameroon.
ALLISON FEUERSTEIN majored in Biology (CALS), received a Certificate in Global Health and participated in the UW -Madison field course in Nepal. Before leaving for Nicaragua she took a graduate course relating to programs for orphans and vulnerable children to help her to better prepare for her Peace Corps Serice.
I first met MONICA RODGERS after I gave a lecture in a global health class she was taking. It turns out that I had served in the Peace Corps with her parents from 1983-1985! Monica received a global health certificate, and did her field work in Ecuador focusing on micro-enterprise and health. Here is is with her parents on the day she left for Peace Corps service in Peru. Two generations of Peace Corps Volunteers!
KEVIN KING majored in Neuroscience and did an internship in India as an undergraduate. This UW Mad Hatter is now serving in Azerbijan.
It was great to have Peace Corps Director Carrie Hesseler-Radelet on campus. In cased you missed here here she is, serving Peace Corps then and now…..
Thanks to UW-Madison students for inviting me to address the topic “Learning in Unexpected Places” at their November 23rd event. It gave me an opportunity to reflect about global engagement that I did in my 20s in Central America –work in an orphanage in Honduras, a war zone in Nicaragua and a water project in a remote rural community in Guatemala. Here is the youtube video and below is a text version of my reflections.
Start Small, Change the World
Today I am going to talk about changing the world. Perhaps I should have a narrower focus, and I did try, but I finally decided that besides saying I love you, or telling a really good joke, changing the world is probably the only thing worth talking about ever. Making change, addressing suffering, and mending the brokenness in our world should be what we dream about, and study, and talk about. With teachers, with friends, with colleagues. With people who are like us, and with people who are different from ourselves. Visions of healing, peace, joy and abundance should inform our lives.If you are a young person who has had the audacity and heart to proclaim to someone older and wiser that you want to change the world, you might have had some surprising, even discouraging, responses.
They might say, who do you think you are? What makes you think you or your ways are best? What right do you have to try to change other people?
Or they might say, Good intentions are not enough. A lot of do-gooders have been ineffective. Some have even done harm. They will tell you stories, mostly true, of unfinished schools, half-built clinics, latrines with holes large enough for a small child to fall inside, and other efforts that have solved one problem, while creating another. Worldchanging, as you have probably already guessed, is messy.
Another common response might be, There is plenty to do right here in your own community. This, of course, is very true. It is easy to be drawn to the drama, the exotic, the faraway places, and sometimes hard to remember that changing the world includes addressing disparities and injustice in your country or neighborhood. On your own street. We all need to visit the familiar places in our lives with our eyes wide open.
Then there is the predictable, Things are more complicated than you realize. What makes you think your simple fix-it scheme will work? Don’t you realize that the cultures that you think you can outsmart are hundreds of years old? Don’t you know that advanced study and assessment are needed before you can do anything at all?
You might be told that the abundant, sustainable life that you want for all people is just not possible! You are too idealistic. To accomplish what you are proposing would take generations. It is not possible to provide food, water, housing, education, and health care to everyone. It is not possible to live in a safe world where ALL people are free to express their identify and culture.
I can’t help but note that these messages about the impossible are spoken in a world that can distribute millions of Harry Potter novels in a single day; in a place where people think it is perfectly feasible to provide cell phones for everyone in the world; in a society where, in a given year, people collectively throw away enough food to satisfy the global food deficit.
Despite my refutations, though, the counsel you are receiving is valid. You must practice cultural respect and humility, embrace complexity, and consider the effectiveness, feasibility and sustainability of your efforts. I come back to these issues again and again in my global health work, and I find new mistakes, and new pathways to something better, every time.
I do sometimes wonder why we who mentor young people often start out with a long list of don’ts and cautions, instead of encouragement. I suspect, there is some generational tension here. Your hopes and confidence about what is possible remind us of all the ways that we, regardless of how much we might be doing, could be doing more. Your energy is wonderful. And terrifying.
You keep things simple. You ask simple arithmetic questions like “what if every student at our university sponsored basic needs for a child or family facing poverty in Milwaukee, Appalachia, Botswana, or India?” Wouldn’t that add up? What if I tutor a child or build a well, or provide a sewing machine? Couldn’t that make a difference? You use the sound and adequate arithmetic of a 5 year old, and it exasperates the experts.
Thankfully you persist. You are more globally interconnected than any previous generation. You are more able to embrace diversity. You are a generation of caring optimists. You are willing to try, take risks, ask questions, take responsibility for your mistakes, and try again. The truth is, you are better able to assess and predict what is possible than we are.
I would like to share some ideas about being part of change in our world. And this is where learning in unexpected places becomes so important. In my global public health work I have partnered with governments and NGOs, and mentored students in global efforts around the world. Today I will talk about my early global health experiences, work that I did when I was in my 20s, as many of you are now.
HONDURAS
In 1983 I left the United States for the first time. I join the Peace Corps and was sent to Honduras. My job was to provide counseling and support to teenage girls in an orphanage there. I lived with them, and also traveled with them to the villages where they were born to help them get their birth certificates. These journeys took me all around the country, on buses, in the back of pick up trucks and on foot.
When I think about the lessons from that time that might be useful for you today, one particular series of events comes to mind. I was having coffee one day with a Peace Corps friend who expressed concern that I was getting burnt out as a live-in counselor, and that I wasn’t really doing development work. There was no sustainability to what I was doing, she said. No multiplier effect, like when you train trainers, or provide seed to farmers, who in turn provid seed to others. I was mainly counseling, comforting, and refereeing the girls on chores. Kind of a gloried babysitter, really. It doesn’t sound like world changing, does it?
A few weeks later I was involved in a fair at the orphanage. We filled the dusty, colorless field near the children’s homes with games and fun for a day. The girls and I dressed up like clowns to entertain the younger children. By the end of the day I was answering to the call “Payaso, venga,” which means “Come here, Clown.” We had a piñata and candy. It was simple. A day at the fair. A magic day that we hoped the children would remember.
That night one of the girls came to my room to talk. Carolina sat down on my bed and said nothing, clearly on the verge of tears. I was sure it was boyfriend trouble again, and began to fill the silence with words of advice, solidarity, support, questions that might help her tell me what happened. “It’s not that,” she said finally. “I just miss her.” At 17 years old, after living in the orphanage for most of her life, she finally wanted to talk about her abandonment, and she had come to me. I felt so sorry to have gotten things so wrong, to have missed the obvious sorrow. I put my arms around her and she cried for a while, and I cried also. She did not expect me to do anything more, and I didn’t.
After she left, I sat alone in my room and thought about the words “multiplier effect” again. Suddenly I realized how arrogant and wrong that whole idea was. It implied that comforting Carolina, being a buffer against her sorrow for a few hours, was not important enough for some one like me to bother with. That a one to one return on investment was not acceptable when it came to the people like Carolina. According to the multiplier logic of international development work, the fun fair didn’t measure up either. Making joyful memories for children who had suffered so much? That was, at best, a loss leader.
I let go of wanting to do great things just a little bit that day. I realized I wanted to be a person who has the time and heart to do small things. The small things that justice, friendship and compassion demand. In this case I had not done the small thing particularly well, but I could work on that, I could keep trying. I hoped that meaningful change could come from this kind of engagement somehow. I took some comfort in arithmetic. After all, one and one does make two. That was certain, multiplication aside.
NICARAGUA
During graduate school I went to Nicaragua as part of a health and human rights research team from the Harvard School of Public Health. We were visiting a town in Chontales, which was as far into the war zone as we could go and still be relatively “safe.” We conducted a household survey to document the impact of the war on civilians. Things like disruptions to the health care systems, damage to schools, internal migration, and various negative health impacts. The results told the story that we expected, an important one, and we published them as planned.
For me though, the greatest learning occurred at the end of the interview, when I put down my clipboard and asked, “is there anything else you would like me to know.” Then I leaned forward and listened. I listened to what people said when they were free from the confines of structured questions and coded answers. When the clipboard was not creating a small barrier between us. They told me stories about how the war had affected them. They talked about their fears and their hopes. They talked about how they might solve problems in relation to food, shelter, and getting the kids back in school somehow.
During the course of the interviewing we came to a house that had all the windows and doors shut, even thought it was the middle of the day. I wasn’t sure if I should knock, but I did, and Juana and Fidelia, two sisters who lived together there let me in. After the survey they told me their stories. Juana spoke briefly and calmly. She was married to a Misquito Indian. He’d been a miner, but was now working as a day laborer. They were relocated by the government because their town was unsafe for civilians. Her home was in a war zone. Violence or the threat of it was everywhere. She looked over her shoulder when she washed clothes or when she walked upright in the quiet fields. She heard gunshots in the morning. Her sister Fidelia had a thin face and urgent speech. She began to speak each time Juana paused for a moment. It was sometimes hard to keep track of who was saying what. Fidelia, a widow with eight children, had lost her husband when he was killed at a family party on their farm, along with nine other men and a woman who tried to defend them. Fidelia began to list the widows and count the orphans — 34 children in that small village had lost their fathers, a while generation of men were lost, she said. Because of what they had been through, Juana and Fidelia were often afraid to speak out, but they wanted to tell me these things. They wanted me to know, and they wanted me to tell someone else.
Research is an important tool for changing the world. I knew that before I went to Chontales. But what I didn’t expect, was that the fact-finding survey that we had worked so hard to design would be the lesser source of information for me. I learned about the importance of story, witness, solidarity, and hope.
GUATEMALA
A few years later I found myself in Guatemala working with CARE to develop a monitoring system for a water and sanitation program. This took me to a remote village in Quetzaletango, to see the newly installed well.
We set out at sunrise (seemed earlier) and drove until the road ended. A simple meal awaited us there — blue corn tortillas, beans, sour cream, and sweet coffee in a tin cup. I am not sure if it was the early morning air, the hospitality, or the food itself, but I still remember this as one of the best meals of my life. Then we hiked up to the village through the beautiful sparsely inhabited terrain. We came to a river that had to be crossed on a walking bridge. It was just a plank really, the width of a log with no rails. Everyone in our party crossed with ease. But I made the mistake of looking down, I hesitated, and then my anxiety spiraled. I was sure I would fall from this balance beam bridge down to the water below. I stood there frozen on one side of the bridge, with the rest of the team on the other. A local woman happened to be coming up the path on the other side. She smiled at me reassuringly – she did not speak English or Spanish, and I did not speak her language, Mam. She looked to be 5 months pregnant, but she crossed over the bridge and extended her hand to help me cross. Her kindness enabled me to look straight ahead and cross the bridge. I am not sure what I would have done without her help.
When we arrived the villagers were assembled, waiting for us. We sat in a circle and they told us about the water project. Until that moment I only knew that CARE had provided materials and assistance with building the water tank. As the head of the water committee told us the history of the project, I realized the extent and intensity of the community effort. What the NGOs called “the local contribution” included working with government over months to procure land rights to the site of the well. It involved carrying every brick, and all other materials, up to the village along the route we had just hiked. It included building the water system, building the latrines, and deciding who would do extra work on behalf of the widows and the elderly who could not do their share.
The lessons of that day in rural Guatemala have echoed again and again in my work. Communities are full of energy and desire for change. While outside assistance can be useful, if we look honestly at our successes, our contributions are always small when compared to the efforts and contributions of partners, local leaders and community members. We who have the privilege of crossing worlds are constant recipients of hospitality, assistance, we are accommodated in ways that we don’t even see, and, mostly, we are treated with kindness.
As you can see from these stories, learning often happens in unexpected places. In the background. On the way. While we are supposed to be paying attention to something else.
There is one more unexpected place that I want to mention. That place is honest reflection in a quiet room. Reflecting in silence, writing in a journal, taking the time to savor and more deeply understand your experiences. Honoring relationships with remembering, and being as honest with yourself as you can. This “unexpected place” is where we learn to live more, love more, risk more, and laugh more. This is where we change ourselves.
So you want to change the world. You want to live the selfless intimacy, the giving, the solidarity, the friendship. I say go for it. Dream about it, study it, talk about it, and most importantly, take action. Personally, locally, and globally. Sing all the songs while you are young, in as many languages as you can.
But go further. Do more than change the world. Have the courage to work very very hard, for small things that you can change. And do this every chance you get. Have faith in others, have faith in the future, have faith in faith itself, if you can. And when having faith is hard, do the math. If you have trouble with the math, ask a five year old for help.
Small changes are big. They move the frontiers of what is possible – they are the galvanizing force behind big important changes. Acting in this way will align your values with who you are in the world, and you will end up being part of change in bigger ways than you ever imagined. Start small. Change the world. And let the world change you.
On October 1, 2013, my friend Eva Villavicencio performed Maria Landó with Internationally acclaimed percussionist Juan Medrano at my home. It was so incredibly special. Here you can watch the video and read the english translation of this beautiful song.
María Landó (with English Translation)
La madrugada estalla como una estátua
Dawn breaks shattering like a statue
Como estátua de alas que se dispersan por la ciudad
Like a statue of wings that scatter throughout the city
Y el mediodía cánta campana de agua
And noon sings like a bell made of water
Campana de agua de oro que nos prohibe la sóledad
A bell made of golden water that keeps us from loneliness
Y la noche levanta su copa larga
And the night lifts its tall goblet
Alza su larga copa larga, luna temprana por sobre el mar
Lifts its tall, tall goblet, early moon over the sea
Pero para María no hay madrugada,
But for Maria there is no dawn
pero para María no hay mediodía,
But for Maria there is no noon
pero para María ninguna luna,
But for Maria there is no moon
alza su copa roja sobre las aguas…
Welcome back from Ecuador, Mexico, Guatemala, Colombia, Togo, Rwanda, Sierra Leone, Uganda, Kenya, Malawi, Ethiopia, Nepal, Germany, Sri Lanka, Cambodia, Thailand and Vietnam — not to mention those of you who explored the global dimensions of improving health and well-being right here in Wisconsin!
After classes ended in May, nearly 200 of you set out to expand your understanding of sustainable global health and well-being. You engaged as learners and change-makers with communities around the world. It has been great running into you and hearing your stories on the Lakeshore path, State Street, coffee shops, and the library (really!) — a special thanks to those who have stopped by my office to share!
This year I will be blogging about field work, fall courses, global health networks, and books related to global health. I would also love to feature YOUR WORK as your global health projects and ideas develop.
My travels: In ECUADOR I will be teaming with Instructor Janet Niewold to work with the Sumak Mayo women’s group on a women’s micro-enterprise and health project. The women are selling jewelry and scarves, and are hoping to develop an eco-tour that highlights their rich indigenous culture. In ETHIOPIA I will be continuing to collaborate with leaders on Quality Improvement in Emergency Medicine, and I hope to expand the effort to have hospital-wide impact. There are many other broad-based initiatives going on in Ethiopia with leadership from Dr. Girma Tefera, Dr. Jonathan Patz, and Heidi Busse, MPH, so I hope to blog about their efforts as well. Finally, I will be going to MOZAMBIQUE for the first time, to work on quality improvement in the pediatric department of a large public hospital. If you see me between campus listening to a WALKMAN don’t worry, you have not slipped through a time warp into the 1980s — I am making use of my vintage equipment (cassette tapes!) to brush up on my Portuguese.
Books Related to Global Health: I will be reviewing a mixture of fiction and non-fiction related to global health. I’ll be covering a pair of South African novels, Ways of Dying by Sakes Mda and Disgrace by JM Coetzee, which I read during my recent visit to South Africa. I’ll review Strength in What Remains, by Tracy Kidder (of Mountains Beyond Mountains fame) and I also have Inferno, by Dan Brown, on my desk. That is about the World Health Organization – should be fun. Of course I will cover this year’s UW-Madison GO BIG READ, A Tale for the Time Being by Ruth Ozeki. Also on my bedside table is La Linea by Ann Jaramillo and What is the What by Dave Eggers. If you have books to suggest please post in the comments section and I will add them to the list, and maybe even review your suggestions first.
Global Health Networks: I will blog highlights from my reunion at the Harvard School of Public Health, where there will be some workshops and lectures on leadership, and the American Public Health Association — the theme this year is Global Health. I will be participating in an Roundtable on Inter-professional Competencies with a network of other universities –the concept note that I will present draws on insights from the global health teaching and lecturing that I have done at UW and at John’s Hopkins University over the past 20 years. Also, I will be presenting a “TED talk” at a Conference related to Care for Orphans and Vulnerable Children in April — so I will blog or tweet items of interest.
Teaching: This semester I will be teaching Foundations in Global Health Practice for graduate students in the health sciences, and a new course, with Professor Nancy Kendall, entitled Education and Global Change. I’ll also be doing grand rounds for the OB/GYN department, and preparing a workshop session for the residents at UW hospital. These will be highly interactive sessions, and I will share key resources and insights here.
GUEST BLOGS: I welcome these from all of you! Please email your global health reflection with 1 or 2 images that go with it to dipretebrown@gmail.com. and I will contact you about next steps.
GH Student Mailbox: We have had some amazing email exchanges about your field work. I am going to share some of these as blog posts (making them anonymous first) from time to time — so that by “reading each other’s mail” and sharing comments, we can all learn more about Global Health.
On April 13-14 Unite for Sight hosted its 10th Annual Conference on Global Health and Innovation. Participants representing 50 states and 50 countries gathered on the Yale Campus to share ideas and experiences related to social entrepreneurship and global health. I have been to a number of global health conferences this year, but this one gets highest marks for new ideas and energy. This is a great gathering for students, scholars and innovators!
Tina Rosenberg gave the opening keynote, drawing on insights from her recent book, Join the Club: How Peer Pressure Can Change the World. Identifying behavior change as a major public health challenge, Rosenberg challenged the conventional wisdom of public health approaches that provide sound, evidence-based information about behaviors such as drinking, smoking and poor eating habits.
“The problem with public health experts,” said Rosenberg, “is that they have no idea how non-experts think..”
Rosenberg went on to outline some key communication principles that have many implications and applications to Global Health.
Focus on motivation, rather than a flood of information.
The best messenger is “someone like me who has made the change.”
Marginalize unhealthy behavior –don’t emphasize the magnitude of the problem.
Tell people about their peers who have adopted the positive behavior.
It helps to support change by having a mentor AND being a mentor.
And Finally –small groups are powerful engines for behavior change!
We also heard from economist Jeffrey Sachs, Director of the Earth Institute at Colombia University and author of The End of Poverty. He talked about the amazing promise of information technology for global health – ehealth, mhealth, smart phones, dumb phones, GIS systems – how they can all conspire to reach people with needed information and health services. Sachs boldly pronounced that the Post 2015 Development Agenda could end extreme poverty and eliminate hunger and preventable disease. He also encouraged us to join the club — by engaging with the newly developing UN Sustainable Development Solutions Network (www.unsdsn.org). Visit the site, register as a follower, and stay up to date on state of the art solutions to development challenges in 12 thematic areas ranging from health care to food systems to sustainable energy.
Pediatrician Dr. Sonia Ehrlich Sachs talked about the One million Community Health Worker Campaign (http://1millionhealthworkers.org/) for Sub-Saharan Africa. And yes, she wanted us to join the club, too! During the final 1000 days before the end of 2015 this effort (by a coalition of established global health actors) aims to put one million new community health workers into service. These would be salaried jobs for (mostly) young women, who are given 3 months of training and ongoing supervision and refresher training. They will be formally linked to the Ministry of Health, assuring reliable supply chains and referral mechanisms. Here’s what the program looks like, and there are lots of ways to get involved.
Lori DiPrete Brown, Njekwa Lumbwe, Jim Cleary, and program leader from African Palliative Care Association.
During August of 2012, The UW Madison Global Health Institute was privileged to welcome Njekwa Lumbwe, that National Coordinator of the Palliative Care Association of Zambia, for an exchange visit to Madison where she participated in a Pain Policy training session led by GHI Program Director Dr. Jim Cleary. Dr. Cleary works with leaders from around the world to develop and scale up effective state-of-the-art policies and programs related to pain management.
Mrs. Lumbwe made valued contributions to the meeting and also gained insights about the way forward for Zambia, as she learned from the experiences of 9 other countries from Africa, Eastern Europe and Asia. Engagement with global experts and national leaders from around the world helped Lumbwe to envision policy options and implementation strategies that could be applied in Zambia.
Her commitment to palliative care defines her as a leader, and the participation in the meeting reinforced this commitment. “The meeting opened up a whole different perspective of the global state of pain control. I pledge to use this experience to bring out the desired change. I look forward to stronger future collaboration,” said Lumbwe in her report to the group.
Soon after in November of 2012, we found that Njekwa Lumbe was following through on her promises, working nationally as a change leader, and collaborating with the First Lady of Zambia to make palliative care more accessible. We look forward to welcoming Njekwa back to Madison in the future!
It has been a wonderful week and a great privilege to collaborate with leaders from Zambia and Botswana ton plans to improve the quality of health and social services. At the invitation of the CDC-funded American International Health Alliance Twinning Program, and with the collaboration of their Zambia Country Director Ann Mumbi, I led a QI implementation workshop with a team of UW facilitators that included doctoral candidate, Jason Paltzer, and UW alumna and Global Health Institute staff member, Sweta Shrestha.
One challenging and exciting aspect of the program was that we brought together some very different types of organizations – believing that the concepts about quality, the practical problem-solving tools, and the leadership principles would be relevant for all. The partners in the group included the Palliative Care Association of Zambia, several Zambian teaching hospitals, leaders from ZAMCOM, which provides health communications expertise for the country, and leaders from the Zambian military health services. From Botswana we had faculty members from an academic medicine setting, leaders from an NGO umbrella organization that serves highly vulnerable children, and directors from two programs that do voluntary counseling and testing for HIV/AIDS. They all worked in small group to develop improvement projects, giving each other feedback and encouragement along the way.
Did it work? We think so ….. By the end of the week the participating leaders presented their strategic plans to each other and an audience that included national leaders, representation from the CDC, and the AIHA Twinning Program leaders. We tried not to let the radio and TV crews go to our heads, but it was nice to see the work of the participants noted and celebrated! Of course, this was not the end, but rather the beginning of the quality improvement efforts, since everyone hoped to go back to their organizations to carry out the planned changes as soon as possible.
While geography often conspires against us, this meeting is, thankfully, not our last time together, as many of the participants will be coming together again in July 2012 in Madison, Wisconsin to continue this work together!
Lori DiPrete Brown, Associate Director, UW Global Health Institute.
“Is that smoke,” I asked, pointing to the cloudy billows on the horizon as we headed toward Livingstone. “No,” I was told, “it’s the mist from Victoria Falls.” In Tonga, one of the local languages here in Zambia, the name for the falls is Mosi-O-Tunya, which means “the smoke that thunders.” Now, as we approached from a distance, I could see why. The falls are amazing and grand. The smoke appears first, from out on the highway before you even get to Livingstone. Then, as you approach the gateway to the falls, you hear the force of water, a thunderous whooshing that is too strong to be taken for wind. As you walk toward the sound you see and feel the spray, and then, suddenly, or so it seems, an immense wall of sheer gushing water. The water force is so strong that the thick showers of water falls and rises with a bounce, with droplets breaking off and defying gravity, so that it feels like it is raining from above and below at the same time.
The rushing water, cool mists and sunny skies had me dizzy with delight. Soon I was hoping for a rainbow, and I was not disappointed. In fact, it seemed as if every time I asked, the universe indulged me with colors of reassurance. So many rainbows on demand couldn’t be a coincidence! Eventually I had to accept that miracles are ordinary and everywhere. If you are looking. And if you remember to ask for them.
Our stay in Zambia was short, yet we had seen and learned so much. I had wanted to see the falls, to put my toe in if I could, and now we were here. Water in abundance, rushing like thunder, cold sprays, powerful currents that can sweep you away. The gift of color. Again and again.
Hiking just above the falls we came to the still headwaters. It seemed impossible to me that I could stand so close the edge without being swallowed. In spite of the kinetic frenzy just a few hundred feet away, the headwaters were a quiet pond. There was so much more underneath the still current, and, I knew, so much more below the surface of this country, Zambia.
On the long ride to the Falls I had insisted that our friend and guide, Ali Sad, teach me a Zambian song. It is an absurdly short visit, I reasoned, there will be no evidence that I was here at all if I don’t at least learn a song. He taught me the following song/chant which is often sung when people gather.
Nchale wo wau, nchale chi wau tu,
Nchale wo wau, Nchale chi wau tu.
It means, loosely translated, “Everything is good. It should be like this.” And then it repeats, so there is no mistaking about anything, “Everything is good. It should be like this.”
Global Health Reflections 