She mentioned Height-Ashby. That launched the conversation into a history lesson, beginning with the question: What is the curve of discoveries over the past 150 years? Linear? Exponential? Flat?  The surprise to me was how difficult it was for the graduate students (ages mid-20's to mid-30's) to name inventions. Their lack of a deep modern time scale and of milestones along that scale leaves them without a past that exceeds their first Facebook post. This has some of us as faculty worried, concerned. Why?

What's the value of knowing when the telephone was invented? Or the silicone chip? And how long was that after the transistor radio had been invented? Or, how long before the internet was created? What difference does it make to decision making or the development of scholarship to know when the birth control pill became available in the U.S.? And how long was that before the beginning of the AIDS epidemic?

It matters that they don't know Walt Whitman or Woody Guthrie. It leaves them with a diminished appreciation for the amount of suffering, effort, sweat, and failures it took to get to the amenities, the freedoms, and the opportunities of today. It distorts the distribution of effort across historical figures and those on the edge of their shadows. It makes shallow our culture, rather than deepening it. It leaves us all with fewer and weaker cultural references. Weaker too in the sense of not understanding nor appreciating the distance, differences over time.

The big inventions (e.g., nuclear fission) and the small inventions (e.g.,gram stains) have collectively changed how we as humans live, especially those of us who live in wealthier, more developed countries. That change in living logistics comes with changes in culture, relationships, and expectations about the future. And, therein lies the rub...

Moving Across Country

My absence for the blogosphere has ended. Happily.  As of August 1, I started a new position at University of North Carolina at Charlotte, as Director of a new PhD program in public health sciences. I'll write more about starting a new job in my next post. This week, I want to reflect on what it means to move across the country.

I had lived in Chicago for 16 years. The longest I had ever lived anywhere. Illinois was the 5th state I had lived in, after Texas, Oregon, Washington, and California. I had a home and a house, and felt settled and, in some ways, living on cruise control. Accepting a new position meant selling my house and buying a new house.  Going through each of those events felt nerve racking for a day or two.  Once I had a new address, the move began in earnest. 

Physically packing and unpacking, making the change of address on innumerable websties, waiting in lines to get new forms and licenses, all heightened my awareness of the federalism that is the United States. Federalism rarely surfaces in our daily lives. I hold a passport from the USA, not from the state I live in. Federalism surfaces in ways  that may be too obvious to actually notice. Consider who is listed on the ballots we mark; local, state and federal candidates.

When I give talks to international audiences, as I did in Italy last year and Ireland last month, I compare the United States to the European Union. Until you have live in more than one state, the comparison may seem peculiar. The reality is that federalism is alive and quite healthy in the United States. Witness the licensure laws. Each state governs my practice as a registered nurse. Yes, there is a national examination, but you are licensed  by the state, not the federal government. Each state has its own driving laws and collects fees for being licensed in that state. Each state dictates drinking age and selling of liquor.  Each state has its separate retirement system for its state employees, which includes me. The national retirement system, Social Security, barely provides income "security."

Federalism has deep, obvious as well as hidden public health implications.The breadth of those implications would take more than a 3 semester hour course to fully address. For me, the tension  between state and federal government, the ways that we as a nation acknowledge and deal with those tensions, and the subsequent range (some might say disparities) in availability of services and supports across this nation can serve an international model. The USA and the EU stand as exemplars as ways to achieve economies of scale while maintaining local autonomies.  Yes, it is a royal pain to get relicensed, but I'll suffer those very transitory inconveniences for the vast benefits of living in a healthy federalism.

In this light, from this perspective, what does it really mean to "move across the country?"

Nerds at the Round Table

Some days seem to mark themselves as important.  A memory has substance. A task list rolls forward. The sound of laughter lingers.  Not too long ago, I had one of those days. 

Last month I had served as a grant reviewer for a new federal granting agency, and kept thinking that I can do this.  So, I forwarded to one colleague the announcement for this rather new grant funding stream. She immediately responded with "let's pull out that grant on post partum women that we almost did."  Being office neighbors and friends for several years, I knew exactly what she was referring to. And, as simply as that is how grant application activities get started.

By the following week we had a meeting scheduled with two other colleagues from medicine. We met in my new, slightly larger office which has curtains and a round table for meeting.  Among the four of us (women), the ideas immediately started flowing.  We noted which grant guidance nuances that would need to be addressed. We mapped out an overall research plan and a subject recruitment plan. We all groaned at the short amount of time to do so much, and at a time when we all already have pretty full plates. But, the grant idea is good and like hounds we were following the scent of potential funding. The mix of brain power and enthusiasm around the table far outweighed our reservations.  So, I have a section of the grant proposal to develop, as do the others.

My office neighbor and I handed the title of principal investigator to our younger, not yet tenured colleague. We both have reached a place where we can be more generous in that way, and love the mentoring aspect of this emerging project.

Yes, us four nerds at my office round table were having fun. The way academic work ought to be fun. Now, we are focused on getting the proposal written and pulled together, and then we will cross our fingers. Hopefully, early next year, I'll have good news. Meanwhile, I have the good news of enjoying, a little bit like the "whistle while you work" enjoyment of life.

Most people think of teachers as not working during July. So not true for me. Yes, I had a real 2 week vacation in June. So far, some surprises have emerged in July.

A junior faculty (Assistant level with only 3 years of experience) contacted me to be her mentor on a grant. A wonderful surprise. This type of being sought out not only makes the ego feel good, but it also validates my experiences and expertise. Naturally, I told her that I'd be delighted to work with her, which was immediately followed by a flurry of emails and meetings on making her topic doable within the grant budget. Being a mentor tends to be as much about giving support as it is about giving research advise. Only time will tell whether her grant gets funded. Meanwhile, I am blessed with pushing her and myself in new directions.

One of the looming dooming factors in her being able to apply for the funding is the state budget which has cuts to University support. Once again, the state support is scaled back.  It breaks my heart to see the overall economy (local and global) has been affecting higher education. When I started as a faculty, the presence of international graduate students underscored the global prestige and value of the U.S. university system. I always viewed it as a huge national asset which never seems to be counted in import/export estimations. Over my career, especially in the past 7-10 years, it feels like we as a nation have lost so much in terms of higher education.

My concern is how to regain, in an innovative replace and replenish way, what has been lost, dropped or deleted. My concern is for other junior faculty who might become discouraged or disheartened with the state of higher education and seek alternative careers. We need the bright, new thinking represented by this junior faculty. As a society, we need to be willing to re-engineer higher education in ways that will keep the U.S. at the forefront of technology and knowledge generation.

Spring break, coffee break

Spring break week means quieter hallways, more closed faculty office doors, and less traffic. Some faculty actually take a break from being on campus, although few actually stop working. We still answer email, work on manuscripts and prepare for the next class. For me, spring break means nothing more than fewer students in the hallway and no faculty meetings. I just can't get into the spirit of not working in the middle of the semester. After all, I am paid to work spring break.

For a few students, spring break is a time to get ahead on RA hours in anticipation of a hellish finals week. For a few other students, spring break is a time to get involved and manifest the best of the Millennial Generation characteristics ~ service and social justice. I have two students who are on a trip to Haiti with a group led by a College of Medicine faculty. They are going to do a community assessment of needs. They are paying their own expenses and taking their enthusiasm for making a difference to a place in need of energy, commitment, and enthusiasm. They represent the best of the Millennial character.

Meanwhile, back in Chicago, I struggle to decipher the meaning of clinging to the coffee cup in the classroom. Somehow, a conversation veered to the topic of coffee in the classroom. A student was complaining about the ants that immediate surround her cup. I complained about the distraction of coffee drinking while teaching. Not long ago, I mildly chastised a faculty for taking coffee and food to each of his morning classes, arguing we are not servants or restaurants. (Maybe we ARE more like chefs than I want to admit.) Why does the collective we need to bring coffee wherever we go? Does it signify informality? Addiction? Insecurity? Non-respect? Individuality? Sleep deprivation?

I'd say that I need a coffee break, but, in daily life today, that no longer exists. Demarcations between work, play, break are  faded, like old white car lane lines. I have no crystal ball (only a 9 ball) to tell me the future. Thinking of the students taking their spring break to work in Haiti, I see a future that looks promising and positive, if not caffeinated.

Not bragging but...

One of the obligatory and fun APHA activities is going through the exhibit hall. Comfortable shoes and stamina required for the miles of walking on the cement floor. Walking up and down the aisles, eying the competition for students, glancing into NASA's trailer which looks galaxies removed from a typical public health scene, searching for the latest in condom colors (this year was condom-sparse), bacteria themed neck ties (really, who wears those?) and interesting reads whether it's a textbook for students, a textbook for me, or book for some lateral thinking.

Naturally, I make the rounds to chat up my publishers.  Lippincott Wolters Klewer (aka LWW) to check that they had brought copies of Health Care Management Review, the journal for which I am the Editor-in-Chief. By the time I had gotten to that booth on Sunday afternoon, they had "run out of" copies. Okay, I'll go with that excuse. Late on Monday, I stopped by the Jones and Bartlet booth to see how things were going with my textbook. The reps looked tired, but mustered some enthusiasm for my book. Thankfully, I have another year before I need to worry about updating and next edition.

So, all seemed okay. A week after the conference, this newsletter went out. Seems that my textbook was in demand! Yes, getting a royalty check provides some reward for the effort. But, a even grater reward comes in the form of knowing that I managed to create something that is helpful and useful. A tiny contribution, I hope, to making for better world.

Thanksgiving

I am thankful for enthusiastic students who want to grow. I am thankful for our ability to find the humor in awkward or frustrating situations. I am thankful for gray skies that make sitting in front of the computer all day so easy. I am thankful that the semester is almost over and that it was a good semester. I am thankful that I don't have to go to a soup kitchen for a turkey dinner. I am thankful that my hair still has hints of blond. I am thankful that computers are faster and internet connections work so well (99.9% of the time). I am thankful to be able preview textbooks through Amazon.com.  I am thankful that some former and current students like me well enough to be Facebook friends. I am thankful that I remembered to keep an umbrella in my office. I am thankful for being alive and healthy with friends and family to love.

Disaster in Progress

It's mind boggling. The Illinois state budget deficit even warranted an article in the Wall Street Journal. The economics aside, my concern naturally is for the health of the people of the state. In my work with the local health departments, they are saying that county budgets have been hard hit because the state has not paid for services rendered. No one feels confident that the state will pay its bills, for services given in the past fiscal year, not to mention the current fiscal year.

From the point of view of public health, it feels like an economic disaster for which no preparedness training could help. Many county governments are making some really deep cuts into programs and services most of us have taken for granted for decades. The state funds support mostly health promotion programs and screenings for early detection and prevention. In contrast, federal dollars generally support direct clinical services, like primary care. At least in Illinois, most local health departments have gotten out of the business of providing primary care. Instead, they focus on the health promotion, disease prevention for which reimbursement does not exist.

As the programs are cut because there is no money to pay staff to do the programs, questions arise. What will happen to the health statistics for conditions like sexually transmitted diseases (STDs), breast and cervical cancer, and child abuse? How will health departments reconfigure and reconceptualize themselves in this new economic landscape? What new or old skills are needed by the remaining workforce to actualize this new reality?

I don't worry about those few organizations that are trendsetters, enlightened, prospectors (in the language of Miles and Snow) that can turn this crisis into an opportunity. But, not all organizations have that ability. Those that can't survive or adapt or morph, what will happen to the health of the people they once served?

Winding Down

I'm strating to think about the end, which is to say about grading final papers, giving good-bye presents and scheduling my taxi to the airport.

The six students here sit in two groups, one each at a round table. One table has the older nurses who work at a public specialty clinic, quietly absorbing and concentrating. The other table has the younger nurses working in acute care, wiggling and giggling and trying to speak English. The two groups being a small sample of the nurses in Chile. And both groups coming to terms with their assumptions about how to improve health and the role of the Ministry of Health in do so.

Each time I teach this course here, I struggle with this too. What is the "correct" balance between entrepreneurial health programs and social responsibility as administered through a government? I come from a country which has a history of favoring the private sector's initiative and business approach to achieving health for its citizens. But, where's the profit in helping the disadvantaged to gain equal footing or being compassionate with the dregs of the street who slap all outreached hands? Maybe because I just finished one of Anne Lamont's books, I'm feeling both more radicalized and spiritualized about health care systems.

Chile has a history of dictatorship which has left the boot print of oppression throughout its bureacracy. I saw this during my interviews with people in the Ministry. It was more like a bruise, still sore enough to limit mobility. There is a "system" in place for all citizens to receive health care, and the primary care clinics, called consultorios, are neatly placed throughout the contry. But where's the benefit of creating new options and programs when the resources are distributed centrally based on a plan that has no known origins?

Neither system is right and neither system is perfect. But I do see individuals in both systems who are stepping forward and into the murky waters of what is ethically and morally and socically needed.

In the field

Today I did something I love. I spent 2 hours giving a presentation to public health nurses, 30 of them from one local health department. The goal is to increase their understanding of being a professional, a public health professional, a nursing professional, whose job includes addressing health problems of populations, not only of individuals.They would say it is stretching their minds.

I value the time I spend "in the field", out of the "ivory tower". It's when I get a reality check on what is the current state of affairs. A reality check on how far away I am from where they are. A reality check on my own passions and commitments. More than once I acknowledged that my small diatribes were my soap boxes. But, soap boxes are closer to our hearts and passion than almost anything else. Why not claim, "This is my soap box, this is my passion, this is what I am willing to work hard to change." And, the really weird thing about soap boxes; we rarely know they are there until we step up on it and let the passion flow.

Most successful people who are admired, people who are famous say that they are successful because they are doing what they love. Me, working with public health nurses, to give them a sense of pride and confidence, and a sense of being able to make the next baby step of advancement. This is my passion. I don't expect a raise for doing this work. I don't expect a prize for doing this work. I do expect to have made a tiny improvement in people who themselves contribute to a better world.