Detroit’s complex legacy in the National Florence Crittenton Mission

In researching material for my forthcoming book on the institution of American adoption, I have been collecting stories along with historical documentation and photos of the hospital where I was born in Detroit.

Florence Crittenton Home and Hospital Detroit, 1932. Source: Fifty Years' Work with Girls, 1883-1933: A Story of the Florence Crittenton Homes

The Florence Crittenton Home and Hospital in Detroit, taken in 1932. Source: Fifty Years’ Work with Girls, 1883-1933: A Story of the Florence Crittenton Homes.

At the time of my birth, the facility was called Crittenton General Hospital. It was created by the National Florence Crittenton Mission, a group started in 1883 to serve prostitutes, fallen and vulnerable women, and women who were pregnant out of marriage. This was a social group who were exploited and scorned, and the organization sought to assist them by giving them shelter, training in remedial women’s occupations, and, if possible, the space to build new lives.

As the mission’s 1933 publication states, the organization sought to rescue “young girls, both sinned against and sinning,” and to restore “them to the world strengthened against temptation and fitted in some measure to maintain themselves by work.”

In 1933, a half century after its founding, the organization had already served half a million women. Nearly all were white, and they were cared for around the country and even Canada–from sunny Florida, to rainy Oregon, to my home state of Michigan.

The Crittenton mission was uniquely reformist in the American progressive tradition. It was also deeply faith-based. Its strong public-health orientation proved equally important. It tried to improve the health and livelihoods of vulnerable groups and took an active role in training the newly created class of professional social workers.

Source: Fifty Years' Work with Girls, 1883-1933: A Story of the Florence Crittenton Homes.

Source: Fifty Years’ Work with Girls, 1883-1933: A Story of the Florence Crittenton Homes.

This combination made it a distinctly American institution. It touched the lives of generations of women who passed through its doors, and equally the children who were born either at the Crittenton homes and hospitals or cared for before and after the mothers’ pregnancies.

I am one of those persons who benefited from the organization’s original charitable mission. I was born in one of its hospitals.

But the organization’s much later and more hidden role in promoting adoption as a “solution” to out-of-wedlock pregnancies by the early 1960s had a much larger role. The solution in my case led to my relinquishment into foster care and eventual adoption. The hospital’s transformation during the boom years of American adoption occurred in the years surrounding my birth. Shortly after, in 1971, the hospital severed its ties with the national organization, ending an important chapter for an institution that played a critical role in Detroit’s social and medical history.

Preaching the gospel and saving lives

The mission began in New York City, under the guidance of businessman Charles Crittenton. A deeply evangelical man, he committed to helping one of society’s most vulnerable groups after the death of his 4-year-old daughter Florence from scarlet fever. Her demise created a deep bout of anguish. His autobiography describes how he turned to solitary prayer and saw the light, leading to his future mission. Today that mission lives on in the National Crittenton Foundation, now located in Portland, Oregon, my current home town. It is now dedicated to serving young women who are victims of violence and childhood adversity.

Charles Crittenton, founder of the Florence Crittenton Mission.

Charles Crittenton, founder of the National Florence Crittenton Mission.

At its start, in 1883, Crittenton worked the streets and promoted the Christian gospel, specifically to combat prostitution and provide service to exploited women and girls. The organization’s 50-year summary notes, “In its beginning the objective of Florence Crittenton efforts was the redemption of the fallen woman, the street-walker, and the inmate of houses of prostitution. The great agency in such redemption was the simple one of religious conversion.”

The organization slowly expanded its efforts, finding champions in many U.S. cities: St. Petersburg, Detroit, Boston, Nashville, San Francisco, Phoenix, Portland, and more.  By 1895 he was joined by activist Dr. Kate Waller Barrett, with whom Crittenton corresponded. She later became the only woman on the national Crittenton board, after it was incorporated by Congress in 1898.

The mission was involved in  anti-prostitution efforts during the early 1900s and focussed on training that would enable women to leave prostitution. Its primary focus remained on the rescue and care of unwed mothers, providing them appropriate medical care, and their right to raise their children free from the scorn of society.

Kate Waller Barrett, former president of the National Florence Crittenton Mission.

Kate Waller Barrett, former president of the National Florence Crittenton Mission.

By the 1920s, Crittenton policy opposed separating a mother and child for adoption and believed that children should be kept with their birth mothers. As the mission’s 50-year history notes that promoting this policy helped to deepen the “love of the mother for her child and strengthening her desire to keep her baby.”

Motherhood was viewed as a means of reform. A Crittenton home became the place to promote both responsible motherhood and self-support. “Our girls need the influence of child-life upon them. They need to have the qualities that are essential to a strong, well-regulated character trained in them,” wrote Barrett in an undated pamphlet that described the mission’s philosophy of keeping mother and child together.

Crittenton combats the stigma of illegitimacy and helps “fallen women”

Nationally, the mission also sought to combat societal stigma for children associated with illegitimacy. By the second decade of the 20th century, publicized exposes had revealed the horrors of illegitimately born babies–the bastard children scorned by family, church, and most of society in the United States.

One highly publicized 1914 report called the Traffic in Babies by Dr. George Walker reported virtual charnel houses for unwanted, abandoned, and illegitimate children. These reportedly operated to “save” the single women from the disgrace of being unmarried mothers. The mortality rate of the relinquished bastard children was as high as 80 percent. Some doctors, nurses, midwives, clergymen, and hospital administrators actively referred the disgraced mothers who had sex out of marriage and became pregnant to these lethal, for-profit baby shops. Some hospitals even made money secretively moving the unwanted children from hospital wards to the unsanitary baby homes where most died.

Thc Crittenton mission clearly understood that the stigma of illegitimacy for out-of-wedlock babies was the driving force that demonized both mother and child. Prophetically, the mission in 1933 foretold of larger changes a half century later. The mission’s 50-year history notes: “Nothing short of a revolutionary charge in the mores of the American people will put the unmarried mother on a par, socially, with the married mother. Until such change shall be effected and there is no longer any such person as an illegitimate child, the mother without a marriage ring will continue to be looked at askance by a large proportion of the population and will suffer, even occasionally to the point of suicide, the shadow of social and family disgrace.” By the 1990s, single parenthood largely was de-stigmatized, with one in every three children in the United States being born outside of marriage.

Barrett headed the mission after Crittenton’s death in 1909. She passed away in 1925. By the 1930s, when these photographs were all taken, the organization was providing charitable service to assist those “fallen women,” in order “to restore to her, as far as possible, this most precious asset of a respected standing in society.” At this time, this still meant keeping the mother and child together.

(Click on each photograph to see a larger picture on a separate picture page.)

These pictures of the Florence Crittenton homes, published by the mission, reveal they projected a public image of being well-to-do. The facilities were all found in respectable areas, but had their actual mission hidden by the facade of upper-class and upper-middle-class gentility.

Well-to-do business people contributed to these charitable facilities in the cities where they operated, including my current home town of Portland. Detroit’s efforts at fund-raising, thanks to the Motor City’s new-found wealth from its booming automotive manufacturing sector, led to $700,000 to support the construction of a new hospital–a feat no others could match.

Crittenton General Hospital, the largest in the United States

The first Crittenton home in Detroit opened in 1897 over a store on what is now Broadway Avenue. The operation expanded and moved to a Victorian mansion on Brush Street, also in downtown Detroit. Within six years, it had outgrown its capacity. At any given time, the home was caring for 33 women, not counting the children, according to the mission’s published records. Thanks to the successful fund-raising efforts by the city’s wealthy to support women’s organizations, $700,000 in donations helped to secure land and build a new facility. This was meant to replace the old home, which was reportedly then in a “colored section” of the city. In 1907, the mission opened the Florence Crittenton Hospital on East Elizabeth Street. It offered inpatient and private patient care for indigent and unwed mothers. By 1922, it was offering up to 30 beds for mothers and their children.

National Florence Critttenton Mission convention, 1932, Detroit.

National Florence Critttenton Mission convention, 1932, Detroit.

The hospital and home on Brush street had already become established as a facility that trained new or resident obstetrician. It was certified by the board of health governing local clinics and affiliated with the Detroit College of Medicine and Surgery. By 1927, the hospital had outgrown its capacity to meet the need to serve vulnerable women.

The new Florence Crittenton Home and Hospital, as it was identified in the mission’s records, was opened in 1929 at 1554 Tuxedo Avenue, about three miles from downtown Detroit. The new facility had three wings. Two of the facility’s wings were devoted to the care of the single and pregnant women and their infants. The mission’s records from 1932 note these two wings had 115 dormitory beds, 100 cribs, 40 bassinets, and a nursery that served this ever revolving population. Special recreation rooms were devoted to caring for the infants, and the roof was used for playtime and exposing the babies to sun and air.

According to the mission’s records, the hospital supplemented its operational costs with a third wing. It offered medical care mostly to lower-income women and children and was certified by American College of Surgeons. However, the third wing was separate from the two wings for the unwed women. The public wing also focussed on maternal care and general surgery.

By 1950, the hospital had to expand yet again to meet the growing demand for services. A separate maternity home called the Florence Crittenton Maternity Home, located at 11850 Woodrow Wilson, was built and opened in 1954. It was less than half a block from the hospital, which was then calling itself Crittenton General Hospital. The hospital and maternity home were connected by a service tunnel. The home could accommodate up to 60 young women, who had semi-private rooms. The home offered them class instruction, an auditorium, a dining facility, and even a “beauty shop,” according the mission’s records.

“Every effort was made to maintain a homelike atmosphere for the patient,” according to the official records. In reality, the young women were cut off from family and friends and faced with one of the most momentous decisions of their lives. In many cases, they would be pressured by a social workers, maternity staff, and medical professionals to relinquish their infant children to adoption.

Crittenton General Hospital was the largest of all Crittenton facilities in the country in the 1950s. Crittenton maternity homes–and in the case of cities like Boston and Detroit, combined Crittenton homes and hospitals–had become way stations. Pregnant women from their teens to their early to mid-20s stayed out the last days, weeks, or months of their pregnancy.

Meanwhile the hospital was reorganized after the home had opened. Only one floor of one wing was reserved for “unwed mothers,” like my birth mother. These single women  mostly stayed at the maternity home next door. I was born in that wing dedicated to single women, most of whom would never see their children again. There was also a nursery to care for babies. The rest of the hospital’s 194 beds provided private hospital care, including obstetrics, surgery, and pediatric services.

The hospital also continued to be a training facility for residents, from the University of Michigan and Harper Hospital. In my case, the obstetrician who delivered me was completing a residency. He came from overseas, like many other doctors who arrived in the United States and were employed to serve low-income and high-needs patients in inner-urban and rural hospitals.  When I contacted him for an interview, he told me how the hospital provided basic maternal services but also doubled as a residence to single and pregnant women, who lived next door at the home. He remembered the many “girls,” as he called those young, pregnant boarders. He suggested they worked in the facility, likely to pay part of their expenses.

In many cases by the 1960s, those women who stayed at Crittenton homes and hospitals were relinquishing their children to adoption agencies, at the urging of social workers, family, faith-based groups,  churches, and the systems that were created to address out-of-wedlock marriage and illegitimate children. This marked a radical change from the original Crittenton mission to keep mothers and children together. This coincided with societal change that led to hundreds of thousands of unplanned pregnancies and the American social engineering experiment that promoted adoption as “the best solution” to both restore fallen women and find homes for the estimated 2.4 million illegitimately born babies placed for adoption from 1951 through 1973, the year of the landmark Roe v. Wade decision legalizing abortion in the United States.

One Crittenton center, in Sioux City, Iowa, claims that 98 percent of Crittenton babies were given up for adoption after World War II. (To learn more about how maternity homes functioned in the era of adoption shame and secrecy from the 1950s through 1973, read Anne Fessler’s The Girls Who Went Away.)

A shot of some of the tens of thousands of babies relinquished for adoption through the maternity care facilities run by the National Florence Crittenton Mission. (Source: SIoux City Journal, "Wife of Nobel winner started life at Crittenton Center," Sept.18, 2011.

A shot of some of the tens of thousands of babies relinquished for adoption through the maternity care facilities run by the National Florence Crittenton Mission. (Source: Sioux City Journal, “Wife of Nobel winner started life at Crittenton Center,” Sept.18, 2011.

Crittenton’s legacy serving single, pregnant women disappears from history

A couple of years after I was born, the Crittenton hospital had moved from its inner-city Detroit environs to suburban Detroit, in Rochester. It became known as Crittenton Hospital Rochester. This came immediately after deadly race riots in 1967 that shook the city and left 43 dead and burned more than 1,000 buildings. Detroit was beginning a five-decade-long decay as a once great American city to one that has seen its population fall from 1.8 million souls in 1950 to less than 700,000 as of 2015.

The city’s declining population and expenditures made the Crittenton General Hospital in Detroit too expensive to operate. Occupancy dropped in half by 1973. The Detroit hospital permanently shuttered its doors on March 22, 1974. At the time, I was still a young boy in the St. Louis area. I was completely oblivious to my true origins as a Detroit adoptee who was born and then surrendered into the status of foster child at one of the nation’s preeminent maternal care facilities that promoted adoption. Only decades later I finally pieced together my life and discovered that I literally arrived into the world at the center of the American Adoption experience and experiment.

In 1975, the facility that served as the starting place in life for a generation of adoptees was demolished. The home remained open, run by the Henry Ford Hospital. Though Crittenton General Hospital was reduced to rubble and built over, its ghosts linger in the memory of thousands who were born there or who gave birth there. The former locations today of the hospital and home look more like a war zone, due to Detroit’s struggles to address economic decline and blight.

The suburban hospital that fled from the Motor City is now called Crittenton Hospital Medical Center. The facility’s current web site shows no record how the former and original Detroit facility once served a critical societal and local need helping vulnerable women and children.

Throughout August 2016, I have reached out with multiple emails and phone calls to the hospital in and its communications staff. I have not received any answer to many questions I submitted concerning the hospital’s older records about its service to those woman and adoptees like myself. I did receive some copies of official of pages from an official National Florence Crittention Mission commemorative book, but no answers concerning the number of births and adoptions that were performed at the hospital. I was told in one curt email reply, “Unfortunately we have no historian on staff, however, the website does have a brief description of our history. … Good luck with your endeavor.” Those birth and adoption records may not be available, or the hospital may be intentionally choosing not to draw attention to its former mission serving single, pregnant women and their bastard babies, like me.

The hospital in 2015 reportedly was bought by the St. Louis-based Ascension Health, a Catholic-run care system. It seems far from coincidental that a Catholic-run medical system would downplay or even omit critical historical information how one of its facilities had dedicated decades of service to those who got pregnant out of marriage and paid the terrible price that many organizations, including America’s many Christian faiths and institutions, exacted on those woman and their children. As an adoptee, I find this deeply saddening and at the same time no surprise at all.

It appears the shame and stigma of illegitimacy that the original founders of the mission sought so hard to overcome have not gone away at all in 2016. I doubt any of the tens of thousands of Crittenton babies like myself are surprised.

Note: All of these archival photos of the Crittenton facilities are taken from the 50th anniversary publication by the National Florence Crittenton Mission called Fifty Years’ Work with Girls, 1883-1933: A Story of the Florence Crittenton Homes.

This article was first published on Sept. 3, 2016. It was last updated on Sept. 13, 2016, after I found additional original source material outlining the history of the Crittenton mission in Detroit. I have found two different names for the hospital of my birth: Crittenton General Hospital and Detroit Crittenton Hospital. Because of this inconsistency in officials records, I have updated this blog and will use the former, which is cited more frequently.

What all of us can learn from T.E. Lawrence (Lawrence of Arabia)

All men dream: but not equally. Those who dream by night in the dusty recesses of their minds wake up in the day to find it was vanity, but the dreamers of the day are dangerous men, for they may act their dreams with open eyes, to make it possible.” T.E. Lawrence, Seven Pillars of Wisdom: A Triumph

Thomas Edward Lawrence, aka Lawrence of Arabia

Thomas Edward Lawrence, aka Lawrence of Arabia

I am finishing reading a fascinating biography on Thomas Edward (TE) Lawrence called Hero, by Michael Korda. It is a great study of how a 5’5’’ illegitimate son of an undistinguished, upper middle-class Englishman and Irish nanny became one of the most influential men in history.

Today Lawrence (1888-1935) remains one of the most celebrated and controversial figures of the 20th century. He was both a liberator of the Arabs against the crumbling Ottoman Empire and a sharp instrument in the militarism and diplomacy of the colonial powers—England and France—to carve up the Arab lands into pliable territories that became nation states. As time has shown, these countries had no religious and ethnic cohesion, and it now seems they may not stand the test of time.

For me, however, Lawrence was so many things. A certified hero and brilliant military tactician in guerilla war. A born leader of men. A charismatic fighter. A scholar and linguist. A consummate and tough-as-nails explorer. A great writer. A global celebrity, before there were celebrities, thanks mostly to a multimedia show after the war about his wartime exploits by the brilliant American publicist Lowell Thomas. An innovator in military strategy far ahead of his day.

Perhaps even as important as any other influence in his life, he was also a bastard—an illegitimate child at a time when such stigma had far greater stains than it does today. As a bastard myself (I was adopted), it is a link I have in common with Lawrence, as well as having visited places in the Middle East where he fought, including Aqaba, Wadi Rum, and the Sinai (all as a tourist in my case).

Winston Churchill, himself both a great World War II leader and controversial apologist for the colonial system he defended much of his life, called Lawrence “one of the greatest beings alive in this time.”

Aqaba a Feat of Imagination:

Of all his many exploits, Lawrence’s role in the Arab conquest of the port city of Aqaba, on the Red Sea, in July 1917, remains one of the singular most amazing feats of arms, logistics, and unrestrained imagination.Aqaba Is Over There

In 1917, when it appeared the Allies could lose the Great War, Lawrence and his band of Arab fighters travelled 600 miles on a weeks-long trek was through terrain so inhospitable that the Bedouin called it al-Houl (the Terror). The Arabs numbering 2,500 men entered Aqaba without a shot and lost just two men. Their opponents melted away. Lawrence then crossed the Sinai to Cairo to inform the new British commander-in-chief, Gen. Edmund Allenby, of this history-changing victory.

The event is the centerpiece of the 1962 epic film Lawrence of Arabia. For me, the scene that defines Lawrence and dreaming large is when he stays up all night and envisions how to change the tides of a war. In the morning, Lawrence convinces his ally, Sherif Ali, to join him with just 50 fighters, with the taunting line, “Aqaba is over there. It is only a matter of going.”

To this day, I keep a picture of that scene on my Facebook page as a reminder of acting boldly and dreaming impossible dreams.

What We Learn About Lawrence from Korda:T.E. Lawrence Posing

Korda’s depiction of Lawrence provides keen insight to the real man’s complicated life. As I read it with multiple lenses, I am impressed by many things that come through that have relevance to anyone today:

  • Lawrence followed a classic pattern of mastery: apprenticeship as an archaeologist with a master, multiple areas of intellectual interests, rigorous training and self-directed study, curiosity, open mind, willingness to take great risks.
  • Lawrence achieved military greatness by not being a soldier, but by being atypical and an anti-soldier, which was the right strategy for the right place at the right time. He did know how to shoot and use explosives too.
  • Throughout his life, Lawrence built and used powerful networks. This included the British intelligence-gathering for the Middle Eastern theatre, top cabinet officials in London, the Foreign Office, the Secretary of War, Arab tribal leaders, and military officers. Lawrence built his networks by leveraging the importance of what he could do for them and say to them. And vice versa.
  • Lawrence was supremely confident in his views, which were grounded in rigorous personal experience with first-hand encounters in the field, in dangerous situations, and with an expert understanding of multiple disciplines (cartography, language, military history, religion, and culture).
  • Lawrence never wasted time doing thing that were not of interest to his curiosity and imagination.
  • Lawrence was never afraid of pain and embraced it as a means of understanding limits he always tried to break. Great leaders have always been able to respond to and even master their pain and suffering and not be bent or broken by it.
  • Lawrence was a good judge of character, and understood who to align himself with in his career path–always choosing the right master, such as Gen. Allenby.
  • Lawrence always made his work stand out, and the quality of his work caught the eye of wise superiors, from his work analyzing the Arab revolt for his military peers in Egypt that was keenly followed to his Oxford thesis on Crusader architecture in the Middle East that opened doors to field work in the desert.
  • Lawrence relished the outdoors, adventure, drama, the myth of a hero’s quest, and creating links where others failed to see what he understood.
  • Lawrence fully understood the importance of symbols, such as the knife he bought in Arabia, the Arab dress he wore, and his physical place in a march among leaders of the revolt.
  • Lawrence mastered theater and stagecraft in his actions to influence opinions and motivate and inspire people in a guerilla war.
  • Lawrence inspired others by taking great personal sacrifices and showing he was willing to sacrifice himself for the good of the larger mission.
  • Lawrence never disowned his upper middle-class upbringing, and he used it to navigate his way out of some early young mistakes to positions of power afforded only to the privileged.
  • Lawrence realized that ideas with deep historic and religious roots are what motivate movements, not weapons and tactics alone.
  • Lawrence recognized the importance of storytelling and myth making, and he used all of his talents to control his story and brand.
  • Lawrence was a shape shifter, who could be different things to different people, but always himself.

Becoming Great on Your Own Terms:

T.E. Lawrence fully understood the value of appearances in working with other cultures.

T.E. Lawrence fully understood the value of appearances in working with other cultures.

I think one of the most telling periods of his life came after he graduated from Oxford and spent four years in the Syrian/Turkish desert at Carchemish on a dig, where he learned his craft (1911-‘14) under the auspices of Sir Leonard Woolley. (That relationship would be revived when Woolley became part of the Arab Bureau in Egypt that Lawrence was assigned to.) Lawrence used his time well on this project. This experience meant organizing projects, motivating workers, settling cultural disputes, finding friends in all ethnic groups, studying the larger political world around him, and seeing the chances this knowledge could bring.

Every one of these skills he employed later in his more active setting at war. Lawrence took what appeared to be useless skills and made them his strongest attributes that no other person in the British army had. He had made himself indispensable by following his own path.

For anyone looking for a bit of a reboot in their life, in terms of making more of a mark with their job, their relations, their purpose and meaning, I say, give Korda’s book a look on a long trip or holiday. You may find some lessons to be learned from someone who truly dreamed his life in daylight, and then died young.

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 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).

CopticEgypt5

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.