Living the C-Change

This week was a record for me: 5 flights in 50 hours, with two presentations, consultation, lunches and a little shopping at the Portland airport. The flights took me to Spokane and Vancouver, WA for the KRISP grant.

I flew to Seattle, met up with Betty. From there we flew to Spokane for the night. In the morning, we would do a 3 hour presentation-workshop with the public health nurses at the Spokane Regional Health Department. Betty and I got to the auditorium early. While we awaited our turn, the nursing director was giving staff an update on the state budget and possible scenarios for budget and program cuts. Then some of the nurses added changes (read decreases) to the TANF support for mothers.

Betty and I looked at each other, shook our heads, and sighed. These nurses will be the front line workers who see the consequences of our national economy doldrums.  This reality gives our work urgency, but also an irrelevance. We were there to help the public health nurses learn about using data to improve their programs and to think about populations, not just individual clients. Asking nurses to not get personal satisfaction from interactions with their clients is asking them to change their identity. A huge ask. But, that is all the more necessary given the changes occurring all through the public health system and the national economy.

In the afternoon, we spent a couple of hours with a small group talking about how to evaluate a creative, community-based and community-directed initiative. It was the type of discussion with no single correct answer and certainly no easy answer. In the end, I had flipped their outcome of "decrease child abuse" to the positive of "infants meet developmental milestones."  Why do we (evaluators, practitioners) seem so determined to focus on what we don't want? The group liked the change. It still requires head scratching to figure out how to get "good" data, but it has greater potential to generate enthusiasm and participation from the neighborhood.

The next day we did a 2 hour version of that presentation-workshop for the public health nurses of the Clark and Cowlitz health departments. Not nearly enough time, but far better than none.

During the lunches Betty and I had with the nursing directors, we talked openly and honestly. We talked about the future of health programs for various high risk groups, about the realities of union seniority systems and what that could mean for how programs would be implemented, about the need for more academe-practice collaboration for a wide variety of activities that would be good learning opportunities for nursing students, about the nature of the support from their health administrators, about how local politics of an interpersonal nature affects major health department decisions, and about the way things used to be but never will be again.

As Betty and I said good-bye at SeaTac, we agreed that it had been a good two days. Not perfect, but on balance, good. We both felt committed to doing our parts in moving this segment of the public health system forward, going boldly into a future that has only been outlined. It remains our collective responsibility to give that outline life, texture, success, doing so collaboratively and with a hint of utopian longing.