How much education does it take to learn to wash people’s feet?

By Barbara Waldorf RN, MPH (candidate)
Boston University School of Public Health
Recently, in a health policy class at BUSPH, I listened to Dr. Jim O’Connell describe how, as a hot-shot young doctor fresh from being the chief resident at MGH, he was told that to start his new job at the Pine Street Inn, he would be washing the feet of the homeless clients at the nursing clinic. The struggle with his (and the medical profession’s) ego was palpable. To his credit and the benefit of thousands of homeless people over the next 20 years, he chose, in that moment, to not know, to trust the nurses and to learn a in new way.

Ruth Stark, in her training manual for working abroad, speaks of the critical importance of learning to listen when in a another country or culture. Her advice to everyone who ventures beyond their boundaries, who wishes to have an impact in a different cultural context, is to spend significant time asking questions rather than assuming prior knowledge, and to cultivate humility.

There is no doubt that facts and figures, economic theory and the scientific process are important. These can be taught. Graduate education in public health gives us the tools for financial analysis, the application of management principles and the rigor of epidemiology and biostatistics. These are the building blocks of the profession.

Yet, without the more intangible skills of listening, humility, curiosity about the unknown and a profound respect for the deep threads of humanity that bind us together, we will not be able to make the right decisions. Paradoxically, the depth of respect for, and willingness to learn from, other people’s wisdom and knowledge is based in the confidence and knowledge of one’s own culture, experience and education. Without grounding in self-respect, how can we access that which needs to be given? In order to become an advocate for real change and have the discernment to make important decisions, we need to know ourselves.

I washed the feet of homeless women at the Pine Street Inn the same year as Jim O’Connell. As a student nurse at UMass/Boston, it was my community health placement. I was young, suburban, and middle class with noe xperience of inner city, drug addicted, alcoholic or mentally ill homeless folks. I was scared and felt I had nothing to give. But as I sat with them, day after day, soaking their feet, listening, being with them as a human being, something happened.

Something was touched that opened my eyes, both inner and outer, to a very different way of being. It changed me in a fundamental way and shifted both the trajectory and context of my professional life. I owe the homeless women who allowed me to wash their feet for an education I have utilized all my life. It has taken me throughout the world, and allowed me to be with people I could not speak with; to work in situations I did not understand and to take risks and move into arenas I did not know.

That thread has led me to now pursue a Masters degree in public health, where new vistas are opening up. Understanding how economic theory explains the provision of care, finding a new perspective on health care systems and gaining the building blocks to decide when and where to intervene in complex emergencies. Something has come together here, which is the place where my education from the university meets my education from the women of Pine Street, from the Tibetan refugees I cared for in the mountains of Nepal and from my schizophrenic clients in Boston.

To answer the question, it takes a lot of education to wash people’s feet, to be present for them, to be a true advocate and to understand when to speak and when to listen.

Barbara Waldorf is an RN and working on her MPH at Boston University School of Public Health with a concentration in International Health. Having lived and worked in Asia, Europe and Australia, her current interest is in the emerging field of Global Health nursing and learning from other nurses who are active in this field.

And The Band Played On: Politics, People and the AIDS Epidemic (Book Review)

Guest blogger: Barbara Waldorf, RN
For everyone concerned about public health, HIV-AIDS, MSM and human rights are key issues. Homosexuality is illegal in 80 countries worldwide. A major battle is brewing in Uganda, with a virulent anti-homosexuality bill in parliament and donors like Sweden threatening to cut all aid if it is passed. There are implications for all public health projects. Randy Shilts wrote eloquently about these issues at the beginning of the AIDS epidemic. Despite the extraordinary progress that has occurred over the last 30 years, what he explored is as relevant today as it was when it was written.

Marginalized groups of people die while the world does nothing, despite key players being able to stop the slaughter. Randy Shilts states he wrote this book, so “…it will never happen again, to any people, anywhere.” “Never again” was said after the holocaust in Europe. The AIDS epidemic can be seen as another holocaust. The overarching issues this book reveals are universal. It forces us to contemplate: What would I do? What is the impact of our prejudices? How do we treat the “other”? And how do we care for those that society has disenfranchised – whether they were Jews in Europe in the 1930s, American gay men in the 1980s or undocumented aliens today?

And the Band Played On is a compelling account of the first five years of the AIDS epidemic. Shilts takes us on a journey, starting with an unknown disease in Africa, to the first CDC case report of unusual pneumonia appearing in young gay men, to the growing awareness of the disease by the mainstream society. The breadth of research is staggering, covering the growing controversy within the gay community; the scientists researching a cause while competing for fame; the politicians more worried about popularity than people dying; and the impact of the conservative fiscal policies of Ronald Reagan that cut funding for the CDC and government health facilities, just when they needed to engage the biggest pubic health threat of the century. Shilts delineates the complex response to the emergence of AIDS that was impacted by prejudice against gays and other marginalized people. He was a journalist, and wrote this book to catalogue the lack of response, that caused a huge number of deaths and allowed the virus to spread virtually unchecked for years.

His premise was that because the virus emerged in groups the mainstream culture wanted to ignore, scientists, doctors and politicians were blinded and failed to halt the spread of AIDS. Shilts forces us to question the social and political milieu this medical crisis arose within, which prevented any unified response. It always takes enormous energy and commitment to see our own blind spots. For anyone interested in public health, the important questions that arise are: Who is the “other” now? Do I have the vision and courage to respond to the next crisis, no matter where it arises? Given these questions, this book becomes a contemporary cautionary tale. Shilts warns us to chronicle the ways that AIDS was ignored so that we can have the humility not to repeat history with the next disease that appears among the disenfranchised. He makes the point that despite apparent differences, we are all human beings, intimately connected. He leaves us to contemplate how to create a world where there is no “other.”

Barbara Waldorf is an RN and working on her MPH at Boston University School of Public Health with a concentration in International Health. Having lived and worked in Asia, Europe and Australia, her current interest is in the emerging field of Global Health nursing and learning from other nurses who are active in this field.