Facing Homelessness at Christmastime

I never give money to people on the street. I became convinced years ago that it was not a helpful thing to do. I am the physician for many homeless people in Memphis, Tennessee, and I know that giving them a few bucks does next to nothing to solve their long-term problems.

Still, last week, as I walked down Michigan Avenue in Chicago, I opened my wallet. It was beginning to snow, and the Christmas lights decorating the street glimmered against in the late-afternoon sky. It was beautiful. The streets were incredibly crowded with shoppers, tourists and commuters hurrying to their next destinations. As we waited to cross a street, my wife, Mary, nudged me and pointed to a woman sitting on the curb with an empty glass jar asking for money. She was rocking back and forth in the cold. I looked over and felt sorry for her, but I was ready to move on.

“Look at her leg,” Mary said.

It was awful. I’d seen open wounds like hers on people in the streets of India, but never in America. Her right lower leg was one big exposed, infected sore. It was as bad as anything I’ve ever seen in my office—and I’ve seen a lot. Her sign said, NEED MONEY FOR BANDAGES. I was drawn to her.

“What are you doing for your leg?”

“I just got out of the hospital. I’m going back to see the doctor in a couple of days.”

She never really looked at me.

It seemed to me that she was on the verge of losing her leg. As we talked, dozens of people passed by without really seeing us. The thought of taking her to our hotel room crossed my mind. Instead I reached into my wallet and pulled a twenty-dollar bill and stuck it in her jar. She thanked me profusely, and then Mary and I walked on. I continued to think about her. The next morning, we had breakfast with my brother who lives in Chicago. We told him about the woman. He said, “She used to sit down closer to the river. She’s been out on the street for a long time. Her leg looks awful, doesn’t it?”

There was no way she was faking her wound. But it made me wonder. I know no one would choose to live like that. Years ago, I was treating a patient and noticed his WILL WORK FOR FOOD sign in his backpack. He was plenty smart, so I asked him why he panhandled instead of working.

“I have a permit, and I make five times what I did with a real job.”

“A permit?” I asked.

“Yeah, you can’t beg without one or the cops will harass you. It’s free, but you have to go downtown to get it.” That was all news to me, but it didn’t surprise me that he made more money begging than working a minimum wage job. Still, that isn’t how it’s supposed to be. Not in America. I’ve learned that it’s actually hard to become homeless. To find yourself truly alone so that you have nowhere to turn when you can’t pay rent, you have to burn every bridge with every person who has ever loved you. Addiction and mental illness often accompany homelessness, making it even more difficult to inspire sympathy from friends and loved ones. That said, I know how difficult and expensive it will be for the woman with the leg wound to buy her medicine and bandages. I don’t regret giving her money, even if she’s been sitting on Michigan Avenue for a year.

Still, the moral dilemma of giving money to someone sitting on the street of an American city is something few of us ever come to grips with. Yes, we worry the person will just go buy beer. At the same time, we aren’t fully comfortable with just walking by, because there seems to be an unwritten tenet that no one in America should be forced to beg. On that, I think we could all agree.

Still, I am disturbed that I have no real solution to the problem. The root causes that lead people to beg are complicated, and I am just not sure what I am to do. And I don’t know anyone who is. But we could start with asking the questions and try to do more than shrug our shoulders at the complexity of the answers.



On Victories on the Field and in the Clinic

wrigley_field_400_foot_signI’ve been to many baseball games at Wrigley Field to see the Chicago Cubs play. The first time was in 1977. It was at the beginning of the season, a late-April game. I was of course looking forward to seeing the Cubs play, but my real excitement was finally visiting the sacred space that is Wrigley Field and seeing the famous ivy that covers the outfield wall.

My experience was not what I imagined it would be, though. It can be very cold in Chicago in April, and I almost froze to death as I sat in the stands. There were very few fans at the game – this was back when the Cubs were routinely terrible. But still, there was the ivy.

More disappointment. When I looked to the outfield wall, there was nothing but bare sticks totally absent of green. It was ugly, not beautiful as I imagined. How did I not know that the Wrigley Field ivy was deciduous? The leaves fall off in the late fall and do not return until the spring warms up.

I have always remembered that game and my disappointment, but I suspect every Cub fan will remember last night’s extra inning 7th game win of the World Series with a great deal more fondness. Last night, the Cub’s 108-year history of failure came to an end.

There is something to persevering when all seems hopeless.

This is indeed what makes me love my work at Church Health where we serve those who otherwise would be excluded from receiving the healthcare they deserve because of factors beyond their control. Every day I see people who year after year face insurmountable odds that life has put before them. Just this week in the clinic, we saw an Albanian woman who came to Memphis for an arranged marriage only to find her new husband was abusive. We saw a five-year-old boy whose eye turns out whose mother didn’t know where else to find help.

This is our daily work. It may seem futile, but it is not.

The Chicago Cubs have won the World Series because they spent millions of dollars assembling a superior team and they play in a wonderful city at what is arguably the best ball park in the world. They were always bound to win eventually. But it is not so of many of the people we seek to serve at Church Health. You could even argue that the chances of them “winning” are very small. They will always be talking about the inability to have the life God intended for them. But then, they find Church Health and their lives change. Our lives, too, are changed every day because of the richness we feel from being involved in their lives.

It is not the World Series, but it is in some ways better. The joy they have in having their health restored lasts longer than the fleeting moments of a sports victory.

My brother lives in Chicago and I’m sure he will be there as the Cubs march down Michigan Avenue celebrating their win. I will smile for those who feel a sense of happiness in their victory. But I will most likely be in the clinic when the parade happens.

And that next person whose life we help change will give me true joy in knowing that the power of a healthy life is even better than a game-seven, extra-inning win.

Let’s Talk About the C Word

The C-Word postI have just returned from the Democratic National Convention in Philadelphia.

No, I did not meet Bernie or Hillary. In fact, my agenda had absolutely nothing to do with politics. (Thank God).

But I did have an agenda: to promote the idea that it’s time to rethink cancer.

I was in Philadelphia earlier this week to speak on a panel after a screening of a new documentary film called “The C Word“. The Church Health Center is featured prominently in the movie, which will be in theaters this fall and on Netflix in the spring. It is narrated by Morgan Freeman and produced and directed by the Academy Award-nominated director Meghan O’Hara.

You can watch the trailer here:

The movie is about how cancer can be prevented through improved eating habits, exercise, and stress reduction. Does that sound familiar? It should; the Church Health Center has been preaching prevention for nearly 30 years. The movie centers around a French physician, Dr. David Servan-Schreiber, who developed brain cancer then aggressively began treating himself with the basics of good nutrition, exercise and stress reduction. He then wrote a popular book titled Anticancer: A New Way of Life. He doesn’t advocate a fad diet or his own special treatment plan.

The movie also uncovers ways our lifestyles contribute to the cancer epidemic in the US. But what’s disturbing is that even if we vigilantly do everything we can to avoid cancer, the deck is often stacked against us. Did you know that tobacco companies now own all the major food distributors in America? Or that when a food label uses the term “fragrance” as an ingredient, there is a list of carcinogens that can be included in that term? The movie reveals a great deal of similar information and is extremely thought-provoking.

A portion of the documentary includes several interviews with me, but I am proudest of the Jones family that the movie tracks over a year. Several members of the family lost significant weight by attending our Wellness center and working with our health coaches. They are the real stars of the film.

My hotel in Philadelphia was located downtown near Independence Hall. Staying there reminded me of Benjamin Franklin’s famous quote, “An ounce of prevention is worth a pound of cure.” Franklin wrote that after returning to Philadelphia from Boston in 1735. Impressed with Boston’s fire prevention programs, he sent an anonymous letter to the Philadelphia Gazette with suggestions for how fire prevention could be enhanced in the city. It included avoiding “carrying live coals in a full shovel out of one room to another.” His commonsense suggestions led to licensing chimney sweeps and requiring homeowners to have leather buckets in which to carry coal.

Of course, common sense only seems so in hindsight. It takes an incredible amount of work to make real headway in the way we rethink health and then push for effective implementation of that new way of thinking.

Franklin’s suggestions about fire prevention have parallels in today’s healthcare landscape where we’re constantly talking about prevention of chronic health issues like cancer. It’s my hope that the lessons of The C Word will be heeded.

A “Cure” for Type 1 Diabetes is Not One-Size-Fits-All

Today, I treated someone who has type 1 diabetes mellitus. While it’s common for me to see people with diabetes multiple times a day, this consult was unique. Most diabetics I see weigh well over 200 pounds, but this gentleman weighed barely 130 pounds. Being diagnosed at age 14, he knew a great deal about diabetes.

Now in his mid-twenties, he takes insulin shots several times a day and knows how to check his blood sugar. He knows all the right foods to eat, but still his diabetes was poorly controlled because he is what is called a “brittle” diabetic. Brittle diabetics suffer from dramatic blood sugar spikes and drops, often without warning.

He is the perfect candidate for a new and promising research study that will allow the transplantation of insulin-producing cells into the bodies of type 1 diabetics just like him.

But did you know that less than 10% of all diabetics are type 1?

My patient today was in the minority of the diabetics I treat. Almost everyone I treat has type 2 diabetes, which is in many ways a completely different disease. Type 2 diabetes is determined more by lifestyle and eating habits than by insulin-producing cells.

FACT: Our bodies live off of sugar.

Everything we eat is chewed up and swallowed into our stomachs. Our intestines then turn all food, no matter where it came from, into sugar. That sugar goes into our bloodstream and travels to the cells of our organs. This is where the problem arises. The sugar needs to get into the cells but cannot do it on its own. It needs help, and that’s where insulin comes in. Insulin is produced by our bodies and floats around in our blood until it comes upon the sugar. It then grabs hold of the insulin and connects it to insulin receptors that are attached to the walls of the cells, sort of like a key to a door. Once connected, the sugar enters the cells and the sugar is converted to energy.

Make sense?

With type 1 diabetes, there is a problem with the insulin. With type 2 diabetes, problems arise because of a patient’s lifestyle.

The pills that are used to remedy type 2 diabetes work to make the body’s insulin more effective. These pills don’t work with type 1 patients because the person’s insulin is totally broken.

With type 2 diabetes, there is also the issue of the receptor being “sick”. Interestingly enough, it is often possible to improve the health of the receptors by doing those things that we should all be doing anyway, things like exercising and eating more fruits and vegetables. This is why we strongly encourage all type 2 diabetics to join our Wellness center and work with our dietician on ways to eat better and exercise more. As a Certified Medical Fitness Facility, Church Health Center Wellness is equipped to serve the needs of those struggling with chronic diseases like type 2 diabetes.

I truly hope that the high tech “cure” for diabetes happens in the near future, but if it does it will only be for the small number of people who have type 1 diabetes.

For the lion’s share of people with diabetes and all the terrible consequences it can lead to, the best treatment is prevention.

A Lesson in Kindness From Jimmy Carter

I was sad to hear last week of Pres. Jimmy Carter’s diagnosis with metastatic liver cancer. While his prognosis has not been released, it cannot be good. The cancer has already spread and he is 90 years old.

But I’m reminded of the legacy that Carter will leave behind as he enters the twilight of his life. It’s a legacy of standing up for what’s right on the world stage and extending small kindnesses when no one is watching.

A Lesson in Kindness from Jimmy Carter

I first learned of Jimmy Carter when I was a child. My grandfather was good friends with Lester Maddox, a renowned segregationist, who by happenstance was elected Lieutenant Governor of Georgia in 1966. But prior to his political career, Maddox ran a restaurant on the south side of Atlanta, where my family often ate lunch with my grandfather on Sunday afternoons when I was growing up. Each time we arrived at the Pickrick Restaurant, Maddox was always at the front door greeting people.

Everyone except African Americans, of course.

For some reason he kept a pick handle over the cash register, and one day when a group of African Americans tried to integrate his restaurant, he took the pick handle down and used it to keep them away.

The Pickrick soon became a rallying site for segregationists and Maddox began handing out and then selling pick handles. He was a bit of a clown, which is why he was friends with my grandfather, but I was enamored with his new celebrity although I didn’t understand the background of it.

At the time, Jimmy Carter was a young senator from south Georgia speaking out against Maddox and segregation. When he ran for the position for Governor of Georgia in 1966 – the same year Maddox was elected Lieutenant Governor – he was elected.

I first met Carter when my school’s singing group was preparing for a tour of Europe. We went to the Governor’s office in order to be tapped as his “ambassadors.” Clearly, somebody knew somebody. I still have that picture somewhere. I had long hair, but so did Carter. After all, it was the early 70’s.

When Carter ran for President in 1976, my father was living in Jacksonville, Florida. He went to hear Carter speak at a Kiwanis meeting, and when Carter heard he was from Georgia he came over to him and said, “Bill, it looks really good.” At the time Carter only polled 2% of the vote. Somehow he actually won.

Over the years I have met Carter a number of times, mostly after he opened the Carter Center in Atlanta. While I realize that many people see him as somewhat arrogant and hard to read, I have one memory that will always stick with me. In 1992, the Church Health Center was on the verge of celebrating its fifth birthday. It just so happened that at this time, Rosalynn Carter was here in Memphis for a speaking engagement. I arranged for someone to pass her an invitation for her husband to speak at our event. Who knows? Maybe he would.

A few weeks passed. Finally, I received a handwritten note from Pres. Carter:

Carter Note

It reads:

What you are doing is great! Under Dr. William Foege’s direction, The Carter Center will soon launch a nationwide effort to build on concepts like yours on churches and health.

I can’t attend your anniversary, but we’ll be learning from the video tape and your example.

Best Wishes,

Jimmy Carter

He did not have to do that. But it was personal, it was handwritten, and it was warm. I framed it and it has hung on my wall ever since. His note reminds me of how one small gesture can mean so much.

I have actually spoken at the Carter Center a couple of times. One of the original five interests of the Carter Center was to emphasize the link between faith and health. President Carter actually cares a lot about this idea.

So while I would never say I actually know the president, I do think he has been a part of my life in more than a casual way. He is a very good man. He is complex but he cares deeply about his faith and his country. There is much we can learn from him, and my prayers are with him and his family during this difficult time.

Walking the Walk: Why the Church Health Center Is Committed to Staff Health

Every day at the Church Health Center, we help people experience the life well-lived.

For some, that means receiving care at our clinic. For others, that means working with a personal trainer on our Sports Court to get the best out of their workout. For our youngest visitors, it means learning in Child Life how to establish healthy habits.

It is important that we not only tell people what they should do but show them that we are trying to do the same thing: live healthy lives. Our staff has many of the same health challenges as our patients. In order to help our staff along the way, a number of years ago we began a staff health program. Over the years we have worked hard to make it both enticing for our staff to participate and to present an effective program.

Of course, that is all easier said than done.

Walking the Walk

We have made a number of tweaks to the program and are still looking for the right process. We’re making strides because we have 84% of our employees currently participating. That compares to many companies that believe they are doing well if 25% participate in their staff health program.

Although living a healthy life is its own reward, the truth is that incentives help sweeten the pot. The Church Health Center’s staff health program includes incentives that strike the best balance of personal motivation, financial rewards, and coaches who can help show the way. I am a believer that you need all three. The program needs to be flexible enough for everyone’s needs.

This past spring, our staff was challenged to drink eight glasses of water a day. Maybe the Communications department had a little too much fun with this challenge.

This past spring, our staff was challenged to drink eight glasses of water a day. Maybe the Communications department had a little too much fun with this challenge.

Our program works like this. People set goals for themselves at the beginning of the year. We use an electronic log that allows staff to record their exercise, their eating habits, and their spiritual care. Along the way, we measure their exercise capacity, their flexibility, and a number of blood components such as cholesterol and blood sugar. People earn points as they achieve their goals and log their activity.

Based on a 500 point scale, people earn either a hundred dollars or a day off from work for every hundred points they achieve.

It is so important for us to be able to walk the walk and not just talk the talk. I took this seriously myself a year or so ago and lost almost 25 pounds. Happily, I have been able to keep the weight off while also doing routine exercise. A number of our employees have far more impressive results than that. Major weight loss and lifestyle changes have been logged and continue to evolve.

Our goal is to make living a healthy life the norm for anyone who is a part of the Church Health Center. To do so requires daily devotion to the task. It cannot be a fad and it cannot be done for the rewards. At the end of the day, true results are motivated by the desire to nurture the bodies God has given us. This must be the overriding thought when you are having a bad day and the chocolate cake is sitting right in front of you or you just want to blow off taking a walk. None of us are immune to falling into the pit or what John Bunyan in Pilgrims Progress called “the slough of despair.”

It is why we also set out free fruit bowls around the Center for when people need a snack. We encourage everyone to take advantage of their free membership to the Wellness Center if they do not have an easy place to exercise. And our employee health staff is just a phone call away to help you recommit to your goals. It is not easy, but it is doable.

Every year, we look at our aggregate numbers to see how we are doing. All in all, we are making progress. I still have a goal of 100% participation but I am told that is not reasonable, although I am not sure why. I do, however, believe we can commit to offering to our staff the chance to adopt healthy behaviors whenever someone is ready to make the change. I strongly believe that this is one of the best ways to find our path toward God. It will never be that we always feel connected to God, but we can always be moving toward God. Sometimes that might mean we are just literally walking on the path when our minds are distracted but our bodies and our spirits are one and if either is aimed in the right direction, it is of God.

Top 10 Church Health Center Myths

After doing the work of the Church Health Center for almost 28 years, it is easy for me to come to work every day and think nothing has changed. After all, my office is in the same room it has always been, and in my head I am still 33 years old. (Please don’t laugh.)

There have, however, been enormous changes to our ministry in those past 28 years, and even more are on the horizon with the move to Crosstown Concourse well on the way. As a result, many people misunderstand the extent of the work we are doing. Here are the 10 most common misconceptions people have of the Church Health Center.

Top 10 Myths about the Church Health Center

1. We are a small clinic on the corner.

Actually, we are the largest privately-funded, faith-based clinic in the country, caring for over 70,000 working but uninsured patients. We help faith communities all over Memphis establish health ministries in their congregations. Our Wellness facility boasts an affordable gym and a demonstration kitchen where everyone in our community is welcome. We have a preschool because we believe that education is a health issue.

We are a clinic, but we are so much more. We’re moving the needle on health disparities and helping people live their healthiest, happiest lives.

2. Because of the Affordable Care Act, the Church Health Center is no longer needed.

There were 26 million uninsured Americans when we opened our doors in 1987. Fast forward to 2010 when the ACA began, and that number had risen to between 50-60 million plus the immigrant population. The ACA has helped 11 million people get health insurance, but that means there are millions more uninsured people now than when we began. The ACA has too many gaps to count, and the Church Health Center fills those gaps.

3. We only treat colds and minor illnesses.

Not even close. We care for the full gamut of healthcare needs because the uninsured get sick with the same things that the insured do. From broken bones to life-threatening cancer, our 1,000 physician volunteers allow us to achieve our goal of providing the same quality of care you would want your mother to receive. We offer dentistry and optometry. We offer counseling services and physical therapy. We’re here to care for your whole body, mind, and spirit.

4. We are just a doctor’s office.

In fact, our goal is that for every dollar we spend on treatment we spend a dollar on prevention. Our wellness programs are extensive, ranging from nutrition, to fitness, to spiritual care.

5. Our Wellness Center is just for our patients.

It is actually open to everyone in our community, uninsured and insured alike. There are no income requirements to become a member. Anyone can join and pay on a sliding scale according to their income.

FM berries6. Our Wellness Center is just a gym.

It is actually a Certified Medical Fitness Center. That means we have staff trained to help you return to your highest level of wellness after you have had a stroke, knee surgery, or heart attack. Church Health Center Wellness also houses Child Life, which is far more than daycare for your kids while you run on the treadmill. Church Health Center Child Life offers engaging staff and curricula that prepare our youngest members to be healthy for life.

Need more proof that Church Health Center Wellness is more than a gym? We host a farmers market during the summer. When was the last time you bought a locally-grown tomato at the chain gym up the street?

Have you received your copy of the Church Health Reader? Subscribe here!

Have you received your copy of the Church Health Reader? Subscribe here!

7. We are only touching lives in Memphis.

Actually, we are a national, even international organization. Our magazine Church Health Reader is read all over the world and we are the home of the International Parish Nurse Resource Center, which has trained over 15,000 nurses worldwide to work in faith communities.

8. Health is only about what the doctor does.

That actually has very little with being healthy; 10%, to be precise. For that reason, we run a preschool called Perea. We have a wide array of health programs that have nothing to do with the doctor. We believe that change in healthcare starts with you. Healthcare we can live with starts with growing a new culture that features dignity, community, giving, and prevention.

9. We are a government-funded health clinic.

Nope. We keep our doors open because of the generosity of the wonderful people in our community, congregations, businesses, and foundations. We must raise almost $14 million a year to keep our doors open.

10. I am about to retire.

Sorry, that’s a myth too. I will retire only when I cannot physically come to work. Antony Sheehan has joined the Center as the President and is helping to lead us to our new home at Crosstown, but he and I are working side-by-side and will be doing that for years to come.

The most important point I am making is that the Church Health Center will and needs to exist in perpetuity. Jesus said that the poor will always be among us, so we will, too.

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