No snowflake in an avalanche ever feels responsible.  – Stanislaw Lec

I’m the one in the top left who you can barely see because her skin is reflecting the sun.

I am embarrassed that we are more than halfway through the summer and I have not yet dedicated a blog post to the University of Venda (UNIVEN) students we have been collaborating with throughout the entirety of this project. Though it is easy to become possessive of the research we have been doing since we spent much of this past academic year in preparation of this project, our ultimate goal is to be able to hand over the reins to people already living in working in Limpopo. Why is this important to us?

In the past couple of decades, Community-Based Participatory Research (CBPR) has emerged as one of the most prominent public health research frameworks and social change mechanisms in practice. Championed as “a collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings,” it “begins with a research topic of importance to the community with the aim of combining knowledge and action to bring about social change to improve community health.”

“The task of the modern educator is not to cut down jungles but to irrigate desserts” – C.S. Lewis

The goal of someone who is doing CBPR is similar to that which C.S. Lewis tasks the modern educator: “not to cut down jungles, but to irrigate deserts.” Public health and medical research has a terribly long history of taking advantage of people for “the sake of science.” Much of the past half century in public health research has been spent trying to justify this kind of scholarship in the face of the emotional-historical scars left behind by disasters such as the Tuskegee Syphilis Study and the Willowbrook Hepatitis Study. With this in mind, the essence of CBPR is probably best summed up echoing the words of George Bernard Shaw: “I’m not a teacher: only a fellow traveler of whom you asked the way. I pointed ahead – ahead of myself as well as you.” In other words: CBPR aims to erase the formal lines between the researcher and the researched to empower communities to take charge of ensuring their own well being.

“I’m not a teacher: only a fellow traveler of whom you asked the way. I pointed ahead – ahead of myself as well as you.” – GBS

Though my team did not write the procedures for our project using strict CBPR methodology, it is these principles that have guided our collaboration with the University of Venda. Though we have spent plenty of time with our student research partners during the week preparing focus groups, writing curriculum and practicing our lesson plans, we have spent almost an equal amount of time just trying to get to know them better. We’ve had cookouts and performed in talent shows together; we’ve written poetry and sung songs while waiting for our bus to arrive to take us to Tiyani Clinic. We were even given Xitsonga names by the Tiyani clinic staff that our UNIVEN friends starting using. Mine was Topisa meaning “When she speaks, people listen”—a name that had the unfortunate effect of making me stutter much more often in public.

In last week’s post, I discussed the details of dignity–its form and features and what it might look like if we were to encounter it face-to-face. This week, as an extension of that discussion, I want to touch on how and why we must preserve dignity.

In public health, we talk a lot about this idea that “health is a human right.” As intuitive as this principle may sound, its worth was not internationally recognized until September of 1978 at the International Conference on Primary Health Care at Alma-Ata, USSR. The first tenet of the Declaration of Alma Alta is as follows:

The Conference strongly reaffirms that health, which is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

The Catholic Church maintains that, “human dignity can be protected and a healthy community can be achieved only if human rights are protected and responsibilities are met.” So if we assume protecting dignity also ensures the health of communities then the question we must ask is how can we best protect human rights and responsibilities. The answer, I believe, comes to us through the life of Jonas Salk.

“What makes your heart leap?” – Jonas Salk

Self-proclaimed bio-philosopher and inventor of the polio vaccine, Salk went down in history not for his biomedical innovation, but for his philosophical outlook.

“Who owns the patent on this vaccine?’

‘Well, the people, I would say. There is no patent. Could you patent the sun?”

Salk was raised to believe that each person was responsible for making a difference in the world. However as he aged, he came to believe that we aren’t just responsible for making any kind of positive difference in the world, but one that will outlast our life times. In this 1985 interview with Richard Heffner on The Open Mind, Jonas Salk offered the following framework for how we must live our lives:

The most important question we can ask ourselves is:

“Are we being good ancestors?”

Conversations about ancestry tend to have somewhat of an archaic tinge to them these days. If ancestry comes up at all, it’s in occasional conversations with grandparents or when your friend happens to mention that their great-great-great-great-great-great-great-great-great uncle was a duke or some vaguely important diplomat. If we talk about ancestry at all, it is in the context of who our ancestors were, rather than whose ancestors we will one day be.

What is missing from the majority of modern day discussions on human rights is this question of ancestry. Jonas Salk’s call to good ancestorship asks us to consider what it means to be human. Do our lives just have meaning in the present while we are living them, or can they retain meaning after we have passed? A sense of ancestry tries to get a feeling of inheritance. The opportunities and resources that we are privy to today do not truly belong to us; they have been passed down to us by many generations of our forbearers. And with that in mind, we have a responsibility to protect these opportunities and resources so they are available to generations to come.

It is hard to convince the general public of this. For instance, much of what we have inherited in the field of public health are things that have become such ordinary aspects of our daily scenery that it is hard to imagine people ever got along without them. Storm drains, stop lights, sidewalks and even our view of the night sky have been passed down to us from generations before us who fought to pass laws and start programs that would ensure the public health in a sustainable way. But because we were not involved in safeguarding their existence, it is very easy to take them for granted.

This past week, I have been reading He Leadth Me by Fr. Walter J. Ciszek, a Jesuit Priest who spent 23 years in Soviet prisons and Siberian labor camps. Similarly to Viktor Frankl, through his time in captivity Fr. Ciszek often reflected on the different preconditions of dignity and how one can find meaning in life in devastating circumstances. Not long after arriving in the Siberian work camps, Fr. Ciszek had the following realization:

It suddenly occurred to me how little I had ever had to worry about such things in the past. Even in prison, such things as food, shelter, and clothing–poor as they might have been–had been provided for me…Now, as I watched the thieves and criminals providing for themselves in a universe with its own set of standards and “justice”, I began to wonder about my own survival. The children of this world, surely, were wiser than the children of the light. How would I survive among them? For them, nothing existed beyond this material world and this moment. They survived because they learned how to survive. They were masters of the art of survival. Outside the bounds of civilized behavior or conscience , they preyed upon anyone weaker than themselves and revenged themselves upon society by crimes of violence and theft. In their view, society owed them something. So they took it. It was as simple as that. (Ciszek 86)

What I find most interesting in Fr. Ciszek’s reflection here is the relationship he proposes between time and dignity: that an ability to plan for and live beyond the present moment is the defining difference between the art of survival and the art of living.

Fr. Ciszek one year after his release from the Siberian work camps

Another way of expressing Fr. Ciszek’s point would be to say that to protect human dignity we must protect each other’s sense of ancestorship–our relationship with history and with home. Being a good ancestor calls for a deeper sense of belonging. That our human inheritance does not just consist of honoring the lives of all of those who have come before us, we also must work to honor the lives of those still to come.

There is only one thing that I dread: not to be worthy of my sufferings.  – Dostoyevsky

Viktor Frankl (26 March 1905 – 2 September 1997) was an Austrian neurologist and psychiatrist as well as a Holocaust survivor. On the night he thought was his last, Frankl turned to his friend Otto and said,

Listen, Otto, if I don’t get back home to my wife, and if you should see her again, then tell her that I told of her daily, hourly. You remember. Secondly, I have loved her more than anyone. Thirdly, the short time I have been married to her outweighs everything, even all we have gone through here.

Viktor Frankl with his wife, Tilly, before they were transported to Auschwitz in 1944. Tilly did not survive the year.

Frankl believed that “love is the ultimate and highest goal to which man can aspire” (Frankl 38). But what allowed him to hold onto this believe so fervently amidst the moral deformity of the Holocaust? In Man’s Search for Meaning, Frankl’s autobiographical testament of his time in Auschwitz, he offers this explanation: “Those who know how close the connection is between the state of mind of a man­, ­his courage and hope, or lack of them­ ­and the state of immunity of his body will understand that sudden loss of hope and courage can have a deadly effect” (75). To illustrate his point Frankl details for us his theory on the record high death rate in Auschwitz during Christmas 1944 to New Years 1945: that prisoners died because they had expected to be home before Christmas. When they realized this was not to be they completely lost hope in life beyond the concentration camp.

Lithograph by Leo Haas, Holocaust artist who survived Theresienstadt and Auschwitz (public domain)

Last week, when reflecting on community engagement, I discussed how the sacrament of the present moment allows us to be stronger community members by enhancing our awareness of our connectedness to others. However, in his psychoanalysis of Holocaust prisoners, Frankl offers a different perspective: “It is a peculiarity of man that he can only live by looking to the future…And this is his salvation in the most difficult moments of his existence, although he sometimes has to force his mind to the task” (73).

The Catholic Church proclaims that human life is sacred and that the dignity of the human person is the foundation of a moral vision for society. As far as threats to human dignity go, the Church includes abortion, euthanasia, cloning, the death penalty and war. I feel that it might be necessary to also add time poverty.

Time poverty, according to Maria Konnikova, is “what happens when we find ourselves working against the clock to finish something.” For someone who is financially comfortable, poverty of time is merely an unpleasant inconvenience. For someone whom lack of time is just one of their many burdens, time poverty becomes much more serious. Especially when you take into account that time poverty tends to bring about what Konnikova calls bandwidth poverty or, “the type of attention shortage that is fed by [financial poverty and time poverty].” She offers us the following example:

If I’m focused on the immediate deadline, I don’t have the cognitive resources to spend on mundane tasks or later deadlines. If I’m short on money, I can’t stop thinking about today’s expenses — never mind those in the future. In both cases, I end up making decisions that leave me worse off because I lack the ability to focus properly on anything other than what’s staring me in the face right now, at this exact moment.

And so we begin to see how our need to look to the future for hope and our need to be present in the moment for peace come into conflict. It is clear that we need space in our lives to develop healthy relationships with both “now” and “later” and that a lack of space to do so is detrimental to our overall well being. That poverty, in whatever sense we are discussing it, is not a static issue.

In the past week, my research team has visited Tiyani twice to conduct focus groups with nurses and community health workers (CHWs) from the surrounding area. Though I am not directly a part of the CHW study, my project partners and I got to help our other teammates out with implementing their focus groups. At the beginning of each session, we would go around the circle and ask each woman their name and how long they had been working. Most them had been CHWs for at least five years, some as many as fifteen. It was not until later in the day that I found out that none of these women are paid for rounds they do in their communities each week. They just do it because they believe it’s important.

The Catholic church teaches that our human dignity comes from the fact that we are all made in the image and likeness of God. Or, in the words of Archbishop Desmond Tutu, dignity is the idea that:

We are made for goodness. We are made for love. We are made for friendliness. We are made for togetherness. We are made for all of the beautiful things that you and I know. We are made to tell the world that there are no outsiders. All are welcome: black, white, red, yellow, rich, poor, educated, not educated, male, female, gay, straight, all, all, all. We all belong to this family, this human family, God’s family.

Maria Konnikova’s research on time poverty seems to make it pretty clear that having a deficit of time in one’s life makes it very hard to cultivate a sense of dignity or to honor that of others. However, throughout Man’s Search for Meaning, Frankl insists that “he who has a why can bear almost any how” (Nietzsche).

The experience of camp life shows that man does have a choice of action. There were enough examples, often of a heroic nature, which proved that apathy could be overcome, irritability suppressed. Man can preserve a vestige of spiritual freedom, of independence of mind, even in such terrible conditions as psychic and physical stress…everything can be taken from man but one thing: the last of human freedoms–to choose one’s attitude in any given set of circumstances, to choose one’s own way (Frankl 65-66)

How can one begin to argue with such unfettered faith? Frankl offers us a no-holds-barred answer to the question of how to find dignity in suffering. Or (much) more simply, how to rationalize giving time to that which we might not logically have time for.

However, though I am deeply moved by Frankl’s words, I must return to the “almost” in the Nietzsche quote of which he is so fond. He who has a why can bear almost any how. Though I am humbled beyond belief by the grittiness of Frankl’s faith, I fear the depth of responsibility that he takes for his own well-being can almost makes us forget the severity of his aggressors’ actions. Ultimately, I still believe that the choices that we make are determined by the choices that we have. That spiritual freedom is only a possibility for those who have a concept of the spirit. That even though people like the community health workers that we met in Tiyani this week will always give me hope that people will do good and be good whether or not they have the time to do it, it is our responsibility to not make that choice a burdensome one when we can.

All that being said, sometimes the most we can do is assume the best of people. In this heartening TED Talk. Victor Frankl makes his case for why we should believe in others by offering us Goethe and a Flight Lesson:

If you are starting, here, wish to get here, say east, and you have a crosswind you will land here, so we have to do what we pilots call, eh ‘crabbing’ he told me, C-R-A-B. You have to head north of that airfield, and you have to fly that way, see? As if you’re headed in this direction. If you are heading here, above this airfield, you will actually land here. But if you head here [airfield] you will actually land here [below airfield]. This holds also for man I would say! If you take man as he really is you make him worse, but if we over estimate him–if we seem to be idealists–are overestimating and overrating man, and looking at him that high, here, above, you promote him to what he really can be.

Viktor Frankl with his second wife, Elanore, who he met in 1947.

Claire Constance is blogging from Limpopo, South Africa, this summer for the Summer Internship on Lived Theology. Learn more about Claire and the internship program here, and read more internship blog posts here.

 The final word is love.
—Dorothy Day

Life in Thohoyandou is like doing a never-ending crossword puzzle. Each day brings a new set of obscure clues that aren’t obviously connected at first, but as soon as you figure out one clue, you get a little bit of insight into another. For instance, figuring out that our shower had a temperature other than viciously cold or scaldingly hot allowed me to stay in the shower long enough to both wash my hair and do my laundry. Additionally, realizing that in Tshivenda you pronounce the letter combination “sh” as “ch” made addressing the University of Venda Professors less intimidating and made learning the language easier.

After landing in Johannesburg the morning of June 27th, Andrea and I made our way to a hotel near the airport to rest for a couple of days while the remainder of our nine-person team flew in from their various layover points. We left for Limpopo Saturday morning in our overly fancy rental cars (they were out of Dodges so they gave us Audis??) and got to Thohoyandou just late enough at night to play the extremely terrifying local traffic game of dodge-a-person as pedestrians appeared seemingly out of nowhere to cross the road in the dark.

This past week has been simultaneously like adjusting to becoming famous overnight and being the awkward new kid at school. Everywhere we go, people we meet ask to take pictures with us, but those same people fall over laughing at our pronunciation of basic Tshivenda phrases. At every event we attend, we are treated we the utmost levels of hospitality and kindness, but the ever-present fear of committing some sort of cultural faux pas never quite lets one be at ease in a group.

All that being said, it has been an incredible first couple of weeks and in between meetings with faculty and students from the University of Venda (our primary research partner), writing our child development curriculum and learning to navigate a foreign grocery store, I have been reading The Duty of Delight: The Diaries of Dorothy Day.

Dorothy was arguably one of the most radical Catholics in history. She was a co-founder of the newspaper The Catholic Worker, a publication that espoused Catholic social teaching and was the catalyst for the Catholic Worker Movement, a group of catholic communities that believes “the Gospel takes away our right forever, to discriminate between the deserving and the undeserving poor.” The Catholic workers were famous for their houses of hospitality and Dorothy spent much of her adult life serving the poor and homeless in these houses demanding that “we must talk about poverty, because people insulated by their own comfort lose sight of it.”

As someone with a keen interest in community health, I am struck by what a clear message Dorothy teaches about the necessity of community engagement. “It’s the people who are important, not the masses,” she insists. That, despite what modern individualism may lead us to believe, “[w]e are our brother’s keeper. Whatever we have beyond our own needs belongs to the poor… we must give far more than bread, than shelter.” Instead, she invites, we must give ourselves.

But how to give ourselves? asked the well-meaning but seriously impatient college student, flipping tiredly through Dorothy’s diaries on her bedroom floor.

As it turns out, Dorothy Day was a big fan of the sacrament of the present moment. Discussed extensively in “Abandonment to Divine Providence” by Jean-Pierre de Caussade, the sacrament of the present moment is championed as the entry point to God’s will and the necessary nourishment for a fulfilling life. In the words of de Caussade,

The present moment, then, is like a desert in which the soul sees only God whom it enjoys; and is only occupied about those things which He requires of it, leaving and forgetting all else, and abandoning it to Providence.

 

a black out poem about the sacrament of the present moment by yours truly

Last weekend when my teammates and I were receiving our cultural orientation from the faculty in the Community Engagement Office at the University of Venda, we were told that we must conduct all our work using ubuntu as our research framework. Ubuntu, Zulu for I am because you are, is the premise that guides all community engagement efforts here in Vhembe district of Limpopo. Ubuntu, like the sacrament of the present moment, requires respect for humanity and celebrates the inherent goodness of people. They both offer us a more expansive definition of hospitality by saying, “what I have is not mine alone but to be shared with whoever is present.”

Furthermore, both of these ways of living emphasize the idea that our individual choices affect greater forces of change. Dorothy Day believed that, “each act of love, each work of mercy might increase the balance of love in the world. And she extended this principle to the social sphere. Each act of protest or witness for peace— though apparently foolish and ineffective, no more than a pebble in a pond— might send forth ripples that could transform the world.”

Legendary UCLA basketball coach John Wooden also was famous for teaching his players about the importance of attention to detail. On the first day of practice, when his freshman recruits were raring to get on out the court and show their new coach what they could do, Coach Wooden spent time teaching them how to put their socks and shoes on correctly. After a half hour of showing them how to align the heel of their foot firmly into the heel of their socks, how to keep their socks from crinkling inside their shoes and how to tie their shoes so the sock wouldn’t bunch up, he would face his team and say:

You see, if there are wrinkles in your socks or your shoes aren’t tied properly, you will develop blisters. With blisters, you’ll miss practice. If you miss practice, you don’t play. And if you don’t play, we cannot win. If you want to win championships, you must take care of the smallest details.

John Robert Wooden (October 14, 1910 – June 4, 2010) was an American basketball player and coach. Nicknamed the “Wizard of Westwood,” as head coach at UCLA he won ten NCAA national championships in a 12-year period—seven in a row— an unprecedented feat

What Coach Wooden understood was the importance of working on the little things to prepare for something bigger. And that doing so requires a focused mind and an open spirit.

Public health derives its strength from doing little things for the long term. In fact, our entire project this summer is ultimately just a pilot study and thus is only the very beginning of a potential avenue for change in these people’s lives. To be able to engage communities meaningfully, public health students must remember what Dorothy day called “the sense of the small effort.”

“People say, ‘What is the sense of our small effort?’ They cannot see that we must lay one brick at a time, take one step at a time.”

I am deeply grateful for this single-brick of a project. If nothing else, it will have taught me to take more care when putting my socks and shoes on in the morning.

Claire Constance is blogging from Limpopo, South Africa, this summer for the Summer Internship on Lived Theology. Learn more about Claire and the internship program here, and read more internship blog posts here.

To be is to do – Socrates
To do is to be – Sartre
Do Be Do Be Do – Sinatra

― Kurt Vonnegut

Christianity, to me, has always been just as much about family as it has been about faith. My religious upbringing consisted of two parts dinner table conversation for each part doctrine, and I don’t have any memories of going to church on Christmas with my family because our Uncle Bud (a.k.a Father McCloskey), a Jesuit priest, would just do mass in the living room for us on holidays. Saints were people that my mom and grandma called up for favors and the Pope was a man kind of like the president: I knew I liked the greater organization that he governed but that didn’t mean that I felt obliged to agree with his every proclamation.

Though certain currents of Catholicism were lost on me growing up, others held me rapt. From a young age, I was captivated by the distinction that Catholics make between social service and social justice: that the former responds to the effects of a problem while the latter responds to the cause of a problem. The idea that you could heal broken people by healing broken systems seemed to me like one of the most true ways to love a person; that when Catholics asked how they could do the most good in someone’s life, they were really asking how they could do the longest (or most sustainable) good.

Studying public health has been in many ways a commitment to asking how I can do the longest good for people in need. Tonight I will be traveling to Limpopo, South Africa with a team of graduates and undergraduates from U.Va. to spend five weeks piloting a child development training program for nurses from the Ministry of Health in Limpopo.

When it comes to offering people a means of ensuring the longest good in their lives, child development programs are public health’s Lionel Messi: slight in their appearance but colossal in their impact. What happens during the early years is of crucial importance for every child’s development. It is a period of great opportunity, but also of vulnerability to negative influences. Efforts to improve early child development are an investment, not a cost. Available cost-benefit ratios of early intervention indicate that for every dollar spent on improving early child development, returns can be on average 4 to 5 times the amount invested, and in some cases, much higher.

The nurses at the Limpopo Health Department in Limpopo, South Africa, currently have no standardized methodology by which they can assess the developmental stage of the children that they care for in their communities and no systematized approach for intervention. This would be a significant problem anywhere, but in Limpopo, this disparity is exacerbated by the fact that 39% of the population is under 15 years of age and it is also the province in South Africa with the highest proportion of children living in poverty (83%). Both of these factors contribute to Limpopo’s concerningly high under-five mortality rate of 55 deaths per 1,000 live births, which is 1.2 times higher than the rest of South Africa.

I am very hopeful that we will have good turnout for our training program this summer and that my team will learn a lot from the nurses about what aspects of our curriculum will be most relevant to their work. But it’s easy to get ahead of myself. Though the public health student in me wants this summer to be about collecting good data so we can conduct a good needs assessment when this is all over, I will have to make a continual effort to be open-minded to the cornucopia of people and perspectives that are coming together to work on this project. And that is where this blog comes in.

The Catholic Church highlights seven main themes of their teaching on social justice: life and dignity of the human person; call to family, community and participation; rights and responsibilities; option for the poor and vulnerable; the dignity of work and the rights of workers; solidarity; and care for God’s creation. Throughout the course of my time in Limpopo, I want to study these themes and reflect upon how their meaning comes to life in the context of the people we meet and the places we go.

This week I have been been reading The Power of One by Bryce Courtenay. The book is about a young English boy named Peekay who is growing up in South Africa just as the seeds of Apartheid begin to take root. Peekay has dreams of growing up to be “welterweight champion of the world.” A dream which, because of his small size and proclivity for trouble, actually has a good enough chance of occurring, according to the Improbability Principle.

On the road to becoming welterweight champion of the world, Peekay meets Hoppie Groenewald, train conductor and boxing champion who passes on to him what proves to be transformative advice:

Say always to yourself, “first with the head, and then with the heart, that’s how a man stays ahead from the start” (103)

Peekay calls this ‘the power of one’–the power of ”one idea, one heart, one mind, one plan, one determination” (103). As I head off to South Africa in less than ten hours, it’s hard not to be taken with the simple elegance Hoppie’s limericked advice. Why bother spending part of my time abroad studying themes that I’ve learned “with my head” since a young age?

Peekay loves boxing vocabulary because “the words and the terms had a direction, they meant business.” Similarly, I have loved social justice doctrine because to me these are the words in Christianity that can most clearly be turned into action. However, though conceptually I know that “loving our neighbor has global dimensions in a shrinking world” or that “we are one human family whatever our national, racial, ethnic, economic, and ideological differences,” I have had scant opportunity to live these ideas out in any other context than the socioeconomic environment of Northern Virginia.

I am unspeakably blessed to have grown up with the family, friends, resources and opportunities that I have been given; they are such that they have allowed me to go on trips like this one and write this blog for the Internship in Lived Theology. And though one must not rely on travelling 8,115 miles from home to gain a deeper understanding of values that they hold most dear, to borrow from St. Augustine, “The world is a book, and those who do not travel only read one page.”

And so I am off to South Africa: to read about social justice more deeply and to do so “with the heart.”

Claire Constance is blogging from Limpopo, South Africa, this summer for the Summer Internship on Lived Theology. Learn more about Claire and the internship program here, and read more internship blog posts here.