Why Joan of Arc matters to beleaguered public health

Milla as Joan
Milla Jovovich in her role as Joan of Arc in the film The Messenger: the Story of Joan of Arc.

Recently, I watched a movie about the life of Joan of Arc (Jeanne d’Arc) called The Messenger, the Story of Joan of Arc by French director Luc Besson and starring Milla Jovovich. Though the movie got tepid reviews, I was mesmerized by it.

The period epic faithfully re-tells many key moments in the short life of the world-renown young French leader, including her actual words that were recorded in detailed written accounts. I found the movie intoxicating because of Jovivich’s exuberance as Joan, inspiring her countrymen to arms to free their nation, ensuring the crowning of the Dauphin Prince in the Reims Cathedral as King, and following in her view the will of God.

Few other single individuals had such an impact on world history as this illiterate peasant girl, who rose to prominence in a violent male world and became one of history’s greatest and most inspirational figures—and a saint for Catholic believers. In fact, at the mess hall at West Point, a mural depicting history’s greatest military leaders includes a rendition of Joan, with her holding a sword and in full body armor.

In fact no single historic figure from Europe during the 100 Years War between France and England remains as famous today as Joan. By the age of 17, she unswervingly acted on voices in her head telling her to drive the English from France and crown Charles VII as King of France. This came at France’s weakest moment in its history, with the English and Burgundians in control of half the country.

Yet, this virtual unknown girl never waivered. She gained access to the French court in the spring of 1429 in Chinon, France. She withstood questions from learned and suspicious church officials and a virginity test. She arrived in the besieged city of Orleans in April that year, bearing a standard and ready for action.

In defiance of cautious male commanders, she singlehandedly helped lead the French to defeat the attacking English, suffering several nearly fatal injuries. Her foes called her a witch and remained fearful of her talismanic powers. She brought together violent, power hungry men, like the Count of Dunois and the Duke of Alencon, around a common cause to the point they even would stop swearing and offered blind loyalty to her. Most importantly, she restored confidence of the French people around a common goal. Soon, all of Europe was talking about the Maid of Orleans and her battlefield exploits.

Joan Burning Picture
Joan of Arc being burned at the stake after being tried by the English and church leaders in 1431. She was only 19 years old.

By July that year, Charles VII was crowned king. Yet within a year, the young peasant who worked miracles was captured and ransomed to the English, tried as a heretic, and burned at the stake in Rouen on May 27, 1431, for having worn men’s clothes, no less.

Five centuries after her murder, she was pronounced a saint by the Catholic Church for the miracles that are linked to her remarkable accomplishments. While she did promote violence, she always offered her opponents opportunities for peaceful alternatives, and she reportedly showed great kindness to those captured.

So why should anyone in public health care about Joan of Arc?

As a student of history, I found many elements of her remarkable story relevant for my reality. Instead of beleaguered 15th century France, I find myself in the reality of the beleaguered U.S. public health system.

Religion you say? That has nothing to do with healthcare and public health, right? Well, that ignores the fact that religion has everything to do with healthcare and public health. For example:

Well, an illiterate peasant girl can teach nothing of value to doctors, PhDs, and other well-educated professionals who run our nation’s public health system, right?

I recently read an article highlighting leadership and public health. Some of the attributes associated with leadership include: serving, complex thinking, being a change agent, self-empowerment to empower others, risking failure, creating a future one envisions, and being confident in one’s beliefs and then living the change one wants. I am actually hard-pressed to find examples of such traits in leaders in my field who are resonating widely with the American public. Joan of Arc consistently showed all of these leadership traits, from risking her life on the field, to being a catalyst, to having supreme confidence in her vision.

Former U.S. Surgeon General and "Public Health Hero" Dr. David Satcher.
Former U.S. Surgeon General and “Public Health Hero” Dr. David Satcher.

In the United States, there are always “unsung hero” awards for people who no one outside of the particular field giving the award have heard of, or even care about, it seems. While these may help sustain the field of providers, they likely do little to inspire the public.

The University of California Berkeley in February held its annual event for “public health heroes,” awarding its 2013 prize to former U.S. Surgeon General Dr. David Satcher. However, I doubt few Americans know who Dr. Satcher is, what he accomplished, and why such facts matter to the nation’s crisis of promoting public health in the 21st century.

This is not to belittle Dr. Satcher’s many accomplishments, such as his calling attention to the oral health epidemic in the United States. (Oral health experts have been talking about his report for more than a decade because he and it were spot on.)

Public health, teetering like France before the arrival of Joan of Arc?

Of course medieval France has nothing in common with the reality of modern America and its healthcare system, right? But if you take the view of that history can teach open-minded students of the present many valuable lessons, regardless of their field, one might find parallels.

France at Joan’s time was on the verge of collapse, lacking strong leadership and a vision to restore hope and unity. Joan arrived completely confident in her vision and religious mission, and she never wasted a day. She famously said, “Better today than tomorrow, better tomorrow than the day after.” She also is remembered by her words, “go forth boldly.” Such words and such inspiration are lacking in the U.S. public health system, to me at least.

For those working in the field of public health, one is constantly exposed to the reality of budget cuts that continue to hack away at programs that do everything to promote chronic disease interventions to immunizations. Between 2008 and 2010 alone, in the aftermath of the Great Recession, more than half of all local public health departments had cut core funding and shed 23,000 jobs, as well as cut programs, mainly due to falling tax revenues that hammered local and state funding.

Things continue to spiral downward as the recession’s effects linger, and mandatory across the board federal budget cuts known as the sequester will soon impact every local public health department in the country and national agencies who help fund local efforts.  The Public Health Institute warned that sequester related cuts will be “devastating to the public’s health.” Such cuts, the institute says, “will cost jobs and resources in the short run, and the long-term costs—in money and lives—will be borne by families and communities for years to come.”

Crises also prevent departments from looking to innovation as they focus on life support and triage. Morale suffers, which impacts service and core functions. Leadership, perhaps what little that may exist in this beleaguered environment, is lacking. Public health managers struggle to connect with the public about what public health is and why it matters.

They fail to show that the U.S. health system’s treatment, not prevention, focus is largely unsustainable for the population’s health and the economy. In 2009, U.S. public health spending (at all governmental levels) amounted to $76.2 billion – only 3% of the nation’s overall healthcare outlays of $2.5 trillion. Yet, chronic diseases, which public health efforts can address, make up three quarters of all health care costs.

Public health spending versus all other healthcare spending in the United States.
Public health spending, as measured as billions of dollars, versus all other healthcare spending in the United States and spending on chronic diseases and all other healthcare costs.

Reform does happen, and it can be bold when breakthroughs capture the public’s and globe’s attention.

HIV/AIDS assistance, which is now at the heart of a larger global public health agenda, was launched in the late 1990s when activists outside of the medical and public health establishment demanded that antiretroviral drugs, or ARVs, be made available to many of the world’s poorest and most afflicted nations, most in Africa, to reduce the spread of the virus inside the bodies of infected people and make it possible for them to live long lives.

It was not reformers inside “the system,” it was radicals outside “the system,” who offered a clear vision and the groundswell for change that the establishment eventually fully embraced.

As someone who works inside “the bureaucracy,” however, I am ever mindful of how the great Joan of Arc was ultimately marginalized, tortured, and burned alive at the stake for her completely unorthodox ways that challenged nearly all in authority in her day. The English did not trigger her downfall, it was palace politics and sexism, and likely fear of her power.

Joan statue
One of many Joan of Arc statues in France honoring one of the French nation’s greatest heroes.

The lessons are telling today. You can work miracles, but the machinations of any bureaucratic system can be deadlier than slings and arrows of a battlefield of your sworn enemies. You could transpose the palace intrigues of 15th century French and English courts to any bureaucracy today and it would be a near perfect fit, really. Would any bureaucratic leader trust an uneducated, poor, unconnected interloper to provide a vision for change for the failing health and public health system, such as the one facing the United States in 2013?

Sure, such a thought is laughable, but it happened, and can happen again. It may even be needed if things continue on the present course.

In the end, no one remembers the bishops who tried and convicted Joan or the weak king she helped to bring to power, or in fact any of the kings of her day. Likewise, no one remembers or cares about bureaucrats in the end. Why? Quite simply they are not visionaries.

It is Joan who has statues in her honor, countless biographies recounting her legend, and many movies and documentaries exploring her incredible exploits.


Coptic Christians under assault, and memories of my Egyptian travels

On April 7, a mob in Cairo attacked a funeral procession of Coptic Christians, a minority in the now Muslim Brotherhood-led nation of Egypt. The attackers became violent during their seige, firing guns and throwing petrol bombs according to press reports. Prior to the fall of former president and practically dictator for life, Hosni Mubarak, state police protected Christian monasteries and churches in Egypt, due to the historic persecution of the minority Christians over decades.

Coptic Egyptians protest the assault that killed two and left nearly 100 injured at St. Mark's Cathedral in Cairo on April 7, 2013.
Coptic Egyptians protest the assault that killed two and left nearly 100 injured at St. Mark’s Cathedral in Cairo on April 7, 2013.

During the violent outburst at St. Mark’s Cathedral, two persons were killed and nearly 100 were injured. Christians inside the walled compound sustained what was called a “frenzied assault” from unknown perpetrators.

I visited in Egypt in 2004 and saw well-armed and manned police garrisons at multiple monasteries, including those in unpopulated areas, as well as at St. Mark’s Cathedral, the seat of the Coptic Christian Church. Amid the disintegration of Egyptian civil society and the ascendancy of the long-banned Muslim Brotherhood, Coptic Christians and their most sacred sanctuaries are now under direct assault. Tensions have escalated since the election of U.S.-educated and Islamist Mohamed Morsi as Egypt’s president in June 2012.

Egypt’s Coptic leaders had grown increasingly wary of worsening conditions over the last five years, particularly since the demise of U.S.-backed Hosni Mubarak. Muslim clerics, the Muslim Brotherhood, and its political wing, the Freedom and Justice Party, are credited by some media observers for inciting views hostile to the nation’s Christian minority.

Inside Bishoi Monastery, one of the oldest Coptic monasteries in Egypt 2004)
Inside Bishoi Monastery, one of the oldest Coptic monasteries in Egypt (2004).
Coptic Christians, like the young men seen here from my 2004 photo, are a persecuted minority in Egypt.
Coptic Christians, like the young men seen here from my 2004 photo, are a persecuted minority in Egypt.

In 2009, amid the swine flu scare, the Mubarak government destroyed more than 300,000 pigs, which was rebuked by the United Nations as unnecessary. Many believed the act was motivated Islam’s prohibition for eating pigs and the fact that Egypt’s pork industry is run almost entirely by Copts, many the urban poor.

One blogger wrote, “It is a national campaign to rid the country of its estimated 300,000 pigs in the name of public health.”

Copts allege the military council in the post-Mubarak era—the military still runs many Egyptian institutions and business sectors—is doing little against perpetrators of the attacks. Copts also have long complained of discrimination, including a law requiring presidential permission for churches to be built.

The Daily Star Newspaper of Lebanon reports that many Copts question their future as Egyptians. The paper notes the latest round of violence is the worse since Morsi was elected in June 2012: “Christians have been worrying about the rise of militant Islamists since the fall of President Hosni Mubarak in 2011. But after days of fighting at the cathedral and a town outside Cairo killing eight – the worst sectarian strife since Islamist President Mohammad Morsi was elected in June [2012]–many Copts now question whether they have a future in Egypt.”

Who are the Copts?

Today, Copts purportedly number about one in every 10 of Egypt’s 85 million residents. However, official statistics placed them at half that figure, or 5 million. The Coptic Church challenges that estimate, pegging their numbers at 15-18 million.

Father Tawdros at St. Anthony's Monastery in Egypt, taken in 2004.
Father Tawdros at St. Anthony’s Monastery in Egypt, taken in 2004.

The original term “Copt” simply meant a native Egyptian with no religious connotation, only later taking on its religious meaning today.

The Coptic Church is among the oldest Christian churches, preceding Islam’s arrival in Egypt by centuries in a land that is central to Judaism and Christianity. Some of the most important places to both faiths are within Egypt’s border, including Mt. Sinai and St. Catherine’s Monastery in the Sinai Peninsula.

The Copts split from the Eastern Orthodox and Roman Catholic Churches in 451 AD over a theological dispute over the nature of Christ. Today Copts are more similar to the Eastern Orthodox Church and perhaps the Armenian Orthodox church. In addition, the Coptic language, which is similar to the ancient Egyptian language, and written with the Greek alphabet, is still used in parts of Coptic services.

Increasing violence targets Christian minorities in the Middle East

Among the worst attacks on Egypt’s Coptic minority in recent years was the 2010-11 New Year’s Eve bombing in Alexandria. It targeted a Coptic church and killed 21. No individual has been arrested or brought to trial for the terrorist attack in one of Egypt’s most cosmopolitan and historic cities. The deed was largely forgotten with the world’s attention focussed on the “Arab Spring.”

Since the U.S.-led overthrow of Saddam Hussein in Iraq in 2003, Christians throughout the Middle East have been feeling increasingly under siege. Terrorist attacks and murders of Christians have occurred widely in many countries. (See map of the dispersion of Christians throughout the region—in all cases Christians had preceded the ascendency of Islam, but today are distinct minority communities.)christians middleeast

In Egypt and to a greater degree civil-war plagued Syria, the “Arab Spring” has brought intense disorder and violence to many minorities and minority faiths (Christians, Chaldeans, Kurds, Alawites, among others). Christians regionally remain fearful of a peaceful future of coexistence in the region that gave birth to contemporary Christianity.

In Egypts, Copts are now claiming life was better under dictator Mubarak, who dealt brutally with Islamists and their radical military wing, who waged a military and political campaign for decades.

Many Copts believe Muslim radicals want to eradicate Christianity, whose roots in Egypt predate the Islamic era.

According to an article published by the Middle East Quarterly, Muslim rulers historically have denied collective minority rights of non-believers. The concept of dhimmitude—itself a controversial term—explains the Islamic practice of denying equality to Jews and Christians, who historically since the Middle Ages have lived within the political realm of Muslim rulers and nations. Islam provided religious autonomy, not national freedom. To be fair, political rights for many groups, women, economic classes, and faiths everywhere in the world have not been fully realized until the last two centuries, and slowly at best and still not even today.

Memories of monasteries and my travels in Egypt

Whenever overseas events occur, it is often impossible to feel a connection to them. For me, in the case of Egypt, the collapse of Egyptian civil society has had great resonance for me. I had a chance to tour many parts of the country in 2004, observing the great poverty experienced by tens of millions of Egyptians on Mubarak’s corrupt rule. I was treated well, and I met many wonderful people, Muslim and Christians alike.

My visit to the St. George Monastery near Luxor required the permission of the local army commander for entire region around the Valley of the Kings (2004).
My visit to the St. Tawdros Monastery near Luxor required the permission of the local army commander for the entire region around the Valley of the Kings (taken in 2004).
Suryani Monastery (2004).

I also visited many remote monasteries throughout the country—St. Catherine’s in the Sinai (run by the Greek Orthodox), St. Anthony’s in a remote inland oasis 30 miles from the Red Sea, Bishoi and Suryani monasteries in the Wadi Natrun oasis about 80 miles northwest of Cairo, and St. George’s and St. Tawdros’s monasteries, in the desert near Luxor.

The monasteries date as far back the 4th century AD, preceding the Islamic Arab conquest of that followed in the seventh century. Today about 50 monasteries remain.

I found the Coptic monasteries to be breathtakingly beautiful and peaceful. These are continuously inhabited facilities, but also significant cultural and historic sites.

The monks who greeted me were generous and gave me tours of their facilities. At St. Tawdros’s Monastery, I required a police escort of no less than the commander of the entire military contingent protecting the Valley of Kings region, one of the most popular tourist destinations in Egypt and the scene of one of Egypt’s more violent terrorist assaults. At all of the compounds, there were armed guards in large numbers.

Those guards have now melted away. In fact, it was the Egyptian military that led a coordinated assault on the Bishoi Monastery in February 2011, shortly after the terrorist bombing in Alexandria.

The video shows nothing less than a full assault of armed men, equipped with armored personnel carriers and bulldozers, demolishing an outer protective wall that I recall seeing built during my 2004 visit. The government denied responsibility despite the glaring video evidence. Today the monastery, one of Egypt’s great historic treasures, is now at risk of increased mob and organized violence by Islamic radicals and political extremists.

Egyptian military were filmed leading an attack on the Bishoi monastery in February 2011, which destroyed a protected outer wall.
Click on the image to see the full video of the Egyptian military leading an attack on the Bishoi monastery in February 2011, which destroyed a protected outer wall.

I’m not sure what will happen in Egypt. It is likely Egypt’s Christians will remain a persecuted minority and some of the world’s greatest historic treasures will be desecrated by extremists and opportunists, as was seen after the U.S.-led invasion of Iraq and as the world is observing in Syria amid its civil war.