Monday, July 21, 2014

song post #10: "come out swinging"

Haven't done a song post in a while. This one may not be 100% there (and we definitely got off somewhere between the second verse and second chorus) but man I like playing this one a lot. As is usually the, much credit is owed to Peter on vocals, Tim on bass, Julian on the second guitar, Jon on drums, and Evan for the mixing magic.

Saturday, July 12, 2014

a few quick thoughts on "Downwardly Mobile for Jesus"

Al-Jazeera America recently published an article entitled Downwardly Mobile for Jesus about my church & neighborhood (thanks to everyone who shared it and talked about it!) The author, Lawrence Lanahan, is a local freelance journalist who has done a lot of great work, including The Lines Between Us, a radio series examining inequality in the Baltimore region that I cannot recommend highly enough. It is especially useful if you're one of those people like me who is suspicious about the way that "inequality" is thrown around in modern political discourse; I have found it very helpful in understanding the dynamics of racial inequality in Baltimore and how historic policies are still producing harm today. He & I initially connected after I wrote this post (it takes some kinda mensch to be publicly contradicted and still want to talk!) and I was really impressed with his desire to tell the story of Christian Community Development in a faithful way, using New Song & Newborn as a lens to look at how communities of faith can address inequality.

There were, of course, limitations: there's only so much you can say about a multi-generational, multifaceted movement in 3200 words. I still don't feel particularly comfortable with the fact that the first picture you see at the top of the article is me and my family; the story is about us to about the same degree as Star Wars is about C-3PO and R2-D2. Still, I'm happy with how it turned out and how the voices of remainers & returners (who were doing the work of social justice in Sandtown long before us relocators ever showed up) are prominent throughout the story and do a lot of the heavy lifting on some of the tough questions we face.

I read the comments [I know! Curiosity got the better of me. Don't worry, there weren't too many.] and I figured that responding to some of the common reservations might be a good way to advance the conversation.

1. What you're doing wouldn't be necessary if the government did the right things
Firstly, we do work with the government on a variety of levels: for example, New Song Academy is a public charter school and the ministry that I helped to start spent a lot of effort trying to get people signed up for Medicaid or the insurance exchanges. There are a variety of ways that the community and our work has benefited from public funding or city involvement and while we are all very suspicious of any help that comes from outside of the community, it's clear that when you listen to what John Perkins has to say (including any of his great books, some of which like With Justice For All & Let Justice Roll Down have previews of significant-length previews on Google Books), he (like most CCDA folks) think that the government has a role to play in achieving justice for inner-city neighborhoods like Sandtown.

2. It's okay to help people, just don't proselytize
This one is probably the silliest objection because it ignores the facts that the vast majority of community members already identify as Christians, a large number of people in Sandtown have helped to teach or disciple me, and (probably most importantly) proselytization is a pretty standard practice in these communities. Furthermore, while the historic injustices associated with coercive conversions are real, they have generated a backlash that connects with a variety of other modern prejudices to suppose that trying to make a compelling case for someone to change their mind about something (often while helping them) is morally deranged if you include religious content. However, this practice is used by a variety of public and private organizations to impart a smorgasbord of moral values ("the arts are valuable!" "don't discriminate against others!" "soda is bad!") to impressionable minds. There are lots of ways to do evangelism poorly, but just because it is inherently wicked in some popular moral systems today doesn't mean it's wrong if we do it.

3. The White Savior Industrial Complex
This one is the most bothersome because the article addressed it pretty directly. It is also the most appropriate because it is a constant threat to the life and character of our work. Yes, we have outsiders in leadership positions. Yes, I'm a white person with a lot of natural gifts and an agenda of my own that can (and has) overrun the agenda of my neighbors. No, we are not perfect and often need to repent to one another. But I am working to bless my neighbors and give them skills and power. I submit to their leadership as often as I can, give them the power to rebuke me when I'm out of line, and collaborate with them instead of barking orders. The work of reconciliation, redistribution, and relocation did not end the moment that my wife & I bought a house in Sandtown; there are endless layers (both personal and structural) to sort through and the best place I know to sort them out is at the Cross, where my neighbor & I stand shoulder-to-shoulder.

4. [UPDATE] Be ye not afraid of Al-Jazeera America, my people, for therein thou shalt find good longform journalism and analysis
You know what I'm talking about, guys.

You're always welcome to visit New Song on a Sunday morning if you're in Baltimore; come & see for yourself what God is doing in us and through us. You can also read about our history in To Live In Peace, written by one of the co-founders of our church. If you're still up in Harford County, keeping following Lawrence-- you'll be surprised what you might learn! My hope is that this article helps to challenge perceptions inside & outside the church; let's keep talking about how to love one another.

Thursday, June 19, 2014

around the web: Mere Orthodoxy

Mere Orthodoxy has been one of my favorite blogs for a while and it was an honor to get published there. I most recently participated in an episode of their podcast, Mere Fidelity, which you can subscribe to on iTunes or any other RSS podcast streamer! We discussed The End of the Nature, and specifically the first chapter of Oliver O'Donovan's book Begotten or Made? on nature, sex, technology, medicine, and how people are not like IKEA furniture.

I will hopefully continue to write for Mere-O as time allows, but here's what's been published on the blog so far:

The Poisonous Fruit of the Randian Sexual Paradise: In short, "free market" Randian sexuality is bad for us, as it privileges a certain strata of sexual consumers and the people who profit off of them. Boring sex is the most important kind of sex and marriage qua marriage isn't enough to protect a traditional sexual ethic from the financial-sexual juggernaut; we have to create an inclusive Christian community held together by marriages. I was trying to, in some ways, help to translate some of the ideas from Wendell Berry's seminal essay Sex, Economy, Freedom, & Community for our generation. You can tell me if I succeeded.

Radical Rhetoric, Siege Warfare, and Christian Population Density: Last year, there were two very popular articles passing around the evangelical interwebs (one of which was written by Mere-O's otherwise brilliant proprietor, Matthew Lee Anderson) that tried to attack "radical" Christianity as is popularly expressed by smart, faithful guys like Shane Claiborne and David Platt. I tried to critique their critique and point out both the strength of missionary institutions as well as the ongoing need for more boring, faithful Christians to extend the work of these institutions in unreached places.

The Death of Jerry Umanos: Filling Up What Is Lacking in the Suffering of Christ: There were just not enough people talking about the implications of Jerry Umanos, a modern martyr whose life and practice paralleled many aspects of my own. I wrote this tribute to build on the previous article's ideas.

Faith, Family, and the Dangers of Capitalism: There is not nearly enough suspicion about the effects that modern capitalism has had on the traditional institutions that us conservatives hold dear, and many are swayed by the power of The Market to do good. I sought to rectify that a little.

around the web: healthcare

No, I don't blog here very often. However, unlike most posts that start by talking about the infrequency of posts, this one's better: I'm writing here to let you know that I've been writing (and talking) elsewhere!

First off, here's me and my friend Pascal-Emmanuel Gobry talking about what's wrong with healthcare in America (especially why doctors are monsters and welfare queens), how community health workers could fix things, and how libertarians and conservative ideas might add to the concept of public health:

This discussion is a good intro to another piece I wrote entitled The Future of Family Medicine: Some Sacrifices Required: I love Family Medicine. It is an honor to join as a board-certified member and I genuinely believe that more family doctors are needed to improve the health of our nation and our world-- and that belief is backed up by some strong evidence. I plan to spend my life teaching it in places that don't already have programs training doctors in this specialty. However, I also think Family Medicine in America needs to change some things and make some sacrifices before we are forced to make them by people who may or may not have our patients' best interests at heart. I laid out why family doctors in particular should give preventive care over to community health workers in this piece for the American Family Physician Community Blog.

Preventive care: It's so simple, my toddler could do it!

Also on the healthcare front: Local Hospital Sponsors 5K Fun Run To Raise Awareness About Iatrogenic Injury. I'm particularly proud of this one.

Saturday, February 8, 2014

Baltimore, A Broken Heart Love's Cradle Is

There's no denying it: Baltimore, like many other cities, has serious problems. Terrible crime. Massive unemployment. Atrocious health disparities. Devastated housing. Leaders more interested in making a name for themselves than in properly managing the city's resources. The legacy of postindustrial economic losses and institutionalized racism are still quite real to many people in Baltimore. This is felt most acutely when people see little fruit for their hard work or have to live in fear of violence.
These are not concerns limited to the white & wealthy, as sharp as the divisions between the “two Americas” that David Simon has expounded on may be. Whether you are in Patterson Park or Sandtown, most residents want to be able to work, enjoy the many great things about the city, and commune with their neighbors without worrying that their safety will be threatened, their tax dollars will be mismanaged, or their fellow citizens will go hungry & homeless. In general, however, it is the wealthier people in the city who are able to agitate more loudly for change, especially since they are usually contributing what they believe is their fair share to the public administration.
The recent post from Tracey Halvorsen threw this fear into focus, giving us a broken-hearted perspective on Baltimore’s crime problem in particular. The pieces from Lawrence Lanahan and Tim Barnett have helpfully exposed some of the difficulties wrought by the privilege inherent in Halvorsen’s remarks. I found their articles helpful though a little less practical; for example, Lanahan calls inequality the real “elephant in the room” even though various public leaders have been discussing inequality quite a bit lately while Barnett calls us to love abstractly in a manner that’s stirring but a bit hollow. Mark Brown’s relentlessly pragmatic approach dovetails with City Paper’s 10 New Year’s Resolutions well to suggest a few policies that could make a big impact. These are all a reasonable place to start; I would also briefly suggest that razing more vacant housing and investing in more urban farms would probably help provide jobs in areas that need them, as is happening in my neighborhood.
I want to add to the conversation by talking about reconciliation, which is a crucial element that has been left out. I believe very strongly in the “air war” of policy to fight poverty and its attendant ills, but I believe even more strongly that no policy will work without personal, cultural, and environmental change that accompanies it. Policy helps to shape people, cultures, and our environment from the top down; reconciliation & relationships shape them from the ground up. My experience is shaped by the fact that I’ve lived in the Sandtown-Winchester neighborhood for the past 4 years, which is by many objective standards (including infant mortality & murder rate) not the greatest place to live. I would like to share a few of the things I’ve learned here from my neighbors about reconciliation.
There’s been a lot of talk about privilege in this debate; I don’t think haranguing someone about their privilege is particularly helpful once it’s been pointed out and we all acknowledge that our instincts for self-preservation can lead us to exclude others and even harm them unnecessarily. There has also been a lot of discussion around systemic inequalities and structures perpetuated poverty, which are also very important to consider. However, I think it is easy to forget that you can fall off either side of the privilege tightrope when talking about the poor: you can be “conservatively” apathetic about people ever escaping substance abuse & crime or you can be “liberally” overindulgent in a materialistic view of society that assumes poor people only need more stuff (which is not many of them say when you ask them what they need.) If we look at the billions that have been spent fighting poverty in America, it is clear that we have not invested in the structural reforms that will reduce poverty, nor have we created institutions that the poor in any way enjoy dealing with. Indeed, when you ask poor people around the world to describe what their biggest needs are, they overwhelmingly describe broken relationships & freedom from shame as paramount, not services or cash.
Thus, if Halvorsen's article and the responses to it teach us anything, it is that no desire of our hearts is so pure that it can't be twisted to harm others. Caring for the poor is a good thing; it becomes a bad thing when we deny the agency of the poor in their own self-improvement. Cynicism about political and economic motivations is a good thing; it becomes a bad thing when it chokes our passion until we are bitterly apathetic. Understanding the structures that stratify privilege is a good thing; it becomes a bad thing when we incentivize victimhood and fritter away our energy with privilege-checking. Safety is a good thing; it becomes a bad thing when innocent people must suffer unnecessarily for us to be safe. Dr. Martin Luther King, Jr is instructive here: "You must come to see that it is possible for a man to be self-centered in his self-denial and self-righteous in his self-sacrifice. He may be generous in order to feed his ego and pious in order to feed his pride. Man has the tragic capacity to relegate a heightening virtue to a tragic vice. Without love benevolence becomes egotism, and martyrdom becomes spiritual pride."
The poor are not, as some might implicitly desire, to be confined to areas where they might only hurt each other. However, they aren't helplessly in need of more money and fewer drug arrests from above, either. They have their own resources and capabilities that allow them to survive or thrive in difficult neighborhoods like Sandtown. My neighbors are thoughtful people who support one another through crises and want to make our block a better place. My love for my neighbors and their love for me is magnified by our proximity. My current work to bring better mental health resources benefits greatly from my presence in the community as I have stronger relationships with the people that I am trying to empower and help develop. I can learn from them far more effectively by living here and see how they are already working together to address the inequalities we face.
However, I also have neighbors whose individual moral choices- shaped by policy, culture, and environment- harm others or themselves. They are aided & abetted by others who either benefit from harming others (akin to the businesses that reap greater profits when more teenagers are locked up) or are too intimidated or unaware to exercise their own agency. These neighbors are often young men whose response to their own traumas, desperation, or stubborn pride is violence & intimidation. We can peel the onion layers of environment, culture, and personal decisions for quite a long time (and debate them fierecely!), but eventually we find a person whose relationship with himself, others, and God is broken.
Thus, if policies like more beat cops, fewer marijuana arrests, and a living wage are outside-in ways of reducing external motivations to harm others, reconciliation is the inside-out work of righting those relationships. This is a long and difficult work that is not easily accomplished in a program or a policy. It does not involve targeting just the most “at-risk,” for they live in a network of relationships that help to make up that risk. The people that are a danger to themselves and others become violent moral actors both through sheer relational neglect and through relational indulgence; if we are going to change the culture of violence in this city, we must address these relationships.
I would like to suggest that many of our policy failures have come about because we fail to recognize the strengths & assets that Baltimore’s poor have, especially in regards to relationships. The knowledge that a community has about each other when someone is in need works for the vulnerable when someone is ill or struggling; it works against justice when a desire to keep the peace results in zero tolerance for “snitching.” I have watched someone crash their dirt bike in the street and seen a brave soul move the bike to a hiding place before moving the injured man out of the road; the value system inherent in that interaction is telling. The ingenuity, tenacity, and fraternity shared by my neighbors is inspiring and challenging to me as it works itself out through these complex interactions. I cannot speak for them (though I enthusiastically support things that let them speak louder for themselves), but I can say that being here in Sandtown has challenged my privilege in a way that no college class or Upworthy video ever has.
Reconciliation happens across race, class, and gender in powerful ways when people share life together and work together in ways that respect the innate gifts of every person. It is very easy for me, as a privileged white dude with a graduate degree, to simply list off a helpful smattering of suggestions or scoldings for the problems that my friends face. It is been a discipline for myself to be silent, to listen, and to coax opinions from my neighbors as we try to address the devastation that a barrage of traumas has wrought. It is these personal interactions that have shaped the policies and programs we’re creating, and it is this sort of reconciliation—where I admit my culture’s tendency to fix causes harm and they admit their culture’s tendency to protect causes harm—that we can join together in.
My intention throughout this essay is to make reconciliation intensely practical, as I think it is easy to use a word like “reconciliation” as a careless pipe dream. Again, I think good policies like vigorous audits, more beat cops, fewer drug arrests, and accountability for slumlords are really important and I’m glad people are talking about them (most of them have some very strong component of fostering better relationships and more intimate knowledge of local communities.) All of these will not be as effective if those of us who are privileged aren’t spending more time in relationships with the less privileged in order for our outlooks to be changed and for the good things that we have to be shared in a more meaningfully.
It’s not just enough to spend time, though, as we will retain every opportunity to exercise our privilege that we can. We must build relationships in contexts where our power is stripped away and we can be equally vulnerable with one another. Having (hopefully) brought “reconciliation” out of the realm of empty political cliche, I want to turn to “love” and “brokenhearted,” which are also getting tossed around.
Your heart is not broken for Baltimore if you’re content to have zero crime in Patterson Park while Sandtown keeps up the same murder rate. Being in Sandtown, though, doesn’t really give me, my wife, my daughter, and our housemate the option to just work for justice & safety for people like us. We are slowly becoming enmeshed in a network of relationships and hopefully becoming part of the change as we learn to love our neighbors and they learn to love us. We weep with them when their children die and they weep with us when ours die. I know that it can be easily to idolize this sense of identification and I do not want to pretend that we have somehow atoned for our white guilt or erased our class privilege by buying a house in this neighborhood. (It is also important to acknowledge that the way for us was paved by other incredible pioneers who have given-- and received-- much more, such as the Tibbels family.) However, we have learned, taught, and loved in ways that I think will endure because we have been broken— for proximity has brought vulnerability to brokenness, and vulnerability to brokenness has in turn brought love. As the hymn says, "a broken heart love's cradle is."
Apathy is a bitterly prescient reality in many of these discussions. Just like we can twist our desire to walk to and from our cars in peace into a malignant “just arrest more” attitude, so we can twist our disappointed idealism into a soul-killing eyeroll. This is where I think Baltimore’s poor—who are overwhelmingly and enthusiastically religious— have the most to teach us.
The battleground of faith is where my story met Sandtown’s; I started attending New Song Community Church when I was in med school and moved into the neighborhood a few years later, as they strongly encourage intentional relocation for all the reasons that I have discussed above. It is faith that pushes many people I know forward; a relentless hope like that of Dr. King whose famous quote about “the arc of the moral universe is long, but it bends towards justice” is rooted in a fierce faith in God’s sovereign plan and eventual victory. While I know that faith is not a comfortable subject for many people, what the underprivileged and faithful people of Baltimore have to teach the privilege of the the privileged and faithless is this:
"So the greatest of all virtues is love. It is here that we find the true meaning of the Christian faith. This is at bottom the meaning of the cross. The great event on Calvary signifies more than a meaningless drama that took place on the stage of history. It is a telescope through which we look out into the long vista of eternity and see the love of God breaking forth into time. It is an eternal reminder to a power drunk generation that love is most durable power in the world, and that it is at bottom the heartbeat of the moral cosmos."- from Paul’s Letter to American Christians (don't miss the last 5 minutes of the sermon, rarely recorded elsewhere, where he talks about how he grapples with his own failures to love others and takes those to the cross.)
Faith in the justice of God gives us hope that things will be made right, but it also motivates us to change things for our neighbors in need as we are drawn into reconciling relationships with them. Jesus helps us to reconcile the broken relationships we have with ourselves and with God by forgiving our sins (so incredibly important for our neighbors who have harmed others or been harmed); as that inward relationship is transformed we then have the resources to change our relationships with others.
“For he himself is our peace, who has made us both one and has broken down in his flesh the dividing wall of hostility [...] and might reconcile us both to God in one body through the cross, thereby killing the hostility. And he came and preached peace to you who were far off and peace to those who were near. For through him we both have access in one Spirit to the Father.” -Ephesians 2:14-18
Jesus was the pioneer when it comes to moving into a bad neighborhood; when he “became flesh and dwelt among us” he shared our pain and the suffering that our sins deserved in order to accomplish this great work of reconciliation. Through the liturgy of church we move together from this inward reconciliation to outward reconciliation; we work out the difficult practicalities of life together only after we have stood side-by-side to worship at the foot of the Cross, where my neighbors and I have no choice but to stand on level ground.
So many great initiatives across Baltimore—from the ones we love in Sandtown to ones that get written up in fancy journals, many important works of community development are happening in and around churches. At New Song, we have emphasized reconciliation, redistribution, and relocation for over 25 years and some marvelous things have happened by faith and through grace. There are even a few young men whose lives have been changed by relationships and pulled them out of the dark trajectory of violence towards something far more beautiful; they are now my teachers. Come and see for yourself if you like. There are many people in Baltimore who have a lot to give us if we are willing to come to church and listen.

Friday, January 31, 2014

the future of family medicine

The American Academy of Family Physicians is collecting thoughts now on the future of Family Medicine in America; I shared mine with them and figured that I would post them here:

Right now the health care cost curve is being broken across the backs of hospitals & specialists. I think that they'll come for primary care next. If we're not prepared, we'll find our reimbursements decreased and our specialty torn apart as the hospital systems that own us realize that the reimbursable services provided by MDs can often be provided by mid-level providers. Fighting against nurse practitioner independence wastes time, money, & energy-- we need to define the terms of our health care system. We're calling on our specialist colleagues to sacrifice for the good of the system-- we're going to have to sacrifice a few things, too.

I think that Family Medicine needs to recognize that most primary preventive care doesn't belong in the medical silo at all. To this end, we should support the development of community health worker programs made up of residents local to a particular area who are responsible for giving vaccinations, doing basic health education for simple chronic diseases, and following the protocols for screening that clutter our computer screens. While providing preventive care and talking to patients who don't have very many medical problems is an enjoyable part of practice, we must recognize that our medical degrees overqualify us for such tasks and we should be doing them about as often as we are teaching our patients how to give themselves insulin-- it happens and we can do it well because we understand how it works, but it shouldn't be our bread and butter.

Family Medicine doctors should then focus on mastering the knowledge and expertise that we have acquired during our medical education and residency: managing multiple complex chronic diseases, especially with psychosocial comorbidities. We should be supervising and leading teams of CHWs & mid-levels who are managing the simpler medical issues, as is often the case in many other countries around the world. We should also embrace a more active role in coordinating care across the inpatient/outpatient divide; more family doctors should seek inpatient privileges and care for their patients in the hospital. This is one of the ways that we can avoid become aloof consultants ourselves. We should learn as much as possible about diseases like sickle cell & cystic fibrosis so that we can help transition these patients from their pediatric specialists to adult ones.

Another important aspect to our role as family doctors is embracing public health and population health; we should be spending our time not just in seeing very sick patients but also addressing the structural issues pertaining to our local neighborhoods where our patients live. Capitation may be one way to help tie particular doctors to particular communities, but it is not necessary if we are living in the same places as our patients and getting to know their neighborhoods & leaders. Our residencies should emphasize leadership training as well as opportunities to engage local communities. In case somehow you missed my endless self-promotion about it when it came out, I wrote about this in my Family Medicine Educational Consortium "This We Believe" essay entitled Proximity, Vulnerability, Faith, & Love.

We are too well-trained to order colonoscopies and flu shots all day. Family doctors should find the sickest patients and care for them in a relational, longitudinal, team-based manner that demonstrates our value to payers, hospitals, and specialists and forces them to recognize our role in health care.

Tuesday, November 5, 2013

Proximity, Vulnerability, Faith & Love: This We Believe

The Family Medicine Educational Consortium (an organization that I love being a part of!) hosts an annual "This We Believe" contest modeled off of the NPR "This We Believe" project, featuring family physicians sharing their beliefs and how those beliefs affect their work (a tremendous example on the subject of dying given by one of my mentors on death can be viewed here.) I was honored to be one of three award winners (check out the others here!) this year and the following is an expanded version of what I presented in the plenary session on Sunday, November 3rd.


I believe that transformation requires proximity.
I believe that proximity requires vulnerability.
I believe that vulnerability requires faith & love.

When I talk to a patient or my wife or anyone else that I want to have a conversation with, we have to be engaged with one another, and usually this requires physical distance. If we’re on the phone or Skyping or FaceTiming, there must be no other distractions. If my attention is drawn elsewhere—by my pager, by my cell phone, by something moving in the periphery of my vision—we’ve lost that proximity. We can diagnose an illness over the phone, fill a prescription with a fax machine, or we can even blow someone up from another country. But we can’t take off a mole or remove their appendix—much less get to know a person for who they are—unless we get close to them.

           If we can’t even really exchange ideas without practically being face-to-face, we certainly can’t change people from far away. While medical technology proliferates and invades every patient encounter that we have, family physicians in particular still have that all-important trump card that is suited for every clinical scenario imaginable: the patient-physician relationship. Technology can help our relationships. It can also kill them. The people who get money and glory as technology proliferates may tell you that technology is neutral; that’s nonsense. A scalpel isn’t neutral; it’s usually dangerous unless it’s held by the right person and pointed in the right direction.

           Any technology which puts more distance between us and our patients has the potential to cause more harm; while the most obvious recent examples of this are electronic medical records I am more particularly fascinated by the automobile and the airplane as technologies that purport to bring people together but also enable them to be further apart.

           It used to be a lot harder for doctors to go from one country to another—whether it was physicians coming from countries with less developed medical systems to study in more technologically advanced countries or physicians from here going there. Now a capable and brilliant doctor from anywhere in the world can leave his already under-resourced home country for a more secure position, and the capable and brilliant doctor from an over-resourced technological Mecca can pop in anywhere in the world for a week to hand out some antibiotics and then go home. I hope you can see who is the benefactor in these situations.

           Similarly, it used to be that you just about had to live in the same place where you worked; now you can live, work, worship, play, and be entertained in different places without the ties of proximity to hold you down. There are, of course, advantages to this—but now the disadvantage, particularly for us doctors, is that we have the freedom to be disconnected from the everyday concerns of our patients and the local history & knowledge of the places where they live, work, worship, and play. We can discharge our duties as a physician and simply be a cog in the machine.

           As Wendell Berry (a farmer and writer who has done much to advance this line of thought) once said, “A community is the mental and spiritual condition of knowing that the place is shared, and that the people who share the place define and limit the possibilities of each other's lives. It is the knowledge that people have of each other, their concern for each other, their trust in each other, the freedom with which they come and go among themselves.” Every community has its own local history, its own assets, its own weaknesses. In every place, there are people who are fierce advocates for their neighbors who disadvantage themselves for the sake of others and there are people always looking for an opportunity to take advantage of someone else.

         In my own community of Sandtown in West Baltimore—where the average life expectancy is 65 years young and the infant mortality rate is triple the national average—the needs of the community can only be appreciated by people who take the time to listen. My neighbors have been assaulted by surveys— a hazard, I guess, if you live close enough to multiple academic centers. They have had a lot of people pop in to ask a few questions and then go. They have not had a lot of people come in to mentor them, to develop leaders, to suffer with them. True compassion literally means “suffer with.” As I have piloted a mental health outreach in my neighborhood and tried to find leaders within the community to deal with the severe emotional and behavioral issues that make up the day-to-day reality of inner-city Baltimore, I have had to share in the sufferings of my neighbors, especially within my church. Yet my presence nearby gives me the ability to connect with people that I would not have otherwise.

           My long-term goal is to go overseas and teach at a family medicine residency in an under-resourced country. I want to give physicians in these places the opportunity to become leaders among their own people without ever leaving and reverse the trends that suck the local resources away. While there are a lot of excellent medical education opportunities that are short-term in nature that use technology to its absolute highest benefit, anyone involved a residency can attest that if I want to really see residents flourish, I’m going to have to live there. One such residency in Afghanistan has seen a lot of turmoil, but it is through those experiences that the physicians are bonded to their community.

           If we want to see change in a community, we have to be there. Physically. And if not physically, then our hearts and minds and eyes and hands and our pain must be there. This brings up vulnerability. Proximity requires vulnerability. You have to expose yourself to the risk of being hurt—something that everyone who has ever invested in a patient-physician relationship knows.

           I think it is certainly possible to do a lot of good at a distance. I think that good boundaries are essential, as we must carefully search where vulnerability is indicated. Like the scalpel, it can destroy a patient and their community or save them. Yet when I look at—for example—the School of Public Health at a very well-recognized university in my city and the neighborhood just a block away and the hundred years of history that have transpired between them, I have to suppose that we have drawn our boundaries a little too far.
           Vulnerability requires faith & love. There is on one hand, the faith that every now and then, your suffering will be obviously worth it and your sacrifice will yield fruit; when we see patients that we stayed up late for or argued with their insurance companies on behalf of that are living healthier we can rejoice. And I do think that is an enormous benefit. Yet we also must know that such a scenario won’t always play out, indeed, we could end up more hurt than ever before.

           C.S. Lewis once said, ““There is no safe investment. To love at all is to be vulnerable. Love anything, and your heart will certainly be wrung and possibly be broken. If you want to make sure of keeping it intact, you must give your heart to no one […] The only place outside Heaven where you can be perfectly safe from all the dangers and perturbations of love is Hell.”

           I’m sure that using the word “love” regarding a patient-physician relationship may raise a few eyebrows. However, even the most detached and cautious doctor has felt love towards a patient—not love as a mere emotional sentiment, but as a guiding commitment to care for someone appropriately regardless of the cost.

           I take care of a lot of people who make bad decisions. Many of them involve the greatest proximity you can have with another person. Many times that decision makes another person. Many times I wonder to myself as I’m talking to someone, “why on earth would you give such a sacred part of yourself to this idiot who doesn’t even have the decency to hold your hand while you’re giving birth?” I am terrified by the number of people who are like this.

           I was born at the hospital that I work at. My parents were those people, broken people from broken families. They had no idea what they were doing when I was born. They were loved abundantly by others who gave and gave, which in time transformed them into parents who could love me. But that knowledge—that very, very local and proximal knowledge—always teaches me that I could very well be the second generation sitting in my office, having just brazenly impregnated a woman without any regard for her well-being. That component of vulnerability—the humility to admit that the love I have received has changed me and put me on the doctors’ stool and not on the examining table—is difficult and a fine line must be walked when cultivating relationships with patients. But it can be done.

           How? I can only tell you my answer. You’ll have to figure out your own. For me, I am inspired by meditating on the fact that “The Word became flesh and dwelt among us.” Jesus became flesh and moved into the neighborhood.  He suffered on our behalf—because of his enormous love—to transform our human community. His death & resurrection sealed the promise of victory over death and suffering. His righteous life was not just an example for us of how incarnation leads to transformation-- it was righteousness lived on our behalf that we inhabit as we trust in Him for the forgiveness of our sins. Martin Luther King Jr. said that “The arc of the moral universe is long, but it bends towards justice.” We can know that’s true because Jesus did it first.

What we do as a community is imitate that willingness to suffer on the behalf of others and receive the transforming work of the Holy Spirit that helps us learn to suffer well. When we find our vulnerabilities, weaknesses, sins, and suffering that we experience, we take them to Him. Even when we fail our patients or our patients fail us, we’re guarded from cynicism and despair because we know that we’re just on the near side of the arc of history-- and we’re still getting closer to victory. My tiny little part in that victory is helping people in my neighborhood find mental health care and teaching residents overseas.

This we believe.