Monday, July 24, 2006

Do People Matter or Not?


My good friend, Charles Senteio possesses a wisdom far beyond his years. If you asked him where he received such a gift, we likely would begin talking about his parents.

Charles is program director for Central Dallas Ministries' Institute for Faith Health Research Dallas. He leads our efforts at community-based research, education and advocacy around health and wellness issues here in inner city Dallas.

We are very fortunate to have him.

He comes from a strong business and consulting background both academically and professionally. He is on his way to medical school. We will have him here with us for about another year. We are blessed as a result.

Just last week during one of our regular, weekly "core dumps" with our mutual friend, Dr. Jim Walton, Charles made a statement that caused me to pull out my journal and start writing--not what I normally do on social occasions when relaxation is the agenda!

"The health care problem of the poor is that they feel like they don't matter," Charles declared.

We sat in silence for a bit.

Let that assessment soak in for a moment.

When I feel as if no one cares about my issues, my situation, my problems, my life, my well-being, my survival. . .the impact on my soul can be profound. Such an evaluation creates a personal, psychic context, a self-understanding that takes on a power all its own--a negative power.

If I truly believe no one cares, that belief system begins to affect my behavior. It directs my use of scarce resources.

It may lead me to make negative choices.

My acts of self-determination may seem erratic, ill-advised or irrational to those who don't understand my starting point.

Media may then begin reporting on my life, my choices and my actions. The result can then become a self-perpetuating "feedback loop" of sorts, making certain that negative outcomes continue to "justify" the obvious lack of concern for my health and well-being since I don't make good choices myself.

Discussions about the importance of "personal responsbility" now become code for the "undeserving among us."

Research tells us that factors such as choice, opportunity, collective efficacy and control are all key determinants for a healthy life and community.

When I really feel as if I don't matter, the intangible forces that accompany a sense well-being and personal control simply elude me.

Far too often the results are negative from a health outcomes perspective.

At another time, in a future post, I'll discuss a recent essay I read about health disparities and race. The writer's thesis is shocking, but statistically verifiable: race can be a cause of death. This particular analysis points back to some of the same factors Charles raises with his simple statement about the number one health issue facing poor folks.

Charles' personal, life mantra is very simple: "Everybody matters!"

Our job now is to convince everyone, including policy makers, that this is an absolute truth.

33 comments:

Justin said...

Man, how true that is. Its not just a poverty thing either. Kids who are given everything in the world that they could want, but whose parents are still more concerned with themselves than with their kids, tend to resort to self destruction as well.

This made me think of another point, which is at the root of poverty. When people are told that they can't get out of poverty, doesn't that perpetuate the same feedback loop.

It is a key reason that I disagree with the vast majority of government social programs. Its not because I don't want to help the poor, but I don't believe telling someone they are incapable of helping themself and then throwing them the bare minimum they need to "survive" (and vote) is disgusting. Our welfare system has probably caused much of the problems we have with poverty rather than solved them. Its created slaves out of the African American community... instead of being dependent on a white slaveowner, they are dependent on the mostly white federal government. The leaders of the party that claims to want to help them, coaxes their vote by telling them they are unable to help themselves, that racism will always keep them down, that they need politician x in power so they can have things. Not only has that caused a cycle of poverty, its also destroyed the african american family. With the implementation of a government welfare state, the father has become unnecessary. This feeling of disimportance harms the human psyche, especially that of the male, who has an inner desire to provide for his family. Maybe he turns to alcohol or drugs, or maybe he just jets. Regardless, children living in poverty without a father are going to have a harder time not living the same life of poverty, or looking for that missing acceptance through a gang.

Regardless, I think the answer isn't more government programs, but more relational christians like yourself, and the people at HOPEWORKS here in Memphis, who give people hope, and let them know they are loved and worth something, and that they don't have to follow in the same destructive paths that those that came before them did.

Your thoughts Larry, since you've had more experience first hand than I?

Larry James said...

You and I don't agree here, Justin. The way you characterize government involvement is inaccurate, especially now. We receive government funding for our programs and I can assure you what you say in your post is not our message to our neighbors at all.

Government supported health care, housing, education, and employment programs would not have to convey such a negative message. Adequate expressions of such public efforts would and do convey a positive message about the human worth of those who receive such opportunities. I have observed that most of the negatives come from those who sit in judgment of hte poor and from actions that cut or all but eliminate funding for the benefit of those at the bottom.

Here in Dallas the work of the Dallas Housing Authority is sending very strong, positive messages to the community about the value of all of our citizens. Our public hospital system does the same.

It seems to me that your comments reflect a very one-sided view of government involvement. Of course, currently the government programs are being cut back even further. I could go on with much more here, but Google my blog on topics like the war on poverty, food stamps, public health and community development and you will get more of my viewpoint.

I grew up in the same church tradition as you, I expect. That has played a huge part in shaping anti-government perspective, especially in the South. I reject almost all of that thinking.

Thanks for your post.

Justin said...

I guess I see the Kingdom of God being brough about without the help of Government in the New Testament. I don't know why we'd want to get in bed with Babylon at all. We've seen in the past what states that supposedly are for the poor and working class end up doing to their people. Instead of helping the poor, they penalize those that do have and just make everyone dirt poor with no one to give charity.

I don't have a problem with government dollars being spent to help the poor so much as I have a problem with the government using government dollars to help the poor. Bureaucracy is not a good thing, and it is extraordinarily wasteful. It cost nearly as much to pay for government employees of the SSA as it does to actually pay out social security checks.

How about if the government gave dollar for dollar tax credits up to a certain amount for donations to poverty relief efforts. There's a ton of money coming into you there, and it won't be the government dictating how you use it, but your organization can determine how needs will best be met.

I don't know if its the republichristian church of christ upbringing or maybe just a little David Lipscomb in me.


I just believe if Jesus thought government was the answer to poverty, he'd have taken down Caesar.

Anonymous said...

Even if it doubled -- no, tripled -- philanthropy would still be no match for government support. When fighting something as entrenched and systemic as poverty, how can churches compete?

Imagine saying that the government should stop paying for a military, and we should rely on privately funded militias to defend our country. I assume you would laugh at such an idea. Why, then, would you not expect that we need an attack of equal force against poverty?

Poverty claims far more lives each year than terrorism ever will.

To put it into comparison: thanks to the recent Warren Buffett donation, the Bill & Melinda Gates Foundation now has nearly $50Billion in assets -- roughly five times the amount of the second largest foundation (Ford). Despite this amazing generosity, the annual expenditure of these foundations still pale in comparison to the support provided by governments of the world. I believe, for example, that the NIH (National Institutes of Health) actually awards more research grants than the Gates Foundation.

Furthermore, equating communism with American social programs is ridiculous. Social programs are not about abolishing capitalism: they are about supporting the very heart of the American ideal, that the government should provide for the general welfare of the people and allow us to achieve our potential.

Poverty crushes potential. This is not about personal responsibility; this is about systemic reality.

If you look at the impact of American social programs, they have a positive effect on communities and eliminate poverty. As Larry frequently reminds us, LBJ's War on Poverty dramatically decreased poverty (particularly among minorities).

It all comes back to Larry's post, and Charles' comment: The poor do not matter to the rich.

Jeremy Gregg said...

"For the poor will never cease to be in the land; therefore I command you, saying, 'You shall freely open your hand to your brother, to your needy and poor in your land.'" Deut.15:11

"Give to him who asks of you, and do not turn away from him who wants to borrow from you." Matt. 5:42

"Is this not the fast which I choose, to loosen the bonds of wickedness, to undo the bands of the yoke, and to let the oppressed go free and break every yoke? Is it not to divide your bread with the hungry and bring the homeless poor into the house; when you see the naked to cover him, and not to hide yourself from your own flesh?" Isa.58:6-7

"Whoever has the world's goods, and sees his brother in need and closes his heart against him, how does the love of God abide in him?" John 3:17

Jesus said, "Whatever you have done to the least of these my brothers, you have done unto me." Matt. 25:40

John Greenan said...

I find misinformation like this:

"It cost nearly as much to pay for government employees of the SSA as it does to actually pay out social security checks."

extremely disturbing. In fact, the total administrative expenses for old age social security benefits is only 0.7%.

Here's the link:

http://www.ssa.gov/OACT/TRSUM/trsummary.html

The most expensive social security program to administrate, disability benefits, only has an expense ratio of 2.6%.

These costs are less than the industry average in various private industry insurance, retirement and annuity programs.

But how can you have formed an opinion about the effectiveness of government programs, when the one factual assertion you make is off by about 14,000%?

I think we need to treat issues of poverty seriously; think about them seriously; and make sure the work we do is as serious about the money spent as any private business person is about their own money.

That means having some understanding of the real facts before forming opinions.

Amber G. Lehmann said...

"The health care problem of the poor is that they feel like they don't matter"

This statement is indeed chilling, especially as a medical student. I fear that I am entering a profession that has slowly transitioned from its roots in compassion and caring into the great mess of market based medicine that nearly makes these two things impossible for the physician to practice. Because the poor cannot participate within the market, the quality of care by physicians is doubly compromised, which continues the loop. It is impossible to have a healthy individuals when there are rampant socal injustices.

http://amberlehmann.blogspot.com/2006/02/choices-and-health.html

jacob edwards said...

Larry,
I work for Harding University's Physician Assistant Program and we are working to expand our sites for clinical rotations--especially those in underserved settings. Who should we contact to see about sending some of our students to work with the clinic? My email address is jaedwards(at)harding.edu

MommyHAM said...

Justin,

Hey, gotta agree with Larry here, as an actual social worker.

Used to be, welfare could and sometimes did perpetuate poverty - but with the welfare reform that turned AFDC into TANF, there are measures put into those programs which teach self-sufficiency, and there is FAR more accountability than used to be.

Government sources help FAR more than they hinder with respect to the war on poverty.

There are grant funds available from SAMHSA, HUD, Domestic Violence-specific funds, Faith-Based and Community Initiatives, etc etc, that help ALL of our local "private" non-profit agencies, as well as State, County, and Municipal grant dollars that keep their doors open. Ask a human services provider with 501 (c) 3 status (non-profit) if they can do what they do without ANY gov't funding - the answer will be a resounding NO.

Charles Senteio said...

Thanks again Larry for illuminating very important issues. As I re-read the comments I am struck at how the dialogue very quickly went to the government policy. I may be exposing my naiveté here but aren’t we supposed to be the government? Isn’t the government supposed to represent what we think? Call me crazy but I think it does, we don’t care at the level that we sometimes think we do. The point here is that the spirit of the comment says more about me (us) than it does about the poor (them).
Essentially our very human actions of devaluing some lives and valuing others is at the heart of the root cause. I believe a solution requires a mirror much more than it does an examination of social policy.
My quote was incomplete in that it only captures part of the issue, in order for us to work towards meaningful and sustained solutions we MUST come to grips with the notion that the poor, at least in some circumstances, were not born with these feelings …. We in large part gave it to them and continue to do so.

"The health care problem of the poor is that they feel like they don't matter, our inaction reinforces those feelings."

The poor don’t feel like they matter because I am doing nothing to let them know that they do. We must individually examine ourselves and understand if, and to what degree, we feel connected to our fellow man. I love to have conversations with religious folk who will go to far away lands and get potable water for the ‘natives’ and talk to them about Jesus. Is water what they need from you? Did you ask them? What do you need from them? Well, what about the poor, disenfranchised folk that live among us? Why are we so willing to travel to far away lands, or even outside of Searcy, to dispatch people and resources that may be afflicted with the apathy bug to the degree that the change they profess to catalyze is over before they even land back home? Did the desired reaction even start? Let’s see about putting more energy in examining ourselves and digesting what Dr. King so eloquently wrote about mutuality and reciprocity. Do we really care? Do I believe that we are all connected in a web of mutuality, that affects one of us directly affects all of us indirectly? It is OK not to and work with that, but don’t profess to care at a level that is not consistent with your actions. Prayer without deeds is indeed dead.
Jeremy included some very familiar passages that are dear to me, in fact I’ve shared some with the incarcerated fellas I go to visit. My effectiveness with them, and theirs with me, started to kick in when I digested – really digested – that my success was tied to theirs, and theirs to mine. That is what my God is trying to say to me, and I have to work daily to listen and act on those messages. A few months back I was invited to speak to a health care policy class at the University of Texas at Dallas, most of them were doctoral students who were curious about how to be ‘effective’ in making positive change in poor communities. They wondered how I did this. I told them that the first step was to, before you leave the house, try and understand if and to what degree you are connected to the people you are professing to help. Until you get to this point you will not be as effective as you could be. Those people that catalyze change in my own life do so through deeds, deeds that reinforce our connection. They kick my ass when I’m doing bad and pat me on the back when I’m doing good. These two expressions of connectively are only 18 inches apart, they are very similar acts. This ‘caring’ requires a large emotional investment which sets the stage for connectivity. I am still very early on this journey but I strongly believe that a deep notion of connectivity is where it starts. Go back and read the passages Jeremy included and ask yourself to what degree you believe them, then ask to what degree you live them. JFK said it very well in his inaugural speech, “…here on earth God’s work must truly be our own.”

Larry James said...

Jacob, thanks for your post! I have referred your message to Keith Ackerman, our COO and to Marcus Bryd, our medical practice administrator. They will be in touch!

John, thanks for the statistical documentation. I felt like it would be coming.

Justin, I do believe you, like many really fine people, buy into the myths that have been perpetrated since 1980 on the voting public. Everything from Mr. Reagan's "welfare Cadillac" to supply-side economic theory has shaped our public policy in a very bad way for low-income Americans.

A couple of additional facts. The most efficient "insurance company" in America is Medicare in terms of administrative costs. If we shifted from private insurance to a single-payer system we would save a minimum of $45 billion annually in admin costs. Public insurers such as Medicare and Medicaid don't enjoy richly appointed offices, stockholder demands, etc.

Why do we look to government for solutions to middle and upper class problems, but not under class issues? The G.I. Bill educated and launched America's middle class after WWII. Why wouldn't such a plan help with American poverty? Cutting capital gains taxes, cutting income taxes and eliminating the estate tax are actions aimed at "helping" the upper classes, often at the expense of those at the bottom.

Finally, I don't think we can be taken seriously by continuing to talk as if the church will 1) really step up the plate with great passion and creativity to address the issues associated with poverty or 2) act as if the church, even if it were committed to engage, has the capacity to address problems of this scale.

In short, Justin, I think you have been unduly influenced by the dominant political culture of your denomination.

Larry James said...

Charles, thanks for your words. I wish everyone who visits this site could meet you. Your words help make that a virtual reality!

Justin said...

I feel like I'm being painted as "supply side jesus" from Al Franken's book, and that couldn't be further from the truth.

Why are we doubting the church, and putting our hope in government?

Why didn't Jesus lead an army to take out rome and set up a government that would help the poor?

I am not someone who doesn't want to help the poor... I live in Memphis, so no matter how far east I go, I've seen some poverty. I've done inner city vbs's, worked with the downtown church and hopeworks. I'm not some snotty rich republichristian who thinks that capitalism is salvation for the poor. I think Jesus is salvation for the poor and I think we are called to show him to them by how we help them.

I just can't wrap my mind around where we get the nerve to tell other people how to spend their money. What is that force doing? It doesn't make the "evil rich" any more inclined to give. It makes them more greedy. When they realize that the top 1 % of wage earners are paying 33% of the taxes in this country, and that the top 50% of wage earners are paying roughly 96% of the taxes (Btw, if you make a combined household income of less than 29 grand, you are in the bottom 50%) The bottom 50 percent account for appx 16 percent of money earned in this country, yet pay 3 percent in taxes. At what point are the people at the top going to say, "Screw it! I'm not going to work anymore because the top marginal rates make being productive useless. I don't see any return, so I'll make up to how much is the bottom for the top bracket and live in comfort."

That is not the attitude that you want those with plenty to have is it? Well,that's whats going to happen when you force behavior without changing hearts. You will do the exact opposite of what you desire and it will end up hurting the ones that need the most. The top marginal rates start at anything earned over 130,000 I believe, so that's a comfortable lifestyle... but its not an income that's going to end up being invested in businesses that hire poor people. Small business is needed in the inner city, and when you tax the wealthy to death and you raise the minimum wage to rates that small businesses can't afford to start up, you are hurting the poor.

And on the subject of tax cuts for the "rich", has anyone ever heard of the Laffer Curve... its this wonderful little theory that explains why tax returns generally increase with a cut in taxes. So, there you go, if for no other reason, cut taxes so you can have more money for social programs.

I'm sorry, I definitely feel like I was being talked down to here. I'm not some redneck, brown people hatin' idiot. I care for the poor I just don't agree that we can help them the way we want by getting into bed with secular politicians.

Libertarian party's platform says dollar for dollar tax credits for donations to poverty reduction efforts. Do you know any wealthy people who wouldn't rather give their taxes to a nonprofit charity rather than the government? You say that these organizations wouldn't survive without government funding? In essence they would receive government funding... they'd just get the tax dollars directly from the people and they can bypass the crooks in DC who are generally looking out for their own interests no matter how much they say they are for the poor.

I wrote a post about this today on my blog; anyone is welcome to comment

www.justinmundie.wordpress.com

Anonymous said...

Libertarian. Oh, now we all understand.

Anonymous said...

Justin, not talked "down to," just given some facts. When you spout off stats about govt failure that are untrue, you can expect to be corrected.

Look at what churches are actually doing in this country. Case closed.

Anonymous said...

Anonymous, correct! Look at Memphis, TN and its current racial climate in the churches, forget the city. Some folks with power and privilege just want to keep it no matter who is hurt or how many.

Justin said...

The prevailing attitude I'm seeing here is "God's people can't do it, so let's use the government"

BTW, I'm a christian first, a libertarian second.

I will admit, I was mistaken on my quote about government waste. I don't know that I believe that the government is less wasteful than the private sector... it just doesn't make sense. Have you ever been to the DMV? or any other government office? They are not the epitome of efficiency.

and on government waste... administration costs may be lower, but money is still being wasted in other areas.

http://www.qando.net/details.aspx?Entry=3731

oh, and apparently not only am I a rich snotty republichristian supply side jesus loving poor people stereotyping guy.. but now I'm a racist cause I live in memphis?

I don't feel like anyone is trying to teach me truth in love here. I really feel like people are very much into labels though. If you don't fit the Sojouners Crews politics, you pretty much are a bad person. Am I right?

Jeremy Gregg said...
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Jeremy Gregg said...

Justin, the Laffer curve's theory relies on tax cuts to the majority (i.e. mid and lower incomes), those folks generally spend almost all of the money that they earn (therefore transfering income tax to sales, property and other "consumption" taxes).

Cutting taxes to the wealthy only results in more money locked out of the system, since the rich generally invest or save their "net."

Investing in the poor is investing in the community.

As far as your question about why Jesus did not overtake Rome, I think he said it best when he said "render unto Caesar what is Caesar's."

Governments are worldly institutions created to address worldly concerns. Poverty is the most significant concern in our community, as it is directly related to the other problems that we all acknowledge governments should address (health, crime, etc.).

On a related note, you should read this interesting story about the loss of hope (from The Dallas Morning News).

Justin said...

Right, cutting taxes across the board. the thing is, you can't give a tax cut across the board unless you give a tax cut to the rich. Since the "rich" (people making over 29000 a year) pay 96 percent of all the taxes, its difficult to give tax cuts to those that make less than that without cutting out their taxes entirely.

Btw, if you raise taxes on the wealthy, it definitely keeps money out of the system. Instead of reinvesting, they move stuff into banks overseas and don't pay taxes because they can hire smart accountants to find loopholes. When you lower rates, people don't mind paying the taxes as much, and also they will reinvest in business... and that's what causes the increase in tax returns (the laffer curve theory). When you put more money into circulation, and create incentives for investment, jobs are created, giving more income taxes and simultaneously helping the poor, and more money being in the economy gives people more to spend which in turn brings in taxes.

I appreciate your civility in responding to me... not calling names or making insinuations about my character.

Anonymous said...

No insinuations about character needed!

However, I do question the idea that the removal of US taxes would result in the rich moving their money back into the US. The more you have, the tighter you squeeze.

Justin said...

How many wealthy people (in the church) do you know and keep up with their finances?

Are you judging by appearance? because if you are, you are no better than the person who judges the poor based on the fact that they are poor.

If someone is making 300,000 dollars, but gives away 40% of it every year, but you don't know it, you'd probably still call them rich and say they aren't doing enough. But I'm sure you don't make any negative judgements about the person who only makes 40,000 dollars a year and doesn't give away anything because they are in debt because they bought a house they couldn't truely afford or have name brand clothes?

I'm just sick and tired of the social justice crowd that makes sure nobody judges the poor, but they sit around and judge anyone that has more than they do. News flash. If you are on a computer right now, you are fabulously wealthy in comparison to the rest of the world (the majority of whom live on 2 dollars a day or less). How about stop judging and start convincing people that its not about them. When you lead by example and when you speak the truth in love, rather than condecension, you might accomplish much more than you are now.

Larry James said...

Justin, thanks for your comments. They are appreciated, even when I strongly disagree.

The intention of this site is not to judge you. The intention is to focus on the enormity of the challenge and the depth of the problems of the poor.

We disagree in approach.

The church in its status quo is not up to the challenge. The people still suffer. The government is not doing what it could and should in my opinion. So, I speak out.

Cutting good, solid, useful programs--like Medicaid and housing--to pay for only a part of an irrational tax cut for the wealthiest is not only bad public policy, it is a moral issue. And not just to the "social justice/Sojourners crowd," as you call us. As I said earlier, Amos, Isaiah, Micah, and even Jesus would have something to say to this situation (see Luke 20:45-47 where Jesus blasted the wealthy religious leaders who exploit and grow wealthy at the expense of the poor widow to whom he turns in the next paragraph at Luke 21:1-4; then take a look at the very surprising word at Luke 11:39-41--he gets his points in everywhere!).

I don't see how we can ignore the amazing scale of the problem of poverty or the clear mandate of scripture on the subject.

Justin said...

I'm not saying that we should exploit the poor, nor am I saying that its not scriptural to push for social justice.

I think its sickening that there are preachers out there who make millions of dollars coaxing money out of people all ready in poverty who have been told that if they give to whatever ministry, they will become wealthy. The health and wealth gospel is sickening.

I want to help the poor... I don't know if I've said that enough times. I don't think that just because the church isn't picking up the slack now... that it won't in the future. We have to tell people that this is what its all about. For years, being a christian has been a completely individual thing, we sit around and make sure that we don't do anything to get our butts thrown into hell. We've missed the point there in a big way. People have been missing the point for 2 millenia. We've got to teach people to be followers of Jesus. Forcing it on them through the government is not going to change hearts. I just think that it will have the opposite effect of what you desire

Larry James said...

Thanks for the post, Justin.

I agree with have to teach and persuade.

I just don't have time, from where I sit daily (and that is part of my problem), to wait on people to have a change of heart and "get it." Why do people deserve that luxury when so many suffer and die?

Had we waited on "hearts to change" there would have been no Civil Rights Movement--I think here of Dr. King's "Letter from a Birmingham Jail.'

And then, there is the continuing reality of the sheer scale of the problem.

John Greenan said...
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John Greenan said...
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John Greenan said...

Facts are important. These are the best numbers I can find:

Total of all U.S. charitable giving: $140 billion.

50% of that goes to churches. 3% of church giving goes to benevolence. A little over $2 billion.

Federal government spending on means tested programs: $437 billion.

Even if charitable giving trebbled; even if all of it went to help the poor, and we gave nothing to the arts, education or health; even if every church gave every cent it got to help the poor and nothing to build or maintain, heat or cool a building, no salaries to ministers, and not one cent for children's programs, missions or anything else, then we could still only replace what the federal (not including state or local governments) currently spend on helping the poor.

Of course, none of that is going to happen, and probably shouldn't. It would be nice to think that there is some answer other than the government, but there isn't.

Larry James said...

Thanks, John. Your factual approach is indisputable.

The sad reality is people are not passionately concerned, either in churches or in the political arena, to really take serious action or make sustantive progress on poverty in this nation or around the world.

Daniel Gray said...

"Of course, none of that is going to happen, and probably shouldn't."

Hmmm... I might actually be pretty happy if all of that DID happen -- Not that it would solve much of anything, I'm just not too big on a lot of things "church" spends its money on. Maybe it would at least get churches more outward focused.

Good financial point, though... helps put it in perspective how dwarfed the church is compared to government spending.

MarkS said...

Wow, John! Great stats. Do you remember where you heard/read them? I would like to pass them on, but need some documentation.

Great posts, as always, Larry.

Steve Holt Sr.

John Greenan said...

I put those stats together almost a year ago after spending an afternoon of serious research on the internet.

So, I'm afraid I don't have a source to refer you to, but you could probably replicate my work and record the source of each statistic yourself.

If you do, I'd love to see what you come up with. My email is jgreenan@centraldallasministries.org.

institutedallas said...

I have read the thread from my good friend's post: "Do People Matter of Not?". I was dismayed by the evolution of posts and feel that I may be able to bring one more perspective. It really is more about people than programs.

My perspective is formed by the story of a patient's mother. My hope in posting this story is to shed light upon Charles' point that people need to feel as if they and their story matter more than the critical analysis of programs and their funding...this debate is more about how we have evolved to see the world:

I am not, nor will I ever have the chance to be a mother. While I have been blessed with the opportunity to be a father of four wonderful sons and one “adopted” daughter, I have stood on the sidelines and watched the mother of my sons teach me the little that I understand about the mysterious nature of “mothering”. In my career, I have also had opportunity to observe some fairly incredible women reach new heights in mothering. One such story is a recent patient’s mom, Clara. While I will protect her identity by changing her name, I really want you to know her. She is Lorenzo’s mom, Clara.

Part of knowing Clara, is in understanding where she comes from. Imagine if you can, Clara’s life before her arrival in the United States. She and her husband raised their five children on a ranch in central Mexico over three hours from the nearest city. Typical of the ranch foreman’s lifestyle, Clara and her husband shared the responsibilities of managing the “outdoor” affairs of the ranch, workers and livestock. With limited access to the outside world, the life of their family took on a familiar rhythm of seasonal changes and the cyclical demands of a large ranching operation. Beautiful scenes of sunrises and sunsets in the uncluttered rolling hills were constant companions and “art gallery”. With the help of the children, the family was quite stable and secure, even if the opportunity for wealth creation remained only a curiosity they noted during the limited opportunities they watched television. Indeed, Clara’s world was one we remember hearing about from the older generation lucky enough to grow up in and around the southwestern culture.

Like most mothers, Clara could not guess or control the influences of modern culture and its tempting allure on her children, especially her oldest son, Lorenzo. In spite of his geographic isolation and limited formal education, Lorenzo found himself fearlessly attracted to the opportunities he heard rumored to await him in the affluent lands just a few days drive north. Imagine if you can the mother’s terror during their tearful goodbye as Clara watched her dear son drive away, as if he were being launched on a long space flight to explore a foreign planet.

The phone call that changed Clara’s life arrived over five month ago. The woman on the other end of the line explained that she and her husband were friends of their son living in the world-famous city named “Dallas”. The message collided with her with a devastating force much like the automobile that had struck Lorenzo while he changed the flat tire on the side of a highway. She was told that she should see if she could make immediate arrangements with the Mexican consulate to travel to Dallas, because Lorenzo had been critically injured in an accident and may not survive.

For four months Clara did her best to understand the devastating trauma that had reduced her son to a “vegetative state”, and a hospital culture that moved at seemingly light-speed compared to the ranch. She did her best to slow the thoughts and message down to a manageable pace, but her best efforts were simply inadequate to help make sense out of the present circumstances and the projected future being prescribed by Lorenzo’s brain damage.

During the fifth month, she began to regain her footing as she tapped into the deep well of her mothering instincts. Not only did she master the detailed skills of feeding her son through the tube in his stomach, she managed to learn the nuanced techniques to care for the large bed sore on his back. Not in her wildest dreams could she have imagined that her adult life would have turned so sharply to now revolve around monitoring the fluids going into and out of Lorenzo’s body. As I met with her during those first few days, I learned that one of her core concerns was wondering if the challenges she faced were fully respected by the caregivers of the trauma hospital. She expressed her deep appreciation for the technical skills that were used to spare her oldest son’s life, as she connected them in her mind to the new tools that had come to the ranch over the last few years. These analogies would serve us well as we worked to assist her in accepting the new role that she was entering.

On the sixth month anniversary of his accident, Lorenzo was discharged from the hospital and into the trusted care of Clara. What a bitter-sweet day it was, as I helped lift Lorenzo’s motionless body onto his newly donated hospital bed and mattress. Reviewing his medication list and liquid nutrition requirements, I realized that this mother was not only up to the task, but she had tapped some unknown fountain of strength possibly reserved for mothers, and became his protector and advocate.

As I turned to leave, out of the corner of my eye I witnessed the dignity that I so admired as she smoothed out the sheet on his bed and pulled his blanket up around his neck, gentling stroking his cheek. I knew he was in the right hands.