Tuesday, October 20, 2015

From Baltimore to the Bedside and Beyond: An Outsider’s Exercise in Problem-Solving

Pick a crisis, any crisis. If you need to refresh your memory, simply glance at any media site or social media feed, and there are several from which to choose. Find one that ignites a sense of passionate indignation in you…if you dare. Understand going in that my intention is to make you live with that crisis, at least for a few minutes.

Now, walk through the topic with me and consider two aspects of it.

First, where are your sympathies? Which side are you on? Think about how much you have heard about the issue. Which side of the story do you instinctively accept? Whose arguments do you automatically distrust? What do you consider the non-negotiable principles on which the right conclusions are based? And where are the opposition’s conclusions incorrect?

Second, how deep is your investment? Why do you care? Ask yourself how much you really know about whatever topic you’ve chosen. Now consider how vehemently you disagree with those who are most directly affected, especially those who have extensive experience in addressing the kinds of crises you’re considering. As right as you are in your stance on some or all parts of the arguments, could those who are immersed in the situation have a clearer view of how, or even whether those arguments apply to this case?

Let’s see how these questions apply elsewhere.

A City-Wide Test Case
For Paul Louis Metzger (in his post here), the conflict in view is actually the aftermath of a tragedy. In Baltimore, Maryland a twenty-five year old man was arrested. He was injured while in police custody. He died a week later as a result of his injuries. That is the tragedy, not the aftermath. In fact, Metzger focuses even beyond the subsequent demonstrations, destruction, assaults, injuries and arrests that occurred in the wake of this tragedy. Metzger is reflecting on a request by the No Boundaries Coalition of Central West Baltimore. Entitled “Please do with and not for” (and found here) they plead with “anyone who is planning or organizing events in Sandtown from outside the community.” The poignancy of their experiences is well-documented. Indeed, the anecdotal evidence they offer clearly supports the claim, “Living in Sandtown right now feels like living in a war zone.” And much of the battle is resulting from the “outsiders” that both Metzger and the Coalition have in mind. The Coalition’s post ends with these requests: “Please respect our leadership. Please respect the work we’ve been doing and will continue to do. Please come and work with us and not for us.”

Metzger’s concern echoes that of the Coalition, which in turn echoes my own experience, “All too often, outside experts who claim to be efficient in addressing problems intrude and interfere in communities rather than ask them how they might be able to partner with them.” That perspective resonates with me, but not because I intend to organize community marches, rallies, or other protests over the injustices occurring in the Fall River Valley, the Intermountain Area, or the broader Sate of Jefferson community. Where I am the outside expert, however, I do sometimes “intrude and interfere.”

A Bed-Side Test Case
I, too, was responding in the aftermath of a tragedy. Long after the diagnosis, and well beyond the point where treatment was determined to be ineffective, and even months after being enrolled with hospice care, I was finally invited to meet with the patient. And despite a couple of perfectly charming visits in which the patient exhibited remarkable candor about their condition, their beliefs, and the particular challenges they faced…I was dismissed. At least temporarily, I no longer have an invitation to visit. Even if I were to call ahead, “it’s not you; it just seems like so many are here so often; even a call would make me feel obligated.” We agreed that I would come next only when called by the patient (or others in the household who are also entitled to my care).

And I believe I will be called, when there is a need. When there is an opportunity to “come and work with” the patient, and “not for” them, I will be there. They now have a face to go with my name and title, and a rapport is established so that I know how they prefer to communicate, where their relationships stand, and what kind of crises might arise for which I would be called to intervene, though not to “intrude and interfere.” But until that crisis, my presence would intrude and interfere, since there is not, currently, anything for me to do either “with” or “for” the patient. But if I were to be called, as I often am, to meet and serve a new patient for the first time only once they face a severe crisis, my ignorance of their circumstances can prove insurmountable in seeking to provide them with the best care possible.

In Metzger’s example, it’s a matter of knowing the local community. For me, it’s a matter of knowing the patient’s circumstances. For you, well…we can talk about what you know in a moment.

Exploring Our Responses
As you walk through the issue you chose to consider, and as Metzger walks through the issue He chose to consider, and as I walk through the issue I chose to consider, we all face the same questions.

The first group of questions I posed above, to condense them, could be stated: Whose side are we on, and why? Metzger advises that outsiders best serve when they give “assistance” to others “to take ownership of their problems.” For this to happen, “we need to respect and listen to the local people, learn from them, and invest in them.” I agree. As tempting as it is to try to “fix” things for patients (and others), at the end of the day I go home and leave them alone with the problems they face. As much as I identify alongside various segments of our community, I can only be me, not them. In that light, let me ask you to reflect on those you sympathize with in the issue you chose to consider. Is your investment in equipping them to address their own problems? And is your assistance based on having listened to and learned from those most directly affected?

The second group of questions, again in need of condensing, I would phrase: Whose side are we not on, and have we listened to them as well? Metzger openly opposes “the tragic irony that insider and outsider experts and cultural elites alike fail to listen to the locals in places under duress.” As with my eventual return to my own home, those with “a better idea” for the communities Metzger is discussing are not “the local community (which) will have to bear the burden and carry on with the struggle once the spotlight vanishes and visitors depart.”

But even in his opposition to their “seagull” habits (a description I have learned elsewhere for those who fly in, consume resources, and leave behind only the processed remains of those resources), Metzger engages them (us). Where there has been intrusion and interference, there could just as easily be a far more effective investment. Those “outsiders” have, at least, the potential to offer an objective perspective on such polarizing issues (whether community destruction, terminal illness, or whatever issue you chose to consider). Very often, they (we) have much more to offer as well. But whether we provide the panacea (a cure-all) we imagine, or a poison (the kill-all) in the form of an inaccurate prescription, the ongoing results largely depend upon how clearly we have listened to those who are afflicted, on both sides of the issue.

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